Coronavirus: Local community initiative is essential as we ease lockdowns in Nigeria
Across the globe, the influence of the grassroots has always been a gamechanger. During the second coming of Jerry Rawlings in Ghana, we recall how university students left the classroom and took on their shoulders, the responsibility of rebuilding the economy of Ghana. The same instance manifested in how Chief Sam Mbakwe of the then Imo State mobilized finances from locals in building the Owerri Cargo Airport and how civil servants in Nigeria were willing to accept pay-cuts to finance anti-apartheid in South Africa. The principle of “we the people” will hardly fail in any decent context, and even if it does, same people would in that sense of collective spiritedness take responsibility for failing, and eventually, strive to rise again.
Can the principle of collectivism apply to disease control and scaling up health services? The answer is an emphatic “yes”.
During the Ebola outbreak in Liberia, it was observed that at some point, supports from the formal healthcare system and forces of the state became short in supply and initial lockdowns were barely helping the case. What we saw were communities defining and devising health safety measures and assisting families affected by the disease, all by themselves. The successes of community-driven efforts in containing Ebola in Liberia are documented in a 2015 article by Abramowitz et al., and countries, especially low-resource countries, could learn from such experience.
There are some instances where community initiatives have been adopted in health promotion in Nigeria. One can recall efforts of The Society for Family Health (SFH) in improving the utilization of maternal health services in northern Nigeria. The organization devised a strategy of selecting indigenous women whom they taught the importance of maternal health services and incentivized them to go into their various communities, to pass on the valid information they have gotten to co-women. The SFH has since then recorded an increase in the utilization of maternal health services. The same model was applied by the anti-HIV/AIDS agencies in Nigeria, by bringing together a group of infected mothers called “expert mothers”. The expert mothers were likewise incentivized to actively encourage other infected mothers to utilize prevention of mother-to-child transmission (PMTCT) services across several locations. This strategy equally yielded benefits.
Again, the Nigerian Urban Health Reproductive Initiative (NUHRI) applied social mobilization, exclusively involving the grassroots to scale up contraceptive prevalence rate (CPR) vis-à-vis family planning across certain states in Nigeria. It is on record that in those states where NUHRI was functional, CPR greatly improved as reported by the 2013 Nigeria Demographic Health Survey (NDHS).
The instances as cited, do show that compliance with health services and instructions would be effective if they are driven by the people themselves. While the coronavirus poses a very dynamic form, it still falls within the remit of community vigilance. The question is, how effectively are community authorities and locals involved in the fight against COVID-19 in Nigeria?
The loss of confidence in the Nigerian government is overwhelming. This owes to the “donkey years” of bad governance and blatant disregard of citizens. Most times, citizens break rules and deliberately disobey orders of government as a result of utter dislike and lack of trust in government. Yet same citizens could be found bestowing loyalty on traditional chiefs and rulers, trade, religious and ethnic group leaders. They consider the latter groups as closest to them, having a good understanding of their predicaments, ready to advance their welfare, and capable of “quickly” punishing or scolding them at any time. The leaders in Nigeria understand this protocol and are aware that playing the politics of election at this level secures their victories at the polls. With the enormous potential of the grassroots in changing the game even during elections, why can’t same potential be explored to the fullest in a time as this one?
Human resources in health and security in Nigeria are obviously in short supply. This means a natural suboptimal performance in guaranteeing the safety of Nigerians in a pandemic situation. We know how primary healthcare is comatose in Nigeria, which offers no chance of quality health attention and delivery at that level. However, maximizing the potentials of community stakeholders could in the interim encourage the primary healthcare to function better. We can imagine what the results will be if salient representatives of communities are mobilized and charged to come up with initiatives in defeating the virus. Putting their heads to work and maximizing their creativities would certainly give them a sense of ownership which is the hallmark of sustainability of any project. Making them understand that the victory against the virus is neither for the government nor for the president or governors but Nigerians. Other than issuing commands of “staying at home or be out and die” from “oval offices”.
Stimulating horizontal approaches to health safety compliance makes better sense than the vertical approaches largely adopted in Nigeria. Africa has a history of “ubuntu”, whether it is representative or direct. The continent is historically known for that collectivism. It is time when we begin to integrate this age-long tradition of the continent into policy and programmatic decisions. Emperors do not exist anymore. If we have the right community engagement, road transport workers could police colleagues not to go beyond the acceptable capacity of passengers to be carried, and the local trader could caution his/her colleague not to get into the market without a face mask. Children could become advocates and can compel their parents to heed safety principles. Market leaders will run the markets decently by enforcing the safety rules using locally driven strategies like stigmatization, fines, manual labour, shift patterns, etc. And customers will only patronize shops that are safety conscious. Indeed, it is time to sit with the locals and charge them to rise to the responsibility of keeping Nigerians safe. This is exceptionally important in such time when the government seems to be overpowered by the quest of citizens to overcome hunger created by the lockdown, and even more, the government seeking to get the economy running in a bid to avoid an impending economic disaster. I wish that you all stay safe!
Prince Agwu is a columnist for Modern Ghana, a lecturer and researcher with the Department of Social Work, University of Nigeria, Nsukka, and the Health Policy Research Group. His research niche is in the area of Social Policy and Social Determinants of Health. Email: [email protected] Blog: https://princerhetorics.com/