Introduction to IHP Gender and Social Inclusion Activities in Bauchi, Kebbi, and Sokoto States
USAID’s Integrated Health Program (IHP) in Nigeria, led by Palladium, provides technical assistance and evidence-based guidance and tools to support the States of Bauchi, Ebonyi, Kebbi, and Sokoto, and the Federal Capital Territory (FCT), and strives to achieve three key objectives:
- Strengthen health systems supporting primary health care (PHC) and reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH+N) services;
- Improve access to PHC and RMNCAH+N services; and,
- Increase the quality of PHC and RMNCAH+N services.
It is increasingly clear that gender and social inclusion (GESI) gaps in society have damaging effects on health and create inequities in access to care and service quality. (1) GESI is a foundational element toward achieving responsive services that meet the needs of the population and improve access and quality.(2) As part of this effort, IHP leads GESI, with technical support from WI-HER, in engagement efforts at government, facility, and community levels to address GESI-related barriers and ensure that women, men, girls and boys have access to quality PHC services. It is therefore vital that the gendered impacts of COVID-19 be considered through a GESI lens based on local and global knowledge to promote the use of evidence-based best practices, and to determine how it would impact workflow processes. These efforts are timelier than ever as COVID-19 threatens to strain an already burdened health system in Nigeria.
Gendered Impact of COVID-19
Nigeria is the largest economy and most populous nation on the continent(3), and as such its response to the gendered impacts of the COVID-19 pandemic could have long-lasting effects on not only its own country but other African countries as well.(4) Pandemics can exacerbate existing gender inequalities(5), and as health and support systems “may weaken or break down, specific measures should be implemented to protect women and girls from the changing dynamics of risk imposed by COVID-19.”(6) For example, since partial lockdowns were implemented in Nigeria in March, 23 out of 36 states (for which data is available) have reported increases in cases of gender-based violence (GBV) by an average of 149% from March to April, and Lagos, Ogun, and Kano states, and the FCT, which were placed under full lockdowns, saw an increase of 297% during the same time period.(7) If health services are to be more equitable and efficacious and respond effectively to the gendered socio-cultural impacts of COVID-19, there is a need for recognizing gender-based barriers and designing gender-responsive health solutions and services that more holistically cater to the unique health needs of Nigerians, regardless of age or gender.
Adapting WI-HER Workflows for COVID-19
With the arrival COVID-19 in Nigeria, IHP quickly pivoted with several work style adjustments such as instructing staff to work at home, establishing collaborative working meetings online, and tracking the COVID-19 data to make decisions that responded to the safety needs of the staff, including WI-HER’s five Gender, Social Inclusion, and Community Engagement (GSI-CE) Advisors in Nigeria. WI-HER adopted similar policies for staff in Florida, Kenya, South Carolina, Uganda, Virginia, and even Denmark. Telework and social distancing policies were implemented, and, as in-person activities were put on pause, workflows were refocused on conducting research and developing knowledge management products, strategies, and guides during this restricted period to be ready with next steps once the COVID-19 lockdowns were lifted.
These changes were not completely seamless, as many of our in-country colleagues and partners experienced unreliable internet connectivity, and some sensitization on effectively using online platforms was required to ensure continuity of operations. With regards to the monitoring and evaluation of the project, GSI-CE Advisors continued to develop and refine the project’s online Gantt chart that monitors the project’s implementation on a per activity and per state level of granularity. All the GSI-CE Advisors have reported appreciating the increased accountability, transparency, and collaboration that an online and shared platform can bring to their workflow.
Pandemic or not, WI-HER will continue to look for ways to leverage technology solutions and innovations to increase the capacity of national and state governments and of health systems to sustainably support quality PHC services for RMNCAH+N.
(1) Waters, H. R. (2000). Measuring equity in access to health care. Social Science & Medicine, 51(4), 599-612.
(2) Read, J. N. G., & Gorman, B. K. (2010). Gender and health inequality. Annual Review of Sociology, 36, 371-386.
(3) Central Intelligence Agency. (2020). Nigeria Overview. Available at: https://www.cia.gov/library/publications/the-world-factbook/geos/print_ni.html
(4) Ebenso, B., & Otu, A. (2020). Can Nigeria contain the COVID-19 outbreak using lessons from recent epidemics? The Lancet Global Health, 8(6), e770.
(5) Wenham, C., Smith, J., & Morgan, R. (2020). COVID-19: the gendered impacts of the outbreak. The Lancet, 395(10227), 846-848.
(6) United Nations Population Fund. (2020). COVID-19: A Gender Lens. Available at: https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_A_Gender_Lens_Guidance_Note.pdf
(7) International Growth Center. (2020). The shadow pandemic: Gender-based violence and COVID-19. Available at: https://www.theigc.org/blog/the-shadow-pandemic-gender-based-violence-and-covid-19/