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

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governmental efforts by providing healthcare services, advocating for policy improvements,

and enhancing healthcare infrastructure.

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).

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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).

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.

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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

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

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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).

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

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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

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the research 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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[Link]
Aliyu, A. O. (2023). Examining the role of non-governmental organizations (NGOs) in
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Association for Reproductive and Family Health (ARFH). (2025). About ARFH. [Link]
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BMC Public Health. (2025). Understanding caregivers’ and community influencers’
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