Background: Non-governmental organisations (NGOs) are expected to be in the vanguard, repositioning reproductive health as a central issue in population and development in Nigeria. However, most of them have insufficient knowledge or access to policy and planning processes necessary at engaging effectively with the government. This article highlights the processes and outcome of an intervention aimed at strengthening the capacity of 12 non-governmental organisations on advocacy and policy related activities with emphasis on reproductive health issues. Methods: The study employed a one group, pre and post test study design. Thirty six (36) staff from 12 NGOs was purposively selected and interviewed using a semi-structured questionnaire at baseline to assess their knowledge and level of involvement in reproductive health, advocacy and policy issues. In-depth interviews were conducted with 6 officials of the ministries of health and women affairs to document previous reproductive health and policy related collaborative efforts with the NGOs. Baseline findings were used in developing and implementing a capacity building intervention. A post intervention evaluation was conducted to assess the outcomes. Results: All respondents (100 %) had tertiary level education and were from a multidisciplinary background such as nursing (41.7 %) medicine (25 %) and administration (13.9 %). The mean knowledge score on advocacy and policy issues at pre-test and post test was 39.1±17.6 and 76.2±14.2 respectively (p=0.00). Participants reported making use of advocacy methods and the three most utilized were Phone calls (28.1 %), Face to Face meetings (26 %) and networking with other organisations for stronger impact (17.1 %). The outcome of their advocacy efforts include the provision of free air time by a television station to educate the populace on maternal health issues, donation of landed property to build a youth friendly centre, donation of a blog site for disseminating information on Reproductive health issues and training of other staff of their organisations on advocacy activities. The major challenges experienced by staff of the NGOs were financial (89 %) and time constraints (11 %). Conclusion: Empowered non-governmental organisations can effectively advocate for the implementation of reproductive health policies and programmes.
The study was conducted in 3 Nigerian states. Kwara state is located in the north central geopolitical region of Nigeria and has a population of 2,371,089 [23]. Osun state is an inland state in south-western Nigeria and has a population of 3,423,535 while Ogun state is also in the South-western region of Nigeria with a population of 3,728,098 [23]. The study employed a one group, pre and post test study design and data was obtained from selected staff of the NGOs before and after the intervention. Both qualitative (in-depth interview) and quantitative data collection methods (semi-structured questionnaire) were used. Based on ARFH’s previous experience working with nongovernmental organisations (NGOs), a convenience sample of four NGOs/FBOs/professional organisations each were selected from the three states, totalling twelve partners. They were selected from a pool of NGOs/professional organisations who expressed need for their capacity to be built on the conduct of RH advocacy and policy related issues. Trained research team members (GTM, MMO and OLO) conducted the interviews in the offices of the respondents using English as the language of communication. The interviews lasted approximately 40 minutes and these were tape recorded, transcribed and reviewed for accuracy. The findings of the baseline assessment guided the capacity building intervention for the NGOs. Baseline assessments of the 12 selected NGOs/FBOs/professional associations were conducted in the 3 project states. Instruments used for data collection at pre and post intervention (with modifications at the evaluation stage) were a 13-item open and closed-ended organisational capacity assessment tool (see Additional file 1) which documented the institution’s capability to implement the project and a semi structured questionnaire which consisted of 28 open and close-ended questions covering their demographic profiles, professional qualifications, training needs, the reproductive health advocacy and policy related programmes they had previously implemented, challenges encountered, and priority RH issues in the project states (see Additional file 2). In addition, an in-depth interview guide (see Additional file 3) was used to interview 6 key officials (2 per state) at the Ministries of Health and Women affairs to document previous collaborative efforts with the NGOs/ FBOs with emphasis on reproductive health advocacy and policy related issues. The questions focused on their awareness about the project, advocacy activities carried out by collaborating NGOs at the ministries, initial and current impression of ministries officials about the project, opinion about the project tenets and collaborative aspect of project strategy, lessons learned and project benefits. These tools were reviewed by peers and other professionals with skills in RH advocacy and policy related issues. The intervention phase spanned 8 months comprising six key activities specifically a 5-day training programme and identification of key reproductive health needs in the states , mentoring, conduct of advocacy visits, formation and registration of state advocacy networks, monitoring and consultative meetings. The 5-day training programme conducted for representatives of the selected NGOs lasted an average of 8 h daily. The activities were aimed at updating knowledge & strengthening the skills of trainees on advocacy issues. Thirty six participants attended the workshop. The capacity building programme focused on issues in reproductive health, steps in Advocacy process, policy issues, gender issues, courting the media, resource mobilization, networking, partnership and leadership issues. A main outcome of the training programmes was the ability of the participants to identify key RH issue in the project states using a Participatory Learning approach-“The Pair Wise Ranking of Needs”. The Pair wise ranking is a structured method for ranking a small list of items in priority order. It can help in prioritizing a small list as well as make decisions in a consensus-oriented manner [24]. To conduct the pair wise ranking, participants identified a maximum of 7 key reproductive health issues in their states using free listing. A pairwise matrix was constructed and each box in the matrix represented the intersection or pairing of two items. The team began the process by using consensus to determine which of the paired item had the most significant impact on the reproductive health status of populace using the following criteria rate of occurrence, outcome of the reproductive health issue and the age groups affected. The process was repeated until the matrix was completed. The RH issue with the highest frequency was identified as the key RH issue of significance in the state. Key reproductive health issues identified by each state are as outlined. Ogun state: Inclusion of Family Life HIV/AIDS Education (sexuality education) in curricula at all levels and the provision of Youth friendly services. Kwara State: Inclusion of Family Life HIV/AIDS Education (sexuality education) in curricula at all levels. Osun state: Reduction of maternal morbidity and mortality through the provision of Emergency Obstetric care at the primary and secondary health care facilities. A 6-month work plan indicating the advocacy goal, objectives, activities, target audiences and timeline was developed in line with the key RH issues identified. This served as a guide for the conduct of subsequent advocacy activities in the project states. Two approaches were utilized in the conduct of the advocacy visits i.e. conduct of advocacy visits by the networks and joint advocacy visits by ARFH staff and the Networks. The target audiences for these advocacy activities were the legislators, policy makers, traditional, religious and opinion leaders, officials of reproductive health line ministries and the media. In each of the project states, an advocacy network was formed. All the networks were registered with the State ministries of Women Affairs and Social Development as a criterion to functionality in their respective state, and the Ogun state advocacy network created a blog site to project its activities. The registration of the networks with the State ministries of Women Affairs and Social Development as well as the development of a blog site was a key outcome of the intervention. Bi-monthly monitoring and consultative meetings were held with the networks to supervise the activities of mentees and also participate in their advocacy activities. Mentoring was a key capacity building activity on the project and this was aimed at strengthening the skills and competency of the participants to conduct advocacy programme. To accomplish the mentoring objectives, 4 strategic approaches were adopted specifically the participation of the NGO staff in a 2 day training and practical advocacy events to understudy the advocacy skills deployed by the facilitators, provision of resource materials, attachment to Mentors from ARFH coupled with ongoing mentoring through e-mails and telephone calls for six months. The mentees were expected to provide a progress update on a biweekly basis outlining key achievements and challenges experienced during the conduct of any advocacy event and Mentors were expected to provide technical assistance in addressing the challenges identified. During the six-month online mentoring programme, an average of 2 mails per mentee were received. Key factors which affected this approach were the limited internet connectivity in some of the states as well as the low skills of the participants in operating computers and internet facilities. Final evaluation was conducted 6 months after the intervention. Semi-structured questionnaires were administered to 30 trained staff of the partner NGOs. Compared to the number interviewed at the baseline assessment (36), this number was lower due to the inability of the interviewers to contact some of the trained staff at final evaluation. Utilizing an in-depth interview guide, the opinions of 6 representatives of State Ministries of Health and Women Affairs were also sought regarding project outcome. The data obtained from the semi-structured questionnaires were coded and analyzed using SPSS version 15 software to generate descriptive statistics specifically frequencies. Using a paired sample t-test at 5 % level of significance and 95 % confidence interval, we compared the mean knowledge score of the trainees before and after the training. The in-depth interview discussions were manually transcribed and summarized thematically. Ethics Review Committee of the Association for Reproductive and Family Health, Ibadan, Nigeria (http://arfh-ng.org/) reviewed and approved the proposal. Participation was voluntary with confidentiality assured. The non- governmental organisations and the respondents received detailed information on the objective of the study. Verbal consent was obtained from respondents before questionnaires were administered or interviews conducted. Individual identifiers such as names were not included in the data collection instrument.
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