Volunteer Community Mobilizers – a team of women trained by the United Nations Children’s Fund (UNICEF) – to go door-to-door across Nigeria, raising awareness about polio and delivering life-saving vaccines to children. (Andrew Esiebo/U.N. Foundation)
KANO, Nigeria – Sitting on a narrow wooden bench, her smiling face framed by a bright blue veil, Zainab Abdullahi explains that she had always wanted to help people in her home city of Kano in northern Nigeria.
Once the epicenter of Nigeria’s devastating polio outbreak some 15 years ago, Kano still bears the epidemic’s scars: at intersections across the city, young men roll up on wheeled wooden platforms, pointing at their withered limbs and begging for change.
“I grew up seeing children with paralyzed legs, paralyzed arms. I felt sad. That’s what motivated me to become a VCM,” recalls the 33-year-old Abdullahi, who uses the acronym for Volunteer Community Mobilizers, the teams of women trained by the United Nations Children’s Fund (UNICEF).
thAbout 20,000 VCMs go door-to-door across Nigeria, raising awareness about polio and delivering life-saving vaccines to children. The efforts have paid off: On Aug. 21, Nigeria celebrated three years without a single new case of wild polio, meaning the country, and the continent, may be certified polio-free as soon as next year.
The VCM program was initially developed to tackle polio but has since become a vital part of Nigeria’s efforts to improve its flailing health care system. In the process, it is empowering thousands of women in a country which has long struggled with gender equality.
“People show me that I’m important, and I feel useful to people,” Abdullahi says. “It makes me happy.”
Campaign’s Success Plays on Country’s Traditional Culture
The VCM program began in 2012, when wild poliovirus was still widespread in Nigeria. That year, the country recorded 122 cases. That figure was a marked improvement from the more than 1,000 cases recorded in 2006, at the epidemic’s peak, but aid organizations were growing frustrated at the continued stubbornness of the disease.
VCMs have proved key to ending the outbreak. In many Nigerian households, tradition prohibits a man, other than close male family members, from entering a woman’s home without explicit permission from her husband.
“If you brought in male health workers, it would not work – they would not be allowed to enter the homes to immunize the children,” says Ngozi Nwosu, national coordinator for the polio transition planning committee of the National Primary Health Care Development Agency. “(But) they’re not just women … they’re respected members of those communities, they are people that those community members can trust with their lives.”
UNICEF began recruiting women across the country’s north, training them to give the polio vaccine while also recognizing and reporting the tell-tale signs of the illness: paralysis of a child’s limbs.
The result is not only an army of vaccinators, but also a surveillance team which can quickly report an outbreak and spur a rapid response from both the government and local aid agencies. The year after the VCM program began, cases of wild polio more than halved to just 53, and only six were reported in 2014. Only four cases have been diagnosed since.
“Their usefulness, their advantages cannot be quantified,” says Kabiru Rabiu, officer in charge of polio at UNICEF in Kano state.
Since 2016, Nigeria has strengthened the fight against polio by providing vaccinations for hard-to-reach children in conflict areas. (Andrew Esiebo/U.N. Foundation)
Program May Help Shift Attitudes on Women
Despite their importance to the campaign, VCMs are only paid a stipend of 10,000 Naira (about $27 dollars) per month. Some women reported not being paid for several months.
“This is really pittances,” says Pernille Ironside, deputy representative for UNICEF in Nigeria. “So the fact that they have a willingness to spend their time and energy reflects their commitment to their communities. And I think that’s really noble.” Ironside acknowledges some delays in paying VCMs as UNICEF worked to root out graft in the payment process: “It’s not a perfect system,” she says.
Women’s roles in the health care system also remain largely at the frontline level, rather than in leadership positions: In Kano state, for example, only four of the 44 local government area health-care coordinators are women.
Still, in a society like Nigeria, which ranked 157th out of 189 countries assessed by the United Nations’ 2017 Gender Inequality Index, the recognition and respect afforded VCMs can be an important first step in shifting social attitudes toward women.
Ironside says the increasing prominence of VCMs has given UNICEF some leverage to bring up other women’s rights issues like child marriage with religious leaders in conservative regions, which despite some resistance, is at least a start.
“We’re pushing the envelope,” she says. “So there is discomfort in that whenever it’s done… (But) it’s an entry point, and we will try to maximize that space.”
These efforts have been particularly important in cities like Kano and its surrounds, which are predominantly Muslim and often more restrictive than their southern counterparts like Lagos when it comes to women’s rights.
“Women were to be seen and not heard,” says Nwosu, the polio transition chairperson. “But because of the polio program, the place of women has been boosted.”
Moving Beyond Treating Polio
Zainab Mustapha, 32, says she completed secondary school and earned a diploma in teaching before becoming a VCM in Kano. She’s worked to reduce public resistance to the vaccine, which was widespread in Kano due to rumors that the medicine was laced with birth control.
“Now, parents come to meet me at home, very early in the morning or even late at night to check when the next immunization is going to take place,” she says happily.
After six years of working as a VCM, Mustapha is returning to teaching because, she says, “the money is small” as a health worker. Despite the low pay, Mustapha says she is proud of what VCMs have achieved for women in Nigeria.
“Women were dying because of childbirth, because of lack of knowledge,” she says. “Sometimes we lost the baby and the mother at the same time. Now, that doesn’t happen.”
This, too, has become an important part of the program: While they initially focused on polio, VCMs now provide other vaccines such as measles, as well as antenatal care, encouraging women to give birth in hospitals rather than at home.
Efforts like these have helped reduce maternal mortality in Nigeria, which dropped from 1,170 to 814 deaths per 100,000 live births between 2000 and 2015, according to the World Health Organization. The program remains particularly crucial in the northeast, which still sees 1,549 deaths per 100,000 births.
A health worker takes records of clients at the maternity department of the Nasarawa local government area primary health center in Kano, Nigeria.(Andrew Esiebo/U.N. Foundation)
Program May Benefit Future Generations of Women
With Nigeria looking set to be certified polio-free next year, authorities are turning their attention on how best to utilize this small army of trained and trusted health workers.
“What we are doing now is to look beyond polio,” says Nwosu, explaining that the government is hoping to recruit more women into a new program called CHIPS – Community Health Influencers, Promoters and Services. Like the VCM program, CHIPS is focused on improving access to primary and maternal health care in rural and underserved areas.
But perhaps the VCMs’ greatest legacy will be their impact on the next generation of women and girls in Nigeria.
“It has changed society,” says Aisha Farouk, 30, a doctor at the Kano state health ministry who supervised VCMs while she was a resident. “Others are really looking up to them. A little girl might go to school just so she can be VCM. It can change her life.”
That, at least, is VCM Abdullahi’s hope for her 1-year-old daughter. “I want her to become a health care worker,” she says. “So she can help the nation.”
This reporting was supported by a press fellowship from the U.N. Foundation.