Home to nearly 182 million people, Nigeria is the most populous country in Africa. The country’s health system is fashioned after the three tiers of Government: federal, state, and local government authorities (LGAs).
Although Nigeria has one of the largest healthcare workforces on the continent, it is unable to meet the needs of the population. Current physician density is just 0.41 per 1,000 people and the quality of healthcare services is in need of substantial improvement. According to the The Federal Ministry of Women Affairs and Social Development, there are only only 8,497 social workers across the country, making the country’s social welfare workforce grossly overburdened as well.
According to WHO, Nigeria’s health indices are among the worst in the world. The country’s maternal mortality ratio is almost double the global average and, with 3.4 million people living with HIV (PLHIV), it carries the second largest burden of HIV in sub-Saharan Africa and the third largest HIV burden in the world.
HIV prevalence in Nigeria is highest among vulnerable populations, including commercial sex workers, men who have sex with men, and people who inject drugs. HIV testing rates in the country are low, with only 7 percent of men and women between the ages of 15 and 49 reportedly tested and given their results. Just 18 percent of pregnant women living with HIV have access to antiretroviral treatment (ART) as a means of reducing mother-to-child transmission and only 13 percent of eligible children under the age of 15 who are eligible for ART actually receive this life-saving treatment.
Nigeria’s National Agency for the Control of AIDS (NACA) reported in 2012 that 7.3 million of the country’s 17.5 million vulnerable children have lost one or both parents due to various causes. Of these, 2.23 million have been orphaned by HIV/AIDS, while about 260,000 children are reportedly living with HIV/AIDS. More than 20 percent of these children do not attend school regularly and 18 percent have experienced sexual abuse. Despite these dire statistics, there has been minimal state activity to provide a social safety net for the country’s growing numbers of orphans and vulnerable children (OVCs). Furthermore, linkages between the health, social welfare, and education sectors are extremely weak and greatly undermine the government’s response to OVC needs at all levels.
AIHA began working in Nigeria in 2008, launching a social work and OVC support initiative in Enugu State through our HIV/AIDS Twinning Center Program thanks to support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). This successful partnership graduated from the Twinning Center’s technical assistance program in late 2014 and laid the groundwork for two subsequent replication projects in other parts of the country.
In 2014, AIHA established a local NGO, Twinning for Health Support Initiative, Nigeria (THSI).
Systems Transformed for Empowered Action and Enabling Responses for Vulnerable Children and Families Project
(2013 – Present)
As part of a consortium led by Save the Children, AIHA is helping five states in Northern Nigeria to strengthen local capacity to provide much-needed care and support services to some 500,000 vulnerable children and 125,000 caregivers in the target states of Bauchi, Kaduna, Kano, Plateau, and Sokoto through the USAID-funded Systems Transformed for Empowered Action and Enabling Responses for Vulnerable Children and Families (STEER) project.
STEER is 5-year project is designed to mitigate the impact of HIV and AIDS on Nigerian children and families by creating greater country ownership and leadership through strengthened governments, civil society, and families.
For the past decade, reliance on the ability of community volunteers to interface with families at the household level, identify their needs, and link them to appropriate services has been a key element of the support community-based organizations (CBOs) and civil society organizations (CSOs) provide for orphans and vulnerable children and families in this region.
In 2013 when Project STEER was launched, AIHA was the only pre-service implementer in Nigeria that is addressing the country’s critical social welfare workforce shortage through our successful Auxiliary Social Worker (known in other countries as Para Social Worker) Training Program in Enugu State.
Under STEER, AIHA works closely with Save the Children and its partners to bolster the professionalism of the social welfare workforce in Northern Nigeria, focusing on building the capacity of staff at CBOs, CSOs, local government authorities (LGAs), and other organizations throughout the region.
We are working with state-level bureaus of the Ministry of Women Affairs and Social Welfare, LGAs, polytechnic institutes, institutes of social work, and community service organizations (CSOs) in the five project states to train Auxiliary Social Workers (ASWs). Together with these stakeholders and the Nigerian National Board for Technical Education (NBTE), AIHA has adapted the current curriculum to the northern context; we’ve also upgraded it to a certificate-level course.
Tapping into the knowledge and experience of our Twinning Center partners from Enugu State, we have trained 27 master trainers from institutions of social work in the North, who are taking the lead on the rollout of the ASW Program across the five project states.
Current activities are focused on rolling out step-down trainings in all five states targeted under Project STEER. To date, we’ve delivered ASW training to 739 individuals working at the LGAs and CSOs, as well as to community volunteers associated with the project.
Sustainable Mechanisms for Improving Livelihoods and Household Empowerment (SMILE) Program
(2014 – Present)
THSI, a Nigerian NGO established by AIHA in 2014, is collaborating with Catholic Relief Services (CRS) on the USAID-funded Sustainable Mechanisms for Improving Livelihoods and Household Empowerment (SMILE) program, a five-year project designed to scale-up care and support services for OVC in five states in Central Nigeria — Benue, Kogi, Edo, Nasarawa, and Federal Capital Territory (FCT).
AIHA established an NGO known as the Twinning for Health Support Initiative, Nigeria (THSI) in 2014. With a similar mission to AIHA, THSI has been replicating the highly successful Auxiliary Social Worker Training Program (known in other countries as Para Social Worker) that AIHA piloted in Nigeria under an HIV/AIDS Twinning Center partnership with local social work training institutions in Enugu State from 2008 to 2014.
SMILE is working to improve the well-being of 500,000 vulnerable children in the target states, along with 125,000 caregivers. Other key goals include improving Nigeria’s capacity to address the needs of vulnerable children at the state level by strengthening the technical and organizational capacity of local government authorities (LGAs) in close collaboration with the local bureaus of the Ministry of Women Affairs and Social Welfare, and facilitating enhanced collaboration among CSOs and communities to better integrate and manage comprehensive care and support programs for vulnerable children, including household economic strengthening (HES) services.
During its first year working on SMILE, THSI and our expert resource partners from the University of Nigeria-Nsukka and the Federal School of Social Work adapted AIHA’s Auxiliary Social Worker (ASW) curriculum to the local context and are currently rolling out initial trainings across the five project states.
THSI plans to continue collaborating with CRS on SMILE during the coming year to expand step-down trainings across the target states.
Nigeria Social Work and OVC Support Initiative
AIHA and our technical experts worked to strengthen the capacity of two Nigerian schools of social work to provide high quality pre-service and in-service training for individuals who provide care and services to orphans and vulnerable children in Enugu State and throughout the country.
AIHA’s Nigeria Social Work and OVC Support Initiative has its roots in a partnership linking the Federal School of Social Work in Enugu and the Department of Social Work at the University of Nigeria in Nsukka with a US-based consortium that included Hunter College School of Social Work, Howard University School of Social Work, and the Nigerian Social Workers Association and was established by the Twinning Center in 2008. In late 2010, AIHA and experts from our pioneering Tanzania Social Work and OVC Support Initiative assumed the role of resource partners until the project graduated in 2014.
Based on the successful Para Social Worker Training Program being implemented in Tanzania, the Nigeria Initiative was carefully adapted to the country’s unique needs and regional cultural context. The program was closely aligned with the Nigerian Government’s health system strengthening efforts and played a critical role in building sustainable capacity to train Social Workers and Para Social Workers (PSWs) at both Nigerian universities. It was implemented in collaboration with the Federal Ministry of Women’s Affairs and Social Development and the Enugu State Ministry of Gender Affairs and Social Development with funding from PEPFAR and CDC / Nigeria.
PSWs are community-level health extension workers who receive specialized courses that arm them with foundational skills in basic social work and child development concepts, as well as service delivery for OVC. In between a social worker and a volunteer, most PSWs are already working in their communities and can be quickly trained to effectively provide much-needed services to vulnerable children and their caregivers.
PSW training modules focus on:
- Improving knowledge of HIV/AIDS and available interventions;
- Making active referrals to HIV counseling and testing services;
- Linking clients to HIV-related treatment, care, and support services, as well as to other healthcare services, via active referrals;
- Providing case management to increase adherence to HIV treatment and improve health outcomes; and,
- Helping ensure access to comprehensive, holistic care, including nutrition, education, legal, psychosocial, economic, and other needed support.
To increase recognition and absorption of this new cadre of community-level social workers, AIHA worked with the Nigerian Association of Social Workers (NASOW) to have PSWs included in new national social work legislation, which is currently in its final hearing stages.
From 2008 to 2014, the two partner institutions in Enugu State trained 1,141 PSWs. These workers subsequently returned to their communities better able to provide care, support, and referrals for needed services to children in need.