Over the years, different methods have been applied to provide solutions to the long list of problems the world faces, from cutting down on carbon emissions to help control climate change, to the adoption of a mechanised agricultural system to combat extreme hunger. Although every problem or challenge has unique solutions, it is widely agreed that collaborations from a variety of stakeholders is key to finding solutions to the many of the world’s biggest problems.
Arguably, these collaborations have proved to be more effective in public health than in any other sector. An example to this, is the collaboration between governments, the private sector, philanthropists and communities to produce vaccines which have eradicated smallpox, reduced child mortality rates and halted lifelong disabilities. The largest public-private partnership in global health, The Global Polio Eradication initiative has achieved 99% success in its goal to eradicate the polio virus which had caused disabilities in children. Nigeria remains among the only three countries where polio is yet to be eradicated. In the case of malaria, multiple interventions by various organisations around the world have ensured that mortality rates have reduced by about 54% in Africa in the last decade. Collaborative efforts like these may seem grand and far removed from the common man, but they can be replicated on a smaller scale, in communities and cities and towns. It only takes the courage to make the first move.
Crowd-funding Education: The case of Madadi
Madadi is a small agrarian rural community about 80 kilometres north of Birnin-Kebbi in Gwandu Local Government Area (LGA) of Kebbi State. To access Madadi, you exit the major road which connects Aliero and Tambuwal towns to Sokoto, a neighbouring state and get on to a narrow access road flanked by vast, dusty farmlands with sparse trees dotting the landscape. One of the first things you see when you drive into Madadi are two buildings, the Madadi Primary Health Centre and a maternal and child Clinic, both provide healthcare services to Madadi Village and the surrounding seven communities. These two buildings carry a story that shows what communities can achieve when they come together.
In 2003, the people of Madadi, disturbed by the absence of a place of learning for their children, came together and with no external assistance, built two classrooms. These classrooms momentarily satisfied their desire to provide some form of education for their children, albeit informally. This singular move attracted the attention of the Gwandu local government, the Kebbi State Government and a local Non-Governmental Organisation, Alkali Hussaini Foundation.
Alhaji Aliyu Alkali, the Executive Director of Alkali Hussaini Foundation, said the Madadi community had received little or no attention in terms of developmental projects because it lies on the periphery of the border between Kebbi and Sokoto states. This perhaps explained why the community didn’t have a school or clinic prior to 2003. Buoyed by the efforts of the community members, Gwandu Local Government council constructed an additional two classrooms for the community in 2006, and formally absorbed the primary school. A few years later, the state government added 5 more classrooms, an office and a store and within the span of seven years, the community’s dream of owning a standard school for their children became a reality.
In 2010, while scouting for a community to launch their multiple intervention project, Alkali Hussaini Foundation returned to Madadi village and upon enquiries learnt how a lack of accommodation prevented the school from attracting and retaining quality teachers. Again, the community members demonstrated their dedication towards ensuring that their children received quality education by donating a piece of land. The Foundation took up the land and built a 4-bedroom quarters for teachers beside the school and since then, teachers have willingly accepted postings to the community. This was a huge achievement for the Madadi community, but the story does not end here.
From Education to Maternity Care
In 2013, Madadi village and the surrounding communities did not have a health centre. Community members had to travel to either Tambuwal or Aliero, both an hour’s drive away, to access healthcare. According to the Marafa (village head) of Madadi, countless women had died due to pregnancy complications in the past. “The distance has discouraged our women from going for antenatal. Many women have also died on the way as they were being rushed to hospitals in the towns for delivery”, he said.
The story began to change in 2013 when the Kebbi Social and Community Development Project approached Madadi community with an offer to finance 90% of the cost of a project to be chosen by the community. The offer came on the back of the knowledge that the community had built themselves a school without seeking external assistance. Madadi chose a primary health centre for the project, the requirement being that they would raise the remaining 10% of the funds. The Kebbi Social and Community Development Project was funded by The World Bank. The community rapidly fund-raised their portion of the project, which was 10%, and within months, Madadi had its own clinic.
Although the community could now access basic healthcare in their own domain, the issue of complications during pregnancy and childbirth persisted because maternity care was unavailable at the facility. Sulaiman Aliyu, a resident of Madadi, emphasized, “The cost of transportation to and from Aliero every month discouraged most of us from sending our wives for antenatal”. As a result, the Alkali Hussaini Foundation submitted a concept note to the Swiss Agency for Development and Cooperation (SDC), through the Swiss Embassy in Abuja, for the provision of a maternity care facility in Madadi village.
With approval and funding from the SDC, the maternity care facility was completed, furnished and commissioned in August 2017. The Foundation also approached the Kebbi State Government for assistance. The state government sent two midwives to oversee the facility. In addition to paying the salaries of the midwives, the state government also integrated the facility into its free consultation and drug program for pregnant and lactating women and children under five. The Gwandu local government council also pays an additional monthly allowance to the midwives.
The clinic in Madadi is a great testimony of how skilled maternity care impacts safe deliveries. Fatima Hassan, who said she was the first woman to attend antenatal care at the Madadi clinic, is living proof. “During my previous pregnancies, I never attended antenatal and whenever I was to deliver, it was always at home. Sometimes it took me hours of labour,” she said, adding with a smile, “But my last delivery was very easy. After attending antenatal care, when I started having symptoms of labour I brought myself to this clinic and I was able to deliver without any difficulty. I was even able to trek back home on my own after I delivered”.
The Marafa of Madadi,said that since the clinic started operation in August 2017, the village had not recorded a single maternal death. One of the midwives working at the clinic, Grace James, said 200 women are currently registered and receiving their antenatal and postnatal care from the clinic. Since the clinic started in August there have also been several deliveries.
The Madadi Maternity Care Clinic consists of a nurses’ station, a consulting room, a delivery room, a toilet and a store. Though these serve the basic needs, one critical thing that is missing and which was particularly highlighted by James is an antenatal hall. She pointed out that the lack of an antenatal hall has prevented the midwives from organising larger antenatal counselling and demonstrations which could further educate the women about the healthy lifestyles they should practice while pregnant. It also meant that the women had to sit and wait outside the facility while waiting to be attended to on antenatal days. This exposed the women to the harsh weather conditions Kebbi State is known for, discouraging them from attending antenatal checks. Another limitation which was highlighted by one of the husbands of the pregnant women was the lack of perimeter fencing for the clinic. Without the fence, reptiles and other animals easily got access to the clinic environment and caused harm to the women and workers.
One of the biggest obstacles to successful collaborations in public health is identifying where and how interventions should take place. The right concepts do not often get the right implementation due to inadequate knowledge of where the interventions are needed the most. We can take learnings from Madadi village however, where this community’s singular act of courage created an ever-widening ripple effect that has led to the attraction of better and multiple interventions. Looking at the successes and impacts it has recorded within the seven months it has been operating, the Madadi Maternity Care Clinic is a good example of what could be achieved when government, communities and not-for-profit organisations collaborate to tackle the major public health challenges our people face.