By Elise Meyer
The majority of Lagos’ 20 million inhabitants live in slums or informal settlements where health outcomes are poor, sometimes even worse than those in rural areas notorious for their health inequities. However, health literacy is correlated to health outcomes: low health literacy is associated with poor health outcomes and increasing health literacy has been shown to improve health outcomes. It was on this premise that Northwestern’s Access to Health (ATH) Project devised the Community Health Educators (CHE) Program, a holistic health education and advocacy program aimed at addressing health literacy in targeted informal-urban communities.
In partnership with the Justice & Empowerment Initiatives (JEI) and the Nigerian Slum/Informal Settlements Federation (Federation), the ATH Project developed a first of its kind “train-the-trainers” curriculum. This program was formulated to teach community-based health educators how to transmit health information to low-literacy Nigerian audiences while supporting behavior change models. Using the curriculum, the CHE Program trains and supports community-based health educators, who are trained in inclusive, adult-focused teaching strategies and advocacy techniques and taught the basic health knowledge for 7 community-selected topics including, for example, malaria, family planning, and water and sanitation. The educators then, in turn, hold trainings in their communities, seeking to increase the health literacy of all.
In April 2019, the Northwestern Public Health Review hosted a symposium spotlighting the ATH Project’s CHE Program in Lagos, Nigeria. The half-day symposium featured the interdisciplinary nature of the ATH Project, bringing together presenters from Northwestern’s Medical, Journalism, and Law Schools along with those from University of Illinois at Chicago’s Biomedical Visualization Program and from Slalom Consulting. The presenters shared their contributions to the ATH Project’s CHE Program as it has developed over the past three years.
The Symposium opened with moving clips of two video documentaries created by graduate students at the Medill School of Journalism under the supervision of Professor Brent Huffman. Both of the documentaries arose from the partnership with the ATH Project. Professor Huffman took four graduate students in journalism to Lagos where they worked closely with JEI and the Federation to report on human rights issues. The first documentary focused on the trafficking of children to beg in the streets of Lagos and the powerful work advocates in the Federation are doing to support these children. The second documentary featured the story of Elijah Atinkpo, who was part of the 30,000 people forcefully evicted from the Otodo Gbame waterfront community. The documentary provided insight into how he and others at JEI and the Federation are working to prevent future evictions and uphold the rights of those living in vulnerable communities. Both films will be published on Al Jazeera Shorts later this year.
An interdisciplinary panel followed the documentary clips providing an overview of the CHE Program. Anna Maitland, a human rights lawyer who co-founded JEI, spoke of the CHE Program from its beginnings as a health-needs assessment conducted by Professor Juliet Sorensen’s Health and Human Rights course. Dr. Shannon Galvin, Co-Director of the ATH Project presented on the development of the Program through pre-and-post-testing both the CHEs and the communities at large. Professor Leah Lebowicz provided her perspective on how the UIC Biomedical Visualization partnership further improved the CHE curriculum through in-depth research projects. Professor Huffman elaborated on the documentary clips and the partnership with JEI and the ATH Project in their development. And Annie Conderacci of Slalom Consulting brought the panel to the present where she is leading a team in the creation of an app and website to provide CHEs with easy-access to the core curriculum along with other important health information. The group discussed challenges and solutions to coordinating across continents and in meaningful governmental partnership. Panelists emphasized the importance of supporting the community in leading the Program to ensure efficacy and sustainability.
The Symposium closed with the presentations of six graduate students in Biomedical Visualization from the University of Illinois at Chicago. The students had taken on the challenge of maximizing the effectiveness of the CHE curriculum for an audience with rich linguistic diversity and mixed literacy. Their work focused on personalization, cultural biases, game design, storytelling, retention, and drawing. The students also presented scientific posters on their projects during the reception.
Urban populations are growing at unprecedented rates, with a growth rate of nearly 60 million people every year. Indeed, some have projected that Lagos will be home to between 85-100 million people in the next 60 years – that’s more than the entire population of California in one city. As this growth continues, urban health disparities are likely to become exacerbated. As such, the ATH Project’s CHE Program is ripe for replication and readying communities for the future.
Elise Meyer is the Schuette Clinical Fellow in Health and Human Rights at Northwestern Pritzker School of Law’s Bluhm Legal Clinic, where she supports the Access to Health Project. Elise co-instructs the International Human Rights Law and Practice Clinic and the Health and Human Rights Seminar. She is a graduate of the University of Chicago Law School.