This research study was designed to investigate whether female clients have gender preferences for frontline health workers who provide maternal, newborn and child health (MNCH) services at primary healthcare level in Nigeria. Currently, there are few studies that have sought to investigate female clients’ health worker gender preference and to understand the implications for access to as well as uptake of health services at primary healthcare level15. In a British study by Nicholas, less than 10% of female respondents stated preference to consult female primary healthcare workers for general health problems but more than half of the respondents stated a preference for female primary health workers for maternal health problems16. The finding from this study that there is relatively low stated preference to access maternal, newborn and child health services from male frontline health workers by female clients within primary healthcare facilities raises serious concerns and it also reinforces the perception that gender-based preferences exist for services from health workers at primary healthcare level. The preference of female clients to receive MNCH services from female frontline healthcare workers was reportedly higher in Bauchi (northern Nigeria) compared to Cross-River (southern Nigeria). In addition, the finding that more than half of the clients interviewed indicated that they have no health worker gender preference is also an important finding. This indifference to the gender of health workers providing services at primary healthcare level was much higher in Cross River State (southern Nigeria) than in Bauchi State (northern Nigeria). In gender conservative contexts (such as within northern Nigeria), there is greater preference for female health workers providing MNCH services to female clients17, which is supported by the findings from this research study. Furthermore, it is noteworthy that female health workers in both States actually provided more MNCH services to female clients, reiterating a clear preference among female clients to receive healthcare services from female frontline health workers. This corroborates research findings reported elsewhere that female clients tend to prefer accessing MNCH services from female health workers, especially in primary healthcare settings15. This will invariably have an impact on the uptake of crucial MNCH services as well as health outcomes at primary healthcare level in Nigeria. This preference of female clients for female health workers may be associated with suggestions by some social scientists and the perception that maternal healthcare services are more likely to be better understood and delivered by female healthcare providers18.
Bivariate analysis from this study suggests a relationship between a female client’s health worker gender preference and the following: her pregnancy status, the specific reason for which female clients visit primary healthcare facilities to access maternal, newborn and child health services, the gender of the health worker(s) seen/working within the primary healthcare facilities she accesses and the female client’s location in Nigeria. In other words, where a female client is located within Nigeria, whether she is pregnant or not, the gender of the health worker(s) working within the health facility as well as the reason for which she seeks MNCH services at health facilities are key factors likely to affect the gender of the health worker she will prefer to receive health services from, especially within primary healthcare level. These have serious implications for the uptake of MNCH services at primary healthcare level in Nigeria.
These study results and their implications emphasize the need for gender related issues to be given more serious consideration during the production, hiring and deployment processes for frontline healthcare workers13 as well as during efforts towards health system strengthening more broadly17. Gender mainstreaming should be incorporated more strategically within the planning processes as well as implementation frameworks for human resources for health (HRH) management13 especially at the primary healthcare level in Nigeria. In addition, there should be increased efforts at advocacy and community engagement to promote the acceptability of maternal, newborn and child health services from male frontline health workers, especially within northern Nigeria, to significantly improve uptake of MNCH services and consequently reduce maternal, newborn and child morbidity and mortality, particularly in rural communities across Nigeria.
The study has some key limitations: first the findings from this study apply to specific cadres of frontline health workers i.e. nurses, midwives and community health workers. Second, the study was conducted in rural communities and at primary healthcare level and as a result, it does not provide insights into female clients’ gender preference for frontline health workers in urban settings as well as within other levels of care i.e. secondary or tertiary levels of healthcare in Nigeria. Lastly, the study was conducted in only two out of the thirty-six States in Nigeria and thus cannot be generalized to the whole of Nigeria, however both States represent on large scale two major classifications within Nigeria: a conservative and predominantly Muslim group in Bauchi and a liberal and predominantly Christian group in Cross River. Thus, the results broadly capture female clients’ preferences for the gender of healthcare providers at primary healthcare level in Nigeria.