On 1st December 2014, Damaturu, the capital of Yobe State in northern Nigeria, came under attack by Boko Haram insurgents. Six kilometres away in Dikumari, a diverse farming community of 2,000 residents, the gunshots and chaos forced many people to flee the town.
Barely six months later, Dikumari became a host community to some of the nearly 2 million internally displaced persons (IDPs) in northern Nigeria. There are no reliable population statistics, but according to the community’s own estimates there are now at least 5,000 permanent residents as well as seasonal visits by Fulani nomads. This sudden increase in population put the existing infrastructure under strain. For example, there were no medicines at the dilapidated local drug dispensary. The community didn’t have the capacity nor the resources to manage its health facility, and the attendance dropped.
The MNCH2 programme has been working in Dikumari throughout the period of unrest and reconstruction. Since November 2014, the programme has been supporting the local health services through the renovation and expansion of the health facility and the provision of basic equipment. After May 2015, the focus shifted to accommodating the health needs of the increased population of IDPs and returnees.
Community comes together
A core part of what MNCH2 does is to strengthen community structures. Soon after the insurgency, a Facility Health Committee (FHC) was set up in Dikumari to mobilise resources to help rebuild the community and the broken lives of those who had lost their homes.
To improve the services at the health facility, the FHC members started engaging with some of the demotivated health staff to ensure the facility was open when it was supposed to be, and that the community members receiving services were always treated with respect. By educating the community, women have become more empowered to make choices about their health, especially in terms of family planning. Mohammed Garba, the committee’s Chairman, says he appreciates the robust relationship between the health facility and the community; "We meet with the community members to inform them about progress and challenges of the health facility and also discuss their concerns”.
The combination of new antenatal, labour and delivery services from the reconstruction, and the visible involvement of the community in decision-making through the FHC, has increased the number of women accessing services by almost 150-fold, compared to the pre-insurgency figures (based on DHIS2 data). This includes increased birth attendance by a skilled provider.
Balki is a 23-year old mother who gave birth at the local health facility. She moved to Dikumari after finishing primary school and getting married at 16. She had given birth to her first and second child at home. But with her husband becoming a member of the FHC, the young mother became the first woman in the town to deliver at the facility after the refurbishment; “Although this is my third child, I am proud to be the first woman in the community who attended the antenatal clinic and delivered in the health facility on a new delivery bed! I have made up my mind to mobilise other pregnant women to do the same.”
The Maternal, Neonatal and Child health programme (MNCH2) is a five-year, UK government funded programme, led by Palladium, designed to reduce maternal and child mortality in six states in Northern Nigeria: Jigawa, Kaduna, Kano, Katsina, Yobe and Zamfara. The Facility Health Committee intervention is led by Options, one of the consortium partners, to improve community involvement in decision making, and the quality and use of health services.