On this International Women’s Day, as we inspire inclusion and equitable investments, Nigeria’s commendable efforts to strengthen public health through the introduction of the Human Papillomavirus Vaccine (HPV) into routine immunisation, targeting 7.7 million girls, is a monumental stride forward. This initiative, set to be the largest single-round HPV vaccination campaign in the African region, holds promise in combating the virus responsible for nearly all cases of cervical cancer and will accelerate the progress of the global health agenda.

As we commend this noteworthy endeavour, I, in my capacity as Founder & President of The Wellbeing Foundation Africa, a distinguished member of the Africa REACH Leadership Council, and the Inaugural Global Health Ambassador for the World Health Organization Foundation, am acutely aware of the profound impact such policies can have on the health and wellbeing of young girls and women.

However, while we celebrate this health investment and progress, it is imperative to broaden our focus beyond solely immunisation efforts and shine a light on interconnected groups integral to providing the immunisation and bolstering sustainability in our healthcare systems – midwives, nurses, caregivers and community health workers (CHW), the majority of whom are women, as 67% of the global health and social care workforce are women according to the World Health Organization (WHO).

The WHO has identified the need to increase equitable access to healthcare workers by 2030. Many countries with limited health resources have established midwives and women community health workers to be a point of connection between communities and the health system, addressing the need for grassroots-based care, equity of access and health coverage gaps. In most countries, CHWs are female and have a uniquely valuable social and cultural role, just as midwives are also mostly female and have an essential life-saving role for women and newborns.

Midwives, nurses and CHWs play pivotal roles in vaccination efforts, particularly in combating HIV transmission, while also addressing Sexual and Reproductive Health and Rights (SRHR) concerns. Midwives and nurses, often serving as frontline healthcare providers, are integral in administering vaccinations, including those aimed at preventing HIV transmission from mother to child. For example, our Wellbeing Foundation Africa Midwives implement the Prevention of Mother-to-Child Transmission (PMTCT) programming within our Mamacare360 antenatal and postnatal classes, ensuring that pregnant women living with HIV receive necessary vaccinations and interventions to protect their infants. Additionally, midwives and nurses provide education and support to mothers regarding the importance of vaccinations for themselves and their children, while also addressing SRHR issues with women and girls such as support for family planning, contraception, information about sexually transmitted infections (STIs), and ensuring access to reproductive health services, thus contributing significantly to improving SRHR outcomes.

CHWs, especially women CHWs serve as vital connectors between healthcare facilities and communities, promoting vaccination awareness and facilitating access to services. Often, as trusted members of the community, they advocate for vaccine uptake and provide personal social and health education about the benefits of vaccination, while also addressing SRHR concerns within communities.

In the context of HIV, both midwives, nurses and CHWs are instrumental in the implementation of HIV vaccination programmes, such as administering vaccines for hepatitis B, which can significantly reduce the risk of HIV transmission. They also provide essential support and guidance to individuals living with HIV, emphasising the importance of adherence to vaccination schedules and other preventive measures. The roles of midwives, nurses and CHWs in vaccination efforts, particularly concerning HIV, are indispensable in advancing public health goals and promoting comprehensive SRHR services.

A commentary published by the National Library of Medicine highlights that while PMTCT programs historically emphasised preventing HIV transmission from mother to child, there’s a pressing need to prevent HIV in women of reproductive age, prevent unintended pregnancies in women living with HIV and enhance maternal and sexual and reproductive health services. Our public health strategies and policies must embrace this 360 approach, acknowledging the unique health challenges faced by women throughout their reproductive years, and engendering our midwives, nurses and women CHWs to support them.

Recognising the indispensable roles of midwives, nurses, caregivers and CHWs, I, together with my fellow Africa REACH Leadership Council members, issue a heartfelt call to action, urging governments not only to prioritise maternal vaccines but also to provide unwavering support to these dedicated individuals and the crucial work they do in vaccine administration and uptake. We as WBFA and Africa REACH assert that self-sufficiency in vaccine production is essential for the nation, highlighting the need to strengthen Primary Healthcare Centres (PHCs) to fulfil their role in keeping people well and addressing uncomplicated ailments.

The recent announcement on HPV vaccination is a positive step, but it is just the beginning. The alarming situation of cervical cancer and breast cancer as leading causes of death for women in Nigeria underscores the urgency for a more integrated approach. I continue to advocate and express my concern over the limited availability of resources and diagnostic tools, emphasising the need for a more comprehensive healthcare infrastructure to alleviate screening challenges, which not only impede early detection and treatment but also exacerbate the burden of preventable diseases on women’s health.

This International Women’s Day, let us collectively advocate for comprehensive legislation, policies, sustainable financing, and ongoing global support are essential to fortify the efforts of these frontline female heroes, not just today but every day!

Signed,

Her Excellency Toyin Ojora Saraki