Promoting Adolescent Reproductive Health in northern Nigeria

Yaikah Jeng JoofTrip Debrief

TDY-1/08/10-1/18/10

Overall Objective

• The main focus of this trip was to work closely with FOMWAN and the RL activities’ Consultant to review the implementation of the Religious Leaders’ activities in the 5 Local Government Areas (LGAs), in the states of Kano and Bauchi, as per their action plans, identify challenges in implementation and lessons learnt.

• Identify how the RLs and FOMWAN are working together

BackgroundESD + FOMWAN + COMPASS

Engage Muslim RLs to improve reproductive health of married adolescents in Kano through promoting healthy timing and spacing of pregnancy (HTSP) and changing health seeking behavior.

Target groups: key family members/community gatekeepers: (husbands, mothers-in-law, RLs in 5 Local Government Areas (LGAs))

Strategies: •Capacity building of local partner (FOMWAN) through training•Training of RLs to promote HTSP and support educational outreach to communities to improve the health of young married women•Community outreach/mobilization in 5 LGAs: Kano (4), Bauchi (1)

Phase I: 2008-2009 – Training of 27 FOMWAN members on HTSP;

completed May, 2008– Training of 35 RLs to include RH/HTSP messages in

their sermons February 2009; completed– Development of action plans (APs) by FOMWAN,

Imams after trainings

ESD Objectives

Implementation of activities

Phase 2: Implementation of APs (February-July 2010) - Training

– FOMWAN to conduct state level step-down training for FOWWAN Executive Committee (EXCO) members in Kano and Bauchi (14 participants from Kano and 4 from Bauchi)

– FOMWAN to conduct LGA level step down level training in 5 LGAs in kano State (Nassarawa, Dala, Gwarzo, Bebeji and Bichi)

• Community outreach– 5 or more educational/advocacy visits with influential community groups (traditional

leaders, influential women), house-to-house visits, lectures at Islamiyya schools and wedding venues: mostly completed

– Lectures at 50 Islamiyya schools (10/LGA) and 15 wedding venues (3/LGA): completed– House to house mobilization for 11 or more wards within the 5 LGAs– Dissemination of messages during Juma’a sermons

Trip activities• A meeting with Ameera Aisha Hassan, Kano State Leader, FOMWAN and Fatima Abdul,

Consultant hired to work on the data collection of the RL activities. • Meeting with the Council of Imams and Council of Ulama representative• Meeting with the Council of Ulamas (N=5) representative, our link to the Imams for the

data collection + Ameera Aisha Hassan + Fatima Abdul, to discuss data collection. • Travel to LGAs in Kano:

– Nassarawa (5)– Dala (5)– Bebeji (5)– Gwarzo (5)– Bichi (5)

• Meeting with Imams in LGAs visited to discuss the messaging (Nassarawa, Gwarzo, Bichi), ensure that the correct messaging is being disseminated and explore their thoughts on the activity and its impact.

• Visits to Islamiyya schools in all LGAs visited• Conduct some house to house visits

Meeting with Religious LeadersJanuary 2010

Meeting with the Council of Imams

Visit to Dala Islamiyya School

Data collection flow chart

• Data Collection Methods:– Phone calls from Ulama rep.

to Imams to obtain data (via notes)

– Phone call/meeting between FOMWAN/Consultant and Ulama rep. for data review and filling of form; more communications between Ulama rep. and FOMWAN/Consultant for clarification (if necessary)

– Also calls to Imams directly by FOMWAN, if necessary

– Final report (form and some narrative) sent to ESD

Imams in 5 LGAs

Council of Ulama Representative

Consultant/Ameera Aisha

Hassan

Report to ESD

Status of activities to dateFOMWAN ACTIVITIES

Status Challenges (overall)State level step down training /orientation to FOMWAN EXCO members, on HTSP

Completed (10 FOMWAN EXCO members trained)

Positive male involvement; social pressures to bear more children; delaying early pregnancy/early marriage: not being well received; LGA level step down training

for Islamiyya school teachersCompleted (about 10 per LGA)

Sensitization meetings at Islamiyya school graduations

Ongoing (over 5000 reached)

House-to-house visits Completed

Meetings at community events (weddings, naming ceremonies)

ongoing A slight delay due to Ramadan in November 2009

Advocacy visits (traditional leaders, Imams, RLs, women leaders, traditional leaders)

Ongoing basis (600 women leaders)

Status of activities to date (cont’d)RL activities

Status Challenges (overall)Delivery of HTSP messages after Juma’a prayers by Imams

Ongoing

Counseling Ongoing (approx. 5-7 per week)

Community events (organized both by Imams and community committees)

ongoing

• FOMWAN recognized as HTSP leader in Kano• With support from ESD and COMPASS , FOMWAN trained 35 RLs

(February 2009).Results: • Imams are doing counseling on RH/FP/HTSP (5-7 per week; 275 sessions

to date)• Imams include HTSP messages in Friday prayers • Imams replicating training on their own initiative. From interviews with

champions, estimation of close to 1000 RLs now disseminating HTSP (from 5 to 44 LGAs).

• Imams are also talking to their wives, who are also considered influential women in the communities.

• Increase in uptake of FP: Anecdotal information through unstructured FGDs led by FOMWAN outreach workers with community members. Project does not include facility-level data collection so ESD is discussing methods to get more accurate information

• IEC materials translated to Hausa/ printing: 4000 Hausa; 1000 English

Major Achievements

Anecdotal evidence

• Dr. Dikko:– “I have seen a change in child spacing; it seems it is more common for

mothers to space for 2 years”– “I am now seeing more young mothers asking for advice during their

consultations with me: contraceptives, especially the injection”– “Currently we are seeing higher incidence of sepsis at Murtala

Muhammad Hospital, mostly due to prolonged, obstructed labor, so advice/messages on age at first pregnancy, timing/spacing for next pregnancy especially critical”

Meeting with Dr. Dikko

Anecdotal evidence (contd.)

• Imam of Bichi• “I am seeing girls, husbands, wives also. The

HTSP messages are being received and accepted but they also want to hear about traditional methods”

• “just this week, I received about 5 different girls aged 19-25, who came to lament that they are still unmarried even after finishing school”

Visit to an Islamiyya School

Challenges

• Lack of community-based data (to determine impact of messages on the communities served)

• No access to health facility data• Dependence on remote TA versus direct in-country

support• Low organizational capacity of FOMWAN -

dependence on volunteers-one-woman show

Strategies to overcome challenges

– Discussions underway to conduct a community-based survey to determine impact of our messages on the communities• Sampling• Questionnaire development

– FOMWAN a “one-woman show”• Local consultant has been contracted to focus on RL

data collection and reports and remote TA, in collaboration with Ameera Aisha Hassan; will also use her as point person for community survey

Lessons learnt

• Choice of local Partner: – FOMWAN has strong community mobilization and outreach

experience with women and religious leaders in Kano, but needs further organizational strengthening

– FOMWAN has a strong network of contacts and has recognition among major stakeholders/partners in Govt./MOH

• Use of RLs– As community leaders, they provide inroads to communities’ psyches

and perceptions and messages from them are very much accepted – Their wives are also key players in the communities and some of the

Imams have already been talking to their wives about these messages

• Project design

Visit to Bebeji Hospital

Tiga Hospital

My eye-opener• “””“there she lay on the stretcher, covered in a

green lapa. For an instant, I wondered what “it” was!!!! Until I realized it was a woman who had died!!!!!”””

• After some probing, we found out she had had antepartum bleeding for about 2 days, delivered a still birth, and then developed PPH (another 2 days) all at home!

• IT TOOK HER RELATIVES 4 DAYS TO GET HER TO A HEALTH FACILITY BY WHICH TIME IT WAS TOO LATE!!!!!!!!! SHE WAS GONE!!! Imagine that!!

Thank you