Desk reviews on gender and social inclusion issues affecting service quality, health care access, and health systems in Nigeria

The United States Agency for International Development (USAID) Integrated Health Program (IHP) in Nigeria, led by Palladium, is positioned to reduce child and maternal morbidity and mortality and to increase the capacity of the health system to sustainably support improved access to and quality of primary health care services. Globally and in Nigeria, gender is intricately linked to health access and reproductive, maternal, neonatal, child, and adolescent health, plus nutrition and malaria outcomes.

IHP partner WI-HER conducted a series of desk reviews to identify gender and social inclusion issues affecting service quality, health care access, and health systems in Bauchi State, Kebbi State, Sokoto State, Ebonyi State, and the Federal Capital Territory. WI-HER’s thorough review and synthesis of peer-reviewed publications; USAID and other donor reports; government policies, reports, and budgets; and other related grey literature support better understanding of the health status of women, men, girls, and boys and the social, economic, and political factors that influence health outcomes, including gender inequalities. These desk reviews include targeted, evidence-based recommendations to integrate gender and social inclusion considerations in each of the five states across IHP programming.

Read each of the detailed reports below to learn more about the gender and social inclusion issues affecting health in Bauchi State, Kebbi State, Sokoto State, Ebonyi State, and the Federal Capital Territory (FCT) in Nigeria.

Gender, Social Inclusion, and Health in Bauchi State

BAUCHI Full Gender Desk ReviewDesk review on gender and social inclusion issues affecting the USAID Integrated Health Program in Bauchi State, Nigeria – USAID IHP Task Order 03

Authors: Taroub Harb Faramand, Allison Annette Foster, Kelly Dale, Kate Roberts, Megan Ivankovich, Maddison Leigh Hall, Morgan Mickle, and Tisa Barrios Wilson

Statistics from Nigeria – particularly on maternal and child mortality, malaria, HIV/AIDS, and TB burden – highlight the country’s pervasive poverty, rampant inequality, lack of education, and insufficient access to services, among other gaps in education and health services in the north-east of the country. In support of improved health outcomes in Bauchi State, this review examines the health status of women, men, girls, and boys – along with social, economic, and political factors – and offers recommendations on how to address gender and social inclusion considerations, particularly as they relate to health care and related health and social factors.


Faramand, T.H., Foster, A.A., Dale, K., Roberts, K., Ivankovich, M., Hall, M. L., & Barrios Wilson, T. (2020). Desk review on gender and social inclusion issues affecting the USAID Integrated Health Program in Bauchi State, Nigeria. Palladium International, LLC and WI-HER, LLC.

Gender, Social Inclusion, and Health in Kebbi State

KEBBI Full Gender Desk ReviewDesk review on gender and social inclusion issues affecting the USAID Integrated Health Program in Kebbi State, Nigeria – USAID IHP Task Order 04

Authors: Taroub Harb Faramand, Allison Annette Foster, Megan Ivankovich, Mitali Dahanukar, Morgan Mickle, Tisa Barrios Wilson, Kelly Dale, and Nafisa Zaki

Kebbi State is among Nigeria’s poorest performers in terms of health indices, especially in child mortality and maternal health, malaria, pneumonia, and diarrhea. Furthermore, gender is intricately linked to health access and reproductive, maternal, neonatal and child health, plus nutrition and malaria (RMNCH +NM) outcomes. This desk review addresses the underlying causes – including inequitable access to health information and services – and identifies gender and social inclusion issues, as well as state policies, which affect serve quality, health programming, and health systems strengthening outcomes. Recommendations focus on achieving more effective and efficient RMNCH +NM strategies, activities, and sustainable change.


Faramand, T.H., Foster, A.A., Ivankovich, M., Dahanukar, M., Mickle, M., Barrios Wilson, T., Dale, K., & Zaki, N. (2020). Desk review on gender and social inclusion issues affecting the USAID Integrated Health Program in Kebbi State, Nigeria. Palladium International, LLC and WI-HER, LLC.

Gender, Social Inclusion, and Health in Sokoto State

SOKOTO Full Gender Desk ReviewDesk review on gender and social inclusion issues affecting the USAID Integrated Health Program in Sokoto State, Nigeria – USAID IHP Task Order 05

Authors: Taroub Harb Faramand, Allison Annette Foster, Kelly Dale, Kathryn Roberts, Megan Ivankovich, Aisha Ahmed, and Maddison Leigh Hall

Sokoto State, in the north west of Nigeria, has high poverty levels, weak infrastructure and governance, and low education rates, as well as conflict and instability. These factors, among others, contribute to Sokoto State’s poor performance in both health and development indices. With high poverty and limited economic opportunities, several vulnerable groups in Sokoto are particularly affected by poor RMNCH +NM. This desk review identifies gender and social inclusion issues affecting health service quality, health programming, and health systems strengthening (HSS) outcomes, as well as factors that impede sustainable capacity of systems to achieve increasingly positive RMNCH +NM outcomes.


Faramand, T.H., Foster, A.A., Dale, K., Roberts, K., Ivankovich, M., Ahmed, A., & Hall, M.L. (2020). Desk review on gender and social inclusion issues affecting the USAID Integrated Health Program in Sokoto State, Nigeria. Palladium International, LLC and WI-HER, LLC.SOKOTO Full Gender Desk Review

Gender, Social Inclusion, and Health in Ebonyi State

IHP Ebonyi GESI Desk Review ReportDesk review on gender and social inclusion issues affecting health in Ebonyi State, Nigeria – USAID IHP Task Order 06

Authors: Taroub Harb Faramand, Maddison Leigh Hall, Allison Annette Foster, and Emilia Eyo Okon

Recognizing past gender analyses completed under USAID projects in Nigeria, this rapid desk review first synthesized previous gender- and social-included related analyses in Ebonyi to expand on those targeted studies. The team then identified gaps in knowledge and conducted a desk review to address those gaps. Recommendations shared in this review discuss mainstreaming gender and social inclusion (GESI) in health policies and strategies as well as integrating GESI throughout service delivery to strengthen health systems, improve access to primary health care, and improve quality of primary health care in Ebonyi State.


Faramand, T.H., Hall, M. L., Foster, A. A., & Oyon, E. E. (2021). Desk review on gender and social inclusion issues affecting health in Ebonyi State, Nigeria. Palladium International, LLC and WI-HER, LLC.

Gender, Social Inclusion, and Health in the Federal Capital Territory (FCT)

IHP_FCT GESI Desk ReviewDesk review on gender and social inclusion issues affecting health in the Federal Capital Territory, Nigeria – USAID IHP Task Order 07

Authors: Taroub Harb Faramand, Maddison Leigh Hall, Allison Annette Foster, Anne Kpason, and Kenneth Goughnour

This desk review, focused on the Federal Capital Territory (FCT), aimed to understand how gender-based, age-based, or social marginalization constructs hinder or facilitate access to and quality of healthcare services and health outcomes and where opportunities lie to make measurable improvements. In compiling available sex-disaggregated qualitative and quantitative data, findings are shared from prior gender and social inclusion analyses as well as additional information to fill knowledge gaps. Findings are organized around gender and health according to the three objective areas under IHP: health systems, access to primary health care (PHC) services, and quality of PHC services to facilitate operationalization of recommendations.


Faramand, T.H., Hall, M. L., Foster, A. A., Kpason, A., & Goughnour, K. (2021). Desk review on gender and social inclusion issues affecting health in the Federal Capital Territory, Nigeria. Palladium International, LLC and WI-HER, LLC.


The development of these reports was supported by the USAID Integrated Health Program (IHP). The work of the USAID IHP is supported by the American people through the United States Agency for International Development. The project is managed by Palladium International, LLC under the terms of Contract Numbers 72062018D00001/72062019F00002 (Bauchi), 72062018D00001/72062019F00003 (Kebbi), 72062018D00001/72062019F00004 (Sokoto), 72062018D00001/72062020F00006 (Ebonyi), and 72062018D00001/72062020F00005 (Federal Capital Territory). Palladium’s partners on IHP are Jhpiego, WI-HER, PharmAccess, Avenir Health, and Viamo.