Maternal and child health services funds were also diverted, preventing women from accessing the care they needed. Chief Mrs Abiodun Oroja-Giwa experienced this first-hand: "Personal Protective Equipment (PPE) for Health care workers were not adequate. Transportation to duty posts was also a challenge for health care workers because of movement restrictions. One other major issue during this period was the fear of contracting the COVID-19 which prevented the mothers from accessing Reproductive Maternal Neonatal and Child Health (RMNCH) services."
Fortunately, Chief Mrs Abiodun is no ordinary woman. She is well connected and part of a group that provides her with direct access to representatives from civil society organisations, politicians in the Lagos government as well as representatives from the media and health professional bodies. This group, called the Lagos State Accountability Mechanism for Maternal and Newborn health (LASAM), uses data to actively track RMNCH progress and funding, identifies issues and works to save women and children’s lives.
[...] One other major issue during this period was the fear of contracting the COVID-19 which prevented the mothers from accessing Reproductive Maternal Neonatal and Child Health (RMNCH) services.
Reprioritising funds to combat COVID-19
The COVID-19 pandemic shifted government priorities all over the globe towards curbing the spread of the virus while trying to protect their economies. In Lagos State, this is no different. In April, E4A-MamaYe supported LASAM members to confront decision-makers with evidence that showed that approved funds for maternal and child health in the State were delayed because of the COVID-19 emergency, and to advocate for this funding to be released to ensure mothers and children would be able to continue to access the health services they need.
Reaching political decision-makers through political economy analysis (PEA) approaches
Before the COVID-19 outbreak, the E4A-MamaYe team trained LASAM on how to apply its practical 6-step political economy analysis technique. This method helps identify a specific problem that prevents improvements in maternal and child health as well as map out key decision-makers and gathers evidence and solutions to convince them to take action. Through this method, LASAM identified the Executive Governor of Lagos State as the key decision-maker in control of all Ministry of Health approvals. His attention was entirely focused on delivering a strong COVID-19 response in the State. As the Ministry’s Director of Family Health and Nutrition said: "I had 3 fund approvals for maternal health as of January 2020, but no (fund) release (since) due to the COVID-19 response and we are now in the month of April."
LASAM also identified other influential policymakers and tried to engage them. These included the Executive Governor, the Commissioner for Health, the wife of the Governor, the Chairman, Lagos State House of Assembly Committee on Health, the Accountant General, and the Director, State Treasury Office.
Adapting advocacy for funds release for Maternal and Child Health
The team’s ask was simple: for the Ministry of Health to release funds allocated to MNCH programmes. It gathered and produced compelling evidence to convince stakeholders of the issue. But while it had relevant connections to decision-makers through its members, more was needed to get their attention, namely, the power of the masses. LASAM mobilised maternal health advocates from across the state to collaborate in its campaign and amplified their voices via radio and social media.
To further convince decision-makers, the team explained in their advocacy asks, how continued quality maternal health is an important part of the COVID-19 response. This ensures funding requests would get the Executive Governor of Lagos State’s attention. For example, funding the provision of personal protective equipment to health workers not only protects them from contracting COVID-19 but also reassures mothers that they can safely access health services during the pandemic.
This led to action: there was a significant increase in funding released from the approved budget for maternal and child health services from 0% at the end of June to 81% by the middle of August.
Coalitions are the cornerstones of accountability
Connecting women like Chief Mrs Abiodun Oroja-Giwa, who experienced the direct impact of political decisions on the lives of women in her community, with those in power is essential to bringing about change. LASAM is an accountability coalition that is not unique to Nigeria. Options supports similar coalitions across the country, such as in Bauchi, Niger, Gombe, Kano, Kaduna, Yobe, Jigawa and Zamfara States.
These multi-stakeholder groups don’t position themselves ‘against’ the government. Instead, they build a culture of accountability by: sharing and using evidence in a transparent way, building trust and reinforcing joint action among government, civil society organisations and practitioners. Trust, transparency and collaboration are the cornerstones of promoting health sector accountability in any country. Through LASAM, Lagos State is putting these principles into practice.