WOMEN’S PARTICIPATION IN COMMUNICATING PRIMARY HEALTHCARE POLICY

ABSTRACT
This study set out to explore Women's Participation in Commmunicating Primary Health Care Policy in Zuru and Danko-Wasagu Local Government Areas of Kebbi State, with a view to assessing the extent of women's participation being that the extent of women‟s participation in Primary Health Care is however, unclear or seems to be lacking. The study is premised on its advocacy to engender policy makers see the necessity of involving women in active participation, communication and formulation of primary healthcare policy. The study employed the Participatory communication theory which advocates for peoples particpation in development interventions and as such giving voice to the voiceless. Methodology for data gathering included, Focus Group Discussions (FGD), Indepth-Interview (IDI) and Documentary Observation (DO). Furthermore, a total of 138 women and men were sampled using Purposive Sampling Technique to include 100 members of FGD and 38 interviewees. The findings of this research according to the FGD and IDI revealed that women‟s participation in formulation and communication of primary healthcare policy in Kebbi state is still at its lowest ebb. This is a challenge that has development implications. The study also uncovered factors responsible for women‟s participation to include conservative adherence to customs and traditional beliefs, high rate of illiteracy, as well as communication barrier between women and health workers/experts. The study recommended that for sustainable women participation in Kebbi State, women should take active role and be involved in Primary Health Care Formulation and Communication. Appropriate communication strategies should be intensified as well as geninue women‟s participation should be encouraged by health policy makers.
 
CHAPTER ONE
INTRODUCTION
1.0  Background to the Study
Since the evolution of the concept of development, participation has become a popular discourse in Development communication. Development experts have come to realise the need for the stakeholders to be associated with all phases of development intervention either directly or indirectly. This singular act has necessisated the quest for people to be active participants in development. People‟s participation is at the heart of achieving success in any development effort, either at the primary level or the secondary level. The incorporation of people‟s knowledge and perspectives into development  research  process could enhance relevance of development effort.
Over the decades, national and  international agencies have developed and are still developing  programmes to assist  in effective  communication  and participation of people most especially that of women in development intervention. Frantic efforts at different levels have been made to address the marginalisation of women in development intervention; but unfortunately these efforts have yielded  little or no result. Despite the efforts of many agencies and organizations, and numerous inspiring successful story on paper, the picture is still disheartening, as it will take the active participation of women in the decision making environment in health policy formulation and communication to bring about sustainable development.
Even though, the poor and marginalised have always been at the centre of development communication, they are however, most often the subject of communication rather than  the originators. Women have poor access to communication and the channels of communication respectively rural women fit into this group.
Participation, for women, whether it is in agriculture, health, or politics serve immediate instrumental goals such as the identification of felt needs as well as the mobilization of local resources to meet needs. It requires the direct face-to-face involvement of women in social development and ultimate control over decisions that affect their own welfare. The essence is to empower the disadvantaged to take active part in social and community process. Women are mostly the disadvantaged majority in most of the actions and inactions of the government. This is because there are obstacles that cut across institutional, socio-cultural, logistic and technical limitations that prohibit their participation (Botes and van Rensburg 2000:4).
In policy development, economic planning, and key political inter-governmental arrangements around the world, the role of women has been very minimal especially when compared with the exertions of men. The reason for this drawback hinges on both the socio-cultural and institutional obstacle that patriarchy has created over time and the obliviousness of women to tumble the status quo. However, international development occasioned by globalization has placed women in positions where they can sue for their own development and self-growth even though their development is still being hampered by the vaulting over of women in development process given mostly due to the deeply patriarchal system in Africa and indeed Nigeria. Primary Health Care system is a conscious strategy to meet the Millennium Development Goals, MDGs, 4, 5 and 6 targeted at women and children (Vanguard Newspaper, 2014). Goal 5 is―improve maternal mortality. The goal was arrived at in the pre-2015 discussions given that women die in large number following poor pre-natal, ante natal, and post-natal care. According to the United Nations (2013), only half of the pregnant women in developing countries receive the recommended minimum of four antenatal care visits.
In Nigeria as well as in Africa, women constitute about half of the population. Female population in Nigeria was measured at 49.36 in 2011(World Bank Data, 2011). They make an essential and largely unacknowledged contribution to economic life and play a crucial role in all spheres of the society. Nonetheless, established restrictive practices and constraints have not allowed them to take advantage of their numbers and position in order to significantly influence the decision-making process of almost all the sectors in Nigeria. They are still recipients of hollow government‟s policies in different sectors of Nigeria‟s economic, political, and social life; one of which is primary health care. Evidently, development of primary healthcare policies can not be truly achieved without effective participation of women.
 
The intergration of women’s perspectives and inputs in formulation and implementation of primary healthcare policies could enhance the relevance and acceptability of health communication policies by rural women. The incorporation of women’s inputs and knowledge in health policies is steeped in participatory paradigm which requires a shift in the way individuals are considered, from passive recipients to active agents of development efforts. There are a number of reasons for this shift, a major one of which is presented by Ascroft and Masilela (1994;12), “If peasants do not control or share control of the processes of their own development, there can be no guarantee, that it is their best interest that is being served”. The cardinal objective of participation is, to empower communities, groups or individuals to determine their own directions, objectives, options for change, make well-informed decisions, take collective action to achieve their goals and monitor and evaluate the initiative if they are making progress (Van de Fliert 2007). This study is therefore, justified on the premise that involvement of women in primary health care policy formulation and communication is critical to success of any health policy research.
Women, arguably, cannot be said to have had a reasonable participation in communicating or developing Primary Health Care (PHC) Policy in Nigeria (Ojobo, 2012)  World Health Organization,WHO (1978) and United Nations International Children‟s Education Fund, UNICEF (1998) defined Primary Health Care as the essential healthcare based on practical, scientifically sound, and socially acceptable method  and technology; universally acceptable to all  in the community  through  their full  participation; at  an  affordable cost; and geared toward self-reliance and self-determination, PHC policy in Nigeria have not effectively reflected the spirits of its international description and standard as many community women are still estranged from achieving the„full participatory status‟. For example allowing women to be part of drating documents, that can inform make health policies, be actively involved in Formulation, implementation, Monitoring and Evaluation of Primary Health Policies.
Statement of the Problem
Although, the importance of women’s participation in development has been communicated to people since the inception of development communication and participatory communication in Nigeria and the world at large, agitations on inadequate  and passive women’s participation in development still abounds, especially in Northern Nigeria and in rural areas. With the United Nations(U.N) Millennium declaration of goal 5 which is to improve maternal health, several government non-governmental organisations, women  associations  and  individuals  have  been  involved  in  programmes  to improve the health and nutritional status of women, and promote active women  participation  at  all  levels. Despite all these efforts, there have been rising cases of discrimination, marginalization, oppression and exclusion of women from active participation in sustainable development, which the primary health sector is not an exception. Perhaps this suggests a  participatory gap in the application of participatory communication concept and strategy in the programmes by various agencies and organisations.
The strategy remains  basically  top-bottom approach, and women basically remain passive receptors of health policies, which may not necessarily meet their needs, while their  involvement and  participation in formulation  and communication of  primary health care policies remain  low. Effective communication  strategy  which  includes  women active participation in all the processes of communication formulation, implementation, monitoring, and evaluation is a prequisite for any sustainable development. Women  play a significant role in health development but they are hardly given prominence in the decision making in primary health communication. The role of women cannot be overemphasised in participatory development and communication. However, such prominence in decision  making process  in  health development initiatives has not been widely explored in Nigeria, and most especially Northern Nigeria. Most health  messages targeted at women emphasise their passive role, which is mostly anchored on persuasion and top-down bottom approach, which is mainly a take and use syndrome for the women.
Most formulators of Primary health care policy are unenthusiastic to go into communities to work with the community women to get authentic information which will help inform policies. They rely heavily on foot-dragging local government‟s officials and external sources which do not reflect the ideas of members of community. Hence, what is imported as Primary health care becomes extra-terrestrial to the women in the communities because they were not part of the process that birthed the idea. By being removed from the process, they are disempowered as knowledge and self-help effort is denied them. Development efforts  that  ignore local circumstances, local technologies and local systems of  knowledge have often wasted time and resources
Women’s participation in development is imperative, when the people are secluded their participation is limited, as such little or no meaningful success in development strides is achieved. This research seeks to identify and contribute to the global realisation that despite enormous efforts put in by well meaning agencies and development partners in programmes targeted at women, there are rising cases of marginilisation, exclusion and discrimination of women from relevant participation in development, most especially Northern Nigeria where women traditionally enjoy little or no independent decision making in individual, family, and community issues.
As long as there are continued  rising cases of passive participation, deprivation and marginalization of women in the  approaches  and  processes of communication, the people who are meant to benefit from such programmes are alienated, indifferent and cold towards such initiatives. At best, they mostly concern themselves with immediate and gratifying gains like money. The implication of this  is that  knowledge, behaviour, and attitudes are not changed or positively affected for long term purposes, thereby making women participation and sustainable development more of a myth than a reality.
1.2     Aim of the Study
The aim of this study is to explore the crucial importance of active women’s participation as a way forward  in achieving and sustaining effective Primary Health Care policy communication and delivery in Nigeria.
1.3      Objectives of the Study
The study attempts to achieve this aim through the following objectives.
i)  To identify and examine the role women play in formulation  and communication of primary healthcare policy in selected local government areas of Kebbi state.
ii)  To evaluate the factors that limit women’s active role in the formulation and communication of primary health care policy within the local government areas under study.
iii)  To critically assess how primary health care policy is communicated to women in the local governments of study in Kebbi State.
iv)  To suggest how women’s greater participation in health policy formulation and communication in Kebbi state can be achieved and sustained.
1.4     Research Questions
Owing to the foregoing, this work seeks to ask the following questions.
i)  Do women participate in formulation and communication of primary healthcare policy at all?
 
ii)  To what extent do women participate in formulation and communication of primary healthcare policies in Kebbi state?
iii)  What factors are accountable for the passive participation of women in formulation and communication of primary healthcare policy?
iv)  How primary health care policy are communicated to women in Kebbi state?
Providing answers to these questions is important to identify the gap in the quest for women’s greater participation in primary health care formulation and communication.
1.5    Significance of the Study
This research contributes to knowledge by examining the role of women in the communication of health policy particularly in Kebbi. This research identify the gap inherent in processes of development, critique and offer reccommendations that can enhance women’s greater participation in health policy making. Thus, it has become relevant to assess women’s participation side by side with the development of primary health care policy in Nigeria. Hence this research is justified to the extent of exploring the importance of women’s participation in development and health communication. It shall therefore, fill this obvious gap in the continuum of search for active women’s  participation in achieving sustainable development.
 
The research is justified by the need to recognise the importance of women’s active participation in effective participatory communication because women consitute part of development that cannot be sidelined or ignored. Also, the research shall contribute to knowledge about participatory communication  practice and its effective use in obtaining  sustainable results around the world and specifically within the Nigerian context.
Although, this is essentially an  academic activity, it is hoped that the information and knowledge from the research can be used by policymakers, development planners, decision makers, donor agencies, governmental and non-governmental organizations to set policies and designs for genuine participation and for sustainable development for women in Northern Nigeria and generally in Nigeria at large.
1.6    Scope  of the Study
Women participation in development is a global project as well as a national project in Nigeria. It is being carried out in all the nooks and crannies of Nigeria. But this study is limited to Kebbi State in northern Nigeria. The study focuses on Women’s Participation in Communicating primary Health Care Policy in selected Local Government areas of Zuru and Danko-Wasagu areas of Kebbi State, because of its highest maternal and child mortality rate. The activities of Primary Health Care cover different communities in Kebbi State. It is, therefore, not possible for the study to capture all  the different communities and health programmes in the state at once. In view of this, the researcher streamlined and focused on the selected communities for accessibility and easy manageability of data.
1.7    Definition of Terms
Participation: The conscious and deliberate coming together of a group of people, with equal opportunities to actively contribute and chart a course towards making their lives better than what it use to be.
Communication: Communication is the basis for all human interactions and provides the means for individual or group of people to relate reciprocally and hence enable groups to function. According to Rogers et al. (1981), communication is a process that involves the exchange of ideas between two or more individuals in an attempt to arrive at convergence in meaning.
Empowerment: This can be seen as the means of supporting  an individual or group of people to be  independent, without having to always depend on someone.
Primary Healthcare (PHC):  Primary Health Care is an essential healthcare based on practical, scientifically sound, socially acceptable method of technology made universally acceptable to individuals and families in the community through their full participation and at a low cost that the community and country can afford to maintain at every stage of their development (W.H.O. 1987).