Back to school: The role of Husband Schools    in maternal and child health and nutrition       in Niger

Ali Idrissa is a field officer for the AGRANDIS¹ project in Niger for Helen Keller International (HKI). He supervises 11 intervention villages of the project, located in the municipalities of Koré Mairoua and Tibiri.

Idrissa Oumarou Kandagou is a project assistant for the AGRANDIS project. He has worked for HKI since 2015 and supervises three field supervisors from the northern, central and southern areas of Dogondoutchi and Tibiri departments.

Aichatou Laminou Mamane is the coordinator of the AGRANDIS Nut project, supervising the project team for the implementation of activities. She has been with HKI since 2014.

Halimatou Niandou is the Head of Nutrition Programmes and Communication Officer of HKI Niger. She has been with HKI since 2009. She provides technical support to nutrition projects, including AGRANDIS Nut.

Introduction

In Niger’s social context, the husband is the key decision- maker in terms of maternal and child health and nutrition (MCHN), so there is potential for him also to be a partner in improving the food and nutrition security of both the family and the community. In response to a 2007 survey², threats to MCHN were identified which included men not allowing women to access health services and failing to provide support to women on recommended practices such as exclusive breastfeeding. As a result, the ‘Husband Schools’ (HS) initiative was launched, which seeks to involve men in the promotion of MCHN and reproductive health and to encourage their behaviour change.

Inspired by this strategy, Helen Keller International (HKI) set up its own HS in 2011 in Dogondoutchi and Tibiri departments. Then in 2015, AGRANDIS Nut, the capacity- building project for health and community facilities for the prevention and treatment of undernutrition in Niger in 100 villages, set up HS in 50 villages (one per village).

What makes a ‘model husband’?

Part of the project’s key strategy is a focus on ‘communication for change in social behaviour’. This is achieved through community structures composed of community groups, traditional birth attendants (TBAs) and traditional practitioners (doctors) in villages, as well as exclusive breastfeeding support groups, complementary feeding support services and HS that have been put in place.

Particular emphasis has been placed on the members of the HS as part of the ‘peer educators’ approach. Husbands are chosen from the community using the following criteria: they must be married, have good morals, be at least 25 years old and be able to read and write. Members must have a wife who uses the health services and must agree to their wife taking part in other groups. They should be available for the school and other community members and support their own family and be involved in bringing up the children.

How do Husband Schools work?

Each HS has ten members and is supervised by the project field officer and the head of the village health centre. All members are trained on essential actions in nutrition and in hygiene (French acronyms are NEA/AEH) and given education cards and resources for data collection. Everyone is equal in the group; there is no designated leader and any member who has the group’s support can lead a meeting on a topic he knows well. If necessary, the school calls upon a human resource such as a religious leader, health officer or teacher to teach members and the community at large and to strengthen ties within the group.

“Thanks to the various cooking demonstrations organised by the field officer, the women have acquired a lot of knowledge about the type of food to give to their children.”

Chekaraou Kouabo, village chief of Nassarawa

On the basis of their monthly planning, model husbands organise group discussions with their peers on topics such as the importance of best practices in infant and young child feeding (IYCF), nutrition of pregnant women, breastfeeding, family planning, hygiene and health issues identified in the community. HS members encourage men to share their experiences, doubts and fears about applying these practices. This sharing allows model husbands to observe and identify men who are only partially convinced and who need a home visit to encourage them to adopt best practices. Home visits are also made to the homes of all members to encourage them to maintain their efforts. Couples who agree to practice family planning at the end of the visit are referred to a health centre, with a referral coupon to receive the necessary support. This makes it possible to assess the efforts made by these model husbands in increasing attendance at health centres and use of family planning.

In addition the HS writes and presents sketches or plays on the themes that it promotes in public places, during ceremonies or any other opportunities in the community to raise awareness. The model husbands also promote hygiene and regularly organise public health days in villages, install ‘tippy-tap’ handwashing stations and build indoor toilets in houses. Other construction activities include the manufacture of traditional incinerators, handwashing facilities in public places, and fences, sheds and waiting rooms in health centres.

Monitoring and evaluating the project

Each HS holds a fortnightly meeting to evaluate monthly programming and report back on activities such as visits to village members. Indicators are recorded for each input, such as education on IYCF practices (e.g. number of husbands who buy meat, fruit or eggs at least once a week for women and children in the family). Increases in child visits to healthcare centres have been recorded and the project has documented a number of achievements in community action, such as hygiene/sanitation activities in villages.

One main challenge in the operation of the HS is the exodus of members during the ‘hungry’ or lean season. In response to this, income-generating activities are planned in the next phase of the project to strengthen resilience during this period and to keep communities in the same place. Following requests from HS members who say they are limited in carrying out the village sanitation sessions due to lack of tools, the project also plans to support them with hygiene and sanitation kits (e.g. shovel, rake, wheelbarrow, etc).

A final impact evaluation is planned for February 2018. Operational research so far shows that there has been an increase in communication within couples, and more men are relieving women of domestic tasks (such as carrying water and wood, particularly when their wives are pregnant) and becoming involved in monitoring the health status and nutrition of their families. Annual costs of HS per village, including capacity building, fuel costs for monitoring/ supervision of project staff etc, are estimated at just over US$1,280.

“The activities of the school opened my eyes and improved our life as a couple, since I have made the commitment to help my wife with her daily tasks and make decisions about our family together, such as family planning and accompanying her to the health centre. Sometimes I even cook dinner when she is busy. I planted moringa for the consumption of my household to improve their nutritional status (it is rich in iron and vitamin A) and so that my wife can sell it.”

Tanimoune Amadou, farmer, husband and father of five children, Badifa village

Sustainability of Husband Schools

The next phase of the project is to scale up the HS initiative to the other 50 villages in the project area, building on lessons learned in the first phase. The HS strategy is part of the national policy for family planning/reproductive health in Niger and the final HKI evaluation may strengthen advocacy for its inclusion in the revision of Niger’s national nutrition policy.

¹AGRANDIS is a French acronym for ‘Saving Lives through the Prevention and Treatment of Acute Malnutrition’.

²United Nations Population Fund (UNFPA)/Laboratoire d’Analyses Sociales pour le Développement local (LASDEL) – Etude sur les obstacles à la promotion de la santé de la reproduction dans la région de Zinder (Niger). (2007)