Country Spotlight Series, Health Systems Strengthening
Faith-Based Organizations Providing Health Care in Nigeria
Faith-based organizations (FBO) play a significant role in providing healthcare in Nigeria. This spotlight features the work of a few FBOs, including the Christian Health Association of Nigeria, Rural Health Services, Isaiah 58 Care Foundation, Life Builders Ministries International, and World Renew. These organizations are working in family planning, immunization, nutrition, WASH, overall health systems strengthening and more.
NIGERIA COUNTRY PROFILE
- Country Population: 200,963,599 as of 2019. Source: World Bank
- Life expectancy: 55 years. Source: World Bank
- Gross Domestic Product Per Capita: $2,229 USD. Source: World Bank
Maternal Mortality Rate
512 maternal deaths per 100,000 live births. Source: Nigeria Demographic Health Survey 2018
Under 5 Child Survival Rate
132 deaths per 1000 live births. Source: Nigeria Demographic Health Survey 2018 (This implies that more than 1 in 8 children in Nigeria die before their 5th birthday.)
Skilled attendance at birth
- 67% of pregnant women have an ANC visit with a skilled provider
- 43% of births are assisted by a skilled provider
Source: Nigeria Demographic Health Survey 2018
Child Nutrition
- 22% of children under five are underweight
- 37% of children under five are stunted
- 37% of Nigerian children age 6-59 months are stunted (short for their age), 7% are wasted (underweight for their height), 22% are underweight for their age
Source: Nigeria Demographic Health Survey 2018
Religious Affiliation
- Muslim: 53.5%, Roman Catholic: 10.6%, Other Christian: 35.3%, Other Faiths: .6% (2018 estimate) Source: CIA Fact Book
Featured Faith-based Organizations Working in Health
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Rural Health Services
The Rural Health Services (RHS) of Sudan United Mission/Nigeria Reformed Church was founded by the Netherlands Reformed Church. The work of RHS in health systems strengthening focuses on health manpower and health service delivery. According to Dr. Johnson Diara, Project Coordinator for HIV/AIDS at RHS, the organization has a school of health technology which is accredited by Federal Ministry of Health to train Senior Community Health Extension Workers to manage common illnesses and to train skilled birth attendants in rural and remote communities throughout Nigeria.
RHS also trains Junior Community Extension Workers, Health Attendants and traditional birth attendants (TBAs) to promote healthy behaviors and provide preventive services in their communities. The organization also has some health service delivery outlets in Ebonyi and Benue States; collects routine data, performs ongoing data quality assurance and audits to ensure that high-quality clinical data is shared with its partners.
RHS was tasked by the government of Nigeria to collaborate with the World Health Organization (WHO) to conduct an epidemiological assessment and primary prevention of Lassa and Yellow Fever in the state of Ebonyi in order to prevent future outbreaks and assist with eradication efforts. Data collection efforts have helped RHS secure essential medicines and supplies from the government of Nigeria to provide care in the community.
In its advocacy and community engagement work, RHS utilizes the Partners Forum, a community-based advocacy group of faith leaders, women and youth groups, and other influential community voices, who collaborate to address public health challenges and community needs. According to Dr. Diara of Rural Health Services, “In our organization, we don’t just serve people. We also make them a part of what we are doing.”
“In our organization, we don’t just serve people. We also make them a part of what we are doing.” -Dr. Johnson Diara, Rural Health Services
Rural Health Services’ strength has been its ability to work and implement programs in a way that is relevant to the government, community, and the church. According to Dr. Diara, “Even though we are a faith-based organization, we have strong alliances with the community, the government and other partner organizations.” As a self-financed organization, RHS does not solely rely on the government and donors to solve its problems. It strives to find its own solutions. In addition, the organization is involved with strengthening churches within Nigeria, so that they are equipped to address the needs of their communities.
Isaiah 58 Care Foundation
Isaiah 58 Care Foundation’s work is centered on strengthening health systems through community health interventions. The organization addresses malnutrition among orphans and vulnerable children (OVCs) and increases access to clean water and improves sanitation in communities. To reduce malnutrition and deaths from inadequate or unsafe water and poor sanitation, the foundation partnered with faith leaders and local donors to construct 18 water boreholes, 22 water harvesting tanks, and 39 pit latrines.
Isaiah 58 Care Foundation is aware that poverty continues to be an underlying cause of malnutrition. Therefore, through the foundation strong agricultural initiative and ownership of farms, it grows and produces its own food to address nutritional needs of OVCs and other target beneficiaries. In order to sustain the organization financially and meet the ongoing needs of the people it serves, the organization sells some of its farm produce for income. The foundation provides up-to-date information to parents and caregivers on the best feeding practices for infants and young children, and also provides support. This ensures that children are taken care of and fed in the best way possible to prevent malnutrition. “Because everyone has a role to play to combat malnutrition in Nigeria, we create greater awareness and sensitization of malnutrition to communities and work together to fight the menace,” said Amaka Uja, Founder, Isaiah 58 Care Foundation.
Isaiah 58 Care Foundation has the philosophy that every person should be fully brought up in the spirit of peace, dignity, tolerance, freedom, equality, solidarity and the fear of God to live a satisfying life, and society should provide an atmosphere of happiness, love, reverence for God, understanding and hope for the future of all.
Through its agricultural initiative and ownership of farms, the organization grows and produces food to address nutritional needs of OVCs, and sell produce for income to support the organization’s programs. Its philosophy is that every person should be fully brought up in the spirit of peace, dignity, tolerance, freedom, equality, solidarity and the fear of God to live a satisfying life, and society should provide an atmosphere of happiness, love, reverence for God, understanding and hope for the future of all.
Christian Health Association of Nigeria
Christian Health Association of Nigeria (CHAN) provides technical support and resources to more than 600 mission health institutions and nongovernmental organizations (NGOs) throughout Nigeria. CHAN members deliver health care services in remote health posts. One of CHAN’s areas of expertise is engaging faith leaders in public health and community development initiatives, so the religious leaders can help address community health challenges and become agents of change in their respective churches and communities.
For example, in 2018, CHAN organized an ecumenical event with religious leaders in order to address denominational disagreements on the use of family planning and identify solutions.
In terms of nutrition, CHAN partnered with the Vitamin Angels organization and 27 mission health institutions and distributed 2,178,500 doses of Vitamin A, 77,400 multivitamins, and 977,000 of Albendazole tablets. The goal of the vitamin distribution project was to promote the intake of vitamins among children and pregnant women. The Albendazole was given to pregnant women and children for stomach deworming.
Life Builders Ministries International
Life Builders Ministries International (LBMI) works in both urban and rural areas of Nigeria and is an indigenous faith-based organization. Life Builders owns an 80-bed hospital that provides maternity services, laboratory services, family planning, obstetrics and gynecology services, and general surgical services. In addition, Life Builders conducts free medical outreach within Nigeria. Their second hospital building, currently under construction, is located in the heart of Lagos, a city with a population of over 20 million people. Life Builders also run a government approved college of health where mid-level health workers are trained to fill the huge gap of insufficient manpower in the Nigerian health sector.
Through the ownership of a clinical laboratory and a general surgical services center, Life Builders provides diagnostic services at an affordable cost. Another component of Life Builders’ work is providing health education through seminars and symposiums to faith leaders, community members and national security agencies, such as the Nigerian Police Force, to fill knowledge gaps on health, especially on family planning and immunization. In an effort to address malnutrition, Life Builders works on linking people to affordable and locally grown foods sold by local marketers and vendors.
Life Builders Ministries International provides health education through seminars and symposiums to faith leaders, community members and national security agencies, such as the Nigerian Police Force, to fill knowledge gaps on health, especially on family planning and immunization.
World Renew
World Renew has operated in Nigeria since 1969 and works with local partners within its membership network in order to maximize its work around the world. World Renew uses Village Development Committees (VDCs), which are comprised of community leaders and other influential voices, to strengthen advocacy efforts for community resources at the local governmental level. These VDCs along with Peer Health Educators assist with community mobilization and sensitization to scale up family planning promotion and vaccine uptake. According to Mr. David Tyokighir, Country Director for World Renew Nigeria, the Village Development Committees are led by community members who understand the real needs and challenges of their communities.
Mr. Tyokighir also states that one of the ways to sustain development initiatives is to ensure that “projects are community based with full participation of community members.” In addition, World Renew focuses on training health workers to create and promote friendly clinic environments in order to prevent mistreatment of patients by health workers. According to Mr. Tyokihir, such work is important because people are more likely to visit health facilities if they are treated with respect.
“The Village Development Committees are led by community members who understand the real needs and challenges of their communities.” -David Tyokighir, Nigeria Country Director, World Renew
World Renew Village Savings Groups
In order to promote financial empowerment among women, World Renew established village saving groups. Since clinics are far from where people live, paying for transportation can be a barrier that prevents people from accessing health services. These village saving groups help women to secure transportation fees and also provide financial management skills. In their advocacy work, World Renew works with community and faith leaders to advocate for the construction of clinics in remote areas to bring health services closer to the people. According to Mr. Tyokihir, at times, the challenge is not that health resources are unavailable, but that the distance to the clinics is far and transportation costs are high. When health facilities are close to where people live, people are much more likely to access health services.
Family Planning for Healthy Mothers and Children
Nigeria made tremendous progress in improving family planning (FP) coverage. The use of modern contraception increased from 4% in 1990 to 12% in 2018. However, the use of family planning in rural areas (8%) is significantly lower than use in urban areas (18%). Overall, unmet need for family planning is higher in rural areas (18%) compared to urban areas (20%), per the 2018 DHS.
Genesis 1:28: Procreation as a Commandment from God: Challenges to Family Planning and How we Address Them
Religion and cultural tradition have been significant drivers of resistance against family planning use, according to Dr. Diara of RHS. Some faith leaders believe the use of family planning is not biblically acceptable. Often, biblical verses like Genesis 1:28 are quoted as justification for having many children. Culturally, children are seen as a sign of achievement and honor. Despite these challenges, Rural Health Services has seen a positive shift in attitudes toward FP use, which is a sign that people are beginning to understand the benefits.
“Our health workers distribute family planning to those who need it. This distribution also occurs at churches,” says Dr. Diara. RHS’s work on family planning focuses on advocacy and outreach to various church denominations to promote dialogue and education on contraception. Currently, one of RHS’s areas of focus is promoting that males accompany their wives on antenatal clinic visits. This is especially important because participation of men in maternal and child health care is significantly low in the country.
The Christian Health Association of Nigeria has also encountered challenges with promoting FP while attempting to maintain its religious commitment to both the Catholic and Protestant churches in its network. CHAN has encountered challenges with religious leaders and believers who equate family planning to abortion. This belief is common among Muslims, Catholics, and traditionalists in Nigeria, who believe that children are a blessing from God and should be conceived without hindrance.
CHAN promotes dialogue on family planning use while remaining careful to be culturally sensitive. Since family planning and its terminology can be seen as controversial, CHAN’s working language for family planning is “birth spacing.” In describing this challenge, Pastor David Onomoase Omorebokhae, Director of Advocacy and Communication at CHAN said, “Where others are afraid to tread or have met with brick walls, we have strategically circumvented the obstacles to launch a birth spacing program with success and unscathed.”
“CHAN promotes dialogue on family planning use while remaining careful to be culturally sensitive. Since family planning and its terminology can be seen as controversial, CHAN’s working language for family planning is ‘birth spacing.’” -Pastor David Onomoase Omorebokhae, CHAN
CHAN focuses on promoting family planning dialogue among church leaders who oversee health institutions for their denominations. The goal of educating faith leaders is to combat fundamental biases that religious leaders hold about family planning use and sensitize them with correct information on acceptable contraception methods. Most recently, CHAN engaged and encouraged clergy from Catholic and Methodist churches to champion family planning use consistent with their religious beliefs.
Immunization in Nigeria
Immunization coverage is critical to protecting populations, especially children, from life-threatening disease. It is an indicator used to monitor progress in reducing child morbidity and mortality. Nationally, vaccination coverage in Nigeria has improved over the past 10 years. The Nigeria DHS 2018 shows that children aged 12-23 months who received all basic vaccinations increased from 23% in 2008 to 31% in 2018. The proportion of children who received no vaccinations has also decreased from 21% in 2013 to 19% in 2018.
Though Nigeria has made progress in vaccination coverage, it still falls short of Sustainable Development Goal 3, which has a target of more than 90% coverage of all basic vaccinations among children aged 12-23 months.
Contributions of FBOs in improving Immunization Coverage
Rural Health Services deploys health care workers to rural areas to provide vaccination services to improve immunization coverage. According to Dr. Diara, “We want to make sure that we bring health services where people are.” Its second priority on immunization work is data collection. RHS shares data with the government of Nigeria to inform decisions on vaccine supply and demand in various regions. “Without data, it is often difficult to receive vaccine commodities from the government,” said Dr. Diara.
CHAN holds weekly immunization days to conduct and promote immunization, and takes advantage of regular antenatal visits to vaccinate women and children. Its clinical and community health workers also engage community members and church fellowship groups for women by educating them on the importance of immunizing their children.
To ensure that children are being vaccinated, CHAN conducts follow-ups with mothers through text messages and phone calls, reminding them to bring their children back to the clinic for vaccination. Furthermore, the organization partners with the government on outreach to community leaders and church pastors to promote childhood vaccination. CHAN works to ensure that all mothers have immunization cards with relevant information for their children. Similarly, Life Builders Ministries International organizes seminars, symposiums, and health talks in communities to educate people on the importance of vaccinations.
Nutrition and WASH
Isaiah 58 Care Foundation cares for thousands of orphans and vulnerable children (OVC), and part of its work is to sustainably produce locally grown foods to meet the nutritional needs of the children. Isaiah 58 Care Foundation produces millet, guinea corn, soy beans, maize and groundnuts on farms it owns. These cereals are grounded into powder form, mixed with groundnuts, and then fed to malnourished children in order to increase their weight and growth.
In addition, Isaiah 58 Care Foundation rears goats and chickens, some of which are sold for income to maintain financial stability. Also, the foundation holds regular community training on safe hygiene and management of water facilities, health education on sanitation, hand washing practices, and safe disposal of human waste.
Similarly, World Renew promotes vegetable gardening in communities and the consumption of balanced meals. According to Mr. David Tyokighir, many people in rural areas believe that vegetables and fruits are only consumed by rich people. As an organization, World Renew is working to change the mindset that people have toward consuming healthy foods. In addition, the organization trains and educates community members on proper disposal of waste, environmental cleanliness, and proper chlorination of drinking water.
World Renew’s Contribution to Educating Adolescents on Health
World Renew Nigeria received a four-year grant from Global Affairs Canada (GAC) for the period of 2013 to 2017 to implement health education programs for in-school and out-of-school adolescents as well as parents, community leaders, and school administrators in five Nigerian states (Bauchi, Benue, Cross River, Plateau, and Taraba). Intermediate outcomes for this project included:
1) Increased practice among adolescents of healthy behaviors that reduced risks from HIV and AIDS, sexually transmitted infections, and early/unwanted pregnancies;
2) Improved protection of children and youth from violence and sexual abuse; and
3) Increased engagement in income earning activities by project participants.
Compared to the baseline, the percentage of participants who abstained from sexual intercourse increased by 7.3% in target communities. The percentage of youth who sought treatment for symptoms of sexually transmitted infections improved by 21.3% in target communities. The percentage of youth who reported having more than one sexual partner also decreased.
The project improved the protection of children and youth from violence and sexual abuse by enhancing the ability of parents, school administrators, and community leaders to address concerns related to sexual abuse by encouraging people to recognize the rights of adolescent girls to reject early marriages and unwanted sexual advances. The program resulted in a 6.4% decrease in the percentage of youth having sex for money or material gain. Sexual coercion decreased by 6% in target communities.
Faith Communities as Gateways to Improved Health
The faith-based organizations featured here have a significant impact on health in Nigerian communities. They encourage healthy timing and spacing of pregnancies through family planning use, vaccination to protect against preventable diseases, healthy WASH practices, and other behaviors that protect health.
These FBOs are trusted and respected in their communities, making them important influencers in the daily lives of their communities. In many parts of the world, including Nigeria, faith is a major part of life for many people. Greater engagement of faith-based organizations in promoting healthy behavior and providing health services, especially in hard-to-reach communities, can go a long way in improving health for communities across the globe.
The CCIH Country Spotlight Series features Christian health services in a number of countries, including those provided through facilities, communities and churches. The aim is to help identify Christian health organizations and highlight key partnerships and initiatives that improve health for those in need. These publications are illustrative and will not represent or reflect the entirety of important Christian contributions to the design and delivery of health services.
CCIH Intern Patience Mhlanga, MPH conducted research and writing for this report.
One Comment
Kathy Erb
on January 11, 2022 at 6:31 pm
This is part of a series of country spotlights. We look forward to sharing more.