CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Non-Governmental Organizations (NGOs) play a crucial role in addressing health challenges
across the globe, particularly in underprivileged and rural communities. As independent entities,
NGOs contribute to health awareness by bridging the gap between governmental health
policies and local populations. Their efforts include health education, advocacy, disease
prevention, and community mobilization. They often work in collaboration with governments,
international organizations, and local communities to provide healthcare services and
awareness campaigns tailored to specific needs.
Health awareness is a key factor in disease prevention, early detection, and overall well-being.
Many people, especially in low-income and remote areas, lack adequate knowledge about
common diseases, hygiene practices, and the importance of preventive healthcare. NGOs step
in to fill this gap by organizing educational programs, providing access to medical information,
and addressing cultural or socioeconomic barriers to healthcare. Their work significantly
contributes to improving public health outcomes and reducing mortality rates caused by
preventable diseases. So, health awareness is a biggest canvas to prevent disease such as health
care is a way to treat many diseases in that way NGOs provide helpful hand in both cases.
Healthcare is a fundamental human right, yet millions of people worldwide lack access to
adequate medical services due to geographical, economic, and social barriers. Governments,
particularly in developing countries, often struggle to provide comprehensive healthcare
services to their populations due to resource constraints and systemic challenges. In this context,
Non-Governmental Organizations (NGOs) play a crucial role in supplementing governmental
efforts by providing healthcare services, advocating for policy improvements, and enhancing
healthcare infrastructure.
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NGOs operate at local, national, and international levels, addressing healthcare issues ranging
from basic medical care to complex disease control programs. Organizations such as the World
Health Organization (WHO) and UNICEF frequently collaborate with NGOs to deliver
healthcare services where they are needed most. These organizations play a vital role in
bridging the gap between healthcare needs and available resources by bringing medical
assistance to vulnerable communities, training healthcare professionals, and influencing health
policies.
Non-Governmental Organisations (NGOs) are increasingly significant actors in health
development, especially in countries where government health systems struggle with resource
constraints. In Nigeria, NGOs supplement state provision by delivering health services,
advocating for policy change, and strengthening community health systems (Aliyu, 2023).
Non-Governmental Organisations (NGOs) have long played a vital role in strengthening health
systems in Nigeria. In Northern Nigeria especially, where health access is often limited by
geographic, social, and economic barriers, NGOs help bridge critical gaps in primary
healthcare delivery, community engagement, and health education (Adewumi Foundation,
2024). Their work is not limited to service provision: they also advocate for policy reform, train
health workers, and mobilize communities around health behaviors.
One of the most significant areas of NGO involvement has been immunization. For example,
the CORE Group Polio Partners Project (CGPP) operates in Kano and other high-risk states in
Northern Nigeria, engaging Volunteer Community Mobilizers (VCMs) to support routine
immunization and polio eradication efforts (CORE Group, 2025). These VCMs go door-to-
door, identify defaulters, and provide health education in Kano, they have been instrumental in
raising awareness and improving vaccination rates (Oladeji, Bologna, & Stamidis, 2019). Their
efforts highlight how NGOs use grassroots, culturally-sensitive strategies to promote vaccine
uptake in areas that are otherwise hard to reach (Duru et al., 2019).
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Yet, immunization in Northern Nigeria still faces deep-rooted challenges. A recent qualitative
study exploring caregiver and community influencer perspectives in six northern states found
that barriers such as myths about vaccines, religious beliefs, gender norms, and mistrust of
health services significantly hinder immunization (BMC Public Health, 2025). Specifically in
Kano State, a study identified sociocultural obstacles including gendered decision making and
previous negative experiences with health services that reduce vaccine uptake (Adeleke et al.,
2023). These findings show the complexity of immunization beyond simply making vaccines
available.
Beyond immunization, NGOs in Northern Nigeria also contribute to maternal and child health
more broadly. In the early 2000s, the Partnership for Reviving Routine Immunization /
Maternal, Newborn, and Child Health (PRRINN/MNCH) program supported state
governments in northern Nigeria to strengthen primary health care and community engagement.
This initiative, backed by international donors, reformed health service delivery, scaled up
maternal care services, and established community emergency response systems (DAI, 2014).
Community volunteers, religious and traditional leaders, and health workers were trained to
drive behavior change, build trust, and sustain long-term community ownership
(Communication Initiative, 2018).
In addition, local NGOs have made significant contributions in areas of reproductive and
adolescent health. The Association for Reproductive and Family Health (ARFH) is an
indigenous NGO that has operated across Nigeria, including in northern states, with programs
in maternal, sexual, and reproductive health; HIV/AIDS; malaria; and adolescent health
(ARFH, 2025). Through capacity building and community-based outreach, ARFH helps
underserved populations access vital health services.
Looking more specifically at Kano State, NGO involvement in health has been substantial.
Kano is one of Nigeria’s most populous states and serves as a commercial and cultural hub in
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the North. Despite its urban strength, many residents in Kano still lack reliable access to quality
primary health care, especially in rural or densely populated underserved areas (WHO, 2014).
NGOs like CGPP, ARFH, and communication-focused organisations have stepped in to fill this
gap by delivering community-based health services and mobilising public trust.
In Kano, NGOs are also deeply involved in health education and communication. Entities such
as the Centre for Communication Programs Nigeria (CCPN) provide behavior-change
communication around maternal and child health, immunization, and hygiene (Centre for
Communication Programs Nigeria, 2025). Their communication strategies use local media,
religious institutions, and community structures to make health messages more acceptable and
effective.
Despite these efforts, important questions remain about the sustainability, coordination, and
impact of NGO-led health initiatives in Kano over the past decade. While NGOs deliver
essential services and influence health behavior, the long-term effects on health outcomes (e.g.,
immunization coverage, maternal mortality, health systems resilience) are not fully
documented. Moreover, coordination between NGOs, government agencies, and community
actors may be fragmented, limiting the efficiency and reach of interventions.
Also, in Kano State, the situation reflects both the complexity and opportunity for NGO
engagement. As Nigeria’s most populous state, Kano has historically confronted recurrent
disease outbreaks, such as cerebrospinal meningitis, cholera, and measles (GHAI, 2023).
Recognising this, a civil society coalition including the Legislative Initiative for Sustainable
Development (LISDEL), Nigeria Health Watch, and BudgIT supported by GHAI launched a
strong advocacy campaign beginning in 2020. This led to the formation of the Kano State
Health Security Advocacy Team (KHESAT), which pushed for the establishment of a dedicated
budget line for Epidemic Preparedness and Response (EPR) (GHAI, 2023; Nigeria Health
Watch, 2023).
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Their efforts yielded concrete results: for the fiscal year 2021, Kano State’s government
allocated ₦300 million to EPR and ₦250 million to establish a public health laboratory. These
allocations were not only groundbreaking but have been sustained; by 2022 and 2023, the EPR
budget line had increased to ₦400 million (GHAI, 2023). To ensure continuous funding, a
monthly disbursement mechanism of ₦3 million was secured from the Kano State Health Trust
Fund beginning in January 2023 (GHAI, 2023).
Additionally, civil society advocates contributed to the development of a state-level Public
Health Security Bill, aiming to institutionalise epidemic preparedness and ensure long-term
sustainability (GHAI, 2024). The Kano State Action Plan for Health Security (KSAPHS),
developed with technical inputs from GHAI, the Africa CDC, e-Health Africa, and other
partners, further underlines the strategic role NGOs play not just in service delivery but in
health governance (GHAI, 2023).
Beyond epidemic preparedness, NGOs in Kano also support health communication and social
welfare. In a study of medical social welfare services in Kano’s tertiary hospitals, Shitu, Surajo,
and Yahya (2021) found that communication technologies including radio, mobile phones, and
the internet significantly improved awareness and utilization of psychosocial and financial
support services. Their findings highlight how NGOs and social welfare units can leverage
information and communication technology (ICT) to reach indigent and marginalized patients.
Thus, examining the role of NGOs in Kano State’s health development from 2015 to 2025 is
both timely and critical. Doing so can illuminate how NGOs contribute to health equity, what
barriers they face, and how their strategies might be strengthened for greater, sustainable impact.
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1.2 Statement of the Problem
Although NGOs in Kano State have made significant strides in health development especially
through advocacy, budget innovation, and community engagement their long-term impact
remains uncertain. First, while the establishment and growth of a dedicated Epidemic
Preparedness and Response (EPR) budget line in Kano is a major win, it is unclear how
consistently funds are released and utilised across all local government areas. Second, many
NGOs operate on project-based funding, which raises serious sustainability concerns after
donor cycles end.
Third, despite their advocacy successes, NGOs may still face institutional and political barriers
in translating policy wins into systemic health improvement. The newly developed Public
Health Security Bill is promising, but its implementation, enforcement, and monitoring require
ongoing civil society vigilance and political buy-in. Fourth, at the grassroots level, challenges
in health communication remain: while ICT has improved outreach, many indigent patients
still lack reliable access to communication channels, affecting their ability to benefit from
social welfare services.
Finally, there is a gap in academic knowledge: there are limited comprehensive studies that
assess how NGO-led interventions in Kano State over the past decade (2015–2025) have
influenced health outcomes in both service delivery and public health governance. Without this
understanding, policy makers, donors, and NGOs may not fully grasp which strategies are most
effective or sustainable for future interventions.
1.3 Aim and Objectives
1.3.1 Aim of the Study
To examine the role and impact of Non-Governmental Organisations in health development
and health policy initiatives in Kano State, Nigeria, from 2015 to 2025.
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1.3.2 Specific Objectives
i. To describe and analyse the health programs and initiatives these NGOs have led in
Kano’s health system.
ii. To assess the effectiveness of these initiatives in improving health outcomes and health
governance.
iii. To explore the key challenges (institutional, financial, policy, community) faced by
NGOs in Kano’s health sector.
iv. To propose strategic recommendations for strengthening NGO sustainability,
coordination, and policy influence in Kano State’s health sector.
1.4 Research Questions
i. What major health initiatives and programs have NGOs championed in Kano’s health
system?
ii. How effective have these NGO-led efforts been in influencing health outcomes and
health policy?
iii. What obstacles do NGOs face in sustaining their health interventions in Kano State?
iv. What strategies can be adopted to improve collaboration, accountability, and long-term
impact of NGOs in Kano’s health system?
1.5 Significance of the Study
This study is important for multiple stakeholders. For policymakers, it provides evidence of
how civil society can contribute to building resilient health systems and may inform decisions
on institutionalising health security funding and legal frameworks. For NGOs and civil society,
the findings can highlight best practices, successes, and areas where advocacy or program
design needs strengthening. For donors and development partners, the study may inform
funding strategies that emphasise sustainability and domestic resource mobilisation over short-
term projects. Finally, for academia especially within History and Strategic Studies the research
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documents a decade of civil society engagement in health governance in a key Nigerian state,
contributing to scholarship on development, governance, and public health.
1.6 Scope and Limitations of the Study
The study focuses on the role of NGOs in health developments and initiatives in Kano State
from 2015 to 2025. It examines major international, national, and local NGOs that have been
active in health-related activities during this period. The analysis covers their contributions in
areas such as maternal and child health, immunization, public health education, and disease
prevention.
Geographically, the study is limited to Kano State, though reference is made to broader health
conditions in Northern Nigeria for contextual understanding. The timeframe, 2015 to 2025,
was chosen to capture a decade of continuous NGO participation and to assess both ongoing
and completed health projects.
Limitations of the study include restricted access to some NGO reports and data due to
confidentiality and limited documentation. Additionally, financial and time constraints may
affect the depth of fieldwork. However, efforts will be made to obtain reliable data through
available publications, interviews, and secondary sources to ensure the accuracy and validity
of findings.
1.7 Definition of Key Terms
Non-Governmental Organisation (NGO): A non-profit organisation operating independently
of government, often to promote social or humanitarian goals.
Epidemic Preparedness and Response (EPR): Strategies, funding, and systems put in place
to prevent, detect, and respond to disease outbreaks.
Health Communication: The use of communication methods (e.g., radio, mobile, social
media) to educate and engage communities about health issues.
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Social Welfare Services (in Health): Psychosocial, financial, and counselling support
provided to patients, particularly vulnerable or indigent populations.
Public Health Security Legal Framework: Laws or policies that institutionalise preparedness
and response mechanisms for health emergencies.
Sustainability (in NGO Work): The ability of health programs to continue effectively beyond
the lifecycle of donor funding.
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References
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