The Development Communications (DevComs) Network / NOTAGAIN Campaign team insists that high maternal and child mortality rate, ineffective implementation of health policies, security threats constituted by maternal deaths, and citizens’ fundamental rights to health are major reasons why President Muhammadu Buhari must invest in maternal health in Nigeria
Maternal death is one of the daunting consequences of inadequate health care during pregnancies and within 42 days after termination of pregnancy. The mere fact that it can be avoided unlike some public health issues indicates that it could be reduced to the barest minimum if adequate measure is taken.
With the change in administration, leadership style and ideology that greeted Nigeria on May 29 this year, it is still unclear what the future holds for the health sector, particularly maternal and child health, under the new dispensation.
For so long, the investments of government in the health sector have been determined by so many factors, including the willingness of the leaders to prioritise health. This fact has been justified by the percentage of funds allocated to health under the past administrations. Experts have said that increasing budget allocations to health would ensure that more skilled health workers are employed, trained and adequately motivated to attend to citizens accessing their services. It is also believed that the challenges of inadequate health facilities, drugs and commodities are overcome.
Consequently, the administration of President Muhammadu Buhari would have to learn from the successes, challenges and prospect of maternal health care in Nigeria in order to improve health status of women and children.
In addition, studies have proven that high maternal and child mortality rate, ineffective implementation of health policies, security threats constituted by maternal deaths, and citizens’ fundamental rights to health are major reasons why president Buhari must invest in maternal health in Nigeria.
Nigeria records needless high maternal and child mortality yearly
Nigeria ranks second among countries with the highest maternal mortality rate in the world with about 40,000 deaths and 560 per 100,000 live births according to the 2014 publication of the World Health Organisation titled: “Trends in Maternal Mortality 1990 – 2013“. This means that the country accounts for 14% of global maternal mortality. The chances that a 15 year-old would during pregnancy and child birth in Nigeria is one in 31 compared to Ghana (one in 66) and South Africa (one in 300) who share the same continent with the country.
Similarly, Nigeria’s under-five mortality in 2013 was 804,000 while the under-five mortality rate is 128 deaths per 1,000 live births (NDHS 2013). This also is a far cry from the under-five mortality rate of Ghana (78 per 1000 live births) and South Africa (44 per 1000 live births) according a 2014 report titled:Â ‘Levels & Trends in Child Mortality’Â published by the UN Inter-agency Group for Child Mortality.
Failed promises causing Nigerians to lose confidence in health sector
The last 15 years in Nigeria has witnessed the development of several plan, policies and strategies that have not been achieved. One of such plan is the National Strategic Health Development Plan 2010-2015 (NSHDP) which was developed in the year 2010 to last till 2015, with the over-arching goal of improving the health status of Nigerians through the development of a strengthened and sustainable health care delivery system.
The national plan had targeted a maternal mortality ratio of 273 per 100, 000 live births in 2013 and 136 per 100, 000 live births in 2015, which will amount to a one-third reduction in maternal mortality ratio between 2010 and 2015. Similarly, the percentage of federal, state and local government budget allocated to the health sector was anticipated to increase from 5% in 2011 to 15% by 2015.
However, a number of the targets in the NSHDP was not met as the most recent figure given by the Nigeria Demographic and Health Survey (NDHS) 2013 is 576 per 100, 000 live births while the government ’s spending on health has varied from 4% to 9% between 2001 and 2013. The health budget had declined from 6.07% in 2012 to 5.61% in 2013 and rose slightly to 5.67% in 2014.
The consequence of these failed promises is a weak health system which has encouraged the preference of several pregnant women and communities for antenatal care and delivery at homes, religious places and traditional birth attendants’ (TBA) places.
It will be recalled that the Federal Government and State Governments in Nigeria had committed to improve the health status of Nigerians during the Presidential Summit on Health Care held in Abuja on 10th November 2009. The summit which was tagged “Accepting collective responsibility for improving our health in Nigeria occasioned the signing of several targets including; reducing infant mortality rate of 75/1,000 live births and under-five mortality rate of 157/1,000 live births by half by 2015, increasing budget allocations to health at the Federal, State and Local Governments from the baseline level by at least 25% each year towards achieving the Abuja Declaration target of 15%; committing to at least 90% budget release and 100% utilization by the end of the year; reducing maternal mortality ratio by a third (136/100,000 live births) from 545/100,000 live births by 2015; and many other targets which are yet to be achieved.
Maternal death constitute socio-economic losses and security threats
The loss of a mother during or after childbirth deprives a child and other children in the family of basic motherly care and moral education needed by members of a society to behave in an acceptable manner.
A recent study on the consequences of maternal morbidity and maternal mortality published by The National Academies Press indicated a relationship between maternal death and infant death as well malnutrition among children under five years of age.
Similarly, maternal mortality rate (MMR) has been found to impact negatively on the Gross Domestic Product (GDP) of countries in the WHO African region. In a study on “Effects of maternal mortality on gross domestic product (GDP) in the WHO African region” published in year 2006 by African Journal of Health Sciences, the maternal mortality of a single person was found to reduce per capita GDP by US$ 0.36 per year. The study demonstrated that maternal mortality has a statistically significant negative effect on GDP.
“Thus, as policy-makers strive to increase GDP through land reform programs, capital investments, export promotion and increase in educational enrolment, they should always remember that investments in maternal mortality reducing interventions promises significant economic returns.” the authors concluded.
Health care is a constitutional and human right
The chapter II (article) 17(3)(d)) of the 1999 Constitution of the Federal Republic of Nigeria which refers to the fundamental objectives and directive principles of state policy requires all organs of government, authorities and persons exercising legislative, executive or judicial powers to ensure adequate medical and health facilities for all persons in Nigeria.
In view of this, many experts have likened the right to health to fundamental human rights, which are said to be justiciable rights and guaranteed by the constitution of Nigeria. The United Nations in 1987 described human rights as those rights ‘which are inherent in our nature and without which we cannot function as human beings’.
The right to quality health (including maternal health) is also an important obligation of the government of the Federal Republic of Nigeria because the country has ratified international laws and instruments such as the Universal Declaration of Human Rights, The Convention of the Elimination of all Forms of Discrimination Against Women (CEDAW), The Convention on the Rights of the Child, and other regional treaties like The African Charter on Human and Peoples’ Rights.
Thus, most needless deaths of women and children would be avoided if the government is responsive and provides adequate and affordable maternal and child health care through sufficient, motivated and skilled health workers. This can only be achieved when the health sector is sufficiently funded according to international standards such as the 15% specified by the African Union Head of States during the Abuja Declaration of April 2001 held in Abuja.
In addition, community and religious leaders must do more in mobilizing pregnant women and mothers to attend healthcare provided by skilled health workers. There is a need for training and retraining of health care providers as most women who attend antenatal and failed to deliver in the hospital have claimed poor attitude of health workers was among the factors responsible for their actions. More importantly, there is a need for improved public-private partnership in the health sector with the aim of increasing access to maternal and health care in Nigeria.
