Promoting Gender Equality through Community Systems

Ekundayo Aigbomian, Associate Director of Community HIV Services and Gender for ProACT. {Photo credit: MSH.}Photo credit: MSH.

The Prevention and Organizational Systems – AIDS Care and Treatment project (ProACT Nigeria) is a five-year, USAID-funded, MSH-led project that began in 2009. ProACT supports HIV & AIDS services in six Nigerian states by building the capacity of government and civil society to strengthen the health system as a whole. Using gender-based approaches and small grant programs for local organizations, ProACT Nigeria strengthens community systems to support integrated services for HIV & AIDS, tuberculosis, and maternal, newborn, and child health.

MSH spoke with Ekundayo Aigbomian, Associate Director of Community HIV Services and Gender for ProACT, about how the program is addressing gender challenges in Nigeria.

What are the specific gender challenges in the Nigerian communities where ProACT works?

In the North Central Zone of Nigeria where we work:

  • There is strong male dominance in decision-making, so women have little control over their own life, education, and health.
  • Women are generally less economically empowered than men and men generally have control of family/community resources.
  • The number of women who access antenatal care and deliver in hospitals is low, resulting in a high maternal mortality ratio.
  • The number of men who participate in support groups for people living with HIV is low.

What is ProACT’s approach to addressing these challenges?

ProACT’s approach to addressing these challenges is very practical. We address gender equality within a larger community system. More often than not, many development agencies approach target communities with a set agenda that does not meet the needs of all parties, especially women who are marginalized. Women with HIV are generally marginalized in their communities. ProACT makes a deliberate attempt to integrate their needs and concerns into its interventions.

For instance, female condoms are not commonly available in Nigeria. Where they are available, they are significantly more expensive than male condoms. Male condoms are not usually accessible in outlets where women can purchase them. In order to promote HIV prevention among women, ProACT is empowering women through female peer educators who demonstrate, promote, and strengthen negotiation skills for condom use. Condom outlets have now been established in hairdressers’ and seamstress’ shops, where women are more comfortable with condom demonstration and can discuss condom use. Each condom outlet is equipped with at least one penile model and condoms.

ProACT is also achieving results by working with traditional birth attendants (TBAs) to promote prevention of mother-to-child transmission of HIV. The TBAs are trusted by the women in their communities. Women are more likely to heed a referral to a health facility when it comes from a TBA. ProACT is also encouraging more women to take up leadership positions in support groups for people living with HIV. Men currently occupy more than 80% of leadership positions within the groups but only 30% of group attendees are men.

How does ProACT involve men and boys?

Community leaders, who are most often men, influence community activities. In the community of Argungu, few women were accessing antenatal care at the local health facility. ProACT engaged male a community leader who helped facilitate a series of activities to promote male involvement in maternal and child health. These activities brought together more than 700 men within the community; ProACT provided them with information on how women’s access to health care affects the whole community. In the months following these activities, ProACT documented a steady increase not only in the number of women accessing antenatal care, but also in the number of men seeking health care.

ProACT also recognizes that long-term change in attitudes towards gender depends on reaching young people. Through peer education, we work with boys and young men to build their awareness of gender equality and safe sexual practices.

How will ProACT’s work promote gender equality after the project is done?

ProACT has built the capacity of community networks to carry on the project’s work. We have engaged existing community leadership structures and drawn on local people to provide peer education. Our peer educators teach others to become peer educators themselves, promoting the continuation of the work. In addition, ProACT is currently drawing up a strategy to identify community leaders who can model desirable behaviors and facilitate behavior change in other communities.

Would the ProACT model translate to other regions or countries?

The ProACT model is based on working with local people and organizational structures, making it versatile and adaptable. Any project that is replicated in another location, however, should not be adopted wholesale; it should be adapted to fit the specific context, the specific needs of the women and men in that area.

What more needs to be done to empower Nigerian communities to support gender equality?

Nigeria is a large country with diverse cultures and religions. In-depth assessments/community dialogues are needed to identify the particular needs of the women, men, girls, and boys in target communities. In the context of ProACT’s mandate of HIV prevention and AIDS care and treatment:  

  • We must employ a rights-based approach to addressing gender inequality. Empowering women through realization of their human rights will bring us closer to achieving the Millennium Development Goals.
  • We must continue to strengthen community networks so that community-based organizations can address gender norms from within their communities.
  • We must continue to raise awareness among men about the role they play in reproductive health, women’s right to health, and the health of their communities as a whole.
  • We must make economic empowerment of women an integral part of all HIV & AIDS programs.
  • We must approach gender equality from a systems point of view to ensure effectiveness and sustainability of interventions.