Research and Capacity Building for the Promotion of Sexual Health and Well-Being in the West Africa Region
Board of Regents of the University of Wisconsin
System. Courtesy of Africa
Despite three decades of capacity building, there
is still little research on the health problems of
the poor. This is even more acute regarding sexual
health of people in West Africa. Research is essential
in improving the status of sexual health in any community.
Good quality research is a key tool for identifying
sexual health problems and their causes and demonstrating
their importance to the promotion of sexual health
and well-being. It also assists in formulating solutions
and evaluating progress of sexual health interventions.
Sexual health research demands for interdisciplinary
and integrated research. In West Africa, responding
to this requirement poses great challenges to current
research efforts both within and outside universities.
This presentation begins with an overview of the socio-cultural
aspects of sex in West Africa. It then highlights
some gaps in existing sexual health research in the
region and presents some capacity needs for sexual
health research. The paper goes on to suggest some
means of strengthening the capacity of sexual health
researchers. In several respects the paper is limited
to experiences in English-speaking West Africa.
Some socio-sexual cultural
and research issues in West Africa
It is important to put the current paucity of research
on sexuality in some perspective. Until the onset
of HIV/AIDS, sexual life in Africa received little
serious attention from serious researchers despite
the 'great inquisitiveness in Victorian Europe about
African sexual customs and the widespread belief in
the sexual superiority of the African' (Bleek, 1976:25).
The sexual prowess of the African was described as
'unfettered sexuality' either to be envied or feared
(Schoepf, 1991). This was expected because most studies
that dealt exclusively with sexuality in Africa by
this time were mainly anthologies and impressionistic
notes by missionaries and travelers.
In the region, as elsewhere in Africa,
the force of social change resulting from formal education,
increasing urbanization, and the increasing cost of
living, among others, has blended to produce changes
in socio-sexual culture. In Ghana, Nigeria and several
parts of West Africa, it is clear that even in some
of the societies where premarital sex was not formerly
permitted, it is now considered normal (Ankomah, 1998).
In some societies in these countries, premarital multiple
sexual partnering, serial monogamy as well as partner
switching is fairly common.
To fully understand premarital sexual
relationships in the region, it is useful to view
some premarital relationships as basically transactional,
resulting in sexual exchange where sexual services
are exchanged for material gain- a system quite different
from prostitution. Similar findings have come from
some Nigerian cities such as Benin City (Omorodion,
1993); in Ibadan and Zaria, (Barker and Rich, 1992);
and in comparatively rural areas as for example among
the Ekiti of western Nigeria (Orubuloye, Caldwell,
and Caldwell, 1991). It must be pointed out however,
that, there is a great diversity of sexual relationships.
It is therefore misleading to generalize (which unfortunately
some researchers have done) about African sexuality,
or even a West African one as if the region is one
homogenous entity. There is a variety of mutually
contradictory sexual norms in West Africa, and even
within countries. So when in West Africa Caldwell,
Caldwell and Quiggin (1991) claimed uniformity of
premarital sexual relationships and observed a perfect
fit called the 'Ekiti model' which meant pervasive
societal acceptance throughout history of premarital
sexual relationships it was perhaps an overgeneralization.
Mair had five decades ago observed a continuum:
"In attitudes towards sex
relations before marriage, extremes of severity
and tolerance are represented by the Nupe, who prohibit
them altogether, and the Korongo and Mesakin of
the Nuba hills among whom premarital licence is
complete, and chastity and virginity play no part"
Some gaps in existing sexual
While the quantity and quality of sexual health research
in the West African region has improved in recent
years, there are still several gaps. A few are highlighted
Research output on violence against
women has been very general. Community- and health
facility-based research as well as behavioural research
on violence including longitudinal studies on the
consequences of sexual violence, and the vulnerability
of adolescents to sexual abuse are sorely needed.
The sexual rights of adolescents
in West Africa is a poorly researched area. Further
research is required to gather information on sexual
and reproductive rights, and explore the barriers
that young persons face making choices given the
prevalence of transactional sex, sexual coercion
and exploitation of young women.
Detailed information on gender
roles and life skills (in contrast to knowledge)
to negotiate good sexual health outcomes among teenagers
including married adolescents is lacking.
STI seeking behaviour and treatment
of young persons is an area with limited research
Today there are internationally
accepted definitions of some indicators in sexual
health, but there is an urgent need for further
research on the identification of some indicators
given their importance in the sub-region. These
include indicators measuring violence against women
and transactional sex.
Capacity building needs
for reproductive health research in West Africa
The capacity of academic and research institutions
in West Africa to respond to research needs in sexual
health is very limited. Developing research capacity
in sexual health increases the input of local researchers
into the solution of the region's problems. Research
conducted locally by local people is more likely to
be more timely and cost-effective in addressing local
problems than is research conducted by researchers
unfamiliar with the region and its context.
Lack of funds and other
While this may be true of other parts of Africa, the
lack of funds and other resources necessary for research
and research training is a most obvious constraint
to building research capacity in West Africa. Resources
lacking include not only the availability and conditions
of equipment used in sexual health research training,
but also infrastructure and services such as electricity,
maintenance etc. Access to sexual health information
and networks through libraries and electronic communication
is very difficult. In addition there is problem of
access to sexual health journals. Although a few peer-reviewed
journals with African flavour and coverage has started
to emerge, they appear to be based mainly in Southern
Africa and access to them in West Africa is as difficult
as those published in western countries.
status of sexual health research in West Africa
Again while this may not be limited only to the region,
it is particularly pronounced. There is a particularly
weak social and political status of sexual health
research in the region. Local research results achieved
are often not perceived as contributions to development.
The general lack of political commitment may be exacerbated
in Nigeria where religious and ethnic considerations
may undermine local research even further.
Low recognition of researchers
At the individual level, Nigeria and Ghana have international
level sexual health researchers. The weak economic
situation in the region, which expresses itself, among
others, in low salary levels forces researchers to
do short-term, demand driven consultancy work. It
is sad but true that increasingly researchers from
West Africa (and not infrequently their collaborators
from the North) are motivated in sexual health research
not mainly in the desire to make their knowledge useful
in a development context but with expectation of personal
benefit. Supplementary payments are often included
in research partnership programmes, but these are
uncoordinated, highly variable, and often hidden,
sometimes to avoid overheads been transferred from
individual researchers to general university funds.
Talks and discussions with colleagues have revealed
that if sexual health researchers, and indeed the
whole scientific committee, is used to shape public
opinion, many researchers may obtain greater satisfaction
from their work and find greater acceptance in society,
and hence reduce other activities that divert them.
of donor agencies
Donor funding of sexual health research is often unreliable
and adapted to the needs of recipient countries. Donors
grant several fellowships in sexual and reproductive
health research every year especially in Ghana and
Nigeria. However, most are not linked to any research
programmes, the number given ever year varies greatly
and they are often given in hurry just before donors'
financial year ends (often to ensure donors avoid
being financially penalized by their home governments
for under spending). Sometimes donors select foreign
institutions for awardees and these institutions may
not have strong programmes in sexual health research.
Most of the emphasis on sexual health research capacity
is unfortunately limited to scholarships and travel
with intensive monitoring during the period, compared
with lack of donor monitoring or even interest after
the training. Some donors are quick to withdraw funds
and terminate all existing research grants in times
of political instability. The region that suffers
most from this on the continent is West African region
given the long history of military insurrections.
The way forward
Enhancing sexual health research capacity can be defined
broadly as the process by which knowledge can be increased
in order to understand the phenomena of sexual health
and promotion in different situations and to reflect
on problem-solving. Capacity building relies on three
key areas: augmenting the number of researchers in
sexual health; strongly supporting research-related
institutions and organisations, and enhancing the
quality of sexual health research in both its basic
and applied dimensions.
Assistance from the
North can only be supplementary
Local research capacity, even within strong and credible
research institutions must have national support.
Without the support of local and national programmers,
outside funding cannot be effective in developing
sustained leadership for the solution of sexual health
problems. National investments are needed, particularly
in Nigeria, in research infrastructure and in systems
of higher education in order to maintain a pool of
In Nigeria, with over 50 universities,
a principal objective of building research capacity
in sexual health should be the development of research
centres of excellence in the three main geographical
regions and other evidence-based sexual health organisations
(such as the Society for Family Health). These institutions
should be identified on specific criteria that include
demonstrated institutional commitment to addressing
sexual health issues. Although they may be institutional,
the emphasis should be on networks of these multiple
sites, enabling them to communicate effectively with
one another, and designing initiatives around problems,
not institutions. Good research requires a critical
mass of trained professionals within an institution,
so that initiatives do not crumble when one or two
faculty members relocate. Approaches taken should
permit flexibility in responding to and working with
programme focused organisations and governments departments,
and should also recognize the time constraints commonly
faced by full-time faculty staff. To reduce the waste
on poor and patchy ill-funded research not likely
to be of credible national importance, national governments
with research institutions should establish a limited
list of urgent research priorities most relevant to
Sexual health research
should be institutionalized
Sexual health research has so far been restricted
in the main to university based individuals. Linkage
between universities, NGOs and other non-university
institutions needs to be seen to be working towards
a common goal. Research on sexual health promotion
is not aptly institutionalized. At the moment, there
are no structured courses in sexual health, although
a few health-oriented graduate programmes do undertake
certain aspects of sexual health in the course of
Capacity building must
By definition, capacity building involves sustainability,
not only in the individual skills and capabilities,
but also in its translation into organisational capacity.
In Nigeria, in particular, most of the support is
bound to individual capacity building and is hence
of limited sustainable character in terms of institution
building. Financial support can help research institutions
in West Africa to maintain their activities and formulate
their own research agenda. But this is rare, as donors
see little value in doing this. Usually a significant
component of research cooperation is related to the
funding of researchers in the North who carry out
research in the south with support of local researchers.
Furthermore, most funding schemes
appear not to allow for or to foresee greater long-term
support- an indispensable prerequisite for effective
institutional capacity building. Long-term commitment
through 'funding consortia' with varying financial
contributions over time from each donor involved may
be an option. This is now taking place in Nigeria
where donors have agreed to fund large scale multi-round
reproductive and health surveys for about eight years
which is conducted mainly by indigenous researchers.
Research should be treated
a key component in all development process
Research component of sexual health programmes need
be pronounced and clearly budgeted. Donors are often
not particularly interested in evaluating capacity
building components of projects. One way of enhancing
capacity is to track the success of capacity enhancing
or cooperation is fine but can also be donor driven
The pooling of resources through networking efforts
to share and exchange ideas is an essential element
of any research capacity building. Unlike East and
Southern Africa, where South-South networks are in
existence, (e.g. University Science, Humanities and
Engineering Partnerships in Africa USHEPiA) research
networks are rare indeed in West Africa. There has
been a notable success in sexual health networking
though in West Africa. The West African Sexual Networking
Group with researchers based at University of Ado-Ekiti,
Nigeria and University of Cape Coast, Ghana succeeded
between 1991-1998 to undertake research and train
several young researchers in sexual health research.
At the moment there appears to be no viable network
of sexual health researchers in English-speaking West
Africa. It must be noted however that regional cooperation,
which is often praised, sometimes can be donor rather
than demand driven and hardly reflects the aspirations
of the partner institutions. Such collaboration tends
to be somewhat artificial in nature, fulfilling the
requests stipulated by the funding party.
Making research findings
The cost of disseminating sexual health information
is huge in West Africa, especially in Nigeria, because
of its size. Sexual health researchers stand to gain
more from sharing their results. Although this may
be changing, health correspondents in national newspapers
are often not well-trained and only a handful understand
sexual health research. They often report the sensitive
aspects of research making their reports seem as news
and hardly educational. Nigeria is improving with
the arrival of a new donor initiative InterNews which
provides training and facilities for health personnel
in the media. To reduce the interaction cost of sexual
health research, donors and other stakeholders may
need to train journalists with key national newspapers.
In this case sexual health research findings get written
and published in plain English in national newspapers.
Enhancing capacity of
users of research and teachers of research
Research is poor in West Africa, because there are
poor users of research. Unless public officials, the
media, industry, community groups, programme implementers,
and others use research, the status of research and
researchers will continue to be low. In a sense, therefore,
these groups should also be targets for capacity building
in the use of research. Politicians, editors of media
houses, industry and other stakeholders could be trained
in how advantageous research results can be for them.
The effectiveness of capacity building depends on
a step-by-step approach beginning with existing capacity
building activities. Some university graduates of
statistics or social sciences who have undertaken
courses in Research Methods and who apply for research
positions in organisations may be found not to have
analysed data using computers. West African universities
need to accept these grave shortcomings, develop courses
that ensure that student attachments with industry
are mandatory in research related courses. Teachers
of research-related courses must themselves be willing
to learn new ways of doing research.
West Africa has a pool of researchers in sexual health.
Harsh economic conditions in addition to other infrastructural
and institutional impediments have limited the pace
of effective capacity building of other researchers
in sexual health. Capacity of researchers in the field
may be enhanced, among others, through the establishment
of networks, presenting research findings in friendly
and usable manner, and motivating governments, programmers
and the business community to use research.
Ankomah, A. (1998). "Condom use in sexual exchange
relationships among young single adults in Ghana." AIDS Education and Prevention, 10(4), 303-316.
Barker, G.N. and Rich, S. (1992)
"Influences on adolescent sexuality in Nigeria
and Kenya: Studies from recent focus group discussions." Studies in Family Planning, 23 (199-210).
Bleek, W (1976) Sexual Relationships
and Birth Control in Ghana: A Case Study of a Rural
Town. Centre for Social Anthropology, University
of Amsterdam, Amsterdam.
Caldwell, J.C., and Caldwell, P.
and Quiggin, P. ( 1989) "The social context of
AIDS in sub-Saharan Africa." Population and
Development Review 15(2) 185-233.
Mair, M.A. (1953) "African
marriage and social change." In: Arthur, P. (ed). Survey of African Marriage and Family Life.
Oxford University Press, London; pg 1-71.
Omorodion, F.I. (1993). "Sexual
networking among market women in Benin City, Bendel
State, Nigeria." Health Transition Review,
3 (Suppl.), 159-169.
Orubuloye, J.O., Caldwell, J.C.,
and Caldwell, P. (1991) "Sexual Networking in
Ekiti District of Nigeria." Studies in Family
Planning, 22 (61-73).
Schoepf, B.G. (1991) "Ethical,
methodological and political issues on AIDS research
in Central Africa." Social Science &
Medicine 33(7): 749-763).
A paper presentation by Dr. Augustine Ankomah of the Society for Family Health, Nigeria at the panel discussion of the ARSRC during the First Congress for the Advancement of Sexual Health and Rights in Africa, February 27, 2004. Johannesburg, South Africa.