Global health advocacy significantly influences global health practice by tackling emerging and varying health challenges.1 The progress experienced in reducing the burden of diseases and curbing pandemics and epidemics even in recent years depended immensely on advocacy.2–5

Access to surgical care remains a critical yet often overlooked component of healthcare systems in most low- and middle-income countries (LMICs). The provision of surgical, obstetric and anaesthesia services face significant challenges, contributing to the high burden of untreated surgical conditions, including cleft lip and palate.

To begin to address and scale up access to safe and timely surgical, obstetric and anaesthesia care, Nigeria launched her national surgical, obstetrics, anaesthesia and nursing plan (NSOANP) in 2019.6 As part of implementation of the plan, the country is collaborating with an international cleft-focused organisation, Smile Train, to strengthen the surgical ecosystem in the country.

To facilitate community awareness and understanding of cleft lip and palate and availability of treatment for that condition, the cleft-focused organisation designed a strategy to engage with media practitioners (electronic and print journalists) and incorporated information about NSOANP and access to surgical care in the country. The aim of this report is to highlight the potential of media engagement as a catalyst for change, driving advocacy initiatives that prioritize the strengthening of surgical systems. It highlights the benefit of leveraging on a single-issue advocacy programme to promote focus on a broader range of healthcare challenges without undermining the original programme and recommend a pathway for building such successful collaborations. Through this initiative, we explore innovative approaches to harnessing the reach and influence of media platforms to raise awareness, mobilize resources, and drive policy reforms.


To improve awareness of and access to comprehensive cleft lip and cleft palate care in Nigeria, the international cleft charity, Smile Train, created a media and advocacy workshop targeted at electronic and print media journalists and reporters within the country. The trainings were deployed as 2-day workshops, held once a year, at 3 locations (Abuja, Lagos and Enugu) in the country from 2021– 2022. The objectives of the workshop are detailed in Table 1, and the workshop focused on a broad range of topics and information on cleft care and surgical care (Table 2). The engagements were deployed as didactic lectures, presentations, role plays, breakout sessions, group discussions and tasks with feedback (Figure 1). All participants had a pre-test and post-test to evaluate the level and extent of knowledge acquired.

Table 1.Objectives of the media engagement workshop
Orient journalists on cleft problems (national, regional & internation contexts)
Enhance knowledge and understanding of journalists on basic aspects of cleft lip and palate
Enhance journalists’ understanding of stigma and discrimination related to cleft lip and palate
Promote the voices of patients on surgical diseases by the media
Enable journalists to identify their role towards positive and responsible reporting on cleft lip and palate related issues in Nigeria
Discuss and develop action plan to address the gap in education and promotion of surgical care in Nigeria
Table 2.Details of workshop lectures, presentations, role plays and group discussions
Didactic lectures & presentations
Burden and impact of cleft and surgical conditions
Journalism and Health Journalism in Nigeria
Understanding Health and Visual Literacy
Challenges of living with cleft and other surgical conditions
How to address discrimination and stigma associated with Cleft
Availability of funded comprehensive cleft care
Current gaps in Nigeria’s surgical system
Strategic priorities of Nigeria’s NSOANP
Convergence of media and telling compelling stories for impact
How to effectively report on and advocate for clefts and surgically treatable conditions
Smile Train Cleft Care from the lens of a media advocate
Role plays
Focused on creating stimulating content to drive awareness and sensitization about cleft lip and palate in communities
Group discussions
Focused on addressing the issue of stigmatization suffered by people and families born with cleft lip and palate
Figure 1
Figure 1.Media engagement strategy for cleft and surgical care advocacy

Participants’ selection

Nigeria is divided into six geopolitical zones that are demographically, culturally, and economically diverse. Participants were nominated from the major television and radio stations and newspaper publishers from across the 6 geopolitical zones. The workshop locations were:

  • Abuja, federal capital territory (FCT) (northeast zone, northwest zone, north central zone)

  • Lagos (southwest zone)

  • Enugu (southeast zone, south-south zone)

Training faculty

The faculty for the workshop were experienced media practitioners, surgeons involved in cleft care, members of the NSOANP implementation committee and officials working with the cleft charity.


The cleft and surgical information reporting activities of the participants for each year were tracked. To encourage and motivate those who used their platforms to share quality human interest stories and turned the spotlight on those affected by cleft in their community, a prize, Cleft Awareness Media Award (CAMA) was instituted to be given to the top 3 performing journalists at the annual NSOANP and cleft stakeholder’s forum in November/December of that year. A team of select international media judges independently assessed the entries, and the scores were averaged to select the top 3.

Data Analysis

Data was analysed with the Excel Analyse-it® statistical package. Descriptive data have been expressed as percentages and charts, and medians, interquartile ranges and mean. The difference between pre- and post- test scores was compared using the Wilcoxon signed rank test. The level of statistical significance was set at P< 0.05 at 95% confidence interval.


One hundred and three journalists, including 61 (59.2%) males and 42 (39.8%) females participated in the workshops, distributed across the 3 workshop locations and 6 geopolitical zones (Figure 2). The participants were from 26 newspapers, 23 radio stations, and 6 television stations. The country’s national television, national radio station and news agency of Nigeria were represented. Three journalists were freelancers. The details of the study are summarized in table 3.

Table 3.Summary of workshop objectives, study design demographics and key outcomes
Orientation to cleft problems
Enhance knowledge and understanding
Understanding of stigma and discrimination
Positive and responsible reporting on clefts
Developing action plan for education and promotion of surgical care
Study design
Workshop engagement
Pre- and post-test
Qualitative feedback survey
Number: 103 participants
Males: 61
Females: 42
3 workshop locations covering the 6 geopolitical zones in Nigeria
Key outcomes
  1. 121 media publications on cleft lip and palate, and surgical care
Print media
Broadcast media
Online newspapers
  1. Cleft: How ignorance, stigmatisation pose barrier to treatment in Nigeria ( (Accessed May 25, 2024)
  2. - Digital Newspaper & Magazine Subscriptions (Accessed May 25 2024)
  3. Smile Train encourages Nigerians to avail children with cleft lip for corrective surgery ( (Accessed May 25, 2024)
  4. How babies with cleft lip, palate got lifeline, freed from years of stigma, pain - Punch Newspapers ( (Accessed May 25, 2024)
  5. How cleft surgery unites families, saves lives - Daily Trust (Accessed May 25, 2024)
  6. Boosting the Self Esteem of Children with Cleft Lip, Palate – THISDAYLIVE (Accessed May 25, 2024)
  7. Cleft lip, palate defects: Over 30,000 patients treated free of charge in Nigeria Newsdiaryonline (Accessed May 25, 2024)
  8. In Nigeria, an NGO is Making Children Born with Cleft Smile Again – THISDAYLIVE (Accessed May 25, 2024)
  9. Children With Cleft Palate, Lip:Smile Train’s Intervention – Independent Newspaper Nigeria (Accessed May 25, 2024)
  10. Cleft lip & Palate: Parents’ struggles, children’s quest for smiles ( (Accessed May 25, 2024)
  11. Bringing Hope, Future to Cleft Lip and Palate Babies Through Smile Train | The Reporters News (Accessed May 25, 2024)
  12. Overcoming Adversity: A Cleft Palate Survivor’s Journey to a New Smile – THISDAYLIVE (Accessed May 25, 2024)
  13. Cleft-lip Warrior: Eunice Ajetoro Celebrates Improvement in Speech Therapy – THISDAYLIVE (Accessed May 25, 2024)
  14. Way out for cleft patients in Nigeria ( (Accessed May 25, 2024)
  15. Explaining cleft lip and palate — — Newsletter — Guardian TV (Accessed May 25, 2024)
  16. Ending Bullying, Discrimination against Persons with Cleft, and Need for ‘Smile Therapy’ – THISDAYLIVE (Accessed May 25, 2024)
  17. Sun man, Bere wins Smile Train 2022 Media Cleft Awareness Award | View Point Nigeria (Accessed May 25, 2024)
  18. The Guardian reporter, Musa, receives CAMA award — Nigeria — The Guardian Nigeria News – Nigeria and World News (Accessed May 25, 2024)
  19. Premium Times journalist, others win at Cleft Awareness Media Award ( (Accessed May 25, 2024)
  20. Winners Of 2022 Cleft Awareness Media Award (CAMA) Nigeria - PositiveNaija (Accessed May 25, 2024)
  1. Prize award for 3 top performing journalists in reporting on cleft lip and palate
Award winning reports
  1. Hope for babies with cleft ( (Accessed May 25, 2024)
  2. Pathetic world of babies with cleft ( (Accessed May 25, 2024)
  3. Cleft: How ignorance, stigmatisation pose barrier to treatment in Nigeria ( (Accessed May 25, 2024)
  4. (Cleft report is part of the news programme for the day, starting from 25:53 - 31:05. Accessed May 26, 2024)
Figure 2
Figure 2.Distribution of media participants across the 3 workshop locations (Map obtained from:

Participants’ evaluation

The participants’ pre-test scores were 33% - 53% (median 45.5%, interquartile range 13.6%, mean 45 ± 8.2%) while the post-test scores were 75% - 93% (median 80%, interquartile range 14.3%, mean 82.7 ± 7.7%), respectively. The difference between the pre- and post-test scores was statistically significant (p = 0.03).

Participants feedback

Participants were asked to rate the usefulness of the workshop topics and delivery, as well as make recommendations. Participants rated the topics to be impactful as they helped them obtain better understanding of cleft as well as the enormous work Smile Train was doing in the cleft ecosystem. They indicated that the group discussions provided insight into the issue of stigmatization and the effect on people and families living with cleft.

Participants agreed that the facilitators exhibited great expertise and adequately delivered and passed on knowledge with ease.

The participants then made the following recommendations:

  1. Need for the workshop and other awareness campaigns to be sustained and expanded.

  2. Smile Train should be deliberate in supporting journalists especially health editors to produce impactful driven stories considering the huge gap in cleft knowledge.

  3. The planned media award for outstanding journalists who report on cleft issues should be taken seriously as it will be a motivating factor to drive the journalists who have been given basic knowledge about clefts.

  4. Need for collaboration with the Federal Ministry of Health and relevant international donor agencies for deeper penetration of cleft programmes and activities.

Overall, all 103 (100%) participants agreed that they had gained knowledge about cleft lip and palate anomalies and access to surgical care. They all (100%) agreed that they had also gained knowledge on how to report on cleft lip and palate and surgical care.

Post-workshop follow-up outputs

Public enlightenment programmes were carried out across various media outlets, including the national television and radio stations, which broadcast across all the states of the country. A group of participants presented a collaborative radio drama. In addition, the participants published 121 cleft and surgical-related reports, in both online and print media as well as broadcast media (Table 3).

Cleft Awareness Media Award

Over the 3-year period, deserving journalists have received 3 awards for first, second, and third place each.


Social media has significantly expanded the available platforms for populations awareness and drawing attention of healthcare policy makers to specific health issues. However, traditional mass media journalists can potentially better frame healthcare issues in a way that can be easily appreciated by the population and policy makers. In many settings in sub-Saharan Africa, broadcast (radio and television) and print newspaper media remain important and popular mass communication platforms. While public health programmes use broadcast and print media to reach communities to create awareness and health behaviour change,7,8 the role of media advocacy in healthcare systems strengthening remains underutilized.

The findings of this study underscore the potential of media engagement as a powerful tool in driving advocacy initiatives aimed at improving access to surgical care. The results demonstrate that targeted workshops and training sessions for media practitioners can lead to a significant increase in knowledge about cleft lip and palate anomalies and access to surgical care among participants, as reflected in the post-workshop outputs, with a substantial number of reports published across various media outlets, including national television and radio stations.

Ensuring that healthcare reporting is accurate is important, emphasizing the critical need to engage with journalists and provide them with the right information to support their reporting. One report found that reporters have concerns about the depth, accuracy and social impact of their reporting.9 To address this issue, our approach involved the delivery of relevant information to the participants. One report has noted that in engaging the media for advocacy it’s important to create a media advocacy strategy.10 In our approach, our strategy included defining the media advocacy needs and goals, selection of participants to reflect the geographic diversity of Nigeria, inclusion of both broadcast (radio and television) and print media (newspapers), delivery of relevant information as well as follow up tracking of reporting by the participants. The inclusion of an award system for quality and relevant reporting is innovative. This approach has been successful, as the motivation provided has improved and expanded reporting on cleft lip and palate, and surgical care, as well as interest in these issues from journalists.

The success of this media engagement initiative can be attributed to several factors. Firstly, the collaborative approach involving both national stakeholders and Smile Train facilitated the dissemination of accurate information and resources to media practitioners. By incorporating information about Nigeria’s national surgical, obstetrics, anaesthesia, and nursing plan (NSOANP) into the advocacy strategy, the initiative not only raised awareness about cleft lip and palate anomalies but also promoted broader media efforts to strengthen surgical systems in the country. In Ethiopia, a growing collaboration between media agencies and ministry of health, mental health organisations and non-governmental organisations for mental health advocacy has been reported.11 In our programme, there was a collaboration between Smile Train, an international cleft-focused organisation and the NSOANP programme to deploy the media engagement to drive advocacy.

Media can sometimes empower citizens to demand action on important health issues from their political leaders and policy makers.12 One report has highlighted how the Kenya Advance Family planning initiative supported the media to engage leaders and decision makers. Such media advocacy helped to catalyse actions by decision makers across Kenya to fast-track implementation of policy actions and contributed to advancing family planning initiatives in the country.10 The community and policy impact of media reporting of our approach is yet to be ascertained. Our next steps would be to evaluate the impact of the reporting by the participants on the community and policy makers.


This report has a few limitations. While the increase in knowledge and the dissemination of cleft and surgical-related reports are promising outcomes, further study is needed to assess the long-term impact of media engagement on improving access to surgical care and reducing the burden of untreated surgical conditions in Nigeria. Additionally, the sustainability of such initiatives depends on continued collaboration between media organizations, healthcare professionals, policymakers, and civil society groups.


We are grateful to Drs. Chisom Udeigwe-Okeke, Aderonke Obisesan and Mohammed SA Abdullahi, and Mrs. Ngozi Opara for their useful suggestions during preparation of the manuscript. We are also grateful to Victoria Awazie and Adaeze Mounyelu for providing logistic support during the workshops.

Ethics statement

Ethical approval was obtained from the Institutional Review Board of National Hospital, Abuja, Nigeria, as part of implementation of the NSOANP policy. In addition, participation in the workshop was voluntary and they were made to understand that the workshops were meant to push for publicity and awareness, but no written consent was obtained. Confidentiality was maintained and no identifiable information was collected for the pre-test, post-test and feedback as these were anonymized, To maintain anonymity, age and gender were not included in the tests and feedback information.


The media advocacy programme was funded by Smile Train Inc., New York.

Authorship contributions

JOS contributed to the analysis and interpretation of the data, AND drafting of the manuscript AND final approval of the version to be published AND agreement to be accountable for all aspects of the work; ONA contributed to the analysis and interpretation of the data, AND drafting of the manuscript AND final approval of the version to be published AND agreement to be accountable for all aspects of the work; NO contributed to the conception and design of the work, analysis and interpretation of the data, AND reviewing the manuscript critically for important intellectual content AND final approval of the version to be published AND agreement to be accountable for all aspects of the work; PL contributed to the conception and design of the work, analysis and interpretation of the data, AND reviewing the manuscript critically for important intellectual content AND final approval of the version to be published AND agreement to be accountable for all aspects of the work; EAA contributed to the conception and design of the work, analysis and interpretation of the data, AND reviewing the manuscript critically for important intellectual content AND final approval of the version to be published AND agreement to be accountable for all aspects of the work

Disclosure of interest

Please use the following standard sentence: "The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author). Nkeiruka Obi and Paul Lobi are staff of Smile Train.

Correspondence to:

Professor Emmanuel A. Ameh
Department of Surgery, National Hospital, Abuja, Nigeria
Email: [email protected]