Thomas, a father and member of the community, describes the situation:
In Aduwan II community, we had only one shop that was used as the clinic, with just a few health workers who did not even have enough materials and drugs to test and treat sick people. This bad condition of the small and only clinic made people, including pregnant women, not to go there with their health problems. It was one of the major reasons why pregnant women even preferred to go to local women [called ‘traditional birth attendants’ (TBAs)] who help pregnant women deliver their babies. The community was facing a lot of health problems.
The reliance on traditional birth attendants put the women and their babies at serious risk during delivery as well as before and after. With a high rate of HIV in and around Aduwan community and not a single HIV testing centre, antenatal care (ANC) is needed to identify if a pregnant mother is infected with HIV and, if so, prevent the transmission of HIV to her baby. Without a proper clinic, the number of HIV infections in the community continued to rise and those with the virus suffered unnecessarily.
“Sometimes I regretted being a member of the community,” says Thomas. “Especially when we rush any member of the community to the general hospital which was very far…. At a point in time, I felt like relocating to another community because of the way people in the community suffer before accessing health services.”
For the people of community, this was simply the inescapable reality of living in Aduwan. It was all they had ever known, and all they ever expected to know. However, when ActionAid brought the Enhancing Nigeria’s Response to HIV/AIDS (ENR) programme to Aduwan in 2010, bringing with them the STAR process, the community’s seemingly fated path was forever altered.
The STAR process is a participatory rights-based approach that focuses on supporting community members to work together to identify the core problems and develop solutions. With the introduction of the STAR, people in the community became aware of many of their fundamental rights for the first time, including their right to good health. What is more, they learned that they were not passive subjects of the government; they had a role to play in demanding these rights.
By 2011, with ENR’s support, the community members had been empowered to plan and organise a visit to discuss the community’s problems with their district head. The goal was to enlist his support in demanding a health centre from the local government.
As Thomas tells it:
Initially, the district head felt reluctant to support us in view of the fact that many attempts had been made by the community to draw government attention to their health problems without success. I remember he once told us to stop wasting our time.
It took a lot of persuasion before the district head agreed to accompany them to bring forward their complaint to the councilor representing their ward.
They quickly gained the councilor’s support and the STAR members began to plan out advocacy visits to the Local Government Area (LGA) Chairman. This time, the process went less smoothly. According to Samuel, a STAR Facilitator in the community, “[W]e tried several times to see the Chairman without succeeding… even when we eventually saw him, he out-rightly told us it was not possible to build the said clinic as requested because it was not in the Local Government budget for that year”.
With a great deal of determination, and armed with the advocacy skills ActionAid’s ENR team taught them, the community was finally able to make the Chairman to see reason for the construction of the health clinic. The LGA chairman made contact with the State Ministry of Health and was informed about World Bank healthcare support programmes in the state. Together, the Local Government and the community succeeded in securing the World Bank funds. Aduwan would have a new, modern health clinic. The Local Government agreed to pay the staff salaries and provide all the equipment and drugs needed by the clinic. The community itself offered to provide security.
The once-skeptical district head could not hide his joy when the clinic was commissioned. As he said to the congregation who gathered on the day the clinic was opened:
Today, history is made in Aduwan Community. As a united community, we will continue to demand for our rights legitimately. … As for the STAR cycle in our community, we shall continue to work together for the development of this great community.
Through the continued STAR meetings, people in the community were made aware of the importance of these health services, and many people now know their HIV status and adopt appropriate behavior to reduce the spread of the virus and other diseases. A health worker reports that a pregnant woman who went for antenatal told her that because of what she learned, she has mobilised women in the community to ensure that they immunise their children in the clinic against polio and other potentially deadly diseases.Expressing his joy, Thomas said: “Members of the community, including pregnant women, now go to the clinic to test for HIV and other diseases…because the clinic has health workers, admission beds and even maternity beds and drugs that they can give sick people. In fact, we now carry out polio immunization for children; we gave as many as 1200 children the polio vaccine the other time”. This information Thomas knows well; he is one of the clinic’s staff.
With the delivery of the health centre, Aduwan II Community is now not only healthier and more productive community, they are also more empowered. The health centre, for example, does not yet have a permanent medical doctor, but the community has already begun advocacy efforts at the local and state levels. Thomas is optimistic; there are strong indications, he says, that a doctor will be assigned to the clinic soon.
As for Thomas, who once was embarrassed of his community, he now says he feels quite the opposite: “I feel proud…Other communities have been coming to Aduwan II for coaching and mentoring so that they can do something similar…[O]ther communities around us also come to the clinic and get treatment. All of this success was as a result of the STAR programme that ENR has helped us to organise in our community.”
Written by: Barnabas AnthonyENR Policy, Advocacy and Gender Technical Advisor (ActionAid)