When a plan has a chance to take root and develop over time, then truly transformative change can happen.
This was the opportunity the Women for Health project in Nigeria had during its 8-year run. Funded by UK aid and delivered by DAI Global Health, a development consultancy, the programme set out to train thousands of women in nursing and midwifery in six states in the largely rural north of Nigeria between 2012 and 2020.
But in the end their work achieved so much more besides.
The work sustained development in two major ways: it addressed the acute shortage of health workers in rural communities, helping to save the lives of pregnant women and newborns by increasing the number of midwives; and it transformed attitudes to women in work.
By working closely with state governments, the programme increased capacity at 24 health training institutions in the six states — improving teaching and facilities, and increasing the number of students able to enrol.
Total student capacity in the colleges grew by more than 250%, with the proportion of women enrolling increasing to around 60% in some colleges, organisers said.
Project leaders set up a successful Foundation Year Programme (FYP), which provides a year of learning and support for female trainees from rural areas to help them qualify for professional nursing and midwifery courses. Beneficiaries commit to return and serve their community for two years after graduation.
So far, 2,860 women from nearly 1,000 small rural communities have taken part in FYP, with 556 already graduating — 77% of whom have been employed and posted to rural settings.
Dr. Fatima Adamu, the national programme manager for the Women for Health programme, said that she had seen a transformation in attitudes towards women working during her time in the role. In these communities, social norms had prevented women from being attended by male health workers — and made it impossible for women to leave to study.
“The success of Women for Health is not only about increasing the number of female health workers, and deploying them to rural areas, it’s the way in which we have kick-started the transformation of gender relationships,” Adamu explains.
She said that overcoming perceptions about women’s role in society was a key challenge — but doing so reaped huge rewards.
“Women [now] see themselves as agents of change… and are valued and seen to be an important player in community development,” she added.
Research conducted by the programme found that 95% of FYP students said their communities now show greater support for women’s employment — and 82% say the FYP enabled them to develop careers and become local champions.
Adamu went on to explain in that the insecurity caused by terrorist groups operating in northern Nigeria had posed huge challenges to the programme when it expanded into Borno state in 2018. The programme adapted its approach to take into account the trauma experienced by the majority of students, many of whom were recruited from internally-displaced persons camps across the state.
As part of their studies, trainees worked with women community leaders to provide health and hygiene awareness training to families living in the camps. Their presence “offered hope as role models to girls in the camps,” Adamu said.
While Women for Health came to an end October 2020, the eight years spent improving health care and training women has appeared to have had much more permanent effect.
The governments of each state the project was operating in — Borno, Jigawa, Kano, Katsina, Yobe, and Zamfara — have passed laws committing them to continue financial support for training in health care, while six neighbouring states in the region were inspired to begin establishing similar programmes.
At Bayero University, in the capital of Kano state, Women for Health established a Human Resources for Health Learning Hub — creating a space for learning and training to continue after the end of the DAI Global Health Programme.
And, as Adamu reflects, it’s had an effect beyond health care. “Now it’s very common in Women for Health communities to see some members of the community encouraging girls to go to school.”
She added: “It’s that change, for me, that is the most important thing.”
This story is part of a new series from Global Citizen called “UK Aid Works” — a collection of stories about health care development projects supported by Britain’s aid budget, collated by Action for Global Health UK (AfGH), an influential membership network convening more than 50 organisations working in global health.
In September, the Department for International Development (DfID) merged with the Foreign Office (FCO) to form the Foreign, Commonwealth, and Development Office (FCDO). At a time when the future of poverty-focused aid is under threat, it’s crucial that we hold onto programmes like these that focus on the world’s most vulnerable people. These stories are about the types of initiatives that we must strive to protect. You can check out more stories like this here — and call on the foreign secretary to ensure that aid is transparent and accountable here.