Nigerian women have an average of six children over the course of their lifetime and the national population—already the largest in Africa—is expected to double within 25 years. Poor access to and under-utilization of modern family planning (FP) methods contributes to high death rates among mothers and children across the country. Nigeria had a thriving FP program in the 1980’s and early 90’s.
However, changes in donor priorities and funding caused a 15-year decline in promotion efforts, and trends in fertility, contraceptive use stagnated. In 2009, with contraceptive prevalence at only 10 percent and a total fertility rate of 5.7, there was a pressing need to reinvigorate FP efforts at the national, state and city levels.
The Nigerian Urban Reproductive Health Initiative (NURHI) is a five-year (2009 ‐2014) project funded by the Bill and Melinda Gates Foundation that aims to increase the use of modern FP methods among the urban poor in the six cities of Abuja FCT, Ibadan, Kaduna, Ilorin, Benin City and Zaria by at least 20 percentage points.
To generate demand for FP services, NURHI’s ‘Get-It-Together’ campaign has three main approaches:
- A branded multi-channel campaign encompassing radio, TV behavioral change communication materials and social mobilization materials in each of the NURHI cities
- A popular radio program with drama and live call-ins, tailored to each city’s context and predominant language
- Community level FP promotion activities and referrals for FP services by teams of youth urban social mobilizers
The foundation of the NURHI Demand Generation Strategy is enhanced interpersonal communication about FP during clients/ service provider worker interactions, between spouses, and during association/trade groups meetings, neighborhood campaigns and social events led by teams of NURHI social mobilizers.
Social mobilization activities engage young men and women age 18 to 35 years as potential FP clients, and who also mobilize other potential clients to use FP services. This Spotlight describes the NURHI urban mobilization implementation process.
The growing body of evidence in the international development field has repeatedly demonstrated that community members can make deep and lasting contributions to their own health and well-being and to that of others through example and imitation.
In its first year, the NURHI team conducted a number of studies and assessments to inform its programming:
- Secondary analysis of 2008 NDHS
- Focus Group Discussions in Kaduna and Ibadan 2010
- In-depth Interviews with Service Providers 2010
- FP Social Mapping 2010
- Key Informant Interviews and assessment of the Policy Environment for FP
- Assessment of KAP of Media Practitioners to FP
- Netmap analysis funded by the K4Health project
Using data to inform the strategies and approaches to the program is critical for designing a successful consumer-led FP program. The findings from the discovery phase helped NURHI to understand in depth the FP landscape in the four program cities and gain insightful knowledge into the critical levers for change. The discovery phase allowed for the project to conduct stakeholder consultation and consensus building for framing key messages around FP and also ensured that a solid foundation was built to successfully implement program interventions.
NURHI committed to working within urban community structures (both formal and informal) to strengthen their capacity to assess and address issues related to family health, including FP. Evidence also points to power of electronic media, such as Facebook and mobile phones, to reach intended audiences, and NURHI planned to utilize these channels.
- Perspectives on Family Planning in Ibadan and Kaduna, Nigeria: A Qualitative Analysis
- Family Planning Social Mapping in Ibadan and Kaduna, Nigeria
Design the Strategy
NURHI utilized the concept of ideation to design effective messages and approaches to target key motivational factors that influence behavior for contraceptive use. Ideation refers to how new ways of thinking (or new behaviors) are diffused through a community by means of communication and social interaction among individuals and groups. NURHI used the project survey data to construct a Nigeria-specific ideational model for family planning, which is an index of factors that together predict contraceptive use (see “predictive model” diagram below).
The design was developed through a participatory workshop. The Youth Urban Mobilization Strategy describes plans for community mobilization including criteria for Social Mobilizers selection, their roles and responsibilities, the activities they will conduct, how they will be supervised, the materials and job aids they will require, and how the strategy will be monitored.
The diagram below depicts how NURHI’s key components (service delivery, demand creation and advocacy) link to each other, with details provided for demand creation activities. The small yellow boxes represent areas of linkage, and the red arrow at the bottom represents how all components in demand creation serve to promote services and the FPPN.
NURHI demand activities are linked to each other and to advocacy and service provision
- NURHI Demand Creation Strategy
- NURHI Get it Together Creative Brief
- Ideation Animated Video
- Youth Urban Mobilization Strategy
- NURHI Conceptual Framework
Create and Test
The next step in designing the social mobilization effort was to identify and contract NGOs to manage social mobilization activities.
The strategy calls for recruiting, training, and supervising social mobilizers in selected slum areas in the NURHI cities. NURHI site teams identified and selected NGOs working in the four initial cities that met the following criteria:
- Must be a registered corporate body
- Must have experience working in FP and/or other health related issues
- Must have a financial system in place
- Must be domiciled in the specific city of engagement to oversee the activities of social mobilizers
The contract includes supervision and coordination of identified social mobilizers at the community level.
The roles of the social mobilizers are to:
- Promote the NURHI radio program
- Facilitate and attend radio listener discussion groups
- Conduct key life events celebrations
- Refer potential clients to health facilities
To design support materials for use by the social mobilizers, NURHI held a Media and Materials Development Workshop with program staff, stakeholders and graphic artists. The participants at the workshop designed and pretested prototype social mobilization materials, identified/coined local slang for songs and community events, identified equipment needs, developed “Go referral cards”, branded T-shirts, face caps, wrist bands, pens, shopping bags, hijabs, reflective jackets, beach umbrella, pins and badges. Other materials developed after the workshop were toolkits for NGOs, ‘Be Beautiful’ ,‘Be Successful’ for women and men, and FP method leaflets, GIT Stickers, and FAQ. These materials are available in Yoruba and Hausa.
Guidelines were prepared for the social mobilizers activities. NURHI also preparedguidelines for social mobilization activities. NURHI social mobilizers are responsible for knowledge and visibility parades, key life event celebration, radio listening group guidelines and referrals for FP services.
- Social Mobilization Media Material Development Workshop
- NURHI Advocacy Strategy
- NURHI Get it Together Creative Brief
- NURHI Family Planning Method Leaflet
- NURHI Bumper Sticker
- NURHI Youth Urban Mobilization Gift Bag
- GO Referral Card
- Get It Together Branded Materials
- Be Beautiful
- Be Successful
- Frequently Asked Questions on Family Planning/Childbirth Spacing Methods
- Guidelines for Social Mobilization Activities
- Guidelines for NURHI Key Life Events
- Radio Drama Discussion Group Facilitator’s Curriculum
Mobilize and Monitor
Selecting the Mobilizers:
The next step was to select, orient and train social mobilizers.
Criteria for selecting social mobilizers were that the individual must:
- Live in an urban slum
- Be an artisan (barbers, hair stylists, tailors or okada mechanic, and drivers)
- Be between the ages of 18 and 35
- Be interested in volunteering to be a social mobilizer
The four NGOs conducted orientation for the selected social mobilizers. In training the social mobilizers, NURHI used an orientation guideline which includes basic FP information and how to carry out social mobilization activities.
NURHI social mobilizers conducted the following activities:
- Knowledge and Visibility parades: Social mobilizers organize parades at least once every two months, generally before and during FP outreach services activities to get the community’s attention. Social Mobilizers sing, drum and dance wearing branded t-shirts and caps, perform dramas, use megaphones to talk about FP, distribute leaflets and refer potential clients to services using the ‘Go referral Cards’.
- Key Life Events: Social mobilizers celebrate key life events such as baby naming, wedding and graduation or freedom ceremonies with members of their communities. During these events, a FP service provider is present to talk about FP, entertain and answer questions and offer counselling and referrals. During these ceremonies, a framed photo of either the baby, the newlyweds or the graduates is presented.
- Mobilization for Outreach Services: Each LGA has a monthly and quarterly outreach calendar that is shared with the NGOs. Two days before and during the outreach events, social mobilizers conduct visibility parades, neighborhood campaigns, distribute flyers and refer potential clients to the outreach using ‘Go referral Cards’. “
- Radio listener’s groups: Social mobilizers organize radio listening groups in their localities who listen to the NURHI radio program and discuss FP issues using a discussion guide.
Monitoring and supervising Social Mobilizers:
In collaboration with NURHI, NGOs monitored the activities of social mobilizers using a supervision checklist and through their monthly meetings. Based on the methodology in the NURHI Referral Manual in determining FP uptake, they analyzed the total number of referrals (i.e potential clients that receive the ‘Go Card’) against completed referrals (i.e clients that received FP services).
A barber and FP mobilizer, Bright Lawrence attends to a customer in his shop at Lugbe village, outskirt of Nigeria’s capital Abuja November 9, 2012.
Evaluate and Evolve
The NURHI Project is evaluated through a series of three surveys: Baseline, Midterm and Endline. The evaluation surveys are conducted by the Measurement Learning and Evaluation (MLE) Project through direct funding from the Bill and Melinda Gates Foundation.
- The Baseline Survey included both household interviews and health facility assessments. The survey was conducted in 2010/2011 in the six project cities.
- Summary fact sheets were prepared for Abuja, Benin City, Ibadan, Ilorin, Kaduna and Zaria based on the baseline findings.
- The Midterm Evaluation Survey was conducted in 2012, in four intervention cities (Abuja, Kaduna, Ibadan and Ilorin), providing comparisons on vital health indicators in the time since the Baseline Survey. The midterm design was similar to the baseline survey.
- In addition to the Midterm Executive Summary, summary fact sheets were prepared for Abuja, Ibadan, Ilorin and Kaduna based on the midterm findings.
- MLE conducted an Endline Evaluation Survey in 2014 in the six project citiies. This survey also includes both a household survey and health facility assessments.
All of the evaluation documentation can be found here.
- Building stakeholder support is time consuming, staff-intensive and requires investment of project funds; it is all repaid in invaluable local ownership and support.
- NURHI illustrated that careful use of data can overcome political, ethnic, religious and regional biases. In city selection, the team used an evidence-based process for identifying and ranking cities based on analysis of existing data that resulted in unanimous agreement and support from the project team and partners on intervention cities.
BANNER Photo: A FP mobilizer sings with nursing mothers at the start of a family planning visibility parade in Omuaran township in Nigeria’s central state of Kwara. © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare
Date of Publication: April 20, 2022