Community Health Extension Workers Educate Rural Communities On Family Planning

By Augustina Armstrong-Ogbonna


“As child I so loved the medical profession, that I was always willing to escort my Uncle’s wife to the hospital whenever she went for her antenatal appointments. The neat and well-tailored uniform of the health workers always caught my eyes. And I knew one day, I will be wearing one of those uniforms serving my community,” recounts Mrs. Lateefat Balogun, a 42-year-old mother of three children. She shared her childhood fantasy and how her decision to work as a Community Health Extension Worker popularly called CHEW started.

Lateefat who has now worked as a CHEW for 20 years, is one of many working with the Expanded Sexual and Reproductive Health Cluster Plus Project of the Planned Parenthood Federation of Nigeria PPFN in Oyo state, Southwest Nigeria.The CHEW as the acronym implies are majorly found in the rural communities and categorized as a staff of Local Government Areas across Nigeria, but the work structure from a Nurse is not much different. In some instances where there is a shortage of Staff, the CHEWs function as Nurses but never categorized or paid as Nurses.

The team at CHEW are majorly found in the rural communities and are categorized as staff of Local Government Areas across Nigeria, with a work structure similar to regular nurse. In some instances where there is a shortage of staff in health centers, the CHEW’s function as Nurses but never categorized or paid as Nurses.

These discrepancies that exist between trained Nurses and Community Health Extension Workers, CHEW, has led to them placed on a lower level than nurses. Though in the different communities where they operate they are seen as superstars. The CHEW are a major component in the Planned Parenthood Federation of Nigeria project on Expanding Sexual and Reproductive Health in Ibadan, the Regional Area of Southwest Nigeria.

The Coordinator of the Expanded Sexual and Reproductive Health Cluster Health Project in Oyo state, Mrs. Abimbola Adeyoyin, explained that the project was designed to target those in rural communities who hardly had access to family planning methods and other health services.

“They knew how to communicate with these women in rural communities. They understand their languages and can break down complex issues to them in simpler languages they could understand,” she said.

The CHEWs are exposed to different type of medical trainings.

Mr. Owolabi Temidayo who now volunteers with PPFN in Ibadan as a potent motivator relished with nostalgia how he first came across the family planning team.

“In 2006, I met this group of energetic women in outreach in the market talking about family planning. I have always heard about it, but the way they lectured on it, with simple language in our native dialect made it appeal to me. I said to myself these people are adding value to the lives to our women and girls. I must join them”.

Owolabi continued, “when I started volunteering with them I was lectured on different health issues. There was a time there was stigma towards people living with HIV, but with training from PPFN. People use to believe that if you come in contact with people that have HIV, you will be infected. That even with a handshake you can contact HIV. But this is not the case. These and more were some training I got from PPFN”.

Male motivators volunteering with PPFN Project in Ibadan are used to break barriers that exist among men because it was discovered that most husbands had misconceptions and misinformation so about family planning. These mistakes were responsible for some husbands who refuse to give consent to their wives in undertaken family planning.

Owolabi who is 32 years old and father of one, is also a businessman. He explained the different misconceptions and misinformations which exist among men who refuse to allow their wives/partners access family planning.

“Some men believe that when their wives start using family planning methods, they will become promiscuous. Some other men believe that when their wives have the implantable family planning methods like IUCD, they won’t be able to enjoy sexual intercourse as the implantable plate would interfere during sex. While the religious ones believe family planning is a sin against God and they will be interfering with God’s original plan. Which they believe is go into the world and multiply.”

“My work entails going to meet most of these men in different public areas like motor parks, markets amongst other areas. These beliefs are common among uneducated men. When I start explaining the importance of family planning to them and how it will help them plan for the future of their children. How they can have children when they are ready to and capable of providing for them. How it will boost the health of their wives who when not using family planning methods are prone to get pregnant yearly. Thereby making the women look frail as there is meant to be some spacing between each child. They begin to see reason with me. Their misconceptions and fears are removed”.

Owolabi says the knowledge and experience he has gained volunteering with PPFN has enabled him to plan his family. “After I got married in 2013, my wife and I planned to have two children. After the birth of my first child in 2014, my wife took the family planning method of three years. So by next year, she will be ready to conceive. So we can have our second baby”.

He pointed out that the involvement of men in the advocacy for family planning is important in encouraging women to participate in it.

“I go to public gatherings and places to educate men on the need for their wives to be on family planning. I go to motor parks, markets, town hall meetings speaking on the need for family planning. And this goes a long way in clearing the misinformation out there about it”.

Owolabi said looking back now; he believes that the PPFN project on family planning has created an impact.

“A day that is most memorable for me was when I entered one of our private facilities that offered family planning services and saw over 200 women waiting to be attended to. I felt a sense of pride knowing that this message we have been preaching across the state is making an impact. If I have not met and seen that CHEW that day during the outreach, I won’t have been able to know about the importance of family planning. I can say boldly that I have impacted over 500 lives positively through my work as a volunteer with the team”, he emphasized.

For some of the CHEWs working in different primary health centers and private clinics, their moment of fulfillment is when the women/husband they once tried to convince, now call them to thank them for introducing them to family planning method.

For Mrs. Olufemi Fabiyi working as a CHEWs in the last 16 years has brought her in touch with diverse cases. But one shocking experience was during an outreach in Gbagi market which is about 30 minutes drive from Ibadan metropolis.
At first glance due to her height and built, she could be mistaken for a security officer. In Nigeria, it is common for people to assume that heavily built people are security operatives. But the physique of Mrs. Fabiyi makes her endearing to people in communities where she has worked.

Mrs. Fabiyi who lives in Old area of Ibadan in Oyo state is a mother of three children aged 16,13 and 10. She chose to be a CHEWs because of her love for the medical profession, especially caring for people in communities.
To her every encounter is memorable, but one she delights in sharing is narrated with a sad look on her face.
“I met a man, who appealed to me to follow him so we could visit his younger sister. When I got there, I met a woman, who on the first instance can pass for a woman of about 50 years old. But I was surprised when during counseling, I found out she was just 29 years old and had 12 children. The burden and labor of delivering 12 children could be seen all over her”.

She continued, “it was a pathetic case for me. I imagined, how can a 29 years old lady have 12 children? I counseled her on the need to embrace family planning and educated her on the different methods available. After which, she decided to have a long term method that will last for about five years. Months later, her brother and the lady called me to thank me for introducing the sister to family planning. I was so happy knowing that she appreciated it. Because I wondered, how will she raise all those children and not that she had a good source of livelihood? I was glad to have contributed to helping her plan her family, she concluded.

But for Mrs. Sherifat Adeleke – a 32-year-old CHEWs who lives at Olodo area of Ibadan and a mother of two children aged 10 and 5, working with PPFN helps her continue to fulfill her passion of working with people in the community.

After studying community health and graduating from the School of Hygiene in Eleyele Ibadan, Oyo state in 2004. She worked with a Clinic for five years, after which she worked with a Non-governmental organization on HIV advocacy.

” I love working in the community because I believe it will make me more closer to the people. Nurses mostly stay in the hospitals. To me, that is a boring way to work. I love been on the field, educating the people on health issues”.

Sherifat who now that works as a CHEWs with Joy Hospital in Ibadan, believes her religion contributed to the success of a Muslim family embracing family planning.

“During one of my door to door outreaches, I met this Muslim woman in her house and introduced myself to her. She asked me why I was working with those that want to stop the plan of God. That God wants us to have as many children as possible. I explained to her that family planning was necessary to help a family plan for now and the future. At a point, she told me to leave before her husband comes back because he won’t be happy seeing me discuss family planning with her”.

Mrs. Adeleke insisted that she was not afraid to meet the woman’s husband that rather waited to meet him.

“After waiting for some time, I left and promised to come back another time. On my next visit, the husband was around and praying in a mosque built inside the compound. I joined them in the mosque to pray. After which, I introduced myself to the man and told him the need for his wife to embrace family planning. He was furious at me and kept looking at me with my Hijab. He then asked me if I was a Muslim at all. I told him I was a practicing Muslim and the Quran didn’t instruct Muslims not to practice family planning. After enough lecture, the man agreed to allow his wife undertake one of the family planning methods. That was a victory for me. I felt so excited”.

All through the PPFN expanding sexual and reproductive health project, the integration of community leaders in the execution led to a sense of community ownership of the project by the people.

The community leaders served as the mouthpiece in ensuring people in each community participated in different services offered during outreaches.

The CHEWs were an integral component in spreading the gospel of family planning, sexual and reproductive health.

The Community Leaders are selected among the different Community Development Association popularly called CDA in the Local Government where the project are targeted. These group of people is called Role Model Agent.

Alhaji Lateefat Anifowoshe is a role model agent whose community members uses Wakajaiye Primary Health Center PHC in Egbeda Local Government Area of Oyo state. The PHC is about 30 minutes drive from Ibadan, the capital city of Oyo state.

As a retired school teacher and counselor, it was easy for him to volunteer for the project because according to him “I love to serve my community”. Fifty-nine-year-old father of four and also a grandfather said he was determined to bring change to his community due to a sad occurrence in the area. To him, “for children of school age to be getting pregnant instead of studying and planning for their future” was something that saddens his heart.

“At a time in my community, it was becoming a trend to see teenage girls getting pregnant and been withdrawn from school. As a father, this saddens my heart. When their mates were planning for exams, they will be busy planning for pampers”.

Alhaji Lateef pointed out that through his involvement in the PPFN project, “I can tell you this trend has reduced”.

“I once noticed a teenage girl vomiting, and I called the attention of the mother to the daughter. I told her, it seems your daughter is sick. When the mother asked her daughter, she said it was malaria. I volunteered to take the mother and daughter to the PHC for treatment. On the day we were to go to the PHC, the daughter said she was well. I then said I would take both you and your mother for a medical check. When we got to the hospital and some test were about to be conducted. The daughter called me aside and said she was experiencing pain in her lower abdomen. I told her not to worry that the test will indicate what was wrong with her”.

“The long and short of the story is that the girl was pregnant. She confessed that she only had sex once. The mother was devastated and cried, that her husband will send her packing from the house. I spoke with the husband and the family agreed for the pregnancy to be aborted. After then the girl’s mother agreed for one of the family planning methods to be administered on her. This was to stop any future unwanted pregnancy till the girl was ready and prepared for to rear children.”

To Alhaji Lateef, his involvement in the PPFN Project has impacted his community, to the point that they are appealing to him to contest as the Mayor of his area.

“To me, I am serving my community and never intended to be asked to run for the position of Mayor. But if they feel I am capable of serving in a bigger capacity, time will tell”.

Alhaji Lateef likens his work to that of the CHEWs. “I am a community man and that is why my community residents can relate with what I tell them. I know their sufferings, I feel their pains, I understand their language and most importantly, I live among them”.

Augustina is an award-winning multimedia journalist based in Lagos Nigeria. In the last seven years, she has reported on maritime, politics, environment, climate change, community, and sustainable development. She is currently studying Science [journalism] at Columbia University Graduate School of Journalism. Listen to some of her rural reports:

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