Global frameworks for understanding care-seeking-such as the "Three Delays" or "Pathways to Survival"often assume linear, individual decision-making and predictable movement from home to facility. However, this evidence base rarely reflects the lived realities of caregivers in settings shaped by gendered power dynamics, compound-level hierarchies, pluralistic health systems, and systemic health system failures found in contexts such as Northern Nigeria.
Drawing on 125 verbal and social autopsies from Jigawa, Northern Nigeria, this study demonstrates how narrative data generated by families reveals nonlinear, relational, and socially mediated pathways during fatal childhood illnesses. Caregivers described oscillation between informal and formal providers, consultation with elders and co-wives, financial and mobility constraints, and repeated encounters with misdiagnosis, stockouts, and inadequate care. These pathways diverge sharply from linear global models, highlighting the limits of Western-dominated frameworks in accurately diagnosing barriers.
By elevating community voices, verbal and social autopsies democratise knowledge production and expose critical blind spots in global frameworks. They offer richer, more contextually grounded evidence for designing SBC strategies, strengthening health system responsiveness, and rethinking global assumptions about how families seek care. This study argues for rebuilding care-seeking frameworks based on lived experience, enabling more equitable, systems-oriented approaches that help prevent avoidable child deaths.
Global frameworks for understanding care-seeking-such as the "Three Delays" or "Pathways to Survival"often assume linear, individual decision-making and predictable movement from home to facility. However, this evidence base rarely reflects the lived realities of caregivers in settings shaped by gendered power dynamics, compound-level hierarchies, pluralistic health systems, and systemic health system failures found in contexts such as Northern Nigeria.
Drawing on 125 verbal and social autopsies from Jigawa, Northern Nigeria, this study demonstrates how narrative data generated by families reveals nonlinear, relational, and socially mediated pathways during fatal childhood illnesses. Caregivers described oscillation between informal and formal providers, consultation with elders and co-wives, financial and mobility constraints, and repeated encounters with misdiagnosis, stockouts, and inadequate care. These pathways diverge sharply from linear global models, highlighting the limits of Western-dominated frameworks in accurately diagnosing barriers.
By elevating community voices, verbal and social autopsies democratise knowledge production and expose critical blind spots in global frameworks. They offer richer, more contextually grounded evidence for designing SBC strategies, strengthening health system responsiveness, and rethinking global assumptions about how families seek care. This study argues for rebuilding care-seeking frameworks based on lived experience, enabling more equitable, systems-oriented approaches that help prevent avoidable child deaths.
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