ROLES AND CHALLENGES OF MUSLIM WOMEN IN THE DEVELOPMENT OF HEALTHCARE SECTOR IN NASARAWA STATE

: The paper examines the role and challenges of Nigeria women in the development of the health sector, focusing on Muslim women of Nasarawa state, Nigeria. Women assist in the provision of healthcare; they play roles which complement those of men. Some women are physicians’ that is medical doctors, nurses and top hospital administrators. Women however are mostly concentrated in the low status health-related occupations such as hospital maids, nurses, and other paramedical jobs. The paper begins by conceptualizing some basic concepts such as health sector and women for a better understanding. This is followed by the geographical location of the Nasarawa state. This study also assesses the roles of Muslim women in the health sector both in the conventional and in traditional. These include supportive systems to help women realize their professional or career goals. Interview and desk review were adopted as method of data collection for the research, where in-depth interview was conducted with


Introduction
Women occupy a special position in terms of their roles in the health sector. This includes Muslim women participation in many activities which affect the health and well-being of their families in particular and their society at large. Furthermore, the role of Muslim women as key actors in the health care system are well known with regard to the prevention, cure, rehabilitation and health education dimensions of health care. Muslim women health care system in Nasarawa State comprises of the traditional and Western orthodox medicine and the relevant health facilities such as maternity homes, dispensaries and hospitals. In fact, the development and expansion of these facilities is usually considered as a sign of development of any country, community and society. Despite the role women in the health sector play, some of them play roles that are different and subservient to those of the men. Most men dominate in positions of high status like physicians, and top hospital administrators. Some women are mostly found in the low status health related occupations such as hospital ward attendants, nurses, dieticians and other paramedical jobs.
In order to create a more culturally informed and meaningful environment, it is crucial to understand the Islamic practices and beliefs of this population. "Differences in the social and religious cultures of Muslims living in the West raise challenges for the healthcare professionals that go far beyond language to encompass worldviews, concepts of health, illness, beliefs, and work ethics." 1 Health is like reaching for a bar of soap in a bathtub, just as you think you have it in your hand, and it manages to slip away.
Islam provides its adherents with a moral road map for women's personal, social, and professional spheres. Muslims receiving and providing healthcare, thus navigate carefully whether their practice within their professional sphere is in keeping with Shari'ah (Islamic law). The ethico-legal framework delineated by Islam's normative sources juxtaposes with global health priorities, secular healthcare systems, and patient preferences. Such factors may require Muslims to navigate between multiple moral spheres. 2 Islam as the only religion in the Eyes of Allah plays a central role in many Muslim's women experiences were reflected by several authors as indicative of an integral part in their professional lives. "Islam works within a holistic framework for health care in which physical, social, spiritual, and environmental needs of the patient are taken into consideration. Muslims are required to live a healthy and balanced life incorporating Allah, family, and community." 3 The authors demonstrated the importance of the Islamic traditions in shaping the experiences of Muslims women in their daily lives. Hammoud et al. (1308) suggested "although Westerners tend to view themselves as human beings searching for spiritual experiences, Muslims are more likely to view themselves as spiritual beings having a human experience". Further, according to Yosef (108), the notion of healthcare and health promotion practices are embedded in the Islamic faith. The author suggested that these findings may be explained due to the inherent Islamic belief system as outlined in the Qur'an which placed an emphasis on individual's health.
Islamic teaching has generally been perceived as an act of worship that is usually separate from the context of life. The true Islamic teaching is applicable throughout all lifetime and through all time. None of its teaching can be said as being outdated and it has been proven that Islamic teaching is regarded as the essence and authority of the true way of. 4 The Deen is naseehah (advice). The companion said "to whom? the Prophet (peace be upon him) said "to Allah and His Book, and his Messenger, and to the leaders of the Muslims and their common folk" (The Forty Hadith of An-Nawawi, Hadith No 7).
For guidance, the Qur'an and the Sunnah outline the teachings that show how one is to protect his/her health and live life in a state of purity. This shows that Islam promote healthy lifestyle not only in the physical aspect but also mentally and spiritually. In fact, it is also one's responsibility to maintain and promote health as narrated by Prophet Muhammad (peace be upon him): No one will be allowed to move from his position on the Day of Judgement until he has been asked how he spent his life, how he used his knowledge, how he earns and spent his money and in what pursuits he used his health (Jami' At-Tirmidhi, Book 22, Hadith 1678).
In the Muslim worldview, health is paramount and complete physical, psychological, social and spiritual wellbeing which Muslims need to participate in providing it to the society (Al-Khayat, 68). Spiritual health is an essential component of the Muslim health belief model, and Muslims have a spiritual obligation to maintain their health. 5 The Qur'an provides guidance on caring for health and maintaining the body. Health is seen as a gift or reward from Allah, and Muslims are required to engage in healthy practices as a duty to care for their bodies.
These healthy practices include providing, maintaining cleanliness and personal hygiene, eating healthy food, avoiding forbidden substances that will harm the body and taking exercise and rest. 6 The World Health Organization in Wandler (14), which monitors health matters throughout the world for the United Nations, defines health in a more positive way as: not the mere absence of disease but total physical, mental and social well-being and not merely the absence of infirmity. Health is a dynamic condition resulting from a body's constant adjustment and adaptation in response to stresses and changes in the environment for maintaining an inner equilibrium called homeostatic" for Muslim women participation in healthcare centre. 7 Muslim women have special beliefs, attitudes, and perceptions that may directly impact healthcare received within a westernized health care system that may not share the unique sensitivities of the Islamic culture. 8 Health care providers are able to better advocate for their patients when they have an awareness of the unique cultural beliefs and background of their patients and how to provide a safe and comfortable place for patients to openly participate in health care decision making. 9 Our nation is progressively becoming more culturally diverse and recognition of the need for diversity in healthcare providers has been reported. 10 In defining health, Trowler in Annie (88) asserts that in practice, the medical profession and the population at large tend to define health in different ways. Neverthless, some definitions of health tend to stress the objective lack of disease, but this suggests that we should not feel ill unlesss people have a physical ailment. Aggleton (12) argues that ''this is problematic as we do not always feel pain when we are unwell. It is also the case that such general notions of health ignore the way in which we differ as individuals and the enormously different expectations of health among social groups".For the purpose of this research, health would be viewed as being much more issue than just a biological matter. Health will be examined as related to society -to such matters as cultural and religious beliefs, stage of development and level of participation amongst muslim women. Health is a state of complete physial, mental, and social well being,and not merely the absence of disease and infirmity.
Thus, health involves not only the absence of disease, but also a positive sense of wellness. In other words, health as a multidimensional phenomenon: includes physical,social, and psychological factors. and other physical and mental impairments in human beings.Healthcare is delivered by health proffessionals (providers or practitioners) in allied field. 11 Healthcare provider is also seen as an institution (such as hospital or clinics) or person (such as a physician, nurse, allied health Proffessional or community health workers) that provides preventives, curative, promotional, rehabilitative or palliative care services in a systmatic way to individual, families, or comunities. The World Health Organisation estimate there are 9.2 millions of physicians, 19.4 million nurses and midwives, 1.9 million dentists and other dentistry personnel, 2.6 million pharrmacists and other pharmaceutical personnel, and over 1.3 million community health workers world wide (WHO, 7), making healthcare industry one of the largest workforce. According to World Health Organization (13), the health care sector (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It includes the generation and commercialization of goods and services lending themselves to maintaining and re-establishing health. 12 Women are part of their community, and do not live in isolation. Every decision a woman makes is influenced by those around her, her husband, relatives, friends, and the community. While women may receive accurate health information from facility-and community-based health providers, their health-seeking decisions are influenced also by stories that circulate in the community and their observations of how others around them behave. 13 Accordingly, it is therefore, programs that seek to increase demand for services must understand the cultural milieu and community perceptions and values that drive demand, as well as who influences women's health service-seeking decisions and how. 14 Until recently, medical practitioners had been the principal decision makers within the clinical context globally. This authority was often linked to their superior knowledge, training, and experience in disease pathologies, management, and prognosis. More recently, however, the moral authority of health services and health service personnel, particularly doctors, is on the decline. 15 The importance of health care in modern day society can be gauged from the fact 11 ibid 12 Nahas, V., Amasheh R.N., (1999). "Culture Care Meanings and Experiences of Postpartum Depression among Jordanian Women," Transcultural Study. P. 38 13 Daneshpour, M., (1998). "Muslim Families and Family Therapy," Journal of Marital and Family Therapy, 24. 14  that good health is recognized as one of the fundamental rights of an individual. So much so, that out of the eight recognized millennium development goals of the United Nations, health finds its place in three of them. 16 The revolution around the role of women in the social order has been a global one creating more awareness about gender roles in policy making and the need to adopt gender inclusive perspective goals for the purpose of empowering women. According to United Nations Fund for Population Activities, when these goals are achieved then development, peace and the condition necessary for sustainable development would have been created. 17

B. Methods
The approach used in writing this paper is a literature study approach. Basically, the literature study is the same as research in general, but the research data obtained is secondary data using the literature study method. The three steps that the researcher will take in preparing In pursuance of a better definition of the word 'women', Ikoni conceives thus: "Full grown human females and also it is the adult female of human beings physically weaker than the male and exhibiting feminine characteristics quite distinctive from the opposite sex". That women are weak makes the definition improper to be used in this work. What makes a woman weak when so many of them are taking very good care of their families instead of the husbands who in so many cases may be alive but doing nothing? 21 In pursuance of this study, the concept women mean the female human category. They are our mothers, sisters, aunts, wives, daughters, friends and confidants; they are the blocks, economists, decorators, care givers upon which the foundation of happy homes, families, communities, societies and countries rests. 22 They are physically healthy, exhibiting feminine characteristics quite distinctive from the opposite sex and contributing to developmental processes just like the men.

The Role of Muslim Women in the Development of the Healthcare Sector
The wisdom of Muslim women, their experience and expertise in healthcare sector have been known since before now, which believed and placed healthcare in the domain of women.
Women in all the cultures of the world have practiced medicine. They have equally been subjected to discrimination in their practice of medicine. 23 The most common type of health care giver until the nineteenth century was the female midwife. Labour and delivery were considered too 'dirty and debasing' for men. It was not until the nineteenth century that men began to enter into obstetrics/gynecology in large numbers. At the same time, there was also strong vocal and open discrimination against women who were either practicing as physicians or wanted to enter the medical practice. 24 In the area of traditional pharmacy, Muslim women collected the ingredients, which they turned into medicines. They were often engaged in drying, grinding, and/or pounding of herbs. However, these herbs are used for the treatment of different ailment among communities in Kokona. Not only that they also partake as midwives where they assist pregnant women In Nasarawa State Muslim Women healthcare professionals are very compassionate and can be described as good practitioners. Most people prefer to be treated by women more than men because they see women as more understanding than men. Women have always been 22  Yusuf, she stated that her mother has always been the first person she consulted for medical advice when needed which usually turns out to work for her in a good way (Fatimah Yusuf).
She hinted that she prefers a Muslim female medical practitioner to a male one. Largely, we infer that Muslim female healthcare practitioners are very knowledgeable and are well skillful in their practice especially in the area concerning counseling and prescription.

a. Muslim Women and their Roles as Midwives
In an interview with Mansura Babangida Abdul-Karim emphasizes that Muslim women medical practitioners, who played the roles of midwives were responsible for bathing the babies and putting their heads, noses, and eyes into proper shapes. They also ensured the mother's well-being after delivery by giving her a hot bath and properly massaging her body in order to get rid of unwanted blood as well as to put the body back to its former shape. They also kept the women in warm rooms during the first months of delivery to reduce labour pains and proven future episodes of rheumatism arising from black veins and advised lactating mothers to eat blood enriching traditional foods like vegetables cooked with melon seeds, beans, and guinea corn pap etc. Lactating mothers were advised to abstain from sex in order to avoid unwanted pregnancy. In fact, women's role as midwives was very important. Adama Umar Imam paid attention to the family as a great challenge to Muslim woman's choice as a healthcare practitioner. She purports that families can be negative powerful force responsible for stereotypes and discrimination against Muslim women (Adama Umar Imam). In many families, a daughter is constantly told that medicine is a man's profession because a woman would not be able to combine a medical career with the family life. In addition, parents would want to finance their sons for medical education rather than their daughters. A mother has a great deal to do with the daughter's decision to enter the healthcare profession. Various family obligations have made some women physicians to specialise in some areas they did not originally anticipate. Usually if the mother is a professional herself, she serves as a role model of a woman combining a career with marriage.

Mallama Hajara Sadeeq avers that
The guidance counsellor can also turn a girl away from medicine. Over the years, women have received the counsel that medicine is not a suitable profession for women. The girl child has been counselled that medical programme is a lengthy one; the girl would not be able to combine marriage with medicine and possibly can cause a delay in her marriage.
Majority of male patients feel very comfortable to disclose their illness to women medical practitioners, which is surprising considering the gender inequality that plagues some indigenous communities. Nevertheless, there have been instances where patients, both male and female, were annoyed because they were assigned to female healthcare practitioners (interview with Zainab Abubakar Zakari). These are challenges women health practitioners face. However, they focus on helping patients and closely work with their male counterparts at the hospitals.
Another challenge is male dominance. Interviewees hinted that some male colleagues have respect for female healthcare practitioners. However, the choice of a career which comes with many transfers where Muslim women face serious problem with their spouses at home and will have to also meet different kinds of people, they meet some male practitioners who are problematic and create uneasy environment for their female counterparts. In some settings, male practitioners take over all the practice leaving women with barely nothing to do.
According to a respondent, men in some healthcare facilities hijacked delivery of babies (Zainab Abubakar Zakari).
According to Nafisat Ahmad in an interview, states that that issue of night duty shift is one of the major challenges faced by Muslim female healthcare practitioners in the state as they usually face problems with the husbands at home. Not only that taking care of the home which is the major function of the woman, is not usually observed by the female as times she would have to manage to do that. State and what pertains now in the past. It is however expected that more Muslim women will become doctors, pharmacists and hospital administrators. Already there is on-going sensitization among Muslim females in the nook and cranes of the state to the involvement of more Muslim women in the health sector be it public or private.

D. Conclusion
The upsurge of midwives and nurses is an indication, that the role of Muslim women in the health sector fast growing in the state. It is still mostly tilted towards maternity and child care. It is pertinent to emphasize that Muslim women have seen a lot of changes in every sphere of life, especially in the health sector. This is traced to the education and religion which they have embraced. These roles are further influenced by the socio-economic changes in Nigeria as a Nation.

Recommendations:
Based on the findings and conclusions of this study, the following recommendations were made by the researcher: 1. To improve the roles of Muslim women in the health care sector, and to increase their contribution in the health sector, Muslim scholars and wealthy individuals must help in the education of Muslim women in medical related courses in order to increase their participation in healthcare sector.
2. There should be supportive systems by wealthy Muslims to help Muslim women realise their professional or career goals through the establishment of medical schools with subsidy for women.
3. There should be a supportive measure for women that may include making households self-sufficient by government, through provision of basic social facilities. The provision of these facilities will help women to spend less time on fetching water, cooking, and visiting the health centres, so that they can spend more time on careers. The government needs to get more involved with the provision of day care centres and improvement of already established ones so that child care itself is not a hindrance to female career progress.
4. There is the need of increased Muslim women participation in decision making in the healthcare and policies sector. This would reduce the challenges being faced by Muslim women.
5. Muslim scholars and parents need to educate the Muslim female on the need to study science base subjects.
6. The government should initiate policies such as legislating against sexual abuse of female in schools, and imposing long jail terms for those who abused them sexually, bridging the gap in the medical profession, there should be policies to encourage women to involve in research: priority in working, financing, procedures of approval etc.
7. Muslim Women in health care sector need to strengthen their research activities both in quality and quantity, in scientific and practical values of research findings. They also need to build capacity by self-learning, training, report writing etc.