"Their own project for their own people": Community participation in the Village Health Worker Scheme in Gombe State, Nigeria

Background Maternal mortality in Nigeria, at 560 deaths per 100,000 live births, remains stubbornly high and contributes to lack of progress towards the Sustainable Development Goals. In Gombe State, remote rural communities’ limited access to health services, hampers universal coverage. Low adult literacy restricts efforts to increase community participation for health, particularly among women. To help achieve universal coverage in services to improve the wellbeing of pregnant women, mothers and newborns, the Gombe State Primary Health Care Development Agency (SPHCDA) introduced in 2016 an innovative practice: the Village Health Worker (VHW) Scheme, supported by Society for Family Health (SFH). VHWs, a new cadre of trained, volunteer community-based female health workers, connect the community to health care services by promoting uptake of services, providing basic preventive care, and referring women with pregnancy or postpartum complications and sick newborns. Community participation, particularly through engagement with the Ward Development Committees (WDCs), incorporates community accountability for sustainable universal coverage. Methods To evaluate the scheme’s reach, we are analysing quantitative data from annual household surveys, starting in 2017. To evaluate its responsiveness to community needs and understand the scheme’s scalability and sustainability we are conducting qualitative interviews with community members, VHWs, supervisors, implementers and the donor every six months. Working with all stakeholders we use these quantitative and qualitative data to identify and plan for course correction opportunities. Results After six months of implementation, 24% of households reported at least one VHW visit. Only 5% of wards in the State reported coverage over 50%, while a quarter of wards reported coverage of less than 15%. In response, the SPHCDA and implementers are tailoring health service delivery to address these challenges. A key finding for the scheme’s scalability and sustainability is the high level of community engagement through WDCs’ willingness to support it, by sensitising husbands and families about how VHWs serve their community. Yet challenges remain for resourcing, recruitment, adequate VHW supervision and attrition of VHWs, through marriage, return to education or other employment opportunities. Discussion / Conclusions The reach of the VHW scheme showed variability by geographic area, coverage being lowest in hard to reach areas. Community involvement and State engagement are key contributions to the scheme’s scalability and sustainability. This poster presents useful insights for policy makers and others in LMICs seeking to encourage community participation to create universal coverage of health services.