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close this bookEffective Approaches for the Prevention of HIV/Aids in Woman (PAHO, WHO; 1995; 62 pages)
View the documentExecutive summary
View the document1. Introduction
View the document2. Opening of the meeting
Open this folder and view contents3. Women and HIV/AIDS
Open this folder and view contents4. Effective approaches to prevention of HIV/AIDS in women
close this folder5. Experiences from other fields: implications for HIV/AIDS prevention
View the documentCelebrating mother and child on the fortieth day: the Sfax, Tunisia, postpartum programme
View the documentPromoting health through women’s functional literacy and intersectoral action in Nigeria
View the documentCredit programmes, women’s empowerment, and contraceptive use in Bangladesh
View the documentExperience from other fields: implications for HIV/AIDS prevention - Conclusions
Open this folder and view contents6. Future directions: national policies and large-scale programmes
View the document7. Overall conclusions
View the documentAppendix 1 - Agenda
View the documentAppendix 2 - List of participants
View the documentAppendix 3 - List of background papers
View the documentAppendix 4 - Selected reading list

Promoting health through women’s functional literacy and intersectoral action in Nigeria

Presented by Mrs Priscilla Gbillah, Women in Health Coordinator, Benue State, Nigeria

Nigeria has high infant and maternal mortality rates: approximately 85/1000 live births and 2.5-5/1000 live births respectively. The increasing cost of health care resulting from cost recovery measures has made it difficult for low-income families to access health care. Families must often depend on traditional practices and beliefs, some of which are harmful to health. Maternal illiteracy, strongly linked to infant, child and maternal morbidity and mortality, is high. Yet, as in most societies, women are responsible for most aspects of family health. Therefore, an initiative to improve the health status of women and children was launched by WHO, in collaboration with the Federal Ministry of Health, through improving women’s ability to read and write; creating awareness of the causes and prevention of disease; and increasing women’s economic power.

Two project sites were selected based on needs assessments and centres for conducting literacy classes were identified. Instructors were recruited and trained in the use of a manual developed for the project. Through the existing clan social structure, participants were identified and recruited. They were given a medical examination, and throughout their literacy training, were given regular health talks and demonstrations. Other health-related activities included training of traditional birth attendants and village health workers, and the establishment of mini-pharmacies, managed by the women themselves. Growth monitoring charts and other health monitoring records were provided. Participants were also given seed money to launch their own income-generating activities.

Since 1990, when the project got under way, 489 women have either graduated from or are currently enrolled in the literacy classes. An evaluation was carried out in 1993 to measure progress towards the stated objectives that at least 50% of project participants would be able to read and write in their own dialect within one year, and that their awareness of the causes and prevention of disease would be significantly improved. Twenty per cent of participants in the literacy classes (N=119) and 111 non-participants were randomly selected for comparison and evaluation. The impact of the programme exceeded expectations. Seventy-one percent of participants surveyed reported being able to read (in comparison with 1.6% of non-participants). Of the women whose reading skills were assessed among the participants, 45% had good reading skills and 29% had very good reading skills.

Findings relating to the improved health status of women and children were equally impressive. The under-five death rate fell from 23% to 3% over five years and the number of participants’ children with home-based records increased from 10% to 47%. The immunization status of children of participants and non-participants were compared and results showed that 83% of participants’ first children were fully immunized, as compared with 13% of first children of non-participants (see Figure 8). Corresponding figures for the second children were 96% and 22%. With respect to malaria, 100% of the participants could identify the cause of malaria as opposed to 13% of non-participants. This resulted in the adoption of preventive behaviours such as cutting grass, eliminating stagnant water, and taking children to the clinic when malaria was suspected. Clinic treatment was sought for a child’s malaria in 98% of participants and 35% of non-participants. The incidence of diarrhoea was lower among children of participants and it was found that 100% of participants’ children had been administered with salt-sugar solution compared with 52% of non-participants’ children.

Figure 8

Child health care practices, by women’s participation status, in a health and literacy initiative in Nigeria


This project has also had a positive impact on women’s economic status. For example, 97% of participants reported having a savings account as opposed to 5% of non-participants. These differences were also found in women’s access to loans, with 81% of participants reporting having received a loan to finance a business in the last year as opposed to 1.6% of non-participants.

The prevalence of HIV/AIDS in Nigeria is still relatively low, although data are scarce and unreliable. Reported AIDS cases (a clearly under-reported 1450 in June 1994) indicate that women are increasingly being affected. A tide of concern about HIV/AIDS has been forming in recent years, at the national level and in communities such as the ones that are part of the literacy programme. Instructors report that along with increased awareness about HIV/AIDS, there is increased awareness about women’s and men’s sexuality, and women’s lack of power in sexual relationships. As a result, an STD/HIV module has been added to the literacy curriculum, meetings have been held with men to educate them as well, and traditional birth attendants and village health workers have been trained to discuss STD/HIV and some have begun distributing condoms.

Lessons learned

• Literacy classes can be an effective vehicle for transmitting messages about health, including STD/HIV. They have been shown to have a significant impact on women’s health-related knowledge and behaviour, which has in turn had a significant impact on the health of their children.

• Projects that address fundamental social problems such as illiteracy increase women’s confidence and self-esteem and thereby empower women to take positive action to address the challenges in their lives.

• By combining the provision of important skills (reading and writing) with information (on health) and economic opportunities (loans and seed money), a synergistic effect can be achieved.

• An intersectoral approach can also lead to a broadened base of beneficiaries in the community. The initial and considerable resistance to “women’s projects” from husbands of participants and men in the community can be alleviated by showing sensitivity to their concerns (e.g. feeling threatened).

• Women who participate in empowerment activities (e.g. learning to read, obtaining a loan) can be regarded as health and economic advisers, and role models to other women in the community. The increased status accorded to women could have obvious implications for sexuality in their relationships, including STD/HIV prevention.

• A project that is firmly rooted in the community can be sustainable through integration with local services (e.g. local primary health care), and resources (e.g. a loan scheme with a Nigerian bank to ensure continuity) and the establishment of a committee of project members and local leaders (e.g. to ensure maintenance of project facilities).

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