Background
Despite Nigeria’s sustained efforts towards polio eradication and improved primary health care (PHC) uptake, routine immunization coverage in the southern zones has plateaued, with persistent barriers such as low health literacy, widespread misinformation, socio-cultural resistance, and health system weaknesses. Recognizing the strategic role of trusted community figures in overcoming these challenges, the National Primary Health Care Development Agency (NPHCDA) sought to reassess and map community influencers in the 17 southern states. The objective was to identify and engage key influencers/gatekeepers across the 17 southern states of Nigeria to promote positive health-seeking behaviours within communities. ACE Initiative for Social Impact Development (AISID) in partnership with eHealth Africa, conducted the landscape assessment to identify, categorize, and design tailored engagement strategies for influencers capable of driving positive health-seeking behaviours.
Our Approach
ACE led a structured four-step landscape assessment, involving: (1) defining a landscape mapping plan, (2) conducting desk reviews to identify existing influencers, (3) implementing key informant interviews (KIIs) and focus group discussions (FGDs) across community archetypes, and (4) analysing findings to produce an influencer engagement plan. Data collection covered the Southeast, South-South, and Southwest zones, involving 91 KIIs and FGDs with state health managers, traditional and religious leaders, women’s groups, youth leaders, market leaders, civil society representatives, and traditional birth attendants. Influencers were categorized as primary (high influence and broad reach) or secondary (context-specific influence), with each mapped against an influence–interest matrix. Barriers, drivers, and incentive mechanisms were also systematically documented to inform zone-specific and cross-zone strategies.
Results
The project revealed a complex mix of structural, socio-cultural, and informational barriers that continue to limit health service uptake in the southern zones. Geographical challenges including poor road access, scattered settlements, and areas affected by insecurity emerged as the most persistent constraint, often compounded by financial hardships that make healthcare unaffordable for low-income households. Socio-cultural norms, such as preference for traditional medicine, religious restrictions, and entrenched mistrust in government-led programmes, further weakened demand, while gaps in health infrastructure, workforce availability, and service delivery undermined supply-side capacity. Misinformation and low health literacy cut across all zones, reinforcing hesitancy toward immunization and other PHC services.
Within this area, primary influencers such as the traditional leaders, religious leaders, and women’s groups stood out for their credibility and broad reach, making them well-positioned for unified engagement strategies. Secondary influencers included youth leaders, traditional birth attendants, market leaders, and education sector stakeholders, which demonstrated significant but more localised influence, requiring tailored approaches sensitive to zone-specific contexts. Across all categories, sustained participation was closely tied to both financial motivators, such as stipends and transport reimbursements, and non-financial incentives, including public recognition, capacity-building opportunities, and formal roles in community health initiatives.
Recommendations
To maximize impact, engagement efforts should focus on creating sustainable incentive systems co-designed with communities, while building the capacity of primary influencers through targeted, culturally aligned training. Strategies for secondary influencers should be tailored to local contexts, with strengthened collaboration platforms, such as religious, women’s, youth, and TBA networks, integrated into state ACSM working groups. Influencers should be leveraged to bridge trust gaps, counter misinformation, and drive demand for immunization and PHC services, supported by continuous monitoring and adaptation for long-term sustainability.
Partners eHealth | NPHCDA