Health communication campaigns in Nigeria have undoubtedly played a key role in addressing public health issues like maternal, newborn, and child health (MNCH), infectious diseases, and health literacy among others. Through a qualitative analysis of the literature from the previous ten years, this article assesses recent campaigns, examining their achievements, shortcomings, and unintended outcomes. Major campaign achievements like the eradication of polio and the containment of Ebola demonstrate the effectiveness of multi-channel and culturally specific approaches. Failures occasioned by systemic challenges and cultural resistance highlight the areas that require improvements. In this article, some practical evidence-based strategies are highlighted to augment future campaigns across the country.

INTRODUCTION
Health communication campaigns in Nigeria, to improve public health outcomes and shape behavior, are crucial in Nigeria due to the high rates of maternal and infant mortality, infectious diseases, and low health literacy (Okonofua et al., 2020). Over the last ten years, several approaches and media platforms like social media, mass media, and interpersonal communication (IPC) have been employed to drive health initiatives including campaigns against polio, Ebola, HIV/AIDS, and exclusive breastfeeding campaigns. These efforts and approaches are mostly premised on theories such as the Social Cognitive Theory (SCT) and the Health Belief Model (HBM) (Nkanunye & Obiechina, 2017). Despite achievements, issues like cultural resistance, disjointed health systems, and insufficient assessment continue to exist.

Theoretical Foundations of Health Communication Campaigns
Behaviour change theories are frequently used in Nigerian health communication campaigns to create impactful messaging. Ebola campaigns, which emphasise the risk of diseases and promote prevention, have been largely influenced by the Health Belief Model (HBM), a theoretical framework which holds that perceived susceptibility, severity, benefits, and barriers influence health behaviours (Fayoyin, 2016). In the same vein, Social Cognitive Theory, which places emphasis on self-efficacy and observational learning, has shaped health campaigns such as the Alive & Thrive Breastfeeding Campaign, an initiative that employs role models to promote behavioral change (Ogunlesi et al., 2021). Nevertheless, Adebayo and Iweala(2020) claims that evidence-based design of campaigns is limited as only 30% are premised on theoretical frameworks. The relevance and impact of these campaigns could be increased by tailoring these theories to Nigeria’s varied cultural contexts.

Outcomes and Challenges of Health Communication Campaigns
Nigeria’s health communication campaigns have recorded a mixture of challenges and notable success. Among its significant successes in recent times are the Global Polio Eradication Initiative’s 2020 which was a massive success (Global Polio Eradication Initiative, 2020); Northern Nigeria’s campaign initiative that combated vaccine refusal using communication channels such as radio public service announcements (PSAs), community mobilisation, and edutainment like the Majigi. In addition, the 2014 Ebola response achieved quick containment by efficiently using Twitter and SMS to spread correct information (Fayoyin, 2016). Ogunlesi et al., (2021) also revealed that the Alive & Thrive Initiative raised exclusive breastfeeding rates by 15% by targeting vulnerable mothers with social marketing, IPC, and mass media. These accomplishments demonstrate the effectiveness of multi-channel, culturally relevant approaches that collaborate with communities and influential voices.

Though despite these successes, there are challenges that still need to be addressed. According to NACA (2019), low health literacy and cultural preferences for curative care are the reasons behind the low uptake of preventive measures like regular condom use and HIV testing For example, Saving One Million Lives (SOML) initiative, a campaign launched in 2012 to lower under-5 mortality was a total fiasco because of low community engagement and inconsistent health governance (Ogbuoji & Yamey, 2019). Other challenging factors include poor access to healthcare and rural areas (Okonofua et al., 2020). As noted by Igben and Enebeli(2023) due to the fact that many campaigns lack thorough evaluation, determining their effectiveness is challenging. These limiting factors highlight the necessity of strict adherence and understanding of the sociocultural and systemic realities of the country.

Unintended Consequences of Health Communication Campaigns
During the Ebola Campaign, Fayoyin (2016) opined that the level of digital literacy among urban youth unexpectedly reached a peak never recorded before as seen in the volume of social media engagement. In contrast, Adebayo and Iweala (2020) submitted in their research that smokers have been stigmatised by fear-based anti-smoking campaigns, which in turn has led to a decrease in the numbers of smokers who reach out for help to quit smoking. It has also been observed that abstinence-focused HIV/AIDS campaigns have perpetuated stigma, discouraging testing and treatment (NACA, 2019). For example, to address this kind of issue, fast counter-messaging was necessary to combat misinformation such as social media-spread Ebola cure myths (Fayoyin, 2016). These realities highlight how important it is to test the authenticity of messages beforehand and keep an eye on social dynamics to minimise negative effects.

Role of Communication Channels in Campaign Effectiveness
Campaign results are greatly shaped by the channels of communication used. Radio is still very useful in rural Nigeria because it is easily accessible, and PSAs encourage people to get the polio vaccine (Nkanunye & Obiechina, 2017). With over two million impressions, social media—especially Twitter and WhatsApp—performed exceptionally well in crisis communication during the Ebola outbreak (Fayoyin, 2016). According to Taiwo et al. (2022), the iCARE Nigeria HIV testing intervention demonstrates how IPC, which involves community health workers, fosters trust. The engagement of campaigns that combine these channels is 20% higher than that of campaigns that only use one channel (Ogunlesi et al., 2021). However, social media’s reach is limited in rural areas by lack of electricity access and low levels of digital literacy (O’Brien et al., 2022).

Cultural and Contextual Influences on Campaign Outcomes
With more than 250 ethnic groups, Nigeria’s cultural diversity influences the efficacy of campaigns. Religious leaders’ support was necessary for the polio vaccine to be accepted in Northern Nigeria, but opposition remained elsewhere (Ogunlesi et al., 2021). According to Nkanunye and Obiechina (2017), the HBM emphasises how mistrust of Western medicine serves as a barrier. Gender dynamics are also important. For instance, men, who are usually the primary decision-makers in many households, are often left out of maternal health campaigns (Okonofua et al., 2020). Adebayo and Iweala (2020) observed that 60% of Nigerians living in rural areas have little or no education on health matters, which makes it difficult to understand health information. That is why it is essential to adapt messages to local languages and customs.

Policy and Systemic Integration
For health campaigns to be successful, they must align seamlessly with health systems and policies. A vivid example is the integration of The Polio Campaigns with national vaccination campaigns that boosted its impact and success (Global Polio Eradication Initiative, 2020). The disjointed implementation of SOML, on the other hand, made clear the necessity of improved coordination within the health system (Ogbuoji & Yamey, 2019). To ensure service availability and reinforce messages, campaigns should make use of already-existing infrastructure, such as primary health centres. According to Adebayo & Iweala (2020), several successful tobacco control campaigns, policy integration also makes resource allocation and sustainability a piece of cake.

Strategies to Augment Health Communication Campaigns

Let’s explore several practical strategies to boost health campaign impact and effectiveness.

The target audience of every campaign is key in this process. It is important to carry out a thorough research of your intended audience—the language of communication, the appropriate channel to convey the message to them, their demography, and their level of literacy. Once the audience comprehends the message, then the campaign has hit a home run.

Another factor to consider is community involvement. Take for instance the Ilashe community, a riverine area in Lagos state, where the predominant language is Yoruba and local English called Pidgin. For campaigns to have an impact, the message must be spoken and written in the dialect they understand— simple, clear and digestible. Avoiding technical or vocabulary to impress the audience may result in a woeful outcome.

Not every community has been exposed to digital innovations. While it is ideal to leverage mobile health platforms and social media during campaigns, adopting credible platforms or channels that the target audience trusts is crucial to driving home the message. While audiences in urban areas may find social media, influencers, flyers, national radio and TV programmes relevant and effective, it may lose its value to the rural dwellers who patronise their community leaders, local radio jingles and talk shows and plays, religious leaders, leaflets and other information materials, and town hall meetings among others.

Utilising local channels, mass mobilisation and community engagement will ultimately foster trust and bring the desired impact.

During the outbreak of Ebola, a public health emergency that drove Nigerians into hysteria, false information, and deadly desperate measures, effective campaign strategies were put in place in various forms through diverse channels, and various local languages that created more awareness, demystified disinformation, eased panic, and stop the spread of the virus among the public. One of such methods was the mass public awareness campaign on the benefits of handwash. Various sensitisation programmes the programmes were put in place. One relatable sensitisation campaign that worked was the introduction of frequent hand wash. Various public places like schools, churches, offices, parks and more adopted this strategy to further control the spread of the disease.

In 2022, organisations like the United Nations Children’s Fund (UNICEF) adopted the door-to-door approach in local communities to get the attention of the dwellers. This approach helped in its (THISDAY Newspaper) mop-up programme for childbirth registration across Lagos State. That strategy resulted in the registration of over 600,000 children aged 0-17 in five local government areas. This approach has proven to be effective in certain communities and continues to make a mark to date.

Alao, rhorough assessment and feedback evaluation are another strategy to consider in health communication campaigns. To determine impact, there is a need to conduct and critically evaluate feedback assessments (Igben & Enebeli, 2023). This mechanism in place will help better planning for the ongoing and future campaigns.

CONCLUSION
Nigerian health communication campaigns have used integrated, culturally specific approaches to successfully eradicate polio and contain Ebola. The impact of these efforts is, nevertheless, constrained by issues like low health literacy, cultural resistance, language barrier, and structural barriers. Unexpected consequences, like stigmatisation, emphasise the need to exercise great care and diligence in crafting and delivering health campaign messages.
Indeed, future campaigns can advance Nigeria’s public health goals by bridging the gap between communication and behaviour change through the use of participatory approaches, channel integration, and policy alignment.

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