Community Ambassadors and Health Services for Maternal and Child Care

Policy Context

Despite global reductions in maternal and neonatal mortality, in 2020, Nigeria accounted for the second-highest number of maternal and child deaths globally, with about 12% of the global maternal, stillbirths, and neonatal death burden. Currently, Nigeria offers free healthcare for pregnant women and children under 5 years through the Basic Health Care Provision Fund (BHCPF).  While Nigeria is investing in interventions to address barriers to healthcare access in rural areas, maternal, and child healthcare services are still underutilized. This study explores how community ambassadors, specifically community members who are beneficiaries of the program, can encourage the utilization of public maternal and child health services in rural communities across Edo State, Nigeria.

Study Design

The study employed a community-based pilot intervention design to test whether local ambassadors could increase the uptake of public maternal and child health services under the BHCPF program. It was implemented across four rural communities in Edo State—Ogan, Oza, Oligie, and Urhonigbe.

The study featured two intervention arms, each representing a different type of community ambassador:

1. Beneficiary Ambassadors – women who were direct beneficiaries of the BHCPF program. They shared first-hand experiences and encouraged other women to enroll and use primary healthcare (PHC) services.

2. Community Influencer Ambassadors – respected local leaders or influencers selected from within each community. They leveraged their social networks and authority to raise awareness and promote trust in the health insurance program.

Each of the four study communities included two ambassadors per category (one beneficiary and one influencer) along with a community-based supervisor, allowing the study to compare how ambassador type affected awareness and service utilization outcomes.

The target population was households with women of reproductive age, 15 to 49 years, who are either pregnant or have children under five years old. Data was collected face-to-face through interviews and focus group discussions, comparing service utilization patterns and PHC visit frequencies before and after the intervention to assess changes in healthcare-seeking behavior.

Results and Policy Lessons

The intervention produced mixed but promising results: in some communities, particularly Oza, the ambassadors drove a clear rise in primary healthcare (PHC) visits, while others, such as Ogan, saw smaller or inconsistent gains. Overall, most residents reported seeking care at PHCs rather than traditional birth attendants, and antenatal care (ANC)utilization increased substantially in Urhonigbe, alongside changes in treatment patterns for malaria and respiratory infections.

Statistical analysis confirmed a significant improvement in PHC visits in September (χ² = 9.42, p = 0.0021), though the effect waned over time, suggesting the need for ongoing engagement to sustain behavior change. Barriers such as staff shortages, poor service quality, preference for traditional medicine, and distrust in government facilities limited impact in some areas. Despite these challenges, the project demonstrated that community-driven engagement can strengthen health-seeking behavior. Findings informed the Edo State Health Insurance Commission’s decision to adapt the program—addressing staffing and awareness gaps—and to explore scaling the intervention into a state-wide randomized trial.