Child Survival: Nigeria must build trust at household level, says white paper – The Sun Nigeria

Nigeria must strengthen trust and engagement at the household level to improve child survival, particularly in northern states, a new white paper has said.

The report, titled “Earning Public Confidence and Household Trust in the Reduction of Child Mortality in Northern Nigeria,” noted that reaching caregivers with health information does not always mean reaching those who make decisions about whether children receive medicines.

The white paper examined public sentiment and household decision-making around the SARMAAN/REACH programme, which provides approved doses of azithromycin to children aged one to 59 months through mass administration across 11 northern states.

Evidence from the MORDOR trial showed that the intervention reduced all-cause child mortality by 13.5 per cent in high-mortality settings.

However, the report said the availability of an effective intervention was not enough to guarantee participation, as households must also trust the programme.

According to the sentiment study, the overall Emotional Sentiment Index across the 11 states stood at 48 out of 100, indicating that while caregivers were participating in the programme, their confidence and understanding remained fragile.

The report said there were significant differences among the states, with Kano recording an ESI score of 73, compared with 36 in Yobe and 28 in Kaduna.

It stressed that the figures should be treated as baselines rather than permanent assessments, noting that public trust could change depending on how governments and health programmes respond to concerns.

A major finding was that mothers do not always have the final say on whether their children receive medicines.

Only 16 per cent of mothers surveyed said they had sole authority over the decision, while 51 per cent said the decision was made jointly with other household members. In 33 per cent of households, the husband had sole authority.

The report therefore recommended that health communication should extend beyond mothers to include fathers, male elders and other household decision-makers, particularly in communities where they wield significant influence.

Despite the challenges, the study found strong willingness among caregivers to continue participating, with 96 per cent saying they intended to participate in SARMAAN again.

The white paper recommended that states build year-round relationships with trusted community messengers, including frontline health workers, religious leaders and women’s networks, rather than engaging them only during medicine distribution campaigns.

It also called for stronger systems to identify and address emerging concerns before they become deeply rooted.

The report cited Nigeria’s experience with polio vaccination as evidence of the importance of trusted community engagement, noting that structured investment in credible community messengers helped reduce new polio cases from 384 to 21 in one year after distrust disrupted vaccination efforts in parts of northern Nigeria in 2003.

The white paper stressed that trust could not replace adequate financing, health workers, supply chains or effective service delivery, but argued that public confidence should be treated as part of the health system’s infrastructure.

It called on policymakers to budget for trust-building, maintain credible community networks between programme rounds, engage household decision-makers and establish mechanisms for tracking and responding to concerns.

The report said such investments could extend beyond SARMAAN/REACH and help strengthen relationships between communities and health systems for future child-survival and other public health interventions.