Politics of joint advocacy for women’s health in Nigeria: political economy and advocacy coalition framework analysis

Abstract

Background

Women’s health joint advocacy platforms are often constrained by elite dominance, donor dependency, and weak integration with formal governance systems, thereby limiting inclusive participation and sustained policy influence. Despite growing recognition of joint advocacy as a mechanism for improving health outcomes, there remains a limited systematic understanding of how political interests, power relations, and institutional dynamics shape the design and effectiveness of these platforms. This study examines the political, institutional, and social factors influencing joint advocacy for women’s health in Nigeria.

Methods

This qualitative study used an integrated Political Economy Analysis (PEA) and Advocacy Coalition Framework (ACF). It examined how structural conditions and coalition dynamics shape advocacy processes and outcomes. Data were collected through 52 key informant interviews and multi-stakeholder dialogues in Lagos, Kano, Kaduna, and at national-level institutions. Analysis was conducted using a hybrid deductive–inductive thematic approach.

Results

Findings show that joint advocacy platforms work within complex political and institutional environments. These environments shape participation, agenda-setting, and policy influence. Resource dependence and donor-driven priorities lead to uneven participation and concentrated influence among well-resourced actors. Weak institutional embedding limits integration into formal decision-making. This reduces the translation of advocacy into policy and budget outcomes. Coalition dynamics (like leadership structures, belief alignment, and trust) also affect coordination and effectiveness. While joint advocacy can support collective action, its outcomes often depend on how macro-level political-economic conditions interact with coalition-level processes.

Conclusions

This study demonstrates that the effectiveness of joint advocacy depends on the interaction between structural conditions and coalition dynamics, rather than on coalition presence alone. By integrating PEA and ACF, the study provides a nuanced understanding of how power, resources, and institutional arrangements shape advocacy processes and outcomes in Nigeria, with implications for strengthening inclusive and contextually grounded advocacy models.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s13690-026-02030-x.

Text Box 1. Contributions to the literature
This work advances public health scholarship by identifying joint advocacy and governance arrangements as structural determinants of women’s health outcomes alongside financing and service delivery factors
The study introduces a methodological contribution by integrating PEA and ACF, which enables multi-level analysis of the interactions among power, institutions, and coalition dynamics
Empirical insights from Nigeria demonstrate how political, institutional, and social dynamics, such as elite dominance, donor dependency, and weak institutional anchoring, shape the effectiveness and inclusivity of joint advocacy platforms
This research extends theoretical understanding of advocacy processes by illustrating how power relations, belief systems, and institutional incentives influence coalition behaviour, coordination, and policy outcomes within complex health systems

Background

Evidence from literature reveals that joint advocacy (a collaborative effort by different organisations, groups or individuals, to influence specific policies, initiatives or programs) is a major determinant of public health performance and advances women’s health policy by mobilising governments, civil society, donors, experts, and resources for change [1, 2]. When advocacies are jointly led by civil society organizations (CSOs), academia, experts, and citizens/beneficiaries, localownership is achieved, leading to improved policy integration (defined as coherent incorporation of the advocacy issue into cross sectoral policies, institutional structures, budget lines or accountability mechanisms) as evidence from various countries suggest [3–5]. Yet, establishing and sustaining effective joint advocacies requires understanding of the power play among key actors including government institutions, beneficiaries, CSOs, donors, private sector, academia, researchers, community structures, and any key interests [6, 7]. Poorly managed power play may weaken joint advocacy outcomes.

Although joint advocacy is often labelled a coalition, partnership, or network, this study defines it as coordinated political action [8–10]. General collaborations usually focus on service delivery, information sharing, or program implementation [11, 12]. In contrast, joint advocacy seeks collective influence over policy, resource allocation, and accountability [8, 13]. Coalitions or networks may merely coordinate activities [14, 15]. Joint advocacy instead aligns strategies, engages decision-makers, and unites efforts to shape policy agendas [8]. It moves beyond simple cooperation: it organises power, negotiates interests, and uses a collective voice to influence outcomes [8]. This is critical for women’s health advocacy in Nigeria, where collaborative platforms may hide unequal power, conflicting incentives, and weak institutional ties [16].

Evidence from Kenya and Uganda demonstrates the potential of joint advocacy and offers broader theoretical insights [17, 18]. The same evidence reveals that, in Kenya, joint advocacy contributed to policy gains, including free maternity care and expanded post-abortion services [17]. These outcomes illustrate key dynamics, including the influence of shared belief systems, coordinated coalition strategies, and sustained engagement with policymakers. Such engagement shaped policy outcomes. However, uneven implementation across regions highlights the mediating role of institutional capacity and governance structures in coalition influence [17]. This underscores the limitations of coalition coherence in the absence of strong state systems. In Uganda, joint advocacy efforts have been more closely aligned with decentralised governance structures, enabling stronger community participation and local accountability [18]. This approach reflects institutionally embedded advocacy, where coalitions are integrated into subnational planning and decision-making processes. Nevertheless, these efforts often face challenges in scaling to the national level, revealing tensions between local effectiveness and broader policy impact [18].

In comparison, the Nigerian experience exhibits both similarities and significant divergences [19, 20]. While coalition-based advocacy and multi-actor engagement are present, outcomes are more strongly influenced by elite dominance, donor dependency, and weak institutional anchoring [20]. These factors constrain inclusive participation and limit sustained policy influence [19]. The comparative analysis suggests that the effectiveness of joint advocacy is not determined solely by coalition formation. Instead, it depends on the degree to which coalitions are institutionally embedded, politically aligned, and capable of navigating power asymmetries within specific governance contexts.

Within women’s health (especially in reproductive, maternal, and adolescent health) joint advocacy offers clear strategic advantages. For example, it may help stakeholders agree on policy goals and pool their expertise. Civil society organisations, professional associations, community groups, and technical experts can work together to influence laws, synthesize evidence, facilitate use of research in policy making process, and keep government agencies accountable [21]. Working together draws more supporters for reform, saves resources by sharing information and tools, and strengthens credibility by showing a united front to policymakers [22].

Despite these advantages, weak institutionalisation and limited community ownership remain significant challenges in Nigeria’s women’s health sector. Emerging evidence from civil society reflections, grey literature, and policy reviews suggests that joint advocacy efforts have not always translated into sustained, system-wide impact [20, 23–25]. For example, coalitions such as the Health Sector Reform Coalition (HSRC), the White Ribbon Alliance Nigeria (WRAN), and state-level RMNCAH + N Technical Working Groups have routinely highlighted concerns about irregular government commitment, inconsistent state-level engagement, and frequent turnover of programme focal persons. These recurrent issues (documented across various civil society communiqués, learning briefs, and sector review reports) have been noted to disrupt continuity, weaken the durability of advocacy gains, and limit the ability to translate short-term achievements into systemic change [20, 25].

Addressing these challenges requires joint advocacy models that are context-sensitive, politically informed, and institutionally embedded to achieve more durable improvements in women’s health outcomes [25–27]. The Policy Innovation Centre’s scoping review on women’s health joint advocacy in Nigeria, identified several joint advocacy models: government-led (public sector leadership), civil society organisation-led (NGOs or advocacy groups), community-led (managed by affected communities), private-sector-led (businesses or industry coalitions), and government-embedded (hybrid) models (integrating governmental and other sectors) [28]. Each model is shaped by unique power dynamics, organisational incentives, and influence pathways [3, 20, 28–30]. Effective models rely on a thorough grasp of political economy (how politics, economics, and stakeholder interests interact) and these factors shape agenda-setting, resource allocation, and the interests of key actors at national and subnational levels [8, 13].

As a result, advocacy models integrate adaptive strategies, such as flexible and context-responsive approaches that adjust to changing political and institutional conditions. These models also foster the development of governmental reform champions, defined as key government officials who actively support and advance policy change. Furthermore, they enhance accountability by encouraging community participation and citizen engagement, which enable affected populations to influence decision-making and hold institutions accountable for outcomes. Embedding these models in mechanisms such as the Reproductive, Maternal, Newborn, Child, Adolescent Health + Nutrition (RMNCAH + N) Technical Working Groups promote continuity beyond project cycles and leadership changes. Connecting evidence generation with coordinated messaging and multi-level engagement enables coalitions to leverage policy windows, sustain advocacy, and maintain the visibility of women’s health priorities as political conditions shift. Ultimately, well-designed joint advocacy models not only harmonise stakeholder actions but also build resilient advocacy ecosystems capable of sustaining women’s health commitments over time.

However, to address joint advocacy challenges highlighted above, the Sector-Wide Approach (SWAp) in Nigeria seeks to align government and donor health initiatives within unified frameworks [31]. Although this has the potential to support joint advocacy [32], most women’s health platforms remain parallel projects. This lack of integration undermines sustainability and limits both the influence of policy and its incorporation into governance systems. Such fragmentation reflects power dynamics that shape advocacy platforms for women’s health in Nigeria, revealing exclusionary patterns in participation, priority setting, and institutional arrangements [3, 5, 27].

Beyond financing and service delivery inputs, the performance of public health systems is strongly shaped by the configuration, interests, and power relations of advocacy coalitions operating within the policy space. In Nigeria, the alignment or fragmentation of joint women’s health advocacy influences agenda-setting, policy coherence, and accountability mechanisms, thereby acting as a structural determinant of public health performance. Although joint advocacy is increasingly utilized in Nigeria’s women’s health sector, there remains a limited systematic understanding of how political interests, power relations, and institutional dynamics influence the design and effectiveness of these advocacy models. This knowledge gap is particularly significant. Therefore, this research tried to answer the question: how do political, social and institutional and power dynamics shape the design and sustainability of joint advocacy models for women’s health in Nigeria?

This study provides qualitative, theory-informed evidence regarding the influence of political, institutional, and social dynamics on the design and effectiveness of joint advocacy platforms for women’s health in Nigeria. First, it integrates Political Economy Analysis (PEA) with the Advocacy Coalition Framework (ACF), linking macro-level structures to coalition dynamics, belief systems, and strategic interactions. Second, it presents evidence from multiple Nigerian states, demonstrating how joint advocacy platforms operate across different political, institutional, and socio-cultural settings. Third, it advances the use of integrated governance and coalition frameworks in public health research by showing how power relations, institutional incentives, and coalition behaviour shape advocacy outcomes.

The study holds significance for a range of stakeholders. For policymakers, it clarifies how advocacy can be integrated into governance and financing structures to support decision-making. For donors, it details how different funding modalities shape coalition dynamics and long-term sustainability, informing effective investment. For civil society and women-led organisations, it identifies the structural barriers to participation and outlines ways they can strengthen their collective voice in advocacy efforts. For researchers, the study offers some concrete, theoretically grounded approach for analysing advocacy and policy processes within complex health systems.

Theoretical framework

This study employed an integrated theoretical framework that combined Political Economy Analysis [33, 34] and the Advocacy Coalition Framework [35] to examine the formation, negotiation, and sustainability of joint advocacy models for women’s health in Nigeria. The integration of these frameworks was essential, as the complexities of women’s health advocacy (particularly in reproductive, maternal, newborn, child, and adolescent health) could not be adequately addressed from a single analytical perspective. The combined framework facilitated analysis of how advocacy was influenced by both the broader political and institutional context and the internal dynamics, belief systems, and strategies of coalitions.

PEA established a foundation for understanding the macro-level context influencing advocacy [33, 34]. It clarified how formal institutions, such as ministries of health and legislative committees, interacted with informal norms, political incentives, bureaucratic interests, and elite networks to shape policy prioritization. PEA also identified structural and systemic constraints, including weak advocacy platforms, inadequate inter-agency coordination, frequent leadership turnover, and conflicting incentives. It explained how these constraints impacted resource allocation, decision-making processes, and the long-term sustainability of joint advocacy initiatives.

ACF complemented this macro-level perspective by focusing on micro-level coalition dynamics [35]. It elucidated how advocacy platforms coalesced around shared beliefs and accommodated diverse actors, including government officials, civil society organizations, donors, academia, community representatives, and health professionals. These groups sometimes held conflicting perspectives, which influenced coalition strategies, role distribution, and resource management. Internal challenges identified by ACF included power imbalances, competition for resources, shifts in donor agendas, and difficulties in maintaining unity when priorities diverged. This framework clarified the factors that enabled some coalitions to advance their agendas, while others lost focus or influence.

The integration of PEA and ACF provided a comprehensive analytical lens that connected macro-political structures with coalition-level behaviors and decision-making processes. PEA clarified external political and institutional barriers, while ACF illuminated how coalition beliefs, interactions, and power relations shaped responses to these barriers. Collectively, these frameworks explained the frequent fragmentation and persistent power imbalances in women’s health advocacy. They also identified key design elements for improvement, such as fostering shared beliefs, aligning incentives, embedding advocacy within institutions, cultivating reform-oriented leadership, and this dual-lens approach offered a nuanced and contextually grounded understanding of joint advocacy models. It underscored the interplay between political power and coalition dynamics in shaping these models. By linking governance arrangements, institutional incentives, and resource distribution (PEA) [36] with coalition learning, coordination, and strategic behavior (ACF) [13], the study generated critical insights. These findings are essential for developing coherent, resilient, and politically informed joint advocacy strategies to improve women’s health outcomes in Nigeria.

To enhance analytical clarity, the study conceptualised power as a multidimensional construct. It comprised material, institutional, ideational, and relational forms [37–39]. Material power denotes control over financial and technical resources. Institutional power pertains to formal authority within governance structures. Ideational power includes the capacity to shape narratives, evidence, and policy framing. Relational power involves informal networks, gatekeeping, and access to decision-makers. These dimensions informed the analytical coding framework. This facilitated a systematic examination of power holders, how actors exercise and distribute power, and who is excluded from decision-making. This approach enabled analysis of power not only as a descriptive feature of advocacy platforms. It also considered power as a structuring force influencing coalition dynamics, participation, and policy impact. See Fig. 1.

Fig. 1.

Integrated Political Economy-Advocacy Coalition Framework for Joint Advocacy

Methods

Study area

The research was conducted in Lagos, Kano, and Kaduna. These states were chosen for their distinct political, cultural, and institutional characteristics. Each state served as a case to analyse the development and sustainability of women’s health advocacy within different governance and social frameworks. Lagos, as Nigeria’s commercial and policy centre, provided insights into the operations of advocacy groups in urban settings characterised by substantial funding and established governance structures. Kano represented a more conservative context shaped by religious influences, demonstrating the impact of informal authority and cultural norms on advocacy participation and messaging. Kaduna, recognised for its reform-oriented leadership, exemplified how political commitment and institutional collaboration can foster more inclusive and sustainable advocacy initiatives. National-level stakeholders, such as federal policymakers, donors, and civil society leaders, were also involved. Interviews and consultations with these groups provided broader perspectives on policy frameworks, funding mechanisms, and the role of the SWAp in advocacy and institutional sustainability.

Study design

An exploratory qualitative research design, utilizing key informant interviews (KIIs) and multi-stakeholder dialogues (MSDs), was employed to examine how power, interests, and institutions influence the design of joint advocacy platforms for women’s health in Nigeria. The study investigated diverse stakeholder perspectives and analyzed both formal and informal dynamics shaping advocacy architecture. Given the emphasis on power relations, actor incentives, coalition dynamics, and belief systems, a qualitative approach was deemed most suitable, as it enables the capture of complex, context-specific, and informal processes underlying joint advocacy. These dynamics are not easily quantifiable and thus necessitate an in-depth examination of actors’ experiences, perceptions, negotiations, and interactions.

Comparable qualitative and Advocacy ACF-based methodologies have been employed in prior policy and governance research to examine coalition dynamics, policy change, and institutional processes in Nigeria and other settings. Recent studies, for instance, have applied ACF and qualitative policy analysis to investigate advocacy coalitions, policy stasis, and institutional influences within governance systems [8, 19]. Additionally, other research has utilized discourse analysis, document reviews, and policy subsystem mapping to elucidate how coalitions mobilize resources, coordinate interests, and affect policy outcomes [8].

While these studies indicate that qualitative and coalition-oriented methodologies are established, most existing research has concentrated on policy change, governance reforms, coalition discourse, and subsystem interactions within formal policy environments [19]. There has been limited focus on the co-design of women’s health joint advocacy platforms and the relational dynamics involved in negotiating shared advocacy structures among diverse actors. Furthermore, previous research has predominantly relied on discourse network analysis, document reviews, surveys, and policy analysis, with relatively few studies integrating KIIs and MSDs to examine informal negotiations, institutional interests, power relations, and the processes underlying the formation of collaborative advocacy [8].

Therefore, while the present study builds on established qualitative and ACF-informed traditions, its methodological contribution lies in integrating KIIs and MSDs within a PEA and ACF lens to examine the design of sustainable women’s health joint advocacy models in Nigeria. This approach enabled deeper exploration of stakeholder interactions, coalition-building processes, institutional negotiations, and power configurations that are often insufficiently captured in conventional policy process studies.

Sample and participants selection

We used purposive sampling to recruit participants who were directly involved in designing, coordinating, or influencing women’s health advocacy at both national and subnational levels. Eligible participants had hands-on experience in family planning (FP) or maternal, newborn, child, and adolescent health (MNCAH) advocacy, policy, or program design. We also included those who took part in joint advocacy platforms, coalitions, or decision-making groups among key stakeholders like government, civil society organizations, donors, and professional bodies. People who were not directly engaged in advocacy or policy work, or who did not have roles in decision-making, coordination, or implementation, were not included. We also used snowball sampling to find more relevant stakeholders, especially those in informal networks or less visible advocacy spaces. In this study, a key informant was someone with specialized knowledge, influence, or direct experience in women’s health advocacy.

We conducted 52 key informant interviews (KIIs) in Lagos, Kano, Kaduna, and at the national level. Senior officials from state ministries of health and women’s affairs, national policymakers, donor representatives, civil society leaders, feminist activists, women-led organisations, professional associations, and technical advisors participated. We emphasised representation across government, civil society, and development sectors, and ensured geographic and gender diversity. In addition to the KIIs, about 75 participants took part in four MSDs held in the three states and at the national level. These dialogues enabled broader discussion and helped validate emerging themes. The sample size and diversity, along with the integration of interviews and dialogues, enabled thematic saturation. This approach provided a comprehensive understanding of advocacy platform design, grounded in the practical experiences of those working within Nigeria’s complex health governance system. Table 1 highlights the diversity of stakeholder engagement across sectors, underscoring the complex, multi-actor environment within which women’s health advocacy operates in Nigeria. By incorporating perspectives from government, civil society, faith-based organisations, and other actors, the study captures variations in power, resources, and institutional positioning. This breadth of engagement enhances the analytical depth of the study and supports the application of the Political Economy Analysis and Advocacy Coalition Framework in examining how different actors influence advocacy processes and outcomes.

Table 1.

Summary of study sample and engagement methods

Sector	Total KIIs	Total MSDs	Total participants (KII + MSD)
Government	18	29	47
NGO/CSO	21	14	35
Private Sector	2	1	3
Faith-Based	7	26	33
Professional Associations	4	2	6
Media	0	1	1
Donor	0	2	2
Grand Total	52	75	127

Media and donor actors were included in the study design but participated only in MSD and not in KIIS, primarily due to availability constraints during data collection

Data collection

Data collection used KIIs and MSDs. This aimed to capture diverse perspectives on the political, institutional, and social factors influencing the development of women’s health joint advocacy models in Nigeria. Interviews addressed topics such as platform formation, leadership structures, power dynamics, institutional alignment, and sustainability. A semi-structured guide was used, and interviews were conducted in English, Pidgin, Hausa, or Yoruba, according to the participant’s preference. The KIIs lasted approximately 45–60 min, depending on participant availability and depth of engagement. The guide employed in this study was specifically developed for the purposes of this research and has neither been published nor submitted elsewhere (see additional material 1). All interviews were audio-recorded with the participants’ consent and subsequently transcribed for analysis. Based on interview findings, the study held MSDs in the three study states and nationally. The multi-stakeholder dialogues MSDs were organized according to predefined thematic areas that corresponded with the study’s analytical framework. The discussions addressed the formation of joint advocacy platforms, leadership and governance structures, power dynamics and issues of inclusion or exclusion, coalition coordination and conflict, integration within health-sector institutions, and the sustainability of advocacy initiatives. Consistent with the Political Economy Analysis and Advocacy Coalition Framework, the analysis emphasized the distribution and exercise of power, the negotiation of coalition beliefs and interests, and the influence of institutional incentives on advocacy outcomes.

The scope of the discussions excluded clinical service delivery, individual organizational program implementation, and technical health interventions, except in cases where these were directly relevant to advocacy processes or policy influence. This approach maintained a focus on the political, institutional, and coalition dynamics that shape joint advocacy for women’s health.

The research team led these dialogues, which involved group reflection and discussion on challenges and opportunities related to the advocacy platform. These dialogues also made it possible to compare perspectives and highlight state-specific issues on representation, legitimacy, and coordination. All data collection followed ethical guidelines. Participation was voluntary, we obtained informed consent, and we maintained confidentiality. These steps ensured data captured technical, political, cultural, and social factors shaping joint advocacy design in Nigeria’s complex health governance.

Data management and analysis

An integrated analytical framework combined PEA and ACF to examine joint advocacy models for women’s health in Nigeria. This dual-lens approach enabled a multi-level analysis, linking macro-level political and institutional conditions with coalition-level dynamics, beliefs, and strategies—factors that together shape advocacy outcomes. PEA examined the broader governance context, including resource control, political incentives, institutional arrangements, and informal power structures, all of which create both opportunities and constraints for collective action. In turn, the ACF complemented this by examining coalition composition, shared beliefs, leadership dynamics, resource distribution, coordination, and conflict, and explored how these factors influence actors’ responses to structural conditions.

The analysis used this integrated framework to capture three related dimensions. These were: (i) macro-level political economy factors, (ii) mechanisms shaping access, inclusion, and coordination within advocacy spaces, and (iii) coalition-level processes and behaviours. The analysis also considered implications for policy influence, participation, and sustainability. This approach aligns with the conceptual model shown in Fig. 1, which links political-economic conditions to coalition dynamics and advocacy outcomes.

Interview and dialogue data were managed to ensure both confidentiality and analytical integrity. Interviews conducted in local languages were transcribed and translated into English by trained bilingual research assistants. To enhance accuracy, a subset of transcripts was independently reviewed and backchecked by senior members of the research team fluent in both languages. Discrepancies were discussed and resolved through consensus to ensure consistency in meaning and interpretation. In addition, key terms and context-specific expressions were carefully preserved during translation to minimise loss of nuance. This process was implemented to strengthen the credibility and rigour of the qualitative data. All personal identifiers were removed prior to analysis. The analytic process utilised thematic analysis with a hybrid deductive–inductive coding approach. Deductive codes were based on key constructs from PEA and ACF, while inductive coding identified emergent themes grounded in participants’ experiences, such as donor dependence, informal gatekeeping, symbolic participation, and context-specific power asymmetries. Thematic saturation was defined as the point at which no new themes, patterns, or analytical insights emerged from additional data collection.

To ensure analytical rigour and reliability, findings from KIIs and MSDs were triangulated. Regular team debriefings enhanced consistency in coding and interpretation, and reflexive practices were implemented to account for the researcher's positionality and potential biases. The integrated PEA–ACF framework facilitated a coherent analysis linking power relations, institutional incentives, and coalition dynamics, thereby generating contextually grounded insights for designing more inclusive, resilient, and politically informed joint advocacy strategies for women’s health in Nigeria.

Ethical approval and consent to participate

Ethical clearance was granted by the National Health Research Ethics Committee of Nigeria’s Federal Ministry of Health (NHREC Approval Number NHREC/01/01/2007–16/10/2023). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality, and provided written consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence. All data were stored securely. Quotes in this article are anonymised to protect the identities of participants.

Results

Macro-level political economy factors shaping women’s health joint advocacy

Resource control and financial structures

This section examines how macro-level political economy factors, such as political interests, institutional arrangements, informal norms, and structural incentives, shape both the design and functioning of joint advocacy platforms and the conditions affecting coalition dynamics.

Financial, organisational, and accountability structures play a critical role in shaping the design, operation, and sustainability of joint advocacy platforms for women’s health. The findings indicate that structural factors, especially budget fragility, donor dependence, and the concentration of financial resources among a few actors, create systemic constraints that affect platform priorities, participation, and decision-making. Dependence on external funding leads to uncertainty and short-term planning, while resource concentration strengthens existing hierarchies by favoring well-funded organisations with greater access to advocacy spaces. As a result, financial structures actively determine whose voices are heard, which issues receive attention, and how collective action is maintained over time.

The findings from this study showed that joint advocacy platforms for women’s health were shaped fundamentally by the incentives and strategic positioning of the actors involved. Organisations frequently aligned their participation with donor funding cycles, visibility opportunities, and institutional priorities rather than shared long-term advocacy goals. Although many stakeholders expressed strong commitments to improving women’s health outcomes, the actual patterns of attendance and contribution reflected a political economic environment where competition for recognition, funding access, and proximity to government shaped engagement more than collaborative or sustained commitment to joint advocacy. This created a system in which joint advocacy was often episodic, rising and fading in response to shifting resource flows rather than grounded in continuous constituency-driven action.

“Most organisations only come when a donor has announced funding. After the grant ends, you will hardly see them at meetings.” CSO Representative, Lagos - KII 07

This suggests that resource dependence shapes when and how organisations participate and may influence which issues receive greater attention within advocacy platforms.

The interviews revealed that patterns of leadership across platforms reinforced these structural inequalities. A small cluster of influential organisations (typically those with donor credibility, historical presence in the sector, or close government ties) repeatedly occupied convening and decision-making roles. Their influence extended to shaping agendas, managing relationships with ministries, and determining which issues gained prominence. While their technical capacity strengthened some aspects of coordination, their dominance concentrated power and limited the emergence of new or diverse leadership. This form of elite capture reflects the broader political economy of civil society engagement in Nigeria, where resources, reputation, and proximity to political actors accumulate within a small set of organisations over time.

“The same organisations always chair the platforms; they rotate leadership among themselves.” Coalition Member, National - KII 09

“If you are not connected to the big NGOs, your agenda will struggle to be heard.” CSO Representative, Lagos - KII 16

These findings indicate that differences in resource access are associated with variations in participation, with less-resourced actors appearing to face greater constraints in engaging in decision-making processes. Also, it suggests that leadership concentration may influence whose perspectives are prioritised within advocacy platforms.

In fact, joint advocacy platforms operate under conditions of significant budgetary fragility. Across Lagos, Kano, and Kaduna platforms rely heavily on external funding, which creates cycles of uncertainty and constrains long-term planning. Lagos joint platforms, while benefiting from comparatively abundant donor presence, are highly sensitive to shifts in funding priorities. In Kano and Kaduna, limited budgets compel actors to combine multiple small grants and rely on informal networks for operational continuity. These structural financial pressures influence both the selection of advocacy priorities and the scale of interventions, limiting the capacity of platforms to pursue long-term systemic change.

“Our advocacy activities depend almost entirely on donor funding; if the funds stop, the platform grinds to a halt.” CSO, Lagos—KII 07

These arguments reflect the fact that financial instability may affect the continuity of advocacy activities and the ability of platforms to plan beyond short-term cycles.

Consequently, the reliance on donor funding encourages a focus on short-term outputs at the expense of sustained policy engagement. Joint advocacy platforms frequently design interventions to meet immediate reporting requirements and donor-defined performance metrics, thereby reducing flexibility to respond to emerging local needs. In response to these constraints, actors develop informal resource-sharing mechanisms, pool grants, and negotiate joint visibility strategies. While these adaptations reflect ACF concepts of strategic response, structural limitations inherent in donor-dependent funding cycles persist, exposing platforms to recurring operational vulnerability as amplifies by the participants voices.

“Sometimes we coordinate with other platforms to pool resources, but it’s temporary and unpredictable.” CSO, Lagos—KII 09

“Donor timelines shape everything; we often have to rush activities to meet reporting deadlines.” Policymaker, Kaduna—KII 06

Transactional partnerships are prevalent, with alliances frequently formed around funding availability rather than long-term strategic alignment. While these arrangements allow rapid mobilization for discrete projects, they often undermine trust and cohesion once donor support ends. As a results, actors negotiate co-branding of initiatives, rotate leadership visibility, and establish shared responsibilities within platforms. These adaptive strategies reflect ACF’s actor-level mechanisms for maintaining functionality under structurally constrained conditions. In participants’ voices:

“Sometimes partnerships exist purely for funding; once the grant ends, the collaboration disappears” Policymaker, Kano—KII 03

“We have to manage expectations because some partners are interested only in funding, not sustained advocacy.” CSO, Lagos—KII 08

“Joint advocacy initiatives sometimes exist more for grant applications than for policy impact.” Excerpts from MSD, National

Hence, actors demonstrate strategic allocation of scarce resources to maximize platform impact. By prioritizing initiatives that simultaneously satisfy donor requirements and local needs, platforms leverage pooled resources to achieve multi-objective advocacy outcomes.

“We have to be very strategic with limited funds, focusing on projects that satisfy both donors and local communities.” CSO, Lagos—KII 08

“Resource-sharing allows us to extend the reach of our advocacy despite budget constraints.” CSO, Kaduna—KII 11

“Prioritizing interventions is critical; otherwise, small budgets get spread too thin to achieve impact.” Policymaker, Kano—KII 05

The cumulative effects of budget fragility, donor dependence, resource hierarchies, transactional partnerships, and weak accountability mechanisms significantly challenge the long-term sustainability of joint advocacy platforms across the states. While adaptive strategies such as learning systems and strategic resource allocation enhance resilience, structural constraints persist some participants noted that without stable funding, long-term advocacy is almost impossible. Participants further highlighted that institutionalization of learning processes, diversified funding sources, and inclusive decision-making are essential to strengthen sustainability, optimize platform performance, and improve long-term policy impact.

Political incentives and elite competition

Political commitment to women’s health advocacy was reportedly inconsistent and often performative, shaped by the pursuit of visibility and short-term political gains rather than sustained policy interest. Government officials frequently attended highly visible launches or donor events but rarely supported the institutional follow-through needed to translate commitments into action. This dynamic reflects a political economy environment in which symbolic gestures carry more political reward than systemic reforms.

“Politicians attend our events, but after the cameras leave, nothing happens.” CSO Representative, Abuja - KII 21

“They like to be photographed at maternal health events, but they don’t stay for the technical sessions.” Policymaker, Lagos - KII 06

These expose how political engagement with advocacy may be influenced by visibility and timing considerations.

Regardless, the participants reported that selective political will was also shaped by electoral incentives. Issues perceived as politically favourable (especially maternal health) received temporary attention, while adolescent health, sexual and reproductive rights, and gender-transformative policies were deprioritised. Political actors supported advocacy messages that aligned with their campaign narratives or public image, reinforcing a pattern where visibility outweighed need.

“Political will is selective; they support what aligns with their interests.” Advocacy Network Member, Lagos - KII 17

“Adolescent health only comes up when there is donor pressure, not because politicians see it as a priority.” Youth SRH Advocate, Abuja - KII 15

Kaduna State emerged as an exception that demonstrated how political leadership combined with bureaucratic responsiveness can create a genuinely enabling environment for advocacy. Stakeholders described structured engagement, consistent invitations to planning meetings, and visible integration of CSO recommendations into state health strategies. This suggests that when leadership priorities align with coherent bureaucratic practices, advocacy gains become more durable.

“In Kaduna, government invites CSOs and actually listens, our inputs appear in the plans.” Women’s Health Advocate, Kaduna – KII 03

“Here, they treat CSOs as partners, not accessories.” Excerpts from MSD, Kaduna

“Kaduna stands out because decisions are explained, feedback is taken, and follow-up actually happens.” Policymaker, Kaduna

This enabling environment in Kaduna was further supported by predictable coordination systems and clear bureaucratic processes. Unlike other states where engagement depended on personal discretion, Kaduna embedded participation into routine governance. Stakeholders emphasised that meetings were scheduled regularly, decisions were documented, and responsibilities were clearly assigned.

“There is real partnership here; it’s not just for show.” Excerpts from MSD, Kaduna

“Kaduna works because the system, not just the people, is organised.” Policymakers, Kaduna - KII 10)

“Even when staff change, the process continues; it’s not built around one person.” Policymakers, Kaduna - KII 05)

The results also show that in most other contexts, advocacy gains depend heavily on individual champions within government (directors, programme managers, or donor focal persons) who act as the entry point for CSOs. These champions facilitate access to decision-makers, ensure issues are tabled, and sometimes defended CSO recommendations during internal deliberations. However, their transfer or exit frequently disrupt progress, highlighting the fragility of personality-dependent systems.

“When our champion left the ministry, our advocacy stalled; we had to start all over again.” CSO representative, Kano - KII 08)

“Once the supportive director was moved, everything went quiet for months.” (CSO Representative, National - KII 19)

“You almost have to start a new relationship every time there’s a reshuffle.” (NGO Representative, Lagos - KII 11)

Institutional structures and governance systems

Findings revealed that joint advocacy platforms face a persistent challenge: most platforms lack formalised anchoring within government systems. Despite strong enthusiasm from civil societies, many joint platforms operate outside statutory structures, relying on personal relationships or informal invitations to engage ministries. Without clear institutional homes, joint advocacy efforts remain vulnerable to administrative turnover and shifting political priorities. This reflects a broader political economic pattern in which policy influence is contingent on personal access rather than institutionalised pathways, limiting the ability of women’s health coalitions to drive long-term reform.

“We are not formally recognised anywhere; everything depends on who is currently in office.” CSO Representative, Kano - KII 04

“When officials change, we have to start building relationships from zero.” Joint Advocacy Member, Lagos KII 13

This study shows that a broader structural weakness was the absence of institutionalised processes for incorporating civil society evidence into formal planning cycles. Many joint advocacy platforms invest heavily in generating policy briefs, evidence syntheses, and position papers, yet lack predictable mechanisms for submitting or discussing these with government planners. Without structured channels for feedback, review, and adaptation, advocacy outputs often remained external to the annual planning, budgeting, and review processes that drive health sector decisions. This reflects governance patterns where bureaucratic routines prioritise internal government processes over inclusive evidence uptake, particularly in areas like women’s health that may not be politically prioritised.

Institutional fragmentation also created uncertainty about accountability roles. In several cases, government agencies offered ad hoc engagement; inviting CSOs to policy launches but excluding them from subsequent implementation discussions. This inconsistency undermined trust and contributed to a perception that civil society was valued more for legitimate optics than for substantive partnership. From a political economy perspective, this behaviour demonstrates how government actors selectively include CSOs when it aligns with visibility or donor requirements, while withholding influence in areas involving resource control or political risk.

The combined effect of weak anchoring, limited integration into sector-wide mechanisms, and fragmented access to financial decision-making produced coalitions that operated largely at the margins of formal governance systems. Their influence depended heavily on individual champions, donor-initiated opportunities, or the goodwill of selected officials rather than institutionalised processes. This fragility reflects the broader governance context in which health sector decision-making is centralised, bureaucratic, and shaped by path-dependent routines that exclude external actors unless strategically beneficial.

As a result, the institutional positioning of joint advocacy platforms underscores the importance of designing coalitions that can navigate both formal and informal governance structures. Without clear anchoring, predictable engagement mechanisms, and embedded pathways for influencing budget and planning cycles, advocacy platforms risk remaining peripheral rather than shaping the institutional DNA of women’s health policy. Strengthening institutional integration is therefore essential for ensuring that advocacy gains become durable, system-level changes rather than temporary project-driven achievements.

Evidence buttressed that weak bureaucratic systems further undermine the enabling environment, with inconsistent coordination, slow administrative approvals, and shifting leadership priorities disrupting advocacy timelines. Frequent changes in technical leads or state focal people result in lost institutional memory and stalled implementation. These bureaucratic inefficiencies reflect deeper systemic constraints in health governance.

“You can push for months and then a change of leadership resets everything.” CSO, Lagos - KII 13)

“Sometimes files sit on desks for weeks because no one wants to take responsibility.” Policymaker - KII 02)

“There is no continuity; projects start, stop, and restart depending on who is in charge.” Policymaker, Kaduna - KII 01)

Nevertheless, the enabling environment for women’s health advocacy remained shaped by fluctuating political incentives, informal power structures, and uneven governance systems across states. Without institutionalised engagement pathways, advocacy success relied heavily on timing, relationships, and external pressures rather than predictable government processes. Strengthening formal mechanisms for CSO participation and embedding engagement in statutory structures are therefore essential for creating durable policy gains.

“A lot depends on the goodwill of individuals, not the system.” Excerpt from MSD, National

“Until engagement is institutionalised, we will always be starting from zero.” Policymaker, Kano - KII 07

“For advocacy to last, it must survive beyond personalities and politics.” CSO, National - KII 20

Accountability and monitoring structures are frequently underdeveloped. Many joint advocacy platforms rely on donor reporting or informal peer feedback, lacking institutionalized mechanisms to assess outcomes or integrate lessons into strategy. Lagos platforms, despite technical sophistication, exhibit elite dominance that constrains participation. In Kano and Kaduna, relational trust and informal oversight partially substitute for formal mechanisms, yet the absence of institutionalized feedback limits the capacity for adaptive learning and reduces overall effectiveness.

“We submit reports to donors, but there is no mechanism to evaluate whether our advocacy actually achieves change.” CSO, Lagos—KII 10

“Learning is informal; we discuss lessons among ourselves, but nothing is institutionalized.” CSO, Kaduna KII 13

“Evaluation is donor-driven; local lessons are rarely incorporated into future planning.” Policymaker, Kano, KII 05

These macro-level conditions shape the interaction mechanisms through which actors engage in advocacy processes, including access to decision-making spaces, inclusion dynamics, and coordination patterns.

Interaction mechanisms: access, inclusion, and coordination

The findings indicate that macro-level political economy conditions shape specific interaction mechanisms within advocacy spaces. These mechanisms include unequal access to decision-making platforms, exclusion of less-resourced actors, informal gatekeeping through personal networks, and fragmented coordination across formal structures such as SWAp and Technical Working Groups. They influence how actors engage, whose voices are prioritized, and how coalition processes develop.

Resource balance and access to influence

Access to decision-making is also shaped by donor-linked resource control, where actors with funding access gain privileged entry into policy and coordination spaces. According to excerpts from multi-stakeholder dialogue, the uneven distribution of convening power further entrenched structural hierarchies within advocacy spaces. Platforms led by organisations with donor backing, strong reputational capital, or political proximity achieve higher attendance and greater traction with government actors. Their convening ability lends legitimacy to their initiatives, enabling them to mobilise diverse stakeholders quickly. However, this concentration of convening authority also deepens dependency on a small number of institutions and limits the autonomy of less resourced organisations to initiate or steer collective action. This dynamic reflects political economy logics where authority and alignment with dominant actors shape joint advocacy cohesion and participation patterns.

“People attend when certain organisations call a meeting; they have credibility with the government.” CSO Representative, National – Excerpts from MSD

“Some platforms only function because a donor is behind them; without that, the turnout drops.” Youth-Led Organisation, Lagos - KII 10

Control over financial and material resources constitutes a primary determinant of influence within joint advocacy platforms. Larger CSOs (especially international NGOs) with direct donor access dominate agenda-setting, resource allocation, and inclusion decisions, while smaller CSOs often align their priorities with those of resource-rich actors to maintain relevance. This hierarchical dynamic illustrates insights regarding structural incentives and how actors respond adaptively through negotiation, strategic partnerships, and the deployment of technical expertise to secure influence.

“Who controls the money controls the advocacy agenda. Smaller CSOs often must align with bigger organizations’ priorities.” CSO, Lagos—KII 14

“Resource-rich partners decide which advocacy interventions are funded and whose perspectives are included” CSO, Kaduna—KII 06

“The larger NGOs dominate; they decide what counts as priority for the platform.” Policymaker, Lagos—KII 09

Access to decision-making spaces

The inability of many joint advocacy platforms to engage meaningfully with basket funding systems further revealed institutional asymmetries. Stakeholders reported limited visibility into how pooled funding allocations for women’s health were made, who participated in prioritisation meetings, and what information shaped budget decisions. Because access to these spaces was largely restricted to government and major donor actors, civil society voices were frequently absent from discussions that directly determined the financial sustainability of advocacy goals. This pattern aligns with political economic insights showing how control over financial decision-making is tightly held, reinforcing hierarchies that limit redistributive or equity-focused policy shifts.

“There is no space where CSOs can formally input into funding discussions.” Women’s Rights Representative, Kano - KII 01

Limited integration into formal coordination structures (e.g., SWAp) constrains how advocacy inputs translate into policy processes. This study illuminated how fragmented integration with sector-wide coordination mechanisms further constrain the effectiveness of joint advocacy. For example, although the SWAp was designed to harmonise government and donor priorities, many joint advocacy platforms remain detached from its planning and accountability structures. CSOs struggled to understand how SWAp function, who manages entry points, or how their recommendations could feed into pooled decision-making spaces. The findings show a parallel operational reality where advocacy happens outside the formal structures intended to shape national health priorities. This disconnection reflects systemic communication barriers and bureaucratic opacity that sideline civil society in key sector-wide processes.

“Many platforms don’t even know how SWAp functions or where advocacy should plug in.” Excerpts from MSD, National

“We operate parallel to SWAp, not within it.” CSO Representative, Kaduna - KII 0

Coordination and gatekeeping mechanisms

Access to decision-making spaces is mediated by informal gatekeeping, disconnections from formal structures (SWAp exclusion), TWG variations, and donor access. Nevertheless, this study exposed how informal power structures further shape how joint advocacy platform’s function. Personal relationships, long-standing professional networks, and insider familiarity with government processes often matter more than formal roles or joint advocacy mandates. Individuals who had cultivated close ties with ministry officials or donor representatives operated as informal gatekeepers, determining who gained access to policy spaces, which organisations were invited to technical meetings, and whose voices were prioritised. These informal arrangements mirror Nigeria’s broader governance culture, where “who you know” influences access and legitimacy as much as formal rules. This demonstrates relational (informal) power, where personal networks and insider access determine participation in policy spaces.

“There are invisible hands that determine who get to speak at government meetings.” TWG Member, Kano - KII 05

“Some people act as gatekeepers; you must pass through them before accessing the ministry.” NGO Representative, Kaduna - KII 12

Formal coordination platforms such as TWGs function unevenly, shaping the extent to which actors can influence decision-making. Even when formal structures exist, such as Technical Working Groups (TWGs), their effectiveness vary significantly across states. In some contexts, TWGs provide genuine channels for joint planning, monitoring progress, and embedding CSO insights into technical decisions. In others, TWGs function primarily as information-sharing venues, with government actors dominating conversations and determining priorities unilaterally. These differences highlight how institutional culture and local politics shape the extent to which formal coordination mechanisms can serve as meaningful vehicles for women’s health advocacy, rather than mere procedural rituals.

“Being in the TWG does not mean your voice will be heard; government still decides everything.” TWG Member, Lagos - KII 19

“Some TWGs are vibrant, but others are just for reporting activities.” CSO Representative, Kaduna - KII 02)

Conflict, competition, and coordination patterns

Beneath these structural patterns, the competitive funding environment contributed to a transactional orientation toward joint advocacy. Organisations often viewed participation in joint platforms as a strategic move to position themselves for future grants, align with donor priorities, or increase their chances of being included in consortium bids. This competitive ethos reduced incentives for genuine collaboration and reinforced tendencies to prioritise issues that appealed to donors rather than those most relevant to affected women and communities. Such behaviour aligns with political economy insights showing how scarcity and dependence on external funding shape organisational strategies within civil society.

These structural forces also created fragile joint advocacy platforms whose momentum depended heavily on external catalysts. When donors shifted priorities or funding windows closed, joint advocacy platforms often lost steam, revealing a lack of institutionalised systems for sustaining collective action. Without predictable resources or formalised roles, joint platforms struggled to maintain coordination, share responsibilities, or implement long-term advocacy agendas. This volatility underscores the vulnerability of issue-based coalitions within Nigeria’s health governance environment, where institutional memory and continuity remain weak.

Joint platforms that established structured learning mechanisms demonstrate higher adaptive capacity and resilience. The interviews show that post-advocacy debriefs, systematic documentation of lessons learned, and peer review processes enable actors to refine strategies, respond to emergent policy shifts, and sustain effective advocacy. These practices illustrate how actors operate adaptive mechanisms to navigate structural constraints imposed by financial and organizational limitations.

“After each campaign, we hold a debrief to understand what worked and what didn’t.” CSO, Kano—KII 04

“Peer accountability and information-sharing help manage resource constraints and maintain advocacy performance.” Excerpts from MSD, National

Advocacy coalition dynamicss

This section presents findings aligned with the coalition-level dynamics of the Advocacy Coalition Framework, showing how actors respond to structural conditions through belief systems, leadership patterns, coordination strategies, and learning processes.

Core coalition composition and leadership

This research sought to understand the dynamics, interactions and belief systems within joint advocacy platforms in Nigeria. Findings from both MSDs and KIIs show how coalition dynamics are shaped by underlying structural conditions, particularly through variations in resource distribution, belief systems, and leadership patterns across states. For example, we found that Lagos, Kaduna, and Kano demonstrated varying capacities for participatory policy engagement, with state-level joint advocacy platforms such as TWGs reflecting different levels of responsiveness to civil society inputs. This reflects material and institutional power, where resource-rich organisations and those with formal access to decision-making spaces shape advocacy agendas. Whereas smaller community-based organizations struggled to have their perspectives incorporated, reflecting both organizational asymmetries and the uneven operationalization of joint advocacy principles across states.

“Being in the platform does not guarantee that our ideas are considered; bigger NGOs and donors have more influence.” Lagos—KII 07

“Power is not only about money; it’s about connections and being able to push your knowledge forward.” National, KII 14

“Being in the TWG does not mean your voice will be heard; government still decides everything.” Lagos—KII 19)

“Some TWGs are vibrant, but others are just for reporting activities.” (CSO Member, Kaduna—KII 02)

Shared belief and ideology

Our research pointed out that belief systems strongly influenced advocacy priorities, with religious, organizational, and personal convictions shaping engagement across states. In Kano and Kaduna, conservative religious norms often limit the public discussion of adolescent sexual and reproductive health, while Lagos exhibited more flexibility due to its cosmopolitan demographic and history of progressive policy engagement. Joint advocacy platforms navigate these ideological divides carefully, ensuring that messaging does not provoke resistance from either political actors or local communities.

“Some groups will only support reproductive health if it aligns with their religious views, which limits what we can campaign for.” CSO, Kano – KII 10

“Beliefs determine what is considered acceptable; even evidence cannot always override ideology.” Excerpt from MSD, National

“We often avoid framing that might trigger religious or political opposition, even if the health evidence supports it.” CSO, Lagos—KII 07

Ideological divisions were particularly pronounced in family planning initiatives. For example, faith-based organizations sometimes withdrew from joint campaigns that conflicted with core values, while secular NGOs prioritized evidence-based interventions. This tension necessitated strategic negotiation and adaptive framing to maintain joint advocacy platform cohesion.

“Family planning discussions often cause friction; the science is clear, but beliefs slow consensus.” CSO, Kaduna—KII 02

“We have to carefully navigate religious sensitivities to keep everyone engaged in the coalition.” CSO, Lagos—KII 07

“Sometimes partners withdraw entirely if advocacy conflicts with their core beliefs, weakening collective efforts.” Excerpts from MSD, National

Findings from this study indicate that sometimes, strategic framing was deployed to reconcile these ideological differences. Messaging was carefully crafted to resonate with stakeholders’ values, align with societal norms, and satisfy donor expectations. For instance, adolescent health was often framed in terms of overall wellbeing rather than sexual rights to increase acceptability in conservative contexts.

“We frame adolescent health as a broader wellbeing issue rather than only reproductive rights.” Policymaker, Kano—KII 05

“Messaging must appeal to everyone; otherwise, partners withdraw from campaigns.” Excerpts from MSD, National

“Data alone is not enough; we need culturally sensitive storytelling to gain support across ideological divides.” Excerpts from MSD, Lagos

Feedback from CSO indicated that Donor funding cuts intensified the reliance on strategic framing to secure resources, as coalitions adjusted messaging to ensure alignment with funders’ priorities while navigating local sensitivities.

“Donors are cautious; we adjust messaging to fit their expectations to access funding.” CSO, Lagos—KII 14

“Sometimes framing is more about donor approval than local relevance, which can be limiting.” Excerpts from MSD, Kaduna—KII 03

“We constantly negotiate between donor requirements and local realities to maintain both credibility and funding.” Excerpts from MSD, National

Nonetheless, evidence was strategically leveraged to support negotiation across ideological divides. Our findings show that joint advocacy platforms used community case studies, statistical data, and testimonials to illustrate the societal benefits of interventions, enabling inclusive engagement while mitigating potential conflicts.

“We use outcomes like reduced maternal deaths to show benefit across all beliefs.” CSO, Lagos—KII 09

“Data and stories together help us navigate ideological disagreements effectively.” Policymaker, Kaduna—KII 11

“Highlighting community success stories often convinces even hesitant partners to engage in advocacy.” CSO, Kano—KII 05

Resource distribution within coalitions

Knowledge hierarchies were particularly salient in Kaduna and Kano, where community-based insights on maternal and adolescent health were often overlooked in favor of evidence produced by international NGOs. This illustrates ideational power, where formally produced evidence is privileged over community knowledge, shaping whose perspectives influence policy. Findings indicate that while joint advocacy principles mandate inclusive participation, resource constraints and donor-driven reporting norms meant that technical capacity, rather than local relevance, determined influence. This created a system where the epistemic authority of organizations was heavily weighted toward those with research capacity and formalized knowledge outputs.

“Our local knowledge is overlooked; reports from bigger organizations carry more weight in Abuja.” CSO Representative, Kaduna – KII 03)

“The field stories we bring are real, but they are often seen as anecdotal.” CSO, Kano – KII 11)

“Even if you have critical insights, they are discounted if they are not supported by formal studies or published evidence.” Excerpts from MSD, Lagos

Epistemic access was further constrained by recent donor funding cuts that reduced the number of technical assistance programs and capacity-building opportunities in Kaduna and Kano. This limited the ability of smaller CSOs to participate fully in knowledge generation and advocacy strategy formulation, reinforcing hierarchies and privileging actors with pre-existing skills or networks.

“If you don’t have a recognized qualification or donor connections, your insights rarely influence policy decisions.” Policymaker, Lagos—KII 22

“Knowledge determines who speaks and who remains on the sidelines; it is a form of invisible power.” CSO, Kaduna—KII 09

“Our research gets attention mainly because it comes from a recognized institution, not necessarily because it reflects urgent community needs.” CSO, Kano—KII 16

“Sometimes I feel I am included only symbolically, not substantively.” CSO, Kaduna—KII 13

Coordination and conflict dynamics

Joint advocacy platforms in Nigeria are formed through a combination of shared goals, resource complementarity, and external pressures, including donor requirements and SWAp coordination structures. In Lagos, joint advocacy often benefits from pre-existing networks and urban proximity to federal institutions, while in Kaduna and Kano, joint advocacy formation is influenced by local political actors, traditional authorities, and faith-based groups. The interplay of these factors shaped the composition, mandate, and operational approach of each coalition.

“We formed the coalition because no single organization could address maternal mortality alone.” Regional CSO, Kaduna—KII 01

“Donor calls for joint proposals often accelerate coalition formation, even among previously unconnected actors.” CSO, Lagos—KII 06

“Collaboration sometimes happens out of necessity rather than shared ideology, but it can still produce results.” Excerpts from MSD, National

Across different states, reports indicate that crisis mobilisation often test joint advocacy cohesion and adaptive capacity, particularly during policy rollbacks, maternal health emergencies, or adolescent reproductive health controversies. Joint advocacy platforms with strong trust networks and clearly defined roles could respond rapidly, while fragmented structures experience delays and reduced impact.

“When a policy threatened adolescent reproductive health, we convened in 48 h and issued a joint statement.” Excerpts from MSD, National

“Rapid mobilisation only works when roles and responsibilities are clear in advance.” Policymaker, Lagos—KII 07

Strategic framing and learning

This study, however, found that adaptive capacity was strengthened by flexibility, learning mechanisms, and leadership dynamics. Joint advocacy platforms capable of pivoting strategies, reallocating resources, or adjusting messaging in real time demonstrate greater resilience. It is clear from the interviews that distributed leadership models facilitate continuity, particularly in states with volatile political or security contexts.

“When leadership is shared, we can act even if one person is unavailable.” CSO, Kano—KII 05

“Centralized decision-making often slows mobilization when time is critical.” Excerpts from MSD, National

One interesting finding is that external partnerships with government ministries, media, and international organizations enhance joint advocacy capacity to respond to crises. This study highlights that collaborations enable rapid access to data, policy platforms, and public visibility, particularly during periods of donor funding reductions, which constrain resources and technical support.

“Our connections with state health ministries allowed us to quickly access data and push interventions.” Excerpts from MSD, National

“Media engagement during crises amplifies advocacy messages and ensures timely policy attention.” CSO, Kaduna-KII 02

“International partners can provide technical advice that helps us adapt interventions quickly in a changing environment.” Excerpts from MSD, National

In some instances, reflections from past collaborators of joint advocacy buttresses that lessons learned during crises reinforce joint action preparedness and institutional memory, informing future interventions and sustaining advocacy momentum. Also, documentation of best practices, debriefing sessions, and knowledge-sharing were critical for ensuring long-term effectiveness.

“Every emergency teaches us something new about collaboration and response.” Excerpts from MSD, National

“Lessons learned during crises help us refine procedures for faster action next time.” CSO Member, Lagos—KII 08

“Recording and sharing experiences is critical for building resilient coalitions.” Policymaker, Kaduna – KII 12

Joint advocacy outcomes

Macro-level political economy conditions and coalition-level dynamics shape advocacy outcomes, including policy influence, inclusion of marginalized actors, coordination effectiveness, and platform sustainability. When structural constraints such as donor dependency, weak institutional anchoring, and informal gatekeeping persist, advocacy tends to be fragmented, exclusionary, and short-term. In contrast, stronger institutional integration and aligned incentives, as seen in Kaduna, support more inclusive participation, sustained engagement, and greater policy influence.

Policy influence

The study finds that policy influence varies across contexts and is largely determined by access to formal decision-making spaces. In many states, joint advocacy platforms operate outside core planning and budgeting processes, which limits their impact on policy priorities. Participants noted that advocacy efforts often do not lead to budgetary decisions because of restricted access to financing discussions and unclear institutional processes. However, in contexts where advocacy platforms are integrated into formal structures, such as in Kaduna, stakeholders reported greater influence over planning and resource allocation.

Despite sustained advocacy efforts, participants consistently reported limited translation of advocacy into formal budgetary outcomes, largely due to restricted access to financial decision-making processes. As one respondent explained: “We advocate, but it never reflects in the budget because we don’t know how basket funding is decided…” This suggests that advocacy influence may vary depending on access to decision-making spaces and positioning within coordination structures.

Agenda-setting within joint advocacy platforms is shaped by concentrated leadership structures and external funding dynamics, which together influence which issues gain prominence. A small group of well-resourced and well-connected organisations often play a central role in prioritising advocacy themes, reinforcing existing hierarchies within the coalition. At the same time, funding timelines further shape engagement, as organisations adjust their participation to align with donor opportunities rather than long-term advocacy goals. As reflected in the findings, “Organisations frequently aligned their participation with donor funding cycles…”. These dynamics extend to resource allocation, where actors with greater access to funding and institutional networks exert disproportionate influence over how resources are distributed and which interventions are implemented, ultimately shaping both the direction and effectiveness of joint advocacy efforts.

Inclusion and marginalized voices

Inclusion in advocacy platforms is shaped by structural and relational factors. Grassroots, rural, and women-led organizations face persistent disadvantages due to financial limitations, restricted access to technical spaces, and dependence on intermediaries. The findings also reveal gendered barriers, as women and junior staff report less influence in decision-making. Despite formal commitments to inclusivity, participation often remains symbolic rather than substantive.

Evidence highlighted that representation within these joint advocacy platforms was uneven, with grassroots, rural, and women-led organisations consistently disadvantaged by structural barriers. Despite being the closest to the lived realities of maternal and reproductive health challenges, smaller organisations often lacked the financial resources, staff availability, and familiarity with technical health sector terminology needed to participate consistently. This imbalance reflects broader inequities within Nigeria’s civic landscape, where organisational capacity and political access determine whose voices are amplified and whose experiences are filtered through intermediaries. As a result, the priorities of the most affected groups were often interpreted and presented by better-resourced actors rather than articulated directly by the women and communities themselves.

“Grassroots women’s groups are invited but they cannot attend every meeting - transport alone is a barrier.” Women-Led CSO, Kaduna - KII 03

“Most of the time we speak for rural women instead of hearing directly from them.” CSO Representative, Kano - KII 11

Government engagement with CSOs was also shaped by informally enforced access rules. Organisations that were perceived as cooperative, politically neutral, or technically aligned were invited to high-level meetings, while those known for rights-based or critical advocacy were quietly excluded. This informal vetting determined whose voices entered policy conversations, reinforcing political control over civil society participation.

“Sometimes they only invite those they feel will not ‘disturb’ them too much.” (NGO Representative, National - KII 12)

“If they think you are too outspoken, they quietly leave you off the list.” (Gender Justice Activist, Lagos - KII 05)

“We were told to ‘tone down our language’ if we wanted to remain part of the TWG.” CSO Representative, Kano - KII 16)

Gendered dynamics intersected with these hierarchies across all three states. Female leaders and junior staff often faced additional barriers in asserting their expertise, limiting their influence in coalition decision-making and in shaping state-level policy discussions.

“Even if I lead the research, during meetings, my contributions are questioned more than my male colleagues’.” CSO, Kano—KII 05

“Women’s voices are present, but men still dominate discussions, especially in policy negotiations.” CSO, Lagos—KII 08

Sustainability of advocacy and coordination effectiveness

The sustainability of joint advocacy platforms depends on funding structures and institutional anchoring. Many platforms operate in cycles tied to donor funding, causing episodic engagement and limited continuity. When external funding declines, coordination weakens and participation drops, showing the lack of institutional mechanisms to sustain collective action. In contrast, contexts with stable institutional integration and structured coordination demonstrate greater continuity and resilience.

Coordination effectiveness varies across platforms, influenced by trust, leadership structure, and learning mechanisms. Fragmented coalitions with competing interests and weak coordination face delays and reduced impact, especially during crises. In contrast, platforms with shared leadership, clear roles, and learning processes show stronger collective action and more effective advocacy.

Coordination effectiveness within joint advocacy platforms is strongly influenced by levels of trust among coalition members. Platforms characterised by mutual trust and clearly defined roles demonstrate faster and more coordinated responses, particularly during periods of crisis, while low trust undermines timely action. As one participant noted:

“Coalitions that trust each other can respond faster; distrust slows down emergency action.”

These findings show that advocacy outcomes depend not only on coalition presence but also on how political-economic conditions shape interaction mechanisms and coalition dynamics, as shown in Fig. 1. This highlights the need to address structural constraints while strengthening coalition processes to achieve lasting advocacy impact.

Contextual variations

Cross-state analysis shows significant variation in joint advocacy dynamics across Lagos, Kano, and Kaduna, driven by differences in political economy, institutional arrangements, and socio-cultural contexts. These factors influence interaction mechanisms, coalition behavior, and advocacy outcomes, as shown in Fig. 1. The findings demonstrate that the effectiveness, inclusivity, and sustainability of joint advocacy platforms depend heavily on context.

In Lagos, joint advocacy platforms benefit from strong technical capacity, established organizational structures, and significant donor support, enabling evidence-based advocacy and rapid mobilization. However, fragmentation and competition for visibility and funding weaken coordination and collective alignment. Larger organizations dominate knowledge production and agenda-setting, limiting the participation and influence of smaller actors. As participants noted:

“There is a lot of technical expertise in Lagos, but small CSOs struggle to get their ideas heard.”

“Technical capacity is high, but platforms are fragmented; everyone wants visibility and funding.”

In Kano, joint advocacy operates within strong religious norms and traditional authority structures, which limit its scope and framing, especially on sensitive issues such as sexual and reproductive health. These conditions require actors to use culturally sensitive strategies to maintain legitimacy and avoid resistance. Advocacy efforts rely on adaptive framing, negotiation, and alignment with community values. As reflected in the findings:

“Religious leaders control what we can say publicly; we must frame messages very carefully.”

“Even when data support a program, beliefs often override evidence.”

Kaduna presents a more enabling environment for joint advocacy, with stronger political commitment, institutional support, and structured coordination. Joint advocacy platforms are integrated into formal decision-making processes, including Technical Working Groups and budget discussions, allowing civil society to influence policy and resource allocation. This institutional integration supports sustained engagement and improved advocacy outcomes. As participants observed: in TWGs, CSOs can influence budgets and priorities.” “Kaduna has strong political support for maternal health; our advocacy is integrated into formal structures.”

A comparative analysis highlights distinct political-economic conditions and coalition dynamics across states. Lagos combines high technical capacity with fragmented coordination and elite dominance. Kano requires adaptive advocacy strategies due to strong socio-cultural constraints. Kaduna benefits from institutional integration and political alignment. These differences show that the effectiveness of joint advocacy depends on how structural conditions interact with coalition processes in each context.

Overall, these findings reinforce the central proposition of the analytical framework: advocacy outcomes result from the interaction of macro-level political economy conditions, mechanisms, and coalition dynamics. State-level variations show how differences in institutional structures, power relations, and cultural contexts shape advocacy processes and outcomes. This highlights the need for context-specific strategies to strengthen joint advocacy for women’s health.

Discussion

Persistent stagnation in maternal and adolescent health indicators in Nigeria cannot be explained by resource constraints alone. Weak coordination among women’s health advocacy actors (through fragmented agendas, duplicated interventions, and uneven engagement with policy institutions) undermines collective influence on policy implementation and limits the translation of evidence into population-level health gains. From a political economy perspective, structural factors like power distribution, institutional incentives, and coordination failures play a critical role in shaping advocacy effectiveness beyond resource availability.

This study demonstrates that joint advocacy platforms for women’s health in Nigeria operate within a highly complex interplay of political, institutional, and social forces. Although previous studies highlight the benefits of embedding joint advocacy in governance frameworks, our findings indicate these outcomes do not occur automatically [3, 40]. In Nigeria, elite dominance, centralisation, and donor-driven priorities shape joint advocacy, often resulting in platforms that are procedural rather than genuinely inclusive. This divergence underscores the limitations of applying global best practices without accounting for local political economic realities. It also reflects the interaction between macro-level political economic conditions, such as donor dependency and institutional fragmentation, and coalition-level dynamics, including belief systems, coordination patterns, and resource asymmetries.

A key insight from the study is the centralisation of decision-making power within women’s joint advocacy platforms. Like findings from other reports [41, 42], a small set of capital-based, well-resourced NGOs disproportionately influence agenda-setting, resource allocation, and strategic direction. However, unlike some countries where formal mechanisms or regulatory frameworks mitigate elite control, Nigerian women’s health joint advocacy platforms lack institutionalised checks, leaving grassroots and women-led organisations largely excluded from decision-making processes. This exclusion is not merely procedural; it limits the relevance and responsiveness of advocacy initiatives and reduces their legitimacy in the eyes of the communities they aim to serve. The significance of this finding lies in demonstrating that inclusivity cannot be assumed based on formal participation or joint advocacy membership alone; genuine influence must be structurally embedded and operationalised across all governance levels. Within the Advocacy Coalition Framework, this concentration of influence reflects unequal resource distribution within coalitions, where actors with greater financial and institutional capital shape belief systems, agenda-setting, and strategic direction.

The study also highlights that women’s health joint advocacy in Nigeria is frequently disconnected from formal health governance frameworks [43], particularly the Sector-Wide Approach. While SWAp in other countries and settings has enabled structured civil society engagement, budget alignment, and policy mainstreaming, [44, 45], our findings suggest that women’s health advocacy platforms in Nigeria largely function in parallel, restricting their ability to influence national health priorities or resource allocation. This disconnect has significant implications: advocacy outputs may be well-intentioned but remain peripheral to policy and programmatic decision-making, reducing their potential for systemic impact. The findings also suggest that formal integration into SWAp processes (through participation in technical working groups, budget reviews, and performance assessments) would strengthen the alignment between advocacy objectives and government priorities, enhance accountability, and increase the likelihood of sustainable outcomes. From a political economy perspective, this disconnects results from institutional misalignment. Advocacy platforms that operate outside formal governance structures have limited influence on policy processes and resource allocation [8, 35].

Leadership structures within joint advocacy platforms emerged as another critical determinant of effectiveness. The monopolisation of leadership by a few elite NGOs mirrors patterns reported in the literature on coalition governance, where access to resources and donor networks shapes influence [4, 8]. Unlike contexts where leadership reforms are codified and enforceable [46], Nigerian women’s health joint advocacy platforms rely on informal arrangements, making them vulnerable to power imbalances and competition. Institutionalising equitable leadership mechanisms is therefore essential not only for fairness but also for joint advocacy resilience, as it allows smaller organisations to build capacity, contribute meaningfully, and sustain advocacy momentum beyond individual personalities or funding cycles. This finding aligns with ACF propositions that coalition leadership and resource control shape internal power dynamics, influencing whose preferences dominate collective action [47].

In this study, crises, such as spikes in maternal mortality or high-profile program failures, serve as important catalysts for joint advocacy. This observation aligns with global evidence showing that emergencies can unite stakeholders, mobilise political attention, and prompt immediate action [48, 49]. However, our study finds that in Nigeria, these moments rarely result in sustained systemic change without deliberate post-crisis interventions. The episodic nature of crisis-driven joint advocacy underscores a broader structural challenge: joint advocacy is often reactive rather than proactive, lacking mechanisms to convert heightened women’s health attention into long-term policy reform, budgetary commitments, or institutionalisation of best practices. This finding is significant because it emphasises the need for joint advocacy models to develop “crisis-to-policy pipelines” that translate urgency into structured, durable change, rather than temporary mobilization. Regardless, the pattern suggests that external shocks temporarily realign coalition interests, but without supportive institutional structures, these shifts do not translate into sustained policy change [50].

In the same vein, knowledge production and validation within joint advocacy platforms also reflect systemic inequities, highlighting how epistemic power weaves through coalitions, elevating select forms of knowledge that ultimately mould coalition beliefs and lend weight to advocacy efforts [51]. Grassroots actors and community-based organisations possess valuable contextual insights, but their contributions are often marginalised in favour of technical evidence designed to meet donor expectations. This concern has been reported elsewhere [52, 53]. This mirrors critiques in other global settings where epistemic hierarchies privilege formal, quantitative data over lived experience. Our findings imply that these practices have tangible consequences: policy recommendations and advocacy priorities may be misaligned with community realities, reducing both the legitimacy and effectiveness of interventions. Our finding extends existing literature by demonstrating that integrating diverse forms of knowledge is not merely a matter of equity but a critical determinant of policy relevance and advocacy success. Institutionalising community-driven research, co-creating policy briefs, and recognising experiential evidence in technical working groups can help recalibrate power dynamics and improve the impact of advocacy initiatives [54]. Within the ACF, learning mechanisms are central to coalition adaptation; their absence limits the ability of advocacy platforms to evolve, refine strategies, and sustain influence over time [8, 20].

Nevertheless, monitoring, evaluation, and learning systems were identified as major gaps across Nigerian joint advocacy platforms, echoing global critiques that donor reporting often emphasizes inputs over outcomes [55]. Without robust systems to track performance, assess impact, and facilitate iterative learning, joint advocacies risk losing institutional memory, reinforcing donor dependence, and limiting adaptability. These weaknesses have practical significance: joint advocacy is inherently iterative, requiring platforms to respond to shifting political environments, emerging health challenges, and evolving community needs [56]. Platforms that fail to embed internal learning mechanisms are less able to refine strategies, replicate successes, or sustain momentum, highlighting the critical role of monitoring and evaluation for both accountability and resilience [56].

Our study reports that youth and intergenerational inclusion also emerged as a crucial factor in sustaining advocacy platforms. While global research recognises the value of youth engagement in promoting innovation, responsiveness, and digital advocacy [57], our study demonstrates that young people are largely confined to mobilisation and outreach roles, with limited strategic input. The exclusion of youth not only constrains innovation but also undermines joint advocacy renewal, leaving platforms vulnerable to stagnation as senior leaders maintain prolonged authority. Nonetheless, structured youth engagement through mentorship, rotational leadership, and inclusion in decision-making committees is therefore essential for building adaptive, forward-looking advocacy platforms capable of responding to technological, social, and political shifts.

These findings illustrate that the politics and challenges faced by joint advocacy platforms in Nigeria are multifaceted and systemic. Unlike models in other countries where inclusivity, institutional embedding, and structured learning enhance sustainability, Nigerian joint advocacy platforms contend with elite dominance, donor dependency, weak governance integration, inadequate knowledge validation, and limited youth engagement. The significance of these findings lies in their practical implications: strengthening joint advocacy requires deliberate reforms to leadership structures, governance linkages, knowledge systems, monitoring frameworks, and intergenerational inclusion. By addressing these structural and operational barriers, joint advocacy can transition from episodic, donor-driven initiatives to sustainable, locally owned platforms capable of shaping policy, improving accountability, and advancing women’s health outcomes in contextually appropriate ways. These findings extend the literature by showing how macro-level political economy conditions interact with coalition-level dynamics to shape advocacy outcomes. Structural constraints, such as donor dependency, weak institutional integration, and concentrated power, combine with coalition processes, such as belief alignment, coordination, and learning, to produce varying levels of influence, inclusion, and sustainability.

However, several limitations should be noted. First, the study focused on three states (Lagos, Kano, and Kaduna) as well as national-level actors. Although these locations were chosen for their regional, religious, and political diversity, they may not represent advocacy dynamics in other Nigerian states or geopolitical zones. Also, the cross-sectional design limited the assessment of long-term joint advocacy evolution, sustainability, and impact. Because many advocacy platforms operate in cycles linked to donor funding or political tenure, a longitudinal approach would better capture how platforms adapt over time, respond to political changes, or manage funding challenges. Despite these limitations, this study makes a timely and substantial contribution to understanding advocacy in Nigeria’s women’s health sector. The findings provide important guidance for policy and practice, laying the foundation for future research, particularly longitudinal studies on the impact, resilience, and adaptation of coalitions.

Conclusion

This study analyzes how joint advocacy platforms for women’s health in Nigeria are shaped by political, institutional, and social dynamics. Using an integrated PEA and ACF, the findings show that macro-level structures, such as resource distribution, institutional arrangements, and political incentives, intersect with coalition-level processes, including leadership patterns, belief systems, and coordination mechanisms, to influence advocacy outcomes. Although joint advocacy is often seen as a tool for collective influence and inclusive participation, this study finds that its effectiveness depends on the broader political economy.

The findings show that joint advocacy platforms in Nigeria are marked by centralized decision-making, ongoing dependence on external funding, and limited integration with formal governance. These factors influence participation and the representation of whose priorities in advocacy agendas, affecting legitimacy, inclusivity, and policy impact. Unlike contexts where strong institutional integration and structured participation support coalition effectiveness, the Nigerian case demonstrates that fragmented governance and uneven resource distribution can limit advocacy platforms' ability to achieve lasting policy and programmatic change.

The study also highlights that advocacy engagement is often episodic, with periods of increased activity, usually triggered by crises, rarely leading to lasting institutional or policy change. This pattern results from the interplay between short-term mobilization and a lack of supporting institutional mechanisms. Furthermore, the limited involvement of younger actors in strategic roles restricts coalition renewal and adaptability over time.

In summary, this study moves beyond simply presenting the advocacy results to analyze the underlying mechanisms and contextual factors shaping joint advocacy for women’s health in Nigeria. By integrating PEA and ACF, it highlights how the interplay of power, resources, and institutional arrangements shapes coalition strategies and effectiveness. The analysis focuses on how these dynamics create both opportunities and constraints for joint advocacy, offering a context-specific understanding that informs future coalition-building and policy engagement.

Recommendation

The findings point to several context-sensitive pathways for strengthening joint advocacy. However, their feasibility depends on existing institutional arrangements, actor incentives, and resource availability. First, efforts to decentralise decision-making (such as rotational leadership or shared convenership) are more effective where coalition members have relatively balanced capacities. These efforts work best where minimal governance rules can be collectively agreed and enforced. In contexts with pronounced power asymmetries, such arrangements may need external facilitation or incentives. This helps ensure compliance and prevents symbolic adoption.

Second, to reduce competition, the government should prioritise donor alignment through collaborative grant management or pooled funding. Also, government should encourage donors to modify existing funding structures. It is recommended that donors revise requirements and accountability frameworks to incentivise coalition actors to engage in collective action. Support for shared financing models should include changes to funding modalities and reporting expectations.

Third, strengthening the inclusion of grassroots organisations and community voices (through mechanisms such as co-creating policy briefs) requires more than formal inclusion. It also needs a deliberate redistribution of influence within advocacy spaces. This may mean redefining what constitutes valid evidence, expanding participation in technical forums, and ensuring that less-resourced actors can engage meaningfully, not just symbolically.

Fourth, to effectively integrate advocacy platforms into governance processes (including SWAp structures and budgetary discussions): 1) Governments should prioritise institutional openness and create political incentives for inclusion. 2) Government actors must recognise the value of advocacy inputs. 3) Advocacy coalitions should align strategies with policy cycles and planning. 4) Where institutional barriers exist, incremental approaches (such as joining technical working groups) should be considered as entry points.

Finally, strengthening monitoring, evaluation, and learning systems, as well as structured youth engagement, depends on internal processes within coalitions becoming institutionalised. These mechanisms can enhance adaptability and continuity. However, resource availability, leadership commitment, and organisational culture shape their effectiveness. Without deliberate investment, such practices may stay informal and inconsistent.

Overall, these pathways show that strengthening joint advocacy is not only a technical exercise. It is also a political and institutional process. The ability to implement and sustain these approaches will depend on their alignment with existing power relations, incentive structures, and governance systems in the Nigerian health sector.

Abbreviations

ACF

Advocacy Coalition Framework

CBO

Community-Based Organization

CSO

Civil Society Organization

FBO

Faith-Based Organization

HSRC

Health Sector Reform Coalition

INGO

International Non-Governmental Organization

KII

Key Informant Interview

MSD

Multi-Stakeholder Dialogue

NGO

Non-Governmental Organization

PEA

Political Economy Analysis

SRHR

Sexual and Reproductive Health and Rights

SWAp

Sector-Wide Approach

TWG

Technical Working Group

UN

UN United Nations

WRAN

White Ribbon Alliance Nigeria

RNMCAH + N

Reproductive, Newborn, Maternal, Child, Adolescent Health + Nutrition

Authors’ contributions

The study was conceptualised and designed by OD, who also provided strategic direction, refined the research objectives and frameworks, guided policy relevance, and reviewed the manuscript for coherence with advocacy goals. EN supported conceptualization, methodological design and analytical framing, coordinated fieldwork and stakeholder engagement, led analysis and synthesis using the Political Economy Analysis and Advocacy Coalition Frameworks, and took primary responsibility for drafting and revising the manuscript. MK, SN, JO, and contributed to methodological design, technical oversight during data collection, stakeholder dialogue, data validation, analytical framing, and synthesis of findings. They also supported tool development, coordinated interviews and workshops, and contributed to the discussion, policy sections, literature review, and critical review of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Funding

This research was supported by a program grant that covered fieldwork and stakeholder engagement activities but did not include any funding allocation for publication or open access charges. The study was implemented by Policy Innovation Centre (PIC), a new, locally established non-profit policy and social behavioral science research organization in Nigeria. PIC did not receive any institutional or external funding to support the article processing charge (APC) or publication costs for this manuscript. Consequently, the authors request an APC waiver under Springer Nature’s Country Tiered APC Pricing Pilot, for which Nigeria qualifies for a 0% APC rate.

Data availability

Data that supports the results reported in this study are available and upon request, shall be made available via Policy innovation Centre’s Intellectual Property Protocol. Policy Innovation Centre is willing to share.

Declarations

Ethics approval and consent to participate

Ethical clearance was granted by the National Health Research Ethics Committee of Nigeria’s Federal Ministry of Health (NHREC Approval Number NHREC/01/01/2007–16/10/2023). The committee rigorously reviewed the protocol, methodology, and safeguards. This approval confirmed compliance with national and international standards, especially in sensitive areas such as women’s health and advocacy. Social clearance was also obtained from state authorities in Lagos, Kano, and Kaduna prior to conducting fieldwork. This included engagement with State Ministries of Health and other agencies. These steps ensured local acceptance, sensitivity, and alignment with state protocols. The approvals legitimised the study and helped engage stakeholders at the subnational level. Informed consent, written or verbal as preferred, was obtained before each session and interview. Participation was voluntary, and withdrawal was possible at any stage without penalty. All data were stored securely. Quotes in this report are anonymised to protect identities.

Consent for publication

Not applicable. No individual-level personal data are reported in this manuscript, and all information is presented in an anonymised and aggregated form. All authors consented to this publication.

Competing interests

Authors declared none.