Sustaining MNCH2’s gains of engaging traditional, religious leaders for improved maternal, child health in northern Nigeria

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As the Maternal, Newborn and Child Health (MNCH2) programme of the UK’s Department for International Development (DFID), being implemented across six states of northern Nigeria, draws to a close, there are ongoing efforts by DFID to ensure sustainability of the programme’s engagement with traditional and religious leaders in the efforts to improve the quality of healthcare services available and accessible to women and children across the region.

Kano State Commissioner for Health, Dr. Kabir Ibrahim leads the Emir of Kano, Muhammad Sanusi II, Kano State Governor, Ganduje Umar, SFH Nigeria Managing Director, Dr. Omokhudu Idogho and MNCH2 Project Director, Dr. Jebu Nyenwa to partner exhibition stands during the learning event. Photo credit: Nigeria Health Watch
Kano State Commissioner for Health, Dr Kabiru Ibrahim, leads the Emir of Kano, Mallam Muhammad Sanusi II, Executive Governor of Kano State, Dr Abdullahi Umar Ganduje,  Managing Director of Society for Family Health (SFH), Dr. Omokhudu Idogho and MNCH2 Project Director, Dr. Jebu Nyenwa to exhibition stands of partners shortly after the opening ceremony of the learning event held at Government House, Kano.                                Photo: Nigeria Health Watch

Thus, it was as part of the series of closeout events being organized by DFID in collaboration with the respective state governments across the MNCH2 focal states that a learning event themed: “Achieving better Health Outcomes through Engagement with Traditional and Religious Leaders”  and focused on sharing best practices and identifying new techniques and strategies of engaging community leaders for improved health results was recently held in Kano. It was attended by traditional and religious leaders from across the six MNCH2 states: Kaduna, Kano, Katsina, Jigawa, Yobe and Zamfara.

Conscious of the strategic role traditional and religious institutions play in influencing people’s attitude and behaviors including acceptance of new initiatives in northern Nigeria, MNCH2, has since its inception leveraged the enormous influence of religious and traditional leaders to raise awareness, create demand and improve uptake for reproductive, maternal, newborn and child health (RMNCH) services. MNCH2 is aimed at saving lives by improving the quality of life for women and children across the six respective states. In Kano, for example, MNCH2 successfully leveraged the Kano Emirate Committee on Health and Human Development (KECCoHD) to tackle maternal and child health issues.

The event which was hosted by the Kano state government was personally attended by the Emir of Kano, HRH Muhammad Sanusi II, and the Executive Governor of Kano State, His Excellency Dr Abdullahi Umar Ganduje. Other dignitaries in attendance were HRH Alhaji Abubakar Umar Suleiman, the Emir of Bade in Yobe State, Alhaji Bashir Muhd Sunusi, Galadima of Dutse, who represented the Emir of Dutse as well as the representatives of the emirs of Katsina and Anka, respectively. A host of religious leaders from across the respective states and representing various sects of Islam and faith-based groups such as Council of Ulama, Hisbah as well as Imams were also in attendance.

In his welcome address at the learning event, Kano State Commissioner of Health, Dr Kabiru Ibrahim Getso, said traditional and religious leaders had a major role to play in addressing maternal, newborn and child health challenges in northern Nigeria adding that the Ganduje administration in Kano had taken various steps aimed at addressing healthcare challenges in the state. He also appreciated DFID’s interventions aimed at addressing healthcare challenges in the state.

“DFID has implemented lots of projects aimed at addressing healthcare challenges in Kano state including eradicating malaria and providing eye care services.  MNCH2’s support is across the entire healthcare system – manpower, infrastructure, healthcare financing. Our door is open for collaboration with CSOs, CBOs and donor agencies to continue to improve the healthcare system in the state. All these were achieved because of the support of His Excellency Governor Abdullahi Ganduje, His Royal Highness Mallam Muhammad Sanusi II and the Kano Emirate Council. No doubt, traditional rulers have an important role to play in addressing healthcare challenges,” said Dr Getso.

In his keynote address, Emir Sanusi II said the traditional institution was integral in ensuring acceptance of government policies by the people, since the traditional institution was long before colonial rule governing the affairs of the people through what he referred to as “well-organized, hierarchical system of governance down to community level.”

“It makes governance easy for the government – leveraging traditional leadership structure. The government should leverage the structure beyond healthcare governance. This is the idea behind KECCoHD which is working with the State Ministry of Health, Civil Society Organisations (CSOs), Community-Based Organisations to implement the government’s healthcare programmes. It is our role at the Emirate and also your role as members of the community to monitor the quality of healthcare service delivery at the level of PHCs including staff punctuality and management of medical consumables,” said the monarch.

He narrated a particular incidence where a certain community in Kura LGA of Kano state rejected Routine Immunisation (RI) for their children, simply because of a political grudge they had against the governor. Emir Sanusi said he personally led a delegation of Islamic scholars to the community which sensitized the community members on the enormity of the responsibility of ensuring their children had access to quality healthcare in Islam and why they shouldn’t allow their beef with the governor stood in the way of their children’s access to health. This is but a perfect example of how the traditional and religious leaders in Kano are working hand-in-hand to improve access to quality healthcare services for women and children in Kano state.

He furthermore cautioned his subjects against early marriage, arguing that the fact that girls as young as 11 and 12 could conceive pregnancy didn’t mean they could also withstood the rigors of pregnancy, child delivery and be able to effectively care for their children. He also admonished them on the importance of child birth spacing (CBS) in the growth and development of the child and healthy wellbeing of the mother. “Child birth spacing is very important for the growth and development of a child; breastfeeding for up to 2 years ensures quality health for both nursing mothers and their children,” he said.

In his remarks, the Executive Governor of Kano State, Dr Abdullahi Umar Ganduje, said religious and traditional institutions were playing a key role in creating awareness and sensitizing  people on the importance of public health in Kano, which he said had led to “improved health outcomes” in the state. He said the Kano state government, on its own part, had “committed enormous resources” to various healthcare interventions in the state including the tripartite agreement with the Bill and Melinda Gates Foundation (BMGF) and Dangote Foundation.

“We want Kano to sustain the improvement in terms of access to quality healthcare at affordable cost. Health-seeking behavior of citizens can only be improved if healthcare is accessible, affordable and sustainable. DFID is our key partner not only in the area of health but also other sectors; our partnership has led to reduction in maternal, newborn and child deaths in Kano state. They have also intervened in the areas of Neglected Tropical Diseases (NTDs), Malaria. We are committed to continued reduction in maternal and child deaths as well as tackling preventable diseases such as Tuberculosis and HIV/AIDS,” said Ganduje.

Dr Zahra’u Muhammad, deputy commander-general in charge of women affairs at the Kano State Hisbah Board, while speaking during a panel discussion on the role of religious scholars in achieving improved health outcomes for women and children said the Quran had instructed husbands to cater for all the needs of their wives – during pregnancy and after birth.

“Men should provide for the needs of their wives and children; women should be taken cared of right from during pregnancy and after delivery, by ensuring they have access to quality food and other care. Kano Hisbah is working to ensure that is achieved  by supervising the payment of breastfeeding allowance for infant children whose mothers have been divorced; we manage a fund to the tune of five million naira for that purpose,” she said.

In his goodwill message at the learning event, earlier on, His Highness Alhaji Abubakar Umar Suleiman, the Emir of Bade in Yobe state, said it was also the responsibility of traditional rulers, taking care of pregnant women and children, by ensuring they had access to quality healthcare including guaranteeing pregnant women in labour were taken to a healthcare facility to successfully deliver of their babies. “Your Excellency, we rely on you [governors] to ensure there are good roads so that women will deliver of their children at the healthcare facility, on time and with relative ease,” he told Governor Ganduje.

Alhaji Bashir Sunusi, Galadima of Dutse, who represented Dutse Emirate Council, said the traditional institution in Jigawa played a key role in the realization of the recently improved health indices in the state. “In Jigawa state, the traditional institutions have engaged the services of 11 people at each community whose work is to go round and sensitize women at the grassroots on the importance of ANC and hospital delivery. On its part, the ministry of health has procured motor vehicles for the purpose of conveying pregnant women to nearby healthcare facilities for delivery,” he said.

In her goodwill message, Ms Nafisa Ado, DFID’s regional coordinator and head of Kano office said DFID’s partnership with the respective MNCH2 project states had resulted in significant improvement of the quality of maternal, newborn and child health services in the states such that the various state governments had now “agreed to work to sustain MNCH2’s interventions even when the programme finally closes”.

“Such successes in Kano state for instance, include government’s achievements of various reforms in the health sector that has significantly improved in the quality of maternal, newborn and child health services in the state. Just recently, His Excellency Governor Ganduje, and Ms Debbie Palmer, the Head of DFID Nigeria, consolidated these achievements by signing an MOU that committed both Kano state and DFID to ensure the sustainability of best practices from the MNCH2 programme. Same was achieved in all the other MNCH2 states,” she said.

Ms Ado added that the learning event which brought together religious and traditional leaders from across the MNCH2 focal states “to share experiences around improving maternal and child health through strategic community level engagements,” and was focused on achieving better health outcomes through engagement with traditional and religious leaders, was also part of the sustainability commitment of the MNCH2 project states.

She said the event was being hosted in Kano because of the “improved health outcomes recorded in the state” thanks to the “effective community engagement of KECCoHD under the able leadership of HRH Malam Muhammadu Sanusi II and also expressed DFID’s appreciation to Governor Abdullahi Umar Ganduje, for his commitment to the health sector and also agreeing to host the event in Kano.

“DFID Nigeria profoundly appreciates His Excellency Dr. Abdullahi Umar Ganduje OFR, for agreeing to host this event, and especially for his commitment to health reforms that made him create the time to personally be here regardless of his tight schedule. Mai Martaba Sarkin Kano, has been a father, and a mentor who patiently guided our steps directly, and through KECCoHD from the implementation up to this sustainability stage of the community engagement phase of the MNCH2 intervention,” she said.