Executive Summary of Girls for Health (G4H) program in Northern Nigeria

Girls for Health (G4H) will promote the economic empowerment, agency, and voice of rural adolescent girls by supporting their transition from secondary school to tertiary training in midwifery, medicine, nursing and other health careers, and in so doing, will address the acute shortage of female health workers in rural Northern Nigeria. G4H will integrate proven girls' education strategies with innovative vocational interventions to build 1,350 girls' career aspirations and academic achievement and will significantly increase the number of rural girls entering health training institutions (HTI) in four northern states. The program will include: 1) a bridge program offering accelerated academic instruction in science, math, and English; 2) vocational counseling and practicums at local health facilities; 3) safe spaces to enhance critical life skills; 4) four month science immersion courses for girls accepted for admission to a health training institution; and 5) HTI capacity building to cultivate a rural female-friendly learning environment. G4H will work towards sustainability from the start by using secondary school and HTI infrastructure, and feeing into government rural health worker employment schemes. 

G4H participants will have excellent prospects for employment—and ultimately for increasing women's access to health care in rural areas—because Nigerian federal and state government programs to increase the number of skilled providers virtually guarantee female Hausa-speaking midwives, physicians, and nurses employment in health services in rural areas. This is extremely important, not only in terms of lives saved, but also because women's ability to gain formal employment may be one of the most visible and monumental ways to transform traditional gender roles, duties, responsibilities, and identities. Very few interventions for adolescent girls in developing countries combine all three of these essential components: core academic training, life skills acquisition, and vocational training. The G4H outreach staff will work with communities to create contractual agreements to ensure that the girls return to their rural areas for 3 years once they have completed HTI or other vocational training. As a primary goal of the program is to support vocational aspirations and opportunities, girls who are unable to advance to a HTI or who prefer a different vocation with high employment potential, such as teaching, engineering, or entrepreneurship, will be assisted as they prepare to enter tertiary training in these fields. Each cohort of trained rural women will serve as compelling role models in their communities about the benefits of delaying marriage and pursuing a vocation. G4H will improve health, economic and gender equity outcomes by creating pipelines leading to formal employment for girls who would not otherwise have this opportunity and by enhancing access to female health workers, teachers and other female workers in rural communities. 

G4H will improve the effectiveness of teaching at collaborating institutions by prioritizing the hiring of female instructors from the collaborating secondary schools and HTIs to lead the accelerated classes in science, math, and English, and mentor the safe space clubs. The 56 female teachers will attend a series of preparatory workshops and be trained in student-centered approaches to learning including small group activities, interactive teaching methods, skills rehearsal, and open discussion. Project staff will periodically observe each teacher/mentor and then provide coaching and feedback. Gender equity is central to the design of the program, and thus central to the training of the G4H teachers. Hence, teacher training and participation in this model will result in a more knowledgeable and culturally sensitive teacher workforce at our collaborating secondary schools and HTIs, thereby improving capacities at these institutions. 

G4H will build on 10 years of pioneering programming in girls' education and the training of female health workers in Northern Nigeria by Women for Health (W4H) and the Centre for Girls' Education (CGE). Both organizations have unique expertise in the region in the design and implementation of interventions that improve girls' educational attainment, build girls' agency, voice, and future vocational aspirations, and maximize their economic and health outcomes. G4H will be evaluated using a rigorous controlled trial design, randomizing at the school level to assess its impact on key outcomes of interest that include rural girls' secondary school graduation and subsequent HTI enrollment, retention and completion, as well as delayed marriage and improved agency and voice. Process monitoring and costing analysis will be conducted to support quality implementation and dissemination efforts. The design will ensure that high quality evidence is available to guide the field regarding the effectiveness and costing of in-school bridge programming in broadening rural girls' participation in education and career opportunities in the context of low resource settings characterized by low rates of female participation in education and income generation.