Citizen voices: An important resource for improving health systems

Jul 22, 2019 | Blog, News, Nigeria

By Tariah Adams, White Ribbon Alliance Nigeria

Nigeria is one of the highest contributors to the under-five and maternal mortality rates worldwide (UNICEF-2015). Required interventions to reduce maternal mortality emphasize the need to increase governments realizing health commitments made.  In 2001, Nigeria set a target of allocating at least 15% of their annual budget for health sector improvements. However poor service delivery still plagues its health care systems, particularly affecting women and children who depend on local health centers for prenatal and basic primary care.

White Ribbon Alliance Nigeria (WRA Nigeria) was founded in 2009 in Abuja, Nigeria. A member of the Global White Ribbon Alliance, WRA Nigeria’s mission is to activate a people-led movement for reproductive, maternal and newborn health and rights, because we know when citizens drive change it meets their needs and is sustainable.

A 2015 Niger State Community Perception Survey conducted by UKAID/DFID demonstrated that citizens felt poorly engaged in governance and service delivery. Fewer than 5% of respondents agreed that government informed citizens about how it spent money or that government regularly asked people what they thought of its plans to improve services; whereas, 73% expressed dissatisfaction with government services in public hearings where policymakers were present.

In 2015, WRA Nigeria began a campaign in three local government areas of Niger State to increase citizen-led accountability for maternal, newborn and child health. The campaign had three main goals whose achievement  would ultimately improve  maternal and child health.

  1. Increase citizen demand for the right to involvement in health-related decisions;
  2. Obtain a public commitment from the State Ministry of Health to implementing accountability processes;
  3. Implementation of those processes.

WRA Nigeria used its theory of change and best practices in social accountability to address these issues.

Approaches included:

  • Advocacy visits to policy makers and traditional leaders to discuss the issues
  • Community dialogues to bring citizens together
  • Public hearings, or town halls, to connect citizens with policy makers
  • Media campaigns to raise awareness and create demand
  • Training and deployment of citizen journalists

Community dialogues were attended by an average of 375 people, and the town halls by an average of 550 people. Each activity produced a joint action plan, which directed WRA Nigeria’s advocacy efforts.

Following a town hall meeting, the government supplied necessary equipment to 10 facilities in a Local Government Area; the equipment had been procured prior to the town hall but was sitting unused in the state medical store. It took hearing directly from citizens – and the impact it was having on their daily health and lives – to spur action.

Another town hall highlighted the lack of qualified midwives in health facilities, following which the state government ultimately employed an additional 100 midwives, part of the broader effort to improve primary health care in the state.

WRA Nigeria’s campaign demonstrates that citizens are willing to demand better health care services and have benefited from the support of an outside organization in doing so. Although the campaign has not yet increased health care utilization, the campaign has convinced the previously unwilling state government to engage with citizens, and anecdotal evidence in response to town halls and citizen journalist reports suggests improvements to health care facilities. To ensure gains from the campaign are sustained, government at all levels must create opportunities and platforms to engage citizens, improve feedback loop, develop a viable accountability mechanism that allows citizens to monitor implementation and utilization of health funding.

Read more in this Accountability Note, jointly published by Accountability Research Center and White Ribbon Alliance.