How Poverty Affects Health, Development

from All Africa

This Day (Lagos)

By Godwin Haruna
Lagos

Given Nigeria's natural endowments, its poverty level has often astounded development analysts. This situation has placed the health index of Nigerians among the worst in the world. But as the leading not-for-profit health organisation in the country has discovered, improved health services could be ignited through advocacy by concerned groups or individuals. Godwin Haruna writes

"There was a time in Kogi State when there was no single CD-4 Count machine in the entire state. Meanwhile, the state had its own fair share of people living with HIV/AIDS and a number of them, who could afford it, had to go to Abuja, Ilorin or elsewhere to access the service. The machine is invaluable to managing those living with the virus so, the Christian Health Association of Nigeria (CHAN), met with the state officials to impress on them the necessity of acquiring the machine for their PLWHA. Today, more than five health facilities own the CD-4 count machine in Kogi State. That is the fruit of advocacy".

This statement was made penultimate week in Jos by Mr. David Omorebokhae, director of advocacy of CHAN at the two-day advocacy meeting organised for personnel of the member institutions to drive home the imperative of this tool in kick starting development in the country. Speaking to THISDAY later at the venue, Omorebokhae said the concept of advocacy meant speaking for the deprived and oppressed of the society.

"It is like speaking out for people, who are oppressed, neglected, vulnerable or people who are helpless. If an individual takes it upon himself to advocate for a community that lacks water to government and other agencies and the water is provided on the long run to that community, his aim would have been achieved. Even here at CHAN, at a point, we were going down the ladder in terms of public perception of our role, but once an advocacy department was created, the whole picture changed. Today CHAN is attracting resources and this has enabled us to reach the unreached with health services", he stated.

He added that an advocate could follow the implementation of the project if the funds are directly channeled through him. He gave the instance of the Global Funds in which the Federal Government is among the sub-recipients to CHAN, which is the principal recipient. He said although advocacy was good in attracting resources for better health care to the mission health institutions, the conservatism of the Church that is selective on whom to take money from, remains a major challenge. Nonetheless, he advised those in secular institutions not to relent in advancing their situations through the strategy of advocacy.

He said part of the problems of CHAN is that some of the mission institutions were already in existence long before it was formed. He said CHAN has a herculean task because of the diverse nature of the needs of the various mission institutions scattered throughout the country. He said they would not relent in the face of the obvious difficulties in seeking for assistance on a continuous basis. He cited the instance of highlighting the constraints of Holy Memorial Hospital in Kogi State in a news letter once and they were provided with a building and some of their needs by good hearted Nigerians. He said CHAN has accomplished much for the people through the strategy of advocacy in the last five years.

"If you go to Taraba State for instance, you will see that people, who are HIV-positive, are getting their anti-retroviral drugs free. This was something people were buying as much as N10,000 before now. There was a time when there were only 25 centres for ARVs throughout the country, today we have more than 125. CHAN has been in the vanguard of the campaigns extension of these centres to the MIs and today, most of them are treatment sites for HIV/AIDS and PMTCT in the country. All these came as a result of our persistence advocacy because we want the unreached, the vulnerable to be attended to. We are giving voices to all the participants in this meeting to go and enlarge their horizons so as to attract resources out there", Omorebokhae said.

Also speaking in an interview, a former member of the House of Representatives (2003-2007), Dr. Wale Okediran said advocacy has an important role to play in the passing of bills in the National Assembly. Okediran said lobbying and advocating for passage of bills was a universal practice that was not limited to Nigeria. He said three United Nations agencies in Nigeria have earmarked some money to push for the enactment of a law on stigma and discrimination on HIV/AIDS in some West African parliaments.

"In this type of situation, it requires a lot of advocacy before the issue of stigma can be reduced for people living with the virus. So, for CHAN as a faith-based organization, it cannot go it alone to attract resources to its mission institutions. For budgetary allocations to be made to the institutions, the Christians and Muslims faith-based institutions must come together and intensify advocacy visits to principal officers in the National Assembly as well as the various stakeholders, who will be interested in this arrangement", Okediran said.

He said unless the passage of a law is very obvious, people must necessarily advocate for it to scale through the National Assembly. He said it would be a mistake to underrate the powers of opponents when bills are introduced in the legislature. He added that even executive bills are necessarily lobbied for to scale the hurdle. He said lobbying did not necessarily suggest that money would be thrown at legislators, but it involves enlightenment campaigns, seminars and retreats for members to be well schooled on the necessity of the new bill.

However, Okediran stated: "Since democracy is still fledgling in the country, the legislature is still very weak in terms of the quality of membership as well as provision of the relevant infrastructure. Also important is the long military rule which has created a massive backlog of grey areas in the legislative arena. These developments have therefore led to an overburdened and poorly equipped legislature. It follows therefore that in order to successfully engage the legislature, certain procedures need to be followed".

He added that these factors have made advocacy in the National Assembly expensive, time consuming and often frustrating.

In his own perception, Mr. Thomas Gofwan, special adviser to the Plateau State Governor on non-governmental organizations, said advocacy was an important tool for all development organizations, NGOs, governments and individuals to advance the progress of society. Gofwan added that the strategy was invaluable in the provision of both human and material resources to recreate the society along developmental lines.

He said since politics was about giving service to add to the value of human beings in the society, it could not be a stumbling block to advocacy. He therefore ruled out partisan politics as a hindrance to developmental advocacy; "Does a ruling party want water, health services, roads, peace and security for its people? If the answer is in the affirmative, then a contribution from an opponent of this nature will be bought over and made use for the people and by the people".

He said advocacy should be done at all levels for it to achieve the desired results. He said it was not a one-way traffic and the initiative should be whether the policy is acceptable to all concerned. He said the Plateau State government was happy with what CHAN member institutions were doing in the state complimenting the overall efforts in the development agenda.

Also speaking with THISDAY, Ms. Theresa Effa, advocacy advisor, ENHANSE Project said civil society groups partnering with government agencies and other corporate bodies are all out there to advance the cause of development. Effa described advocacy thus: "It is a strategy where you begin to communicate with the policy makers, your partners to know the issue. If they don't know the issue, there is no way they can begin to address these issues that will relate to development that will address the problem they have found in the community to improve the situation. Communication is a critical strategy for development, if we don't talk about it, we won't know what the solution is, we won't be able to identify the problems and those affected by them".

She stated that advocacy pushes partners to dialogue. She added that it was not about confrontation, but coming to the table to negotiate and reach consensus on issues that would be of benefit to the larger society. She said the strategy also involves educating the people in authority on the issues adding that an advocate must also follow it up with an action plan on how to achieve it. She said an advocate must necessarily inform, using the media as an important partner to effect the desired change. Effa said her organization builds the capacity of partners in the development agenda.

Earlier in his welcome address, Mr. Samuel Mafuyai, Ist Vice President of CHAN said from the onset, they put the national advocacy committee together so that they could be voice for the poor and the vulnerable Nigerians on healthcare. Mafuyai saluted the committee for having knocked on the doors of the high and mighty to advocate for resources for the mission institutions.

He counseled them that there is still more work to be done adding: "Polio is still afflicting children in Nigeria. HIV/AIDS is taking lives of thousands on a daily basis. Malaria is killing thousands. TB and even drug resistant types continues to devastate the people. Maternal and infant mortality is still unacceptably high The reality on ground is that we need to collectively work assiduously to attract the needed resources to the mission institutions to tackle these diseases".