Background

The Wellbeing Foundation Africa (WBFA) is a non-governmental organization, based in Nigeria, and with presence in Ghana and the United Kingdom. WBFA works to improve the sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH+N) indices of Nigeria, as well as much of sub-Saharan Africa; and to eliminate, all forms of gender-based discrimination, neglect, abuse and violence. We do this by evidence-based policy analysis and development; healthcare promotion and provision through healthcare workers, particularly midwives; private sector engagement; advocacy, social and community mobilization and awareness creation; and strategic philanthropy and impact investment in healthcare.

WBFA seeks to achieve further progress by leveraging on its Implementing Partner (IP) status with the United Nations Population Fund (UNFPA) in Nigeria, given UNFPA’s shared interests and objectives, for the advancement of women’s health and wellbeing. At WBFA, we believe that our partnership with UNFPA will definitely be synergistic, based on our core competencies, impactful track record, broad reach within Nigeria, and our mutually-held belief that all women and girls deserve access to the highest quality of health and wellbeing, including the elimination of maternal death and disability, as well as optimal and high-quality nutrition.


Problem Statement

According to the Global Health Observatory, as managed by the Word Health Organization (WHO) and other United Nations partners, Nigeria’s maternal mortality ratio stands at 814 deaths per 100,000 livebirths, and its neonatal mortality rate is 34.7 deaths per 1,000 livebirths. With an estimated 7 million births occurring in Nigeria, every year, only 38% of these are attended by skilled birth attendants (midwives, doctors, etc), and only 29.8% of these births are covered by civil registration. According to the 2013 Demographic & Health Survey, at least 37% of children in Nigeria, who are under the age of five years, are clinically stunted, and about 18% of these children suffer from wasting. This is compounded by the fact that only 33% of babies are breastfed in the first one hour; only 17% enjoy exclusive breastfeeding for the first 6 months of life; and at least 57.9% of pregnant women suffer anaemia, with about 11% of women of reproductive age thin or undernourished. If Nigeria must attain the Sustainable Development Goals (SDGs), and improve the livelihoods of its people, surely, concerted efforts are crucially needed to address these stark numbers. Efforts at such improvements must take the cross-cutting importance of nutrition into consideration, for overall improvement of maternal, newborn, child and adolescent health.


Theory of Change

WBFA’s theory of change outlines the major strategic interventions that will guide our collaborative work with UNFPA, for the achievement of the proposed outputs and outcomes, recognizing the assumptions and risks related to them. WBFA shall work within UNFPA’s strategic priorities of ending preventable maternal death, as part of a broader guiding principle of access to timely, affordable, quality integrated sexual and reproductive health and rights (SRHR) services. While we accept the risks as well as the context of recommending for improved nutrition against the backdrop of possible socio-cultural association of inadequate nutrition with poverty, we assume that, with consistent engagement and negotiation, especially around expanding the already-existing antenatal and postnatal engagement platforms, a favourable socio-cultural environment and full civil society engagement (including traditional family members) will evolve, albeit slowly and discretely, to advance public spending on reproductive health and nutrition-related commodities and services, effectively mitigating maternal mortality and morbidity.


Current Programmatic Areas

MamaCare Antenatal & Postnatal Program: The MamaCare Antenatal & Postnatal Program started three years ago, and has now spread across several public and private healthcare facilities in Lagos State, Kwara State and Abuja. The program has reached over 270,000 women in the past three years, using a powerful combination of didactic lectures, practical demonstrations, community-based outreaches, a large-scale WhatsApp Group, and skills training, in order to empower expectant and new mothers on the expectations and realities of pregnancy and the postpartum period. All topics and issue areas are discussed freely, from common themes like breastfeeding and bleeding in pregnancy, to more complicated issues like prolonged, obstructed labour and respectful maternity care. The interventions have been led by fully-qualified midwives who are full-time staff of WBFA, and they have enjoyed the trust of the mothers and their families, over the years. It is worthy of note that, in the 3 years of the program, there has only been one perinatal mortality, the death of preterm baby, as part of a set of quadruplets.

 

Alive & Thrive Infant and Young Child Feeding project: Alive & Thrive is led by FHI360, with funding support from the Bill & Melinda Gates Foundation, as well as the Governments of Ireland and Canada, and WBFA is one of the implementing partners of the A&T project, where our specific roles are to ensure adequate training, monitoring and evaluation of healthcare workers, as well as expectant and new mothers (at both facility and community levels) on Early Initiation of Breastfeeding, Exclusive Breastfeeding, and Minimum Dietary Diversity in Complementary Feeding, in privately-owned healthcare facilities in Lagos and Kaduna States of Nigeria. We plan to deploy this to 691 healthcare facilities (HCFs) in Lagos State, and 54 HCFs in Kaduna State; these will be spread across 10 LGAs in Lagos and 4 LGAs in Kaduna, respectively, and this is a currently on-going project till 2020.

Planned Project Activities

Nutrition Counseling and Training Provision: Nutrition counseling and training services will be provided within all local government areas (LGAs) and area councils within the Federal Capital Territory of Abuja. This provision, including community-based services, will be provided within the framework of WBFA’s existing MamaCare Program, as described above. With UNFPA technical assistance, WBFA will ensure a robust, data-driven strategy that deploys and evaluates a midwives-led approach to improving maternal health and survival, through ensuring that women of reproductive age (WRA) are well apprised of the nutritional practices that will improve their health. This will also build nutrition synergy with another currently-ongoing project in infant and young child feeding (IYCF), known as the Alive & Thrive (A&T) Project, described above. 

Conclusion

In conclusion, the Wellbeing Foundation Africa (WBFA) is making this case to UNFPA, which will be accompanied with earlier agreed programmatic activities and budgeted workplans, for the last quarters of 2018, in line with our Implementing Partner (IP) agreement. WBFA is committed to an effective and efficient delivery of the program, and we look forward to the continued support and guidance of UNFPA, as we aim to reach women, girls and families across Nigeria, over the remaining years of the 8th Country Programme of UNFPA.