UNCORRECTED TRANSCRIPT OF ORAL EVIDENCE To be published as HC 840-ii

House of COMMONS

MINUTES OF EVIDENCE

TAKEN BEFORE

international development Committee

 

 

DFID's Programme in Nigeria

 

 

Tuesday 7 July 2009

MR ABOUBACRY TALL and MS JULIA AJAYI

Evidence heard in Public Questions 53 - 102

 

 

USE OF THE TRANSCRIPT

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Oral Evidence

Taken before the International Development Committee

on Tuesday 7 July 2009

Members present

Malcolm Bruce, in the Chair

John Battle

Mr Virendra Sharma

Mr Marsha Singh

Andrew Stunell

________________

Memoranda submitted by Save the Children UK and VSO Nigeria

 

Examination of Witnesses

Witnesses: Mr Aboubacry Tall, West and Central Africa Regional Director, Save the Children, and Ms Julia Ajayi, Nigeria Country Director, VSO, gave evidence.

Q53 Chairman: Good morning and welcome; thank you for coming to give evidence; this is the last evidence session we are taking in this inquiry before we have the minister in front of us next week. I wonder if, for the record, you could just introduce yourselves, who you are and so on?

Ms Ajayi: My name is Julia Ajayi and I am the Country Director for VSO in Nigeria.

Mr Tall: My name is Aboubacry Tall, I am the Regional Director for West and Central Africa for Save the Children.

Q54 Chairman: Thank you both very much for coming in. We visited Nigeria three weeks or so ago and we came away - and we were not surprised to come away - realising how important it is but also how challenging it is. Obviously it is the most populated African country but with some of the worst indicators and huge regional disparities, particularly between the North and South but also between different provinces. From your take, what do you see as the biggest challenges in Northern Nigeria for dealing with poverty reduction and delivering on the MDGs more effectively than is the case on many of them at the moment? We have had weak governance, we have had corruption, we have had the impact of the oil wealth all thrown at us as part of the problem, but in your work do you see any of those as particularly dominant or what do you see as the biggest challenges to delivering poverty reduction? This Committee very often asks a very simple question: what works? To be frank, one gets the impression in Nigeria not a lot, but maybe you will have some more positive things to say. Who wants to go first?

Ms Ajayi: In addition to some of the issues that you mentioned there one of the problems that we face in Nigeria, one of the challenges, is the scale of the country. As you mentioned, it is the most populous country in Africa, a huge geographical area, a huge number of people and such a range of challenges within all sectors that trying to find a way to make an impact within that context is a real challenge for us all working in development. Trying to find strategies that work, in whatever level we are working in, is certainly for VSO how we try to form our programmes, to see what works best. I do agree that governance is an issue, and you talked about corruption which obviously permeates different levels within the country. Being able to take a co-ordinated response as well by looking at working at local, state level and federal level to try and have a joined-up, pragmatic response to creating an impact in Nigeria is the way that we are designing our programmes and the way that we are trying to increase the impact. Also, in terms of trying to have joined-up working between the different agencies we are working closely with DFID in Nigeria, and for our volunteers the more added value we can bring to the partners that they work with, through making sure that the work is joined up with other donors and agencies, then the greater the impact that we can have.

Mr Tall: Thank you, Chairman, and thank you for giving us an opportunity today to give testimony before this Committee. Two things: one, I would like on behalf of Save the Children to congratulate DFID and the UK Government for the sustained focus on the millennium development goals as the vehicle forward guiding interaction with countries such as Nigeria. In terms of what some of the main challenges are in relation to Nigeria, there are just a couple of things that I would like to highlight, using the health sector as an example. We tend to think, at least relatively speaking in the context of Africa, of Nigeria as a relatively wealthy country. It may be relative to its neighbours, but we need to put that in the same context as how much does Nigeria have to spend in-country. Despite the oil wealth and the like it comes out to maybe 17 US cents per person per day; that is what the country has to spend on all the programmes in-country. That is one thing to help us provide a little bit of context. If you look at the health sector in terms of overall expenditure per capita the government is able to put in up to about $53 per person annually, roughly four to six per cent of government expenditure. At the same time, looking at the other side of the coin, the amount of overseas development assistance that goes into Nigeria, focusing on health in particular and now drilling down a little bit to focus on child health in particular - as we talk about the MDGs a number of them, especially those around mortality in particular, relate to children - the investment in child health in Nigeria equates to about two US dollars per child per year. To me those are probably some of the challenges which basically create a situation where individual people, families and persons, spend out of a family budget 63 per cent of their resources on healthcare. That is out of pocket. Donors put in a certain amount of money, government puts in a certain amount of money but of the total cost of healthcare 63 per cent is supported by the individual, coming out of their pocket, whether that is for transportation - getting to the hospital - buying medicine, paying fees, et cetera et cetera. That size of a share of the family budget going into paying for healthcare is one of the significant difficulties in my view of Nigerians getting access to healthcare, especially if we take into account that of the 140 million people in Nigeria it is estimated that up to 70 million live with less than one dollar a day.

Q55 Chairman: I take that point and our other questions will explore that a little bit more. They have a small amount of money and individuals have to find more themselves, but what about your dealings as agencies operating with government and with corruption. Putting it crudely, do you get put in a situation where people are looking for kickbacks and how do you deal with that? Are you in a situation where, if you are not careful, you are engaged and then find that whatever you have done has somehow disappeared or gone somewhere else? How much of a problem is that for your operations?

Ms Ajayi: For VSO we are working through volunteers, as you know, so it means that we have very little direct support in terms of money to partners. We have some small grants that we give to partners but other than that our support is through volunteers. Within the SNR programme (Strengthening Nigeria's Response to HIV/AIDS) we were one of the three partners in the DFID-funded programme with Action Aid and FHI, and within that programme we received direct funds from DFID for our part in that work. We managed those funds ourselves and reported back to DFID and are still doing so, so the support from those funds that we gave to partners including state-level agencies and SACAs - the state agencies for control of AIDS - in the states where that programme was operating in, was through activity-based work. For example, we recently took a tour, a group of partners including government workers, to a programme in Namibia where we had an exchange of lessons learned and examples of home-based care and working with orphans and vulnerable children through our partners in Namibia. That was a mix of partners from civil society organisations and from state level government workers. It is therefore not something that we find that we are concerned about in our everyday work because everyone operates within our own VSO policies. We do pay per diems, which is difficult within a country where per diems are paid or ESTA codes are paid, so we are not able to offer the same kinds of terms and conditions to government workers who travel. That can sometimes be difficult; however, all the people who have come with us on trips have been very pleased with the opportunity they have been given, despite the fact that it has been not as well-supported as it might have been on a government trip. They have really talked about the learning that they have taken from those opportunities, so it is not something that we feel we are compromised by in Nigeria.

Q56 Chairman: How about in terms of Save the Children?

Mr Tall: Overall, because our work is similarly focused at community level, the challenges are less daunting in terms of efficiencies and the like. That said, the overall context in which you work remains something that you need to be aware of in terms of procurement, for example, and other things. There, as in the case of VSO, a number of systems and procedures exist internally to try and control that external environment as much as possible. That said though, the larger element of how well-performing systems are, how much political commitment today exists at different levels - because you also have a structure of government in Nigeria which to some degree is one of the realities that adds complexity. You have your federal level and, while there may be political commitment at the federal level, it does not necessarily translate at a state level, and the concerns of your local government authority, your local government level, your LGA, may not be in line with where the state is going. That is a reality that one has to manage and, yes, it means that although at a national level there is a push for certain direction, a certain policy that is viewed as progressive and useful, there is a lot that happens unfortunately between that national federal level and the translation of it into state level programmes and beyond. One thing we have seen recently which we think is an excellent initiative is the initiative of getting the federal government to publish what has been transferred to states and what is hopefully then expected to be transferred in turn to local government authorities for any number of activities. With initiatives of that nature - I have talked about the problem a little bit in terms of translating policies and priorities down the chain and using initiatives like Publish What You Pay is one way of making sure that there is transparency and people know what to expect and what is coming their way, and are put in a better position to demand that those activities and resources be made available for objectives that have been agreed upon.

Chairman: Thank you for that. Marsha Singh.

Q57 Mr Singh: Nigeria is not aid dependent, quite clearly, and combined donor aid effort represents one per cent of GDP in Nigeria. Is there actually any point, in respect of such small sums, in donors being involved in Nigeria because with just one per cent of GDP surely we cannot be making any impact on poverty reduction, can we?

Mr Tall: The one per cent might seem relatively small but in terms of the leverage that that one per cent can bring in there is an important role for outside partners to remain engaged with Nigeria, especially because if you take a little bit of history going from the years when Nigeria was under military rule to the return of democracy with President Obansanjo and President Yar'Adua now there may be a certain amount of willingness to move things in a certain direction at a federal level that would need to be supported, and a lot of the support coming from organisations like DFID or multilaterals such as the World Bank and the United Nations might actually be extremely helpful in sustaining the government's drives at a federal level towards a certain result. But I still come back to the perception that Nigeria is a rich country, and that may be being a bit optimistic in terms of how we look at Nigeria. Issues of governance as a particular element - and I touched upon it a bit earlier - are a fundamental factor, whether in the education system or the health system. Governance defined a little bit more specifically around the systems and the processes that make the sectors work in my view needs to continue to be supported, and what comes in from DFID or from the World Bank or from other bilateral partners in Nigeria helps to not only support those policy initiatives at a federal level but it also goes a long way towards supporting a lot of the service delivery at the state level. I started talking about leverage; with those resources from overseas development assistance it puts all of us in a much better position to leverage a much larger set of resources of Nigeria itself. I mentioned earlier how much Nigeria puts into the health sector and I would suggest that we might be in a good position to require of Nigeria that they at least try and meet the objectives of the Abuja Declaration, which was to put at least 15 per cent of your total budget expenditure into the health sector, which was agreed among members of ECOS. In between ODA leveraging policy work at the federal level, leveraging additional resources to states might be useful.

Q58 Mr Singh: From what you have said you seem to agree with the kind of distribution of DFID aid, because DFID spends 75 per cent of its budget in Nigeria on technical assistance at, say, government level, and only 20 per cent on programmes for the poor. Is this the right kind of split in terms of its budget?

Ms Ajayi: I actually wanted to make a comment on not just the amount of money that is spent but the skills transfer, and obviously with our work through volunteers that is something that we are focused on, but to me the support that DFID has given, for example through SNR and our volunteers also shows that that technical assistance is important to DFID as well. Part of the lasting legacy of the aid support to Nigeria is building the long term capacity of civil society organisations, of local government, of state government, and that is an important part of the aid package to Nigeria. So when you are saying that most is on technical assistance, that does have the opportunity to offer longer term capacity building in all of those areas. We do need to be careful that we are trying to maximise technical assistance that is available in Nigeria, of which there is some - not all is there - but certainly for us at VSO we have to make sure that we try and look for interventions and partners that need support in areas where those skills are not available in Nigeria. We can also look at expanding that to look at external assistance and trying to maximise the capacity that we have all built in Nigeria, to use it as much as possible where it is available and continue to take a long term view of support in technical assistance to make sure that it stays within the country and is used as much as possible as well.

Q59 Mr Singh: Which brings me to my question, in terms of both your organisations what support does DFID give you in terms of funding and what would be the impact be without that funding or support from DFID?

Mr Tall: For Save the Children DFID supports a health programme which aims to do two things, one is to revitalise routine immunisation in northern Nigeria and the second element is about maternal and child health contributing to reducing morbidity and mortality in Northern Nigeria. Also, as part of the education sector support programme Save the Children is part of the consortium dealing mostly with the community engagement part, meaning participation of communities in the management of schools in Nigeria. Those are the two main areas where we are receiving support from DFID-funded programmes. What would happen without that? Let us take immunisation as an example: of the whole region that I oversee in West and Central Africa the immunisation rates in Nigeria are actually among the lowest anywhere. Without those resources to try and restart the immunisation system we would basically see those probably sliding further and we would have more children contracting and dying of diseases that can be easily prevented. That is just to give you a sense of what would happen there. Coming back to the earlier question, overall my understanding is that the programme of co-operation that the DFID and the federal government of Nigeria have is based on the poverty reduction strategy that Nigeria put together a few years back. I do not know it in detail but my immediate understanding is that a number of the programmes and activities that come under that, whether they are in health or in education or in livelihood, are aimed at reducing poverty and in some instances stimulating growth as part of that poverty reduction. That said, the elements that Save the Children are directly engaged in, in education and in health, in my view contribute directly towards poverty reduction over the medium to long term. What might be useful to keep in mind in doing so though is to make sure that at the level of specific strategic choices the poor do get access - and again I use health as an example - and we increase the access to healthcare for the poor. If indeed one of the barriers is financial then I would want to see those programmes ---

Q60 Mr Singh: We are going to come on to health in a moment.

Ms Ajayi: As well as the in-country support from DFID I just want to acknowledge also the core PPA grant that VSO has from DFID which of course supports our volunteering programme and so the volunteers more widely within Nigeria, which is important to acknowledge. The specific support from DFID in Nigeria that we have had is through the SNR programme that I mentioned earlier, so that has funded much of our work although not the complete HIV/AIDS programme that we have, but it has funded a large proportion of that. We are also one of the consortium members in the ESPIN programme and what that support has done is a number of things. One is that it has allowed us to help with the technical support to those programmes through our volunteers and our volunteers bring something that is quite different from a lot of other technical support and, because they are volunteering, there is a different ethos and mindset when they come to work with organisations. They are with our partners for a long period of time and we know that their experiences of working with a partner, either government or non-government, over a period of two years and sometimes longer, though sometimes shorter than two years, gives them a really rich understanding and they develop very in-depth relationships with the partner organisations that they are working with. The support from DFID for those volunteers allows them to carry out their everyday activities over a long period of time, but also the extra programme funding allows us to support those volunteers and the partners in some additional activities. Some of the things that we have been able to support through SNR - and we hope to do with ESPIN - are things like advocacy training for partners, so being able to bring together a group of partners and talk about what is advocacy, advocacy within the HIV/AIDS field and looking at how those partners can develop their own advocacy strategies. The Links tour to Namibia that I talked about was actually taking organisations and the representatives of organisations who are working on HIV Aids in Nigeria to Namibia, where they are seeing very different kinds of practice and actually bringing that home. One of the participants in one of the SACAs is now talking about engaging with local banks to try and get support for home-based care kits based on something that she saw in Namibia, so actually that added value is what we have been able to gain from that support and I think that is hugely valuable because it is over a long period of time and because it is really responsive then to what the partners need.

Q61 Mr Singh: I am sure the work you do is extremely valuable but how do I know that it is money well spent?

Ms Ajayi: For me the evidence of the money well spent is in what is actually happening on the ground and certainly at VSO we are looking at how we can increase the monitoring and evaluation to show some of that impact throughout the EPA work. The challenge is always how to bring that level of intervention, which actually in Nigeria is so important because of some of the other challenges we have been talking about, to add all of those outputs together to be able to see the impact which is real and which is happening but often gets lost in some of the more macro level monitoring that goes on. The other area of support that is growing is in advocacy and I think through the C4C programme that DFID is supporting it is actually raising some of the newer and emerging issues like climate change and disability, although those are not new issues.

Q62 Mr Singh: Moving to a more macro level question if I may DFID's CPS (Country Partnership Strategy) directs its focus on those states that are performing well and with whom they can work. Does that not leave the poorer states and the people living in those poorer states out on a limb? Is it the correct strategy?

Ms Ajayi: I would say that I do not think there is a right or wrong, I think we have to all of us decide how we work and then do what we can within that. To have an enabling environment in Nigeria in which to work is very, very important and the lead states having been states that have enabling environments means that it is more likely for the programmes to be able to move forward. One thing that we are looking at in VSO - and we have some alignment with the lead states although not solely - is also supporting other states where our work has really over a period of time been shown to be successful and looking at mentoring and keeping those states on board and being able to take examples and work from those states to bring to some of the others. Your question about whether it leaves some people poor in other states, no doubt it does actually, but that comes back to the point I made earlier about the scale of Nigeria and I am not sure that if we were to dilute the funds that are available and spread them equitably over the whole of Nigeria whether there would be any more of an increased impact.

Mr Tall: I could just maybe add to that that while spreading it too thin would probably not give the types of results one would expect, we believe that once you start in the states where conditions are better it is useful then to be able to take the outcomes of what happened in those states and help take it to a larger scale, to other states in the country. I do note as well that while a lot of the actions, especially for the service delivery elements, are focused on a number of lead states, there is an important level of engagement at the federal level in terms of sector policies and the like which would hopefully be an important element in making it possible to bring other states on board. Is it possible within a period of five years to take some elements - not necessarily the full programme in every single case, but some elements that have been successful in five states to another number of states which can benefit from the same type of support? It would be good to see if that was possible to do within the lifetime of a programme.

Ms Ajayi: Just to make one more point on that about donor harmonisation. I know that there is some work that has been going on in Nigeria, but that is also a way to try and increase the spread of support so that different donors are actually increasing the overall reach by not working and duplicating work in the same states and I hope that that continues.

Mr Tall: That is a good point.

Q63 Andrew Stunell: If I can just pick up from the last point that Nigeria is a very diverse place - that is the polite way of expressing it - with many different languages, religious differences, cultural differences and performance and governance differences. It is not very clear to me what is cause and what is effect when one looks at the poor outcomes that there are for the people living in those different areas, so what do you see as being the drivers here? Are the regional and ethnic inequalities creating the bad outputs or are the bad outputs leading to the cultural perceptions? I would be interested in your view of that.

Mr Tall: What we do most of time is look at it as here is a problem, such as child mortality; what are the various factors behind that. From that concept my advice is usually to look at those fundamental factors as being some of the deep-rooted causes of the problem that you may be looking at at a particular point in time. Even if it is immunisation and you look at the performance in the southern part to the central part of the country compared to the northern part of the country, there is almost a clear line. Is it because the response to services in one part of the country is better than another or is it because of a certain number of social and cultural factors in that people in the North do not respond to the services in the way they are provided, or is it another factor? Generally my approach would be to look at how should we be providing the construct of services in area A, should it be different? It is the same service, it may still be immunisation services for children under one, but if in the North the tendency has been that people do not come with their nine-month old child for their measles shot at the health centre should our services be designed differently so that they can identify and find that child in the household, if that is where that child is. My approach is to change our approach of delivering the service as a result of a different analysis of the social and cultural factors at play.

Q64 Chairman: Can I just interject with a supplementary? According to the information we have about immunisation the percentage of fully immunised children of 12 to 23 months in North Central is eight point four per cent, in North West is six point two per cent, but in North East it is 25 per cent. I do not know whether you are engaged in all those areas but that is three northern provinces, one of which seems to be performing much the same as the South while the other two are way behind. Is there a reason for that?

Mr Tall: I would not be able to respond to the specifics of the division within the North but what I would do is basically look at the North East for example which performs in a similar way as the South and compare that to the other two which are standing at six and eight per cent and try and understand why is it that in the central part of the northern region people are not responding. Is it because when they get there there are no vaccines in the clinic - it is often that simple an answer - or is it because as a general rule they do not come and if they do not come what is it that we would need to do to change those behaviours or to modify the ways in which we deliver the service.

Q65 Andrew Stunell: Do you mind me asking, are you from Nigeria yourself?

Mr Tall: No, I am from Senegal.

Q66 Andrew Stunell: Okay, that is fine. I just wondered if you could take this a little bit further. How should the federal government, the state governments and the external NGOs respond to that very different cultural and operational context, what needs to happen?

Mr Tall: Broadly speaking, one of the things that could work for us is the fact that service delivery is within the domain of the state; in other words if a particular state feels that their services need to be designed in a certain way they do have the prerogative to design those services in that way, subject to quality standards and overall policy issues that the federal Ministry of Health would have oversight of. My understanding is that generally speaking the development organisations, be they bilateral or be they non-governmental organisations, often times would have the flexibility to support the construct that that particular state may come up with. I want to just back up a little bit. I am not suggesting that maybe going to the household is the response because I do know as well that for national immunisation days, which are done on a campaign basis, where workers are expected to actually get to the household and find those children, in Northern Nigeria we have been battling with the polio virus for many years and many campaigns so that may not be the specific answer. What I am trying to say is depending on the specific social and cultural factors at play within a particular area the construct allows the state to maybe be able to design the delivery of the service in a manner that is different, that would hopefully get us to numbers that are higher than what we have. I should note that probably going back to the 1980s with the child survival revolution, Nigeria had much better immunisation coverage.

Ms Ajayi: Building on that, the question of what are the drivers is so complex in Nigeria, there are so many, and we could talk about the historical situation, we could talk about religious and cultural differences, governance within states and that changing as well over a period of time as elections come on board and different governors have different roles to play and play it very differently in their own states. Also the support from donors differs, with some states being supported and others not, the question that we were talking about earlier. Performance of those indicators in different parts of the country is so complex and is a very mixed picture of all of those things coming together, but what we really need to do is try and understand what that context is and have an in-depth relationship with the players that we are operating with. That includes the government at state level and at federal level, it includes other partners operating in that area and it means as well understanding and talking to people at community level in the communities that we are working with, and until we have that we cannot make a proper co-ordinated response. That is our responsibility as NGOs or as donors to best understand the context if we can, not only at the government level but also at community level to understand what those drivers are. We need to work with a range of partners again, governments at state level and federal level, but also with partners in the civil society organisations, looking at religious partners and so on to be able to have a depth of relationship as well over a long period of time and a long term commitment too. Many organisations in Nigeria have suffered from help one year and then not the next, priorities change and people move on and organisations move on and donors move, and actually having the commitment over a long period of time to be able to develop a response that is meaningful is something that is very important for us to address.

Q67 Andrew Stunell: Just picking something out of that, clearly one of the great inequalities is gender. It is a particular problem in the north of the country, but it is actually fairly easy to see where the good places and the bad places are, at least on a state-size scale, so do you think that donors have got a role to play in those areas and how does that fit in with a strategy of helping the good areas where there is good governance and you can do things, as against going for places where there is maybe the deepest requirement for help and assistance?

Ms Ajayi: Certainly we all need to address gender in our programming. It is an area that for us has been emerging, it is not something new, but we know we have got to make sure that we look through the gender lens in all of our programmes and we all need to do that in a consistent way and in a very dedicated way as well. We need to take time and this year in VSO we are planning to look at specific activities in terms of gender audits of our own work and also then work with partners to be able to do that, so that we can strengthen our own programming - I think that is where we have to work first in our gender work. In terms of support within the wider context, again I think you are right that there are very clear divisions in access and gender inequalities. We have to be careful in Nigeria to not just pay lip service to what people are increasingly becoming familiar with in terms of gender rhetoric - you have got to be gendered. Often at meetings people will say let us get gender balance and make sure we have enough women in the room, but actually moving away to make a real difference in our programmes is the challenge. If we are working on the other indicators of poverty then we know that gender is implicit in many of those inequalities, so making sure that we have robust programmes will actually lead us to doing that, but we also need within all of our organisations and donors as well very clear gender strategies to try and address some of those inequalities and, as donors, to actually look at making sure that the delivery partners are accountable in terms of gender is important.

Mr Tall: It is a fundamental factor and to address it may require different types of partnership than we usually gravitate towards. I will just give a quick example of another West African country where many years ago we were trying to deal with maternal mortality, among other things. The partnership that we came up with, that worked for us in that particular context, was actually religious leaders and traditional chiefs as the ones that needed to be convinced - not 100 per cent but some strategic window of opportunity where there can be agreement between the objective you are pursuing as an NGO and how much a religious leader or a traditional chief is able to give at that particular point in time. Where those two came together we were able to actually get imams and paramount chiefs to become the advocates for a certain number of behaviours which made it possible for women to then take on certain roles and get into certain practices which had been perceived as contrary to tradition and contrary to religion before. To get those changes to happen in my view is going to need, in addition to legislation in national assemblies and parliaments, the creation of those kinds of partnerships where the other person that people listen to, be they a father or a religious leader, a traditional leader, undertakes to participate in certain changes, such as putting a girl in school, for example, which we know has a number of multiplier effects down the road. That is what I would like to add to what Julia said.

Q68 Mr Singh: Save the Children believes that the primary healthcare system is near to collapse. What are the main weaknesses that we need to address to prioritise it? Is it a staff shortage or lack of drugs or an absence of clear responsibility for delivery of care? How, in your view, should it be prioritised?

Mr Tall: In my view if you look at the healthcare system in the four states where we are engaged with health programming there are two things that we are focusing particularly on. I mentioned revitalising routine immunisation as one area of focus and the other one is improving maternal and child health. Availability of services is an issue, the quality of the services is an issue and financial access, the cost of those services across the board, is an issue. In terms of availability and quality the responses are of a type where we are working at a state level. If you take either of the two projects what we have done is put people in the state level ministry of health to basically help make sure that the systems that are put in place work better and are able to deliver, whether it is vaccines or drugs or training, to the body of health workers in the state. In terms of quality training is one thing but also just being able to support and monitor what happens in terms of quality of diagnosis. Again, a lot of this is relatively simple and focused on the primary healthcare level, and if I look at child health in particular in Nigeria we know that there are a limited number of pathologies that create the biggest risk. If it is malaria, for example, how well does your health worker diagnose and treat malaria whenever he comes into the clinic, or some other pathology of that type. The third barrier is that of cost. We have traditionally advocated away from user fees in Save the Children because, again, when you have somebody who is spending 70 per cent of their income on health, who is expected to have 20 per cent more going into food because of the financial crisis, 12 to 20 per cent into education - the elasticity wears out fairly fast and, as a result, people start adopting behaviours that are counter-productive for the long term such as not seeking healthcare just because they cannot afford it. With the state level as well as the national level we have pushed for not having user fees, we have pushed for at least targeted support to categories of people who would be going without healthcare otherwise to make sure that they can get free healthcare. I do not recall the exact practice in Nigeria but in other countries that has been translated into exemptions for children under five for example or exemptions for pregnant women.

Q69 Mr Singh: You have already touched on the poverty and people's reluctance to seek healthcare because they have to pay for it, and then the priorities come with food and education. What can donors do to help to reduce that cost and encourage people to take up the services? You have touched on that briefly but is there anything you want to add?

Mr Tall: One of the things that has been talked about is revolving drug funds, for example, revolving drug funds which remind me of similar initiatives in the 1980s called the pharmaco initiative, where basically you find ways of providing an initial stock of drugs free of charge which are sold to patients and then the proceeds are used to replenish the stock. That is great in terms of availability of services, to make sure that when people come to the clinic if you have a headache there are tablets to give you so that you do not end up with people travelling a mile or two, coming there as health workers but the place is empty otherwise and then they do not come back. We are saying that it is useful in terms of availability of services but it does not necessarily help on the cost side, so one of the suggestions we would make for the use of revolving drug funds is that you get some exemptions attached to them for certain categories of the population. For example, if you have something where there is community engagement they are in a position to identify which might be the most vulnerable families in that community who may need an exemption. Another method that is often talked about and which we think has some degree of promise is some type of social transfer, some type of social protection programme, be it a mutual society or some type of health insurance where poor people can be covered. It can be either universal, which is easier to administer, or in places like Nigeria it can be targeted when at state level you are talking about fairly large numbers of people. Here again, going back to an earlier point, I do not believe that for social protection programmes they should be funded from the outside, they should be a project, because if they are a project then four years down the road or five years down the road when that donor is no longer supporting that particular activity, it tends to just stop and in the meantime you have a million people or two million people who have been on that programme and who all of a sudden are without coverage. I would suggest that this could become one of the areas where donors should use their leverage to make sure that it is largely funded from national resources.

Q70 John Battle: In the evidence paper submitted by Save the Children on DFID's role - and it is really DFID's role that I want to explore a bit more here - you say "Save the Children UK acknowledges that DFID, in many ways, can be seen as a model donor in relation to pro-poor health financing and an important influencer of national governments as well as bi- and multilateral institutions." A bit earlier on in the submission you say: "DFID is playing a leading role in shaping the way health resources are used and allocated, issues of staffing and management, and service quality. While this approach has much to commend it, the real test of the investment is what it means for the poor, particularly at the community level. DFID has the capacity and the opportunity to support health policies and the development of service delivery models aimed at the household and community level, not simply those aimed at improving health facilities." I was a bit confused having read that whether you were being critical of DFID for not doing enough at the community level or whether you were really saying that supporting the capacity of the federal and state system to provide health systems was the priority. What is your view on that, should they be working in health systems with the government fulfilling the responsibilities of providing community health systems or should they be involved in projects. Where is the critique that you are trying to provide there?

Mr Tall: The way I interpret that is I mentioned the focus on the MDGs, the focus on donor co-ordination and bringing the various parties around the same issues. That is a significantly positive role that DFID has played and continues to play. The health systems, absolutely; in my view you need those systems to perform better in a sustained fashion for there to be hope in the future, so that kind of focus needs to continue. What I think is being suggested is that there may be a certain number of other strategies on the demand side that we should also maybe ask DFID to put additional emphasis on, stuff like access for certain categories of the poor to those health systems that we have now helped to rebuild. In other areas, not in the health sector but in civil society organisations voicing accountability, some work is being done with DFID support to make sure that they do have a much stronger voice in what goes on in these health systems at state as well as at community level.

Q71 John Battle: What were you thinking of then where you say "DFID can be seen as a model donor in relation to pro-poor health financing ..." Are there some examples of where DFID is very effective at improving the healthcare in general in Nigeria? I can see the drive to develop community level participation for the poor but what were you thinking of as a model for pro-poor health systems? An example of what DFID is doing well is what I am looking for.

Mr Tall: What would come to mind, again staying with the health sector, is that it is not just a question of saying, you know, here are some resources at state level, go ahead and do it, it is a construct as much as I understand it where, with DFID's support, there are additional actors that come in - the Save the Children, the VSOs of this world and others - and are working with the state level and are basically trying to extend the performance of the health systems all the way to local government and community. It is making sure that, again in terms of availability and access in physical terms, your poorer people who happen also within each state to be more away from the centre and to be more rural do have access to those health services. Even with the initial proviso that I added to it, it is supporting revolving drug funds to make sure that services can be provided when patients arrive at these places; that would be part of the elements that are working well. Revitalising routine immunisation as opposed to just a campaign-style all the time creates a certain degree of predictability in the availability of service. Where again we think there can be additional emphasis is on the demand side, should we doing more there for the populations. For example, in the earlier case we mentioned in the North East where we have a fairly low percentage for uptake of services should we be doing more there to increase the level of demand for movement towards those systems that already exist.

Ms Ajayi: Can I just add about SNR and the response through that programme, although it is not specifically health and I cannot really comment on the PATHS programme, but in terms of the health element of the HIV/AIDS response what DFID has been able to do is to help the SACAs within the states where the programme has been supported to leverage more funding from the state governments to have a higher profile in terms of the HIV/AIDS response. There is no doubt by looking at the HIV/AIDS work supported by SNR that those states are performing better than the other states, so to me that is real evidence of where DFID has actually contributed to that progress.

John Battle: Thank you for that, that is helpful, that structural impact, but one of the things that is most startling - I believe it was Mr Tall who mentioned the MDGs and can we keep those in the bracket. We did a report on MDG4 on maternal health - and there are miles to go in terms of reaching that internationally, but Nigeria, with two per cent of the world's population has ten per cent of the world's maternal deaths which is incredibly high. I wondered what are the reasons for that and how could they best be addressed by DFID and others, because when you are talking about demand-led it does seem that Nigeria is falling well behind on MDG 4 in particular.

Q72 Chairman: Before you answer that, again the disparity within Nigeria is just huge. In the North it is about ten times so in reality if it is five times across the country it probably means it is 20 times or more. What are the reasons for that? I mean, that almost implies there is the capacity within Nigeria to address the problem if there was the will, but I am perhaps prejudging the answer.

Mr Tall: Starting with that point at least, part of the construct is that in northern Nigeria it is more the exception that you would have deliveries in institutions, most deliveries happen at the household level and by the time a patient with delivery complications gets to an institution often times it is very late. It seems like a fairly straightforward action, but changing that behaviour to the point where deliveries would happen in institutions with skilled attendants and the like, the reflex of your normal northern Nigerian person is away from the institution and more at home, and that may be part of the reasons why it is so much higher in northern Nigeria.

Q73 Chairman: From our report there were two things that came out, one was that a significant factor was young marriage, young girls basically having children when they are not fully developed - that was a contributing factor to high mortality and that would appear to be congruent with what is happening in the North - and the other was something in the attitudes of men towards their womenfolk, to basically say "Just get on with it", not allowing them transport and not allowing them access. The first one would definitely seem to be an issue, I do not know about the second one, but how do you address that if that is the cultural environment you are in. Is it a job for agencies like yourselves and DFID to do that or is it the job of the local leadership, whether it is direct political leadership or traditional leadership or the imams? How do you bring all that together?

Mr Tall: My experience, not in Nigeria but elsewhere, has been that, yes, there is a role there for development partners in general to play there, absolutely, but the way I have seen it work in the past is not so much an initiative that would take people to the hospital as a way of responding to it, but dealing with those who are making the decision. It is the man in the house who just says just get on with it, there is nothing serious here, it happens, just do it, and then the worst outcome often results from these sorts of things. In another country in West Africa, and this is not national, this is a subset of a country, over an 18-month period we had one death related to delivery, one. It was nothing complicated; it was understanding the social and cultural structure of that region and in pregnancy monitoring the maternal mortality reduction of that particular grouping in that country in West Africa. You had a fairly respected woman, because they had a title within the social structure of the village, who took on the role of monitoring all the pregnancies within a particular geographic area, a geographic area that is also the kinship area most of the time. When they saw one or two or three of a number of signs they made sure that that woman got to a health centre and if they needed to be closer to a health centre at delivery time they saw to it that the husband or the father-in-law made the decision to help that woman move to be near a facility for delivery. This was in the Gambia and it was the idea of a young Gambian health worker by the name of Imran Agaju. It was not costly in terms of money but it was brilliant in terms of understanding the local context and creating solutions that take advantage of the roles people generally play, in some cases extending that role a bit more for an objective that they would tie into. In northern Nigeria I would see for maternal mortality, for early marriage, a number of these social and cultural factors that are determinants of mortality and I would think that that kind of approach would be something that development organisations can support with traditional leaders as well as with the political leadership, the lay leadership at state and federal levels.

Q74 Andrew Stunell: I just want to say very briefly that whilst we were in Nigeria we saw a programme that is being supported by DFID on informal midwives in remoter communities. There seemed to be some resistance actually from the medical profession about doing that.

Mr Tall: Yes, that is common. With primary health care workers back then there was initial resistance among the professional community and there is a long debate going on around traditional birth attendants and how effective or ineffective they are. There are probably some good reasons for that that we need to be mindful of so that you do not create a core of people with very little knowledge who do not believe that maybe they can do everything, so there are some dangers there. However, it can work and in the case that I cited one of the things that we ended up doing is creating a partnership so to speak between these kabila heads as they were called in the Gambia and the heads of the health centres so that they knew exactly who these women were and when they brought someone they knew this is referred by Isa Tujani from Village A. It was that kind of relationship and, again, over a fairly short period it made a significant difference. When I was in the Gambia at the time working for Save the Children, this was one of the findings that I sought to take to a national scale. I have not been back to the Gambia recently and one of the things I intend to do whenever I get the chance to is to see if actually any of this became a national strategy or national programme.

Q75 Mr Sharma: HIV is a major issue and Nigeria has the second highest number of people living with HIV in the world. What are the reasons for that and how can we reduce it?

Ms Ajayi: The first point is that whilst Nigeria has one of the highest rates of infection in absolute numbers of people the percentage of infections actually is not as high as in some countries. Because the population is so large there is a large number of people infected - some statistics say up to three million, but actually as a percentage of the population it seems to be dropping and it is still only around five per cent whereas some other countries in the world, as we know, are much, much higher than that, so it is important to recognise that in terms of prevalence rates. Sorry, what was the second part of your question?

Q76 Mr Sharma: How can this rate be reduced?

Ms Ajayi: Certainly for us we look at two strands. The prevention and stigma has been a very important part of programming and has been something that SNR have supported work in, and that runs through our own HIV/AIDS programme outside of SNR as well. Now as we move through the stages of the epidemic we are also looking at care and support, so we are not only working on messaging around the need for prevention and stigma reduction but also recognising that there is an increasing number of orphans involved and children through HIV/AIDS, that they need to be cared for and that there are increasing opportunities to increase the amount of care and support that people receive at home. Some of the ways that we have been working through that are not only through the SNR programme but also through a national volunteering programme. there was actually something that I wanted to raise as well with the health question of looking at increasing civic responsibility and active participation, with people volunteering in their own community. Within VSO we call it national volunteering and we have a support in midwifery, with midwives actually volunteering in a project called Gaia. Within HIV/AIDS we are also supporting partners that are running volunteering programmes, so it is being able to increase the response to carer support programmes with limited resources by actually encouraging the idea of people volunteering within their own community. Lots of volunteering goes on anyway, there is much volunteering throughout churches and informally in family structures and local communities, but we are actually working with partner organisations to try and help them to formalise it and manage volunteer programmes as they grow, making sure that those community volunteers are engaged in work that is meaningful and that they can benefit from as well as individuals. That is some of the work that we are doing. Also, as I said before, advocacy is an increasing area of need in all of our programme areas and through work with civil society organisations to advocate for a stronger response, we think that that is important to support as part of our package. We are working at state level but we also have a relationship with NACA (the National Aids Council) and again it is support at the federal level, at the state level and then at the community level through support to CSOs, so that is certainly how we are trying to address that as are other organisations.

Q77 Andrew Stunell: Once again women seem to be at the bottom of the pile with a higher prevalence rate than men. What do you see as being the factors at work there and are they actually getting access to drugs and support or not?

Ms Ajayi: One of the points as well from the health questions was that in terms of looking at gender and equality we of course have to look at men and women. We know that the statistics show that there are much higher infection rates for women, but obviously that is related to the power relationships between men and women - women not being able to be in a position to negotiate safe sex, negotiate use of condoms. There is also some evidence of transactional sex with many vulnerable women, especially those selling, for example, fish in fish markets, needing to gain credit and using sex to do that because of them not having any capital to be able to have the credit when they need it to access markets, and so the whole area of livelihoods and economic empowerment is also contributing to that. There is lots of debate on that as well and other evidence of inter-generational sex and early childhood marriage in certain parts of the country, so there are many contributing factors in terms of why women are more vulnerable. I have not brought a copy along today but we actually worked with Action Aid to produce a report called Walk the Talk and that has some specific evidence from Nigeria; if you are interested we can get you a copy of that.

Q78 Chairman: We have seen that but we would like a copy, please.

Ms Ajayi: We will get that to you.

Q79 Andrew Stunell: In terms of access to drugs and treatment, would you say that is gender-blind or not?

Ms Ajayi: No, I do not think it is gender-blind but there are some of the same issues that Abou was talking about earlier in terms of access to services. Access generally is often lower for women and, as I understand as well, some of the drugs that are available for women in Nigeria to prevent transmission from mother to child are some of the less effective ones, so there are issues of new technologies needing to come to Nigeria to be supported and to come and meet the challenge of maternal and child infection as well. Looking at general health, the HIV/AIDS responses as I am sure you are aware have been very donor-led in Nigeria and whilst some of that work has been to work with the state SACAs and with NACA to try and join up the response and also bring government funding on board, it still is very donor-led. We need to look at trying to bring it together with health programmes and not have separate programmes running in parallel because of course for women and their HIV-positive children it is the general health of the mother that dictates so much about the life expectancy of herself and her children. Actually, therefore, it is not just about the drugs that are on offer but also her own access to health education, to basic family healthcare services, and I think that we should be looking more and more at how we join up those services.

Q80 Andrew Stunell: That leads me on to my next question which is how effective is DFID's programme in Nigeria. Are you saying it is a little bit superficial, it needs to be more closely embedded with, say, federal provision, or how do you see it?

Ms Ajayi: From what I have seen with the state-level programmes implicit in the funding of the different programmes is the need for those programmes to work together, and because there is the overlap in the lead states that gives the opportunity for PATHS, for ESPIN, for ENR to all work together and that allows the joining up of the programme and the integration of those different elements of it. Certainly from what I have seen of emerging ENR and PATHS too there is collaboration and so the more of that that we can have the more those responses could be joined up.

Q81 Andrew Stunell: If VSO had more support from DFID would it be able to do more? Is there a capacity issue as far as VSO is concerned about how you can contribute to that?

Ms Ajayi: Within SNR we were one of the partners, we are not in the consortia for ENR so that will mean that some of the activities that we were able to do under SNR we will no longer be able to do unless we have additional funding from elsewhere.

Q82 Andrew Stunell: Could you say what the difference between the SNR and the ENR is?

Ms Ajayi: SNR is Strengthening Nigeria's Response and that is coming to an end on August; ENR is Enhancing Nigeria's Response and that is the five-year programme that is in its inception year now.

Q83 Andrew Stunell: And you are not included in that?

Ms Ajayi: No.

Q84 Andrew Stunell: Was that your choice?

Ms Ajayi: No, we joined the wrong consortium. We were part of a consortium that bid for those funds but it was not the successful one. We still feel that we have a role to play in that and we are talking to ENR about how we might take that forward, and to DFID. We also through SNR have established relationships with the SACAs themselves, so there are some requests coming from the state agencies for support from VSO, and what I am keen to do is to make sure that that is all joined up, because at the end of the day it is about ENR helping to continue the support to SACAs. If we are doing it, whether it is through ENR or not is slightly irrelevant because actually what we need to do is to all work together to make sure that the SACA can implement the programme more effectively.

Mr Tall: Maybe I could make two additional points. The first one is to just draw attention to a category of possible victims of HIV/AIDS and those are the orphans and other vulnerable children. They may not be infected themselves, but they are certainly affected because of the loss of a parent or both parents in some cases, or because of a number of other factors. There is therefore a protection dimension of the HIV/AIDS pandemic that I just want to underscore so that we keep it in mind as we talk about response and access to retrovirals and other things. That is one point. The second point is around the way that funding is made available, particularly in Nigeria, through consortia bidding. There I would like to suggest that maybe within a given programme where things are outlined for NGOs like VSO, like Save the Children, like local civil society organisations in Nigeria, some of those resources could be earmarked separately and not as part of the overall competitive bidding so that NGOs can access them in line with the larger programme that DFID will have developed jointly with the Government of Nigeria such as ENR or PRIN or education and the like. That would make it a bit easier for NGOs who are not necessarily competitive at the level of those big consortia to be able to bring in that community dimension, that LGA dimension that those bigger actors have a hard time getting control of. It is to have separate earmarks for NGOs to come in, lined up with the overall programme, without going through commercial processes. There should still be some competition but not of a commercial bid type where you are in one programme but you cannot continue because camps get formed and people will quote unquote go to war against resources.

Q85 Andrew Stunell: The ENR programme is a DFID-driven programme, is that right?

Ms Ajayi: It is one of the suites of state-level programmes. I also just wanted to mention about FLHE (Family Life and Health Education) which is a new part of the curriculum in Nigeria which some states have adopted and some have not. Just in talking about a co-ordinated response to HIV and AIDS and joining up between programmes, something like that which is very fairly within the educational sector but actually is part of the curriculum that looks at sexual and reproductive health, HIV and AIDS and general health awareness for secondary school children, is to me something that is very important and cuts across the different programmes. Being able to support that within the rollout and delivery; we are trying to do that and also advocating for that to be taken on board is another example of where we can use vehicles that are already there within Nigeria to actually make sure that we are delivering lots of different elements, not just through education or health because that cuts across.

Chairman: We are moving to education now. Mr Marsha Singh.

Q86 Mr Singh: Education in Nigeria is in a pretty dire strait, is it not, in terms of service delivery and Nigeria tops the world list of countries with the most out of school children, which is pretty poor, and the majority of those children are girls. I must express a slight disappointment that in neither of your submissions has gender equality really featured as a part of your submissions, but I would like to try and speed it up by asking three questions in one. What, in your experience and in your view, are the major obstacles that prevent girls accessing education? Do either of you know about the UNICEF Girls' Education Project which has succeeded in increasing enrolment of girls in northern Nigeria - if you can comment on that then I would be very grateful for your views. Then a thorny question really, DFID is supporting in the North Islamiyya schools which are trying to run some form of integrated Koranic and secular education but should DFID be doing this or should DFID be concentrating on state schools?

Ms Ajayi: In terms of major obstacles for girls accessing education, certainly as you say the gender disparity is mainly in northern states. There are areas of Nigeria where actually the figures are completely reversed, so the culture in some areas is that actually the girls go to schools and not the boys - so there are particular and regional differences as we have talked about before. Overall, obviously, the picture is that girls have less access to education. There are many reasons for that and I know that there is a programme in northern Nigeria where they are looking at bringing girls who are hawking on the streets back into school, so often in the North you will see many young girls outside school hawking things in markets or walking around the streets and so on, so that is one reason they are often taken out of school, to earn and to help contribute to the family. We know that there are problems with water and sanitation in schools so when girls hit puberty and there are no facilities in school it can be very difficult for them to stay on, and I know that Water Aid have been addressing some of that through their work. Obviously in the North there are areas where early marriage is part of the culture and girls are not expected to stay in school and some of them are not even starting school. Also, the aspirations for many girls from the family are that they will be married and therefore in terms of education, with limited funds to invest in children's education, the boys are seen as a better bet and more able to have a reward from the investment needed. Although we can talk about universal basic education we know that in Nigeria there are many fees attached to sending a child to school, so there is really not a totally free education system - there is uniform, books, often PTA levies and so on if not school fees. All of those factors are contributing to girls not being in school. I cannot specifically comment on the UNICEF programme, I do not know it well enough to be able to do that, but I want to pick up on your point about gender not being addressed in the submission. It is something that within our programme in VSO Nigeria we are very well aware of and I think I made reference to it earlier in that we know we need to do more in terms of our agenda programming as well. As I said earlier we are looking at gender audits within our own office and our own staff and then within our partners to look at first of all what is going on before we then look at ways in which we can address those imbalances within our organisation, within our programmes and within our partner organisations. I take your point there, I think you are right and as the debate about gender continues I do not know if it is louder than it was before but certainly for us in VSO Nigeria and VSO generally it is becoming a much louder voice that we want to respond to.

Q87 Mr Singh: I make the point because women actually suffer the most from poverty and empowering women may be the way out of poverty as well which is why I think it is important.

Ms Ajayi: We have three programmes in Nigeria - we have education, HIV/AIDS and secure livelihoods - and within all of those programmes women are the target group. In HIV/AIDS it is also orphans and vulnerable children and in secure livelihoods we are going to be looking at rural women and support there in terms of access to markets. Although it is not specifically there, it is also running throughout the programme because we realise that we have to address those issues in Nigeria for it to make an impact.

Q88 Mr Singh: Do you have any comment on the Islamiyya schools?

Ms Ajayi: Islamiyya schools are not an area that we have worked in. My only comment would be that any interventions that can be shown to have some success are worth doing. It is a brave move by DFID and we need to be creative in our response. I do not think we should carry on just doing what we have always done, so it is a good move so long as it is properly evaluated and learning is taken from that. Islamiyya schools are certainly there to stay in northern Nigeria, they are not going to go away, so whatever one might think about whether they should or should not be there it is a very important part of the local education system, so a certain proportion of children are going to go to Islamiyya schools. We were talking about religious leaders and we know through other work how important religious leaders are and what a strong message of support to programme interventions they can give, and we certainly had experience of that in our HIV/AIDS work through SNR. If religious leaders - imams - are able to encourage girls going to school into Islamiyya schools and there is support to widen the curriculum that is a very positive move.

Mr Tall: Just two quick things, one on UNICEF's Girls' Education Project. Generally it has three elements: one is distance to school, where there is an issue that girls are not going to school because you have ten kilometres to go to school. That is one factor that they try and address and get the schools as close to the community as possible - that is one. The second one is the presence of female teachers in those schools and the third one that Julia mentioned is water and sanitation facilities. Those usually are three of the factors that you would find in a number of girls' education initiatives that UNICEF would implement. If you look at those three, you have got at least the distance element often taken care of through Islamiyya schools because usually those are inside the community so they do respond to that factor, number one. Number two is that they are integrated, they are not just focused on learning the Koran, the curriculum is opened for students to do a little bit of maths, a little bit of English, a little bit of French, a little bit of history - that is literacy as well. If our objectives in part are to widen that young girl's horizon and to increase the number of years of schooling with an anticipated impact on fertility, on maternal mortality, on the health of the child, if we are able to cater to those objectives through public schools as well as other community schools, Islamiyya schools, it participates towards the same objective and it is a bold move that I think is worth supporting.

Q89 Mr Sharma: When we were talking about health we said that due to the financial difficulties people do not take it up and a similar thing happens when the priority becomes food or education and the education is cut. How can we assist to meet the cost of that education for those families who cannot afford it, and are social protection programmes likely to be an effective mechanism in this respect?

Ms Ajayi: The support that DFID has given to some of the livelihood programmes, which we have not talked about, is very important because we need to look at being able to strengthen the livelihoods of the poor people that we are working with and for to be able to access education and to have opportunities when they finish. I know that there is some DFID work going on with the private sector in connection with some of the agricultural programme, and that is certainly something we are looking at within VSO as well, so to me it is very important that we carry on doing that. Unless we can have some of the other interventions and social protection in place the value of education is lost so I cannot see that we would only support those without the other programmes around, so maintaining the integrated approach through looking at support to health, to HIV/AIDS and so on is very important.

Mr Tall: Definitely social protection should be one of the mechanisms, social protection defined as protecting or supplementing family income, social protection defined as - this all goes in the same direction - maybe certain fees being removed and families not having to pay them, whether that is bringing your own bench to school or bringing your own set of textbooks to school or, if it is a school lunch programme, there are a number of initiatives within the social protection programme that would be aimed at reducing the out of pocket expenses that families would have to put in to support a particular child going to school. There are other elements of the social protection programme where, for example, families choose not to send their child to school because the child has to work to contribute to the income of the family and where some substitute mechanisms mean the family might be able to engage in activities that would make that income while the child is going to school and leverage the going to school for whatever that supplementary income would be. Those would all be elements that can be part of the response to low involvement rates. The gender dimension we have covered; we have mentioned earlier today the need to hold other levels of government accountable for transfers that need to be made within the system. If the federal government is putting X amount of money in education in State A that, as part of the Publish as You Pay initiative, needs to be very specific and very transparent and cascaded down all the way to community level to engage communities in the management of those schools in partnership with the school authorities.

Ms Ajayi: I did not make any comment on the cost of education and you talked about fees. There are lots of hidden charges and some of the work to help support states to be able to draw down funds that have not been accessed by states through increasing the capacity of ministries of education at state level is commendable because obviously the more funds they can draw down the more will reach the school. One point that has been made by many heads that we have talked to is that they do not feel in control of their own school budget and often they do not have a budget deployed to them to be able to manage the school, so looking at that and again advocating for support at school level to be able to do that will then reduce some of the pressure on children and families having to contribute. One could make that assumption, but starting to have more funds coming down at the school level would be a positive move. When we talk about possibly supporting school fees we do need to talk about the quality of education at the same time.

Q90 Chairman: We are coming on to that.

Ms Ajayi: Okay. Obviously, there is varying quality and quality is a real issue in schools at the moment. Many children are paying money to go to schools, sometimes in classrooms with very few teachers, so deployment is also an issue. Deployment in the health sector is an issue as well.

Q91 Mr Sharma: Before you go on let me put my question. We identified, as you said earlier, poor quality teachers, lack of school buildings and materials as the three major areas of weakness.

Ms Ajayi: Yes.

Q92 Mr Sharma: What action should donors be taking to support the three tiers of government - federal, state and local government - to address these three areas? You started answering the question rather than me putting the question first.

Mr Tall: Do you want to continue on that?

Ms Ajayi: Building the capacity, working with state ministries of education to implement the changes and reforms that they need to. I know some of those are going on in colleges of education and we are involved with volunteers in colleges of education in some of the DFID lead states in looking at entry qualifications for teachers into colleges of education and looking at teacher salary scales so that the professionalism of teachers and the teaching profession is raised again. Merely building schools, we all know, is not going to be a long term solution, and although there are infrastructural problems the actual school management is important, with support to heads to be able to better manage their schools, looking at continuing professional development of teachers and of heads, building up the capacity of inspectorate teams to be able to make schools, heads and teams accountable and also deployment. We have not mentioned deployment before but we know there are schools where they are overstaffed and rural schools that are understaffed, and we need to actually take that as a point of advocacy really to try and have a better spread of teachers into different areas.

Q93 John Battle: Could I ask about something we have touched on, perhaps as our last topic, and that is civil society, because there is a general view that there are a lot of organisations in civil society, but the question would be how effective and how representative they actually are. Would you like to say something about their effectiveness in Nigeria?

Ms Ajayi: Yes, I would love to, because civil society is key to what we all do. I do not think we can only work with civil society, we have to work with government - and we should do at different levels - but the fact is that many civil society organisations, and if we include within that religious organisations, though we might not call them civil society organisations, are carrying out service delivery in Nigeria.

Q94 John Battle: When you say "religious" do you mean churches and mosques basically as formal organisations.

Ms Ajayi: Yes.

Q95 John Battle: Not the subsidiaries of those organisations.

Ms Ajayi: No, as formal organisations. Together much service delivery is happening because of those groups. Yes, there are opportunistic civil society organisations or NGOs, yes there are some that do not have legitimate constituencies, but we know that there are also organisations which are working at community level delivering holistic programmes that are really making a difference. We need to know who they are, we need to work with them and we need to make sure that the work we are doing with those organisations complements the work that often other organisations are supporting them with. There are legitimate civil society organisations and having worked in Nigeria 12 years ago I have seen a growing movement which is very positive.

Q96 John Battle: Quite clearly when you look at civil society organisations you look to NGOs and groups who are campaigning under health, the walking group, the group that was with racism, but who would not go to the mosques and the chapels and the churches. Advocacy groups are different from the religious groups but is it these religious churches and mosques that are actually directly providing services in Nigeria?

Ms Ajayi: Some of the bigger churches do. Thinking about Ecowa, Koki and some of these very large churches, they have very big social protection programmes in all areas and some of them are providing services. We talked about their congregation volunteering in Yobe's care and so on, so they are doing a lot of work and are supported obviously by some of the other organisations.

Q97 John Battle: To develop the capacity of civil society organisations what should the donors, including DFID, be engaged in doing practically? Should they be going to the mosques and the churches and work with them or should they be working with amnesty groups? I think of civil society as being tenants' movements or residence groups and that kind of approach really, community action groups. Is that the need, or how do you see donors working to develop the capacity of civil society?

Ms Ajayi: It needs a longer term approach. Developing the capacity of civil society organisations cannot be done overnight so there needs to be a long term commitment to working with civil society and a long term commitment to the organisations being able to make a difference, and a recognition that civil society has a role to play. That has not always been the case and the first step in that - and it is something that we are looking at - is organisational assessment of organisations. We are doing that over long periods of time, to actually say what is an organisation's need, not just is it an issue-based organisation.

Q98 John Battle: For example, I know from work in my neighbourhood that there is a site for travellers and gipsies, so I would ask are they included or are there some groups left out? I am assuming that that is true in Nigeria as well, that there are some groups that have not been developed strongly enough to have a voice. Would you be in your assessment seeking out those groups that are not represented and do not have a voice? They could be rural migrant groups - I am thinking of nomadic people and so on.

Ms Ajayi: Yes, we do, we supported some work with nomadic schools in Naasarawa State so, yes, there are and I actually think that the programme funding for us, for example, through DFID and other donor funds, is where we are able to support those organisations, because they are organisations that do not have the income or even the organisation to be able to do that. We are, through additional support, able to do that and often with our volunteers that is sometimes an additional involvement that they have, so they are doing it alongside their main role.

Q99 John Battle: Bringing groups together around themes nationally, do you get involved in that as well?

Ms Ajayi: Yes, and again that is something we have been able to do with DFID funding, to bring our partners together within HIV/AIDS programmes to look at advocacy, to look at work with certain groups, and in education as well looking at skill-sharing between volunteers and their partners.

Q100 Chairman: Given the issues, especially in the North, do there need to be more and stronger groups for women and girls because there seems to be a lack of advocacy there. We did meet one particular group which was a Sharia Women's Group but we got the impression that there was not really enough activity on their behalf generally - that that was an exception in other words.

Ms Ajayi: Yes, I would say that we need to seek out those groups and we need to do more work with them and certainly when we strengthen our gender work that is something that we will be looking to do, and also developing relationships with national level organisations like the Women's Development Centre, the Federal Ministry of Women's Affairs, the Women in Nigeria State Chapters in some states which are also quite strong.

Mr Tall: There is maybe one group that we may not often focus on and that is all the national Diaspora. If you take a particular state or a particular community there may be many citizens of that state or that community that live elsewhere in Nigeria, and they usually contribute a lot through remittances, through other forms of engagement, in development back in the areas where they come from. Usually they are in associations - village development associations, state development associations - which could probably be useful partners at a state level or a local government level which usually do not figure clearly in our plans. Julia mentioned the national level issue-based ones that might be useful - for example, there is a fairly effective organisation in the health area which is a national, advocacy-based civil society think tank on health issues that is able to help drive a number of elements on the health debate around the country. Those may be useful and similar ones may be focusing on some of the gender elements and some of the social cultural practices that may be part of the problem in northern Nigeria. Another obvious partner is that there is usually a national ulemas and religious leaders' association that might be useful to draw in to address some of the disparities that we see in Northern Nigeria as well.

Ms Ajayi: I do think that civil society organisations have a real challenge in terms of accessing funding and the reality is that if they are to do work they will need to be able to access funding, and some of our support has been through helping them look for funding strategies and where to access funds but it is an ongoing challenge.

Q101 John Battle: Everywhere.

Ms Ajayi: Everywhere, I agree, but particularly in Nigeria.

Q102 Chairman: Thank you both very much indeed for all of that, it has certainly added a lot to our understanding of the issues. As I say, we have the minister next week and our report will be produced during the course of the recess. As I said at the beginning it is a challenging environment, but on the other hand there are people like yourselves engaged in it along with DFID. The way DFID put it to us is that sometimes getting results in a big picture can be depressingly slow or invisible and you have to celebrate the small victories on the way and then hope that gradually they will coalesce into something bigger. Thank you very much for coming to give evidence.

Ms Ajayi: Thank you.

Mr Tall: Thank you.