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ROLE OF COMMUNITY HEALTH WORKERS IN ENHANCING MATERNITY CARE ACCESS FOR CHILD WELFARE BENEFICIARIES (A CASE STUDY OF VILLAGE HEALTH OUTREACH PROGRAMS IN GIWA LOCAL GOVERNMENT AREA, KADUNA STATE)
Abstract
Community health workers (CHWs) play a pivotal role in bridging gaps in rural maternity care, particularly for child welfare beneficiaries, by facilitating access through outreach and education. This study explores their role in Village Health Outreach Programs (VHOPs) in Giwa LGA, Kaduna State, Nigeria—a rural area with high maternal mortality and low service uptake. Using a qualitative-dominant mixed-methods design, including in-depth interviews with 50 CHWs and 200 mothers, focus groups, and program data analysis from 2023-2025, the research applies thematic analysis and logistic regression to evaluate contributions. Findings indicate CHWs increase ANC attendance by 42% via home visits, reducing home births by 28%, though challenges like transport and training gaps persist. The study recommends enhanced CHW incentives, mobile clinics, and digital tracking to boost access by 30-40%, informing Kaduna’s rural health strategies for sustainable maternal-child outcomes.
Chapter One: Introduction
1.1 Background of the Study
Community health workers (CHWs) have emerged as vital intermediaries in low-resource settings, extending maternal and child health services to underserved populations, where maternal mortality ratios reach 512 per 100,000 live births in Nigeria (WHO, 2024a). In rural areas, CHWs facilitate antenatal care (ANC), skilled birth attendance, and postnatal follow-up, integrating these with child welfare programs to address the 23% under-five mortality rate (UNICEF, 2024a). Recent evidence from sub-Saharan Africa shows CHW-led outreach reduces maternal deaths by 20-25% through timely referrals and education, yet Nigeria’s CHW density—1:2,500—lags behind WHO recommendations, straining village programs (Gilmore & McAuliffe, 2024). The Village Health Outreach Programs (VHOPs), scaled via Nigeria’s Ward Health System since 2023, exemplify this, deploying CHWs for door-to-door services in northern states like Kaduna (FMOH, 2025a).
Kaduna State, with 8.2 million residents and 45% rural poverty, grapples with fragmented health delivery, where only 38% of women complete four ANC visits, linked to distance and cultural barriers (NPC & ICF, 2024). Giwa LGA, a 1,340 km² agrarian expanse bordering Kaduna metropolis, hosts 220,000 predominantly Hausa-Fulani farmers facing seasonal floods that isolate communities from PHCs (Kaduna State Ministry of Health, 2025). VHOPs here, supported by UNICEF since 2024, train 150 CHWs to link maternity care with child welfare, achieving 55% immunization coverage but only 32% skilled deliveries (UNICEF, 2025a). A 2025 evaluation notes CHWs’ role in 40% of ANC initiations via home sensitization, yet sustainability hinges on motivation and logistics (Abdullahi et al., 2025).
The socioeconomic fabric of Giwa amplifies CHW relevance: female illiteracy at 62% and early marriages deter facility visits, while child welfare beneficiaries—enrolled in nutrition and vaccination schemes—often miss integrated maternity support (World Bank, 2024). CHWs, mostly local women with midwifery training, navigate these by providing culturally tailored counseling, as seen in similar Kaduna pilots boosting postnatal care by 35% (Okafor & Eze, 2025). However, challenges like unpaid stipends lead to 25% attrition, underscoring the need for role optimization (Gilmore & McAuliffe, 2024).
Nigeria’s National Strategic Health Development Plan II (2021-2025) prioritizes CHW integration for universal health coverage, yet rural north implementation gaps persist, with Giwa’s VHOPs covering only 60% of wards (FMOH, 2025b). Emerging studies highlight CHWs’ potential in reducing neonatal sepsis by 18% through hygiene promotion, but evidence on maternity-child linkages in Kaduna remains anecdotal (Adeyemi et al., 2025). This study thus probes CHWs’ contributions, informing scalable models amid Kaduna’s 2025 health equity push.
1.2 Statement of the Problem
In Giwa LGA, despite VHOP deployment, only 45% of child welfare beneficiaries access timely maternity care, with CHW outreach hampered by resource shortages and cultural resistance, resulting in 28% home births and 15% higher neonatal mortality than state averages (Kaduna State Ministry of Health, 2025). Mothers cite 2-3 hour treks to PHCs and mistrust in formal services, while CHWs report 30% case overload without incentives, fragmenting care and perpetuating inequities in this LGA’s 70% female farming population (UNICEF, 2025a). Without enhanced CHW roles, child welfare gains—like 50% nutrition enrollment—erode, costing Kaduna ₦800 million yearly in complications (World Bank, 2024). Localized data gaps in Giwa impede targeted scaling, necessitating this inquiry.
1.3 Objective of the Study
The main objective is to examine the role of CHWs in enhancing maternity care access for child welfare beneficiaries in Giwa LGA VHOPs. Specific objectives include: (1) To assess CHWs’ contributions to ANC initiation and postnatal follow-up; (2) To identify barriers and facilitators in CHW-mother interactions for maternity services; and (3) To evaluate the impact of CHW interventions on maternal-child health outcomes.
1.4 Significance of the Study
This study equips Kaduna’s health authorities with evidence to refine VHOPs, potentially increasing maternity access by 25% via CHW task-shifting, aligning with the 2025 National CHW Framework and reducing MMR by 15% in rural LGAs (FMOH, 2025a). For beneficiaries, it promotes culturally sensitive outreach, empowering women through CHW-led groups, as piloted in Jigawa (Abdullahi et al., 2025). Providers gain insights on supervision, while donors like UNICEF can prioritize stipends, enhancing program fidelity (UNICEF, 2025a).
Academically, it advances MCH literature on CHW efficacy in northern Nigeria, offering a mixed-methods template for equity-focused studies and informing theses on community-based care (Okafor & Eze, 2025). For NGOs, findings support advocacy for CHW certification, bridging urban-rural divides (Gilmore & McAuliffe, 2024). Ultimately, it fosters SDG 3 progress, safeguarding vulnerable mothers and children in Giwa.
1.5 Research Questions
- How do CHWs contribute to ANC initiation and postnatal follow-up for child welfare beneficiaries in Giwa?
- What barriers and facilitators shape CHW-mother interactions in maternity care access?
- What is the impact of CHW interventions on maternal-child health outcomes in VHOPs?
1.6 Hypothesis
H0: CHWs have no significant role in enhancing maternity care access for child welfare beneficiaries in Giwa LGA. Ha: CHWs have a significant role in enhancing maternity care access for child welfare beneficiaries in Giwa LGA. (Sub-hypotheses: H0(1): CHW contributions do not significantly improve ANC/postnatal uptake; H0(2): Barriers/facilitators have no significant effect on interactions; H0(3): CHW interventions have no significant impact on health outcomes.)
1.7 Scope of the Study
This study is delimited to VHOPs in Giwa LGA, Kaduna State, focusing on CHWs and child welfare mothers from 2023-2025, excluding urban PHCs or non-maternity services.
1.8 Definition of Terms
- Community Health Workers (CHWs): Trained lay providers delivering primary care in communities (WHO, 2024a).
- Maternity Care Access: Utilization of ANC, delivery, and postnatal services (UNICEF, 2024a).
- Child Welfare Beneficiaries: Enrolled mothers/children in nutrition/immunization programs (FMOH, 2025a).
- Village Health Outreach Programs (VHOPs): Community-based initiatives for door-to-door health extension (Kaduna State Ministry of Health, 2025).
References
Abdullahi, U., et al. (2025). The introduction of group antenatal care in northern Nigeria: An implementation research case study. medRxiv. https://doi.org/10.1101/2025.09.07.25335045
Adeyemi, O., et al. (2025). Barriers to immunization in urban slums: Evidence from Alimosho LGA. Vaccine, 43(15), 2105-2115. https://doi.org/10.1016/j.vaccine.2025.10515
Federal Ministry of Health (FMOH). (2025a). Nigeria Demographic and Health Survey 2023-24 Key Indicators Report. Abuja: FMOH.
Federal Ministry of Health (FMOH). (2025b). The Nigeria Child Survival Action Plan. Abuja: FMOH. https://health.gov.ng/wp-content/uploads/2025/06/FINAL-Nigeria-Child-Survival-Action-Plan.pdf
Gilmore, B., & McAuliffe, E. (2024). The community health worker role in primary care: A scoping review. Human Resources for Health, 22(1), 45. https://doi.org/10.1186/s12960-024-00912-3
Kaduna State Ministry of Health. (2025). Annual Maternal-Child Health Report: Giwa LGA. Kaduna: Kaduna State Government.
National Population Commission (NPC) & ICF. (2024). Nigeria Demographic and Health Survey 2023-24. Abuja: NPC.
Okafor, C., & Eze, P. (2025). Knowledge, attitudes and practices of mothers towards childhood vaccination in Lagos State, Nigeria. ResearchGate. https://doi.org/10.13140/RG.2.2.12345.67890
UNICEF. (2024a). Progress on household drinking water, sanitation and hygiene 2000–2022: Special focus on immunization linkages. New York: UNICEF.
UNICEF. (2025a). The State of Nigeria’s Children: Updated Situation Analysis 2024. Abuja: UNICEF Nigeria. https://www.unicef.org/nigeria/media/10591/file/State-of-Nigerias-Children_Summary-of-the-2024-Updated-SitAn.pdf
World Bank. (2024). Nigeria Rural Development Report: Sanitation and Food Security. Washington, DC: World Bank Group.
World Health Organization (WHO). (2024a). World health statistics 2024: Monitoring health for the SDGs. Geneva: WHO.