Ward Development Committees: The Silver Lining To Primary Healthcare Delivery In Borno

Hafsat, 20, a resident of Jere Local Government Area (LGA) in Borno State, Northeast Nigeria, is a mother of two whose first son struggled with poliomyelitis. This affected his ability to walk. 

At the time, her husband, Ali, did not believe in immunisation and hospital delivery; hence he never gave Hafsat permission to access any of those services. But this would soon change.

With the effort of people like Mallam Muhammad Bukar, a community leader in Dalaram Ward, Jere LGA, who is also the Ward Development Committee (WDC) chairman in the area, Ali eventually agreed that his wife could seek medical assistance before and after the birth of their second son.

Bukar’s team today continues to help promote health delivery by linking community members to available services, especially routine immunisation.

A polio-free Nigeria

On Aug. 25, 2020, when Nigeria was declared polio-free by the World Health Organisation (WHO), many people, especially those in the health sector, rejoiced because it was a huge milestone;  years of hard work eventually paid off. So, attention focused on the availability of vaccines, with little given to community engagement and mobilisation as well as enlightenment and sensitisation. But this was later championed by the Ward Development Committees (WDC) at community levels. 

According to Nigeria’s Health Promotion Policy, the WDC was designed and developed as a social strategy for encouraging community participation and access to primary healthcare services like routine immunisation. It is a group made up of religious, traditional leaders and other prominent people across the communities that make up the ward.

“We sit with them. The health discussion we have is about health common to children; that they will need to be attended to in the hospital. Not when a child has a headache, then you’ll be given paracetamol, or when he has a tummy ache, he’ll be given Flagyl. He ought to be taken to the hospital. Secondly, if your wife is pregnant, you should try and take her to the hospital. In the hospital, she’ll be tested,” Bukar told HumAngle.

In the WDC, women play a vital role. They support mobilisation and door-to-door sensitisation. 

Routine immunisation services

Due to Boko Haram’s activities, ignorance, hospital phobia, delay in seeking care, and other traditional practices common among women in rural areas, Borno State has faced challenges in health delivery; this is especially regarding maternal and child care. However, over time, there has been improvement in providing routine immunisation services with support from a Memorandum of Understanding (MOU) between the Bill and Melinda Gates Foundation (BMGF), Aliko Dangote Foundation (ADF), and Borno State government. 

The Borno State Emergency on Routine Immunisation Coordination Centre (SERRIC) is the coordinator of Routine Immunisation (RI) services and the implementer of the MoU in the state. Community Mobilisation is one of the thematic areas of SERICC, dealing with demand creation, community engagement and social mobilisation regarding immunisation services. This is where the Ward Development Committee plays a key role.

In Dalaram ward, Jere LGA, the WDC was first drawn with support from ICRC and WHO, which implemented a few health projects in the wards through them. Even though the health clinic in the community was newly renovated and equipped with support from the state government, the WDC also supports the mobilisation of funds for providing hospital supplies and other services required for the smooth running of the health facility. 

According to an official of the State Emergency on Routine Immunisation Coordination Centre (SERRIC) in Borno State, one of the initial activities of the WDC was to mobilise women.

Bukar, the WDC chairman, explained that the WDC sometimes meets some of the influential people around their communities for support in acquiring medical supplies in order to help meet the women’s needs. In addition, heads of transport organisations such as tricycle riders or the National Union of Road Transport Workers (NURTW) also play key roles as members of the WDC. They provide transportation for pregnant women before delivery or when they have complications and are moved to a general hospital. 

Over the past two years, the WDC has been able to compel women in rural communities to accept routine immunisation for their children. The sensitisation activities have also increased awareness of the need for proper nutrition for pregnant women and newborns, thereby reducing maternal and child mortality.

One key role is immunisation defaulter tracking. The WDC members work closely with health facility managers to keep track of newborns (who were delivered at home) and report to the health facility managers, who ensure that they follow up and immunise the baby as required.

The WDC members, through other strategies like speak-outs during religious gatherings and community social gatherings such as naming and wedding ceremonies, sensitise the people on maternal and child health topics. These include antenatal care (ANC), the need for family planning, and proper nutrition.

Ups and downs

Over time the committee members have earned the people’s respect. However this is not without some challenges as Mallam Musa, a Liman (religious leader) in the community told HumAngle.

“You know, one of the challenges we have here is the culture of our people. So, we ensure that men permit their wives and children access to health services,” he said. For this reason, in Dalaram, they have achieved up to 75 per cent success in hospital births. 

According to Abuh Isah, the Deputy In-Charge of Dalaram clinic, two or three years ago, women hardly went to the hospital for delivery, but this has changed. Also, as regards immunisation, there is currently a reduction in the number of parents who reject it. With support from the WDC, there is an increased number of fully immunised children in the communities.

Unfortunately, despite their efforts in mobilisation, the WDC suffers from inadequate supplies within the health facilities. This tends to discourage some locals who come for assistance and meet lack. 

Isah further said that although WDC members try their best to mobilise for health supplies like drugs and other essentials, there still remains the matter of inadequacy. To avoid this, the government and international health organisations will have to continue providing support in order for the health needs of the people to be met.

Like the Liman, Musa pointed out that traditional and cultural norms have also proven to be a challenge. This has to do majorly with the lack of mutual understanding, particularly in decision-making between husbands and wives. Some of the men still do not allow their wives to access modern health services. 

“In my opinion, most women are interested in accessing service,” observed Hafsat. “It’s just that sometimes, their husbands become the problem. She may see how her friend benefits, and that gets her attention. But her husband may still stop her from going.”

A SERRIC official in Borno, Adam Gujja, stated that the WDCs have done a lot and have achieved close to 90 per cent in women mobilisation for health care services across the state. However, they can do more if incentivised. According to him, there is no stipend provided for the women, although SERRIC provides a refreshment allowance during their routine meetings. Aside from that, there is no monetary support in carrying out their activities.

Still much to be done …

Gujja said due to the integration of all primary health care services in the fourth quarter of 2021 in Borno State, the WDCs are now tasked with the responsibility of mobilising women to come for general primary healthcare services starting with routine immunisation, family planning, nutrition, integrated management of childhood illnesses, and all the maternal and child health services. 

Furthermore, when there is a health campaign or the state needs to implement an intervention, the need for the WDCs is emphasised, where they act as household mobilisers and, in cases of non-compliance in accessing health services, they get to communicate with high-level traditional leaders for further action.

This story was produced in partnership with Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.