Abuja Diary: In Nigeria, Everything Is Big

In November 2007, I visited Nigeria for the first time. But the Nigeria I saw wasn’t what I expected; I have never seen an African city like Abuja.  It is a planned city, carved out of the bush in the 1980s, and known as one of the wealthiest and most expensive cities in Africa.  Abuja is dominated by very large, new and expensive-looking buildings, mostly belonging to the federal government. It has freeways, the only ones I have ever seen in Africa outside of South Africa. Unfortunately, it does have one thing in common with other African capitals — people living in poverty in shantytowns in the semi-developed edges of the city.

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I already knew that Nigeria contains a quarter of the population of the entire African continent. And I knew that 500,000 women die every year around the world from pregnancy-related complications, a figure that, tragically, has not changed in more than 20 years. But I did not know that 20% of the entire malaria burden in the world weighs on the people of Nigeria. And I did not know that more than 10% of those 500,000 women who die every year are Nigerian. Everything about Nigeria is big, including its health problems.

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Fortunately, the Society for Family Health (SFH), the non-governmental organization that PSI helped establish in Nigeria more than 20 years ago, is also big and having a big health impact. In 2007, SFH generated over 1.4 million DALYs (Disability-Adjusted Life Years, an internationally accepted measure of health ), the second highest in the PSI world and very close to South Africa. Most of its DALYs in 2007 (48%) came from family planning; SFH produces more couple years of protection than any other PSI program, including Pakistan and India. In 2007, its CYPs prevented an estimated 3,444 maternal deaths, almost 7% of the 52,000 Nigerian women estimated to have died from pregnancy-related complications. That health impact is certain to go up even more with major new money SFH is receiving from the Global Fund to establish 555 counseling and testing centers and do malaria prevention and treatment.

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My visit just happened to coincide with the Abuja launch of LifeStyles condoms, a for-profit condom brand manufactured by Ansell that targets the middle class. A PSI Issue Brief published in June 2006 referenced this venture as an example of the “Total Market Approach,” a hybrid which seeks to blend bits of the public sector, private sector, social marketing and the manufacturer’s model in varying degrees based on the country context. All parties benefit from the arrangement: PSI and SFH reduce dependence on donor funding, Ansell gains a new market with minimal risk and market development costs and the Nigerian people get another condom choice.

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In a motor park (or what Americans would call a truck stop) in a poor neighborhood on the outskirts of Abuja, I talked to Abubakar Zanna, the secretary of the local chapter of the transport workers union who also runs a community-based organization started by SFH that promotes peer education by and for transport workers. Of course, the conversation initially focused on the desire of his truck drivers to avoid HIV infection, something that could have a long-term impact on their lives and livelihoods. He claimed his drivers employ all strategies for avoiding HIV, including abstinence (in their case, a return to abstinence). I expressed skepticism about the idea of truck drivers returning to absence but he stood by his claim. But Mr. Zanna was equally enthusiastic about his drivers’ promotion of mosquito nets and safe water solution and about the very real and short-term toll malaria and diarrhea can exact on a driver and his livelihood.

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I know I didn’t see the “real” Nigeria — that would have been the urban jungle of Lagos or a poor, rural village far from Lagos or Abuja. But I did see a small slice, and what I saw and heard gave me hope that SFH is big enough and talented enough to make more than a modest difference in helping to alleviate suffering and improve health in this colossus of Africa.

— David J. Olson

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