ASSESSMENT OF SOCIETY FOR FAMILY HEALTH (SFH) COMMUNICATION STRATEGIES FOR MATERNAL AND CHILD HEALTH IN NIGERIA

Abstract

This study examined the communication strategies used by Society for Family Health (SFH) on Maternal and Child Health (MCH) in Makarfi and Sabon Gari Local Government Areas in Kaduna State. The aim of the study is to assess the effectiveness or ineffectiveness of the communication strategies used by SFH for maternal and child health. The study adopted Health Belief Model (HBM) and Protection Motivation Theory (PMT). Data was collected using Focus Group Discussion (FGD), Key Informant Interview (KII) and Questionnaires. 4 KIIs and 9 FGDs were conducted on SFH staff and pregnant women/nursing mothers respectively, while 45 questionnaires were distributed to health workers in the selected health facilities covered by SFH. Probability and non-probability sampling technique were adopted; the simple random sampling was used in selecting 9 PHCs in Makarfi and Sabon- Gari LGA and 4 key informants from Society for Family Health were purposively selected for the key informant interviewed. The data was analysed using the descriptive statistics and percentage frequency distribution table. Findings show that the Communication Strategies used by SFH are interpersonal communication, mass media, posters, antenatal visits, and women and men meetings. Also, the research reveals that these strategies are effective as the women have attested to the fact that they now practice exclusive breastfeeding, attend antenatal, do family planning and many other components of Maternal and Child Health (MCH). Based on the findings the study recommends that there should be constant repetition of the different MCH messages through various strategies especially interpersonal communication which the women prefer.

CHAPTER ONE

INTRODUCTION

1.1         Background to the Study

Communication is at the centre of any development activity. It cuts across various spheres of human endeavors such as health, agriculture, education, infrastructure, among others. Communication has become an indispensable tool used in pooling ideas across all divides, aimed at promoting an enduring environment for humanity. For this reason, it is considered a transactional process, such that all the stakeholders involved in any development are brought together to achieve a definite goal. One key area of communication for development is health – a situation described by WHO as ―a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity‖. Communication in this context is considered as goal-driven, since all the relevant stakeholders of health are involved in decision making towards effective health delivery system in the society. One of the areas of interest in communication for health development is ‗maternal and child health‘ – one of the eight Millennium Development Goals (MDGs) set by the United Nations to be accomplished by 2015. The United Nations set this as priority with a view to promoting healthy living among the vulnerable groups in the society. As Adeniran (2009) recalls, their vow was to ―spare no effort to free women and children from the de-humanising conditions. The health of women and children has been a priority to the Nigeria government for the past two decades. While motherhood is often a positive and fulfilling experience, for too many women, it is associated with ill health and even death (Olatoye, 2009) in Ogunjimi (2012). According to World Health Organisation (2003), more than 25, 000 children in Nigeria, die every day and every minute a woman dies as a result of childbirth related complications. It also records that worldwide, every year, about 500,000 women die due to child birth and over 9million children under age five die mostly from preventable and treatable diseases and everyday in 2015, about 830 women die due to complications of pregnancy and child birth (WHO, 2017).

Merson (2006) opines that Nigeria ranks second in the world behind India, in terms of the maternal mortality ratio and ranks eighth in sub-saharan Africa among seven other countries. Merson (2006) also conducted a research that supported the need for an increased response in maternal health care and advocacy campaign to focus the public, Non-Governmental Organization (NGO) and policy attention on the issue of maternal health in Nigeria.

This is why this research is focused on an assessment of the effectiveness or ineffectiveness of the Society for Family Health (SFH) (NGO) communication strategies to improve maternal and child health in Kaduna State. A statement in 2007 by Northern State Governors Forum in Nigeria, declared their commitment for free maternal and child health programmes in their respective states with the aim of reducing the alarming maternal mortality rate in Nigeria. Kaduna State happens to be among these states. In 2006, the scheme FREE MATERNAL AND CHILD HEALTH SERVICES, guided by a policy document and transitional operational guideline, 26 state governments-owned and local government-owned hospitals, 113 primary health care facilities participated in the programme in which about 184,783 pregnant women benefited. Apart from the efforts of the federal government, NGO‘s (USAID, UNICEF e.t.c) have also made effort towards the MDG goal of improving maternal and child health. More so on the 17^th January 2017 Merck Sharp and Dohme (MSD) announced its $10 million commitment to the Global financing facility in support of every woman and child in low and lower middle income countries worldwide. This commitment represents a critical step toward meeting the Sustainable Development Goals (former MDG) in order to reduce and child and maternal death in the world (WHO, 2017).

According to the National Primary Health Care Development Agency (NPHCDA) (2013), all these efforts and programmes have been introduced over the years to reduce mortality among women in Nigeria, Kaduna state inclusive, yet maternal and child health is still one major challenge facing the country. Therefore, the researcher intends to assess the communication strategies used by NGOs specifically SFH, and how effective or ineffective these communication strategies have been in improving maternal and child health in Kaduna state.

Society for Family Health is an NGO, incorporated in 1985, focused on providing health needs of which Maternal and Child Health is part of its project in 2015. The NGO uses behavioural change communication (through radio dramas, jingles, interpersonal communication, etc) as a strategy to achieve its aim. In 2005, SFH became the 1^st Nigerian organization to receive fund from USAID to implement programmes on reproductive health. It now has 18 regional offices and 12 active projects present in the 36 states of Nigeria.

The organization (SFH) also helps to ensure healthy pregnancies, safe deliveries, child spacing and emergency interventions for women at risk, with funding support from several national and international donors including the Bill & Melinda Gates Foundation, United States International Development Agency, Department for International Development UK, Oxfam Novib, United Nations Population Fund and the Global Fund to fight HIV & AIDS, Tuberculosis and Malaria. (ESMPIN project report, 2013-2014)

There are many maternal and child health projects carried out by Society for Family Health, among them is the Expanded Social Marketing Project in Nigeria (ESMPIN), Project on family planning, antenatal care, diarrhea, and nutrition. The Expanded Social Marketing Project in Nigeria (ESMPIN) is a five-year $56 million project funded by the United States Agency for International Development (USAID). Through ESMPIN, Society for Family Health in collaboration with Population Service International (PSI), BBC Media Action (BBCMA) and Association for Reproductive and Family Health (ARFH), aims to expand access to family planning and improve child survival in Nigeria through the private sector market. Approximately $30 million of the project value is in donated commodities. Contracted in April 2011 to SFH―the lead implementing partner―the project‘s operations commenced in July 2011. ESMPIN project report (2013-2014).

According to ESMPIN project report (2013-2014), ―The project‘s key objectives are to significantly expand family planning access and availability; increase knowledge, attitudes, perception, and practices towards child spacing; engender a sustainable partnership with key stakeholders; and enhance the capability of the commercial sector in Nigeria to provide family planning products. The ESMPIN team proposed to act as a spur in Nigeria‘s family planning intervention efforts in three significant ways: first, Providing direct provision of more than 23 million couples years of protection (CYP) and contribute to achieve national CPR of 19.7% over the life of the project; second, Growing the overall market for family planning in Nigeria by generating increased demand; and third Promoting graduation of short-term method users to increasingly use mid-term and longer-acting methods. Apart from family planning, which is the major component of the project, ESMPIN also aims to promote child survival interventions with focus on nutrition (breastfeeding), malaria prevention and treatment, and diarrhea treatment and prevention (including point of use water treatment and oral rehydration salts and zinc) in an integrated manner.

In September 2011, the State Specific HIV/AIDs Reproductive and Child Health Survey (SPARCS), a household baseline survey, was conducted in 19 states in Nigeria. Findings of the quantitative study provide the basis for the ESMPIN Behavior Change Communication focus in 2012 and 2013, including the interpersonal communication (IPC) strategy and implementation plan. This report outlines the evidence-based IPC strategies that ESMPIN will implement at the local community level. In essence, Communication is vital in every aspect of life especially when it has to do with health. This is why this research assesses the Communication Strategies used by SFH and its effectiveness in the place of MCH.

1.2         Statement of the Problem

According to the United Nations Family Planning Agency (n:d), over half a million women die each year due to complications during pregnancy and child birth. Also, Lindros and Lawkkainen, (2004) found that about 69% of women still give birth in a traditional setting either at home or in a church and that only 30% of people in the rural areas have access to health care within 4 km distance. This also relates to the findings of USAID (2013) which says 43% of women in Nigeria receive no Maternal and Child Health related information within a year. According to UNFPA (n:d), at the millennium Summit in 2000, States resolved to reduce maternal child mortality in three quarters by the year 2015, among which the popular MDG is a part. Nigerian government have made it a commitment to its citizens to see that each of the goals especially MDG 4 and 5 is tackled. Also the report of Ndep Antor (2014) says that Nigeria saw a 27% decline in Maternal death between 2005-2010 that is, in 2005 (820 per 100,000) live birth) and 2010 (630 per 100,000 live births), still Nigeria remains among the top 13 highest maternal mortality in the world. However, Nigeria through the help of some sponsoring agencies like USAID, UNICEF, UNFPA, WHO, Ministry of health etc, has made several efforts in allocating resources, building health centers, training facilitators, commissioning different projects such as ESMPIN, social Franchise in collaboration with National NGOs like SFH; all in a bid to improve health services and standards in Nigeria. In essence, most of these supports can be seen in LGA in various states especially in the North (USAID, 2008). Despite the availability of all the provision and facilities, Nigeria loses about 2,300 under-five year old and 145 women of childbearing age, this makes the country the second largest contributor to the under–five and maternal mortality rate in the world UNICEF (2016).

Maternal and child health promotion is one of the functions of Society for Family Health (SFH), with offices spread across Nigeria. In order to sensitize the public on MCH and other functions, various communication strategies are used to reach their audience. Despite these strategies, the rate of child mortality in Kaduna State remains high in the past10 years with an estimate of 163/1000 live births (Bako et al, 2016). Although, there have been various research like Zamawa (2015) and Odesanya et al (2015) conducted in Nigeria that see communication as key to reducing Maternal and Child Mortality yet most of this research work ignore the fact that there are specific Communication Strategies that suit specific kinds of people not minding their level of exposure or education; this is revealed in the findings of UNICEF (2005), Brown and Small (2016), Okechukwu et al (2015) and many more found in literature review. However, this is a major gap the present research has filled. In other words this study takes a look at the communication strategies being used by the SFH such as interpersonal communication, mass media, talk shows, drama, flipcharts and cinema, in promoting maternal and child health in Kaduna State with a view to assessing their effectiveness or ineffectiveness. It also attempts to identify its most effective communication strategy for the campaign.

1.3         Aim and Research Objectives

The study aims at assessing the Communication Strategies used by SFH for Maternal Child Health in Makarfi and Sabon Gari Local Government Area of Kaduna State, with a view to determining whether they are effective or ineffective. The specific objectives are:

RO1.   To know the communication strategies used by Society for Family Health in creating Awareness, Knowledge and Practice on Maternal and Child Health in Makarfi and Sbon Gari LGA.

RQ2.   To know how the Communication Strategies used by SFH to create awareness, knowledge and practice are used to reduce Maternal and Child Health in Makarfi and Sabon Gari LGA.

RO3.   To assess the Communication Strategies used by SFH in creating awareness, knowledge and practice on Maternal and Child Health in Makarfi and Sabon Gari LGA.

RO4.   To examine the constraints in Communicating Maternal and Child Health by SFH in Makarfi and Sabon Gari LGA.

1.4         Research Questions

The following are the research questions that guide the study:

RQ1.   What are the Communication Strategies used by Society for Family Health in creating awareness, knowledge and practice on Maternal and Child Health in Makarfi and Sabon Gari LGA?

RQ2.   How are the Communication Strategies used by SFH to create awareness, knowledge and practice to improve Maternal and child Health in Makarfi and Sabon-Gari LGA?

RQ3.   What influences do the Communication Strategies have on the target audience (pregnant women, and children under five) in Makarfi and Sabon-Gari LGA?

RQ4.   What are the constraints faced by SFH in Communicating Maternal and Child Health in Makarfi and Sabon Gari LGA?

1.5         Scope and Limitation of the Study

This study involves pregnant women, nursing mothers in the Primary Health Centers, SFH staff in Kaduna state. The areas covered is limited to Sabon-Gari and Makarfi local Government areas in Kaduna state. This is because SFH has carried out its campaign in these areas within the last 10 months, using the various communication strategies such as mass media, interpersonal communication, drama, talk shows, among others.

1.6         Significance of the Study

Maternal and child mortality in Nigeria has consumed millions of lives due to improper communication among other reasons; effective communication programmes are meant to identify the right channels and content that will draw attention to the use of health information (WHO, 2012). International Agencies, Non-Governmental Organizations, Federal Governments have contributed their quota, but it seems their efforts are not yielding the desired results: Could it be that the right communication strategies are not employed for the right target audience? This is why this study seeks to assess the communication strategies used by SFH in communicating MCH messages and know if the strategies are effective or ineffective. A major gap discovered in the review of different literature like, Digamar (2011), Ogunbijimi (2012), Gray-Fielder, Osola (2012), UNICEF (2005) and many others, show that most NGOs do not care about communication strategies, the few ones that care, like Odesanya et al (2015) have no knowledge of the right kind of channel for the right kind of audience. A study by Zamawa (2015) reveals that the media as a communication strategy should be used as instrument for designing programmes that engage men in maternal and child health, but it limited in identifying the best communication strategies to be employed. Digammar and Harribar‘s (2011) review of MCH service reveals that educational level of women and birth order are some factors that influence the low usage of MCH services, but have failed to see communication as a major factor.

Another gap identified is that the study areas of this research Makarfi and Sabon-Gari, has not been covered by the research works reviewed. As such, this research contributes to knowledge as it finds out the best communication strategy to be used for different audience with the aim of reducing the high rate of maternal and child death in Nigeria. This was achieved through the responses gotten from the field.

The findings and recommendations of this study will be significant to NGOs and international donors, as it will make them understand the right communication strategies to be used for any intervention programme like (ESMPIN) and guide them on how to manage resources. This research will also benefit women and children by making recommendations to NGOs, donor agencies and the government on more effective communication strategies. The research will also be significant to the Federal government of Nigeria, because it will help them improve the Nigerian Health system, health policy programmes, and organize training for health development facilitators.

The research will benefit Communication specialist, mass media practitioners, Health communication coordinators and interpersonal communication agents by improving their writing skills and understanding their target audience. It will guide the actual writing of a communication programme or project in order to achieve its development goal. Health workers will not be left out as they are great instrument that will bring about change the desired behaviour. This research will serve as a guide for their daily activities in the hospital by consistently teaching the health workers how to communicate to pregnant mothers and nursing mothers.

The study will also contribute to existing literature on the improvement of maternal and child health through effective communication strategies, because most literature have failed to identify the right kind of channels used for the right kind of audience. The study therefore will help in creating awareness, understanding as well as knowledge of how to communicate well to pregnant women and nursing mothers in Nigeria.

1.7         Operational Definition of Terms

The following terms are used technically in the study.

Assessment:   In this research assessment is seen as an examination or an evaluation of the different communication strategies used by SFH in communicating MCH components.

Communication Strategies: The different channels or means of passing messages to a target audience.

Maternal and Child Health: The complete well-being of a mother and child during and after child birth. i.e physical, psychological and social well-being.

Communication Agents:  These are the people trained by SFH to communicate MCH messages to the Women

Maternal mortality:    is  the  death  of  a  woman  while  pregnant  or  within  42  days  of termination of            pregnancy, irrespective of the duration of the pregnancy,   from   any   cause   related   to   or   aggravated   by   the pregnancy or its management.

Child Mortality:   Also known as under-5 mortality is the death of infants and children under the  age of 5.

 

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