Reducing maternal mortality in rural areas is currently one of the most important unmet public health needs in Nigeria. It is not only a matter of equity and gender equality, but it is also one of the human rights and social justice.
Having a child anywhere in the world is by no means easy. From the stress of carrying a baby for nine months to the stress of actually giving birth, it’s a lot for any woman to handle in Nigeria.
Mrs Hadiza Musa, 39, years- old shared her experience with her first pregnancy and after carrying the baby for nine months she lost the baby due to out of pocket expenses for maternal health, that her husband could not met the demand from the health facility that is two hours away from her resident.
Poor maternal health indicators have been reported in Nigeria since the 1990s. Advocacy and awareness programs have been carried out and many maternal mortality interventions have been implemented to reverse the trend.
Health experts have continued to call on the Federal Government to address these factors through adequate budgetary provisions, programs to reduce out-of-pocket expenses for maternal health, adequate staffing and training, innovative methods of transportation and male involvement are critical in efforts to improve rural women’s access to skilled pregnancy care in primary health care centres in the country.
Corruption, inadequate funding and administrative Bureaucracy are some of the key reasons Nigeria’s health system has remained unimproved.
A lack of political will however stand as the biggest obstacles to improving the nation’s health system. Any progress will be inadequate until the country’s brimming population living below the poverty line have access to quality and affordable healthcare without financial burden, health experts said.
This is the twenty-third year of Nigeria’s uninterrupted democracy – in the fourth republic – after 33 years of military rule. The health sector under this era has evolved but remains weak, inequitable and dysfunctional in faring for citizens.
The COVID-19 pandemic that hit Africa’s most population nation in February 2020 further exposed the country’s weak and inefficient health system.
Players in the health sector have long linked the problem to poor funding, mismanagement, and lack of political will. They say successive governments have failed to prioritize health.
Politicians across party divides know this, and Nigerians have been expecting health and health security to feature prominently in political speeches and media appearances.
As the 2023 general elections draws closer, health advocates are calling for a change in what should be in top political discussions especially by aspirants. They say health and education should take centre stage.
However, given other competing national priorities such as food and insecurity, to get health at the top of political issue might still be an uphill task.
Insecurity is still a major problem in many parts of the country, just like fragile and incomplete democratisation and fiscal weakness. These trends have complicated progress towards improving the health system.
An analysis by civil society organization BudgIT shows that nearly half of the states are struggling to pay workers’ salaries and fulfil election promises such as roads construction and job creation, issues that are absorbing the attention of many governors more than improving the quality of health centres that already exist.
But Nigeria’s staggering health indices cannot be undermined in the dynamics of priorities.
Nigeria is ranked the forth worst country with maternal mortality rate. Nigeria is also the most dangerous place to give birth in the world. One out of every five pregnant women in the world who dies in pregnancy (or within six weeks of childbirth) is a Nigerian woman. Yet some pregnant Nigerian women put safety pins on their cloth for “protection”.
According to experts, The real reasons why pregnant women die in Nigeria: Unsafe abortions, High Blood Pressure in pregnancy; Convulsion from high blood pressure,;Lack of proper antenatal care;
Heavy Bleeding during pregnancy,Heavy Bleeding during/after delivery; Infections during pregnancy/after delivery.
Life expectancy of a Nigerian according to Union Nation world population prospects is 55 years , Egypt is 72, Tunisia is 77, many other African countries including Ghana, Togo, South Africa have higher.
Chronic diseases, a high infectious disease burden, and an ever-present risk of epidemics of Lassa fever, meningitis, and cholera, present additional challenges.
Further compounding these issues, population health has not been highly prioritised in national and state budgets throughout the country’s modern history.
The list is endless.
Stakeholders familiar with this trend point to a lack of political will as the chief denominator, faulting citizens’ inability to hold leaders to account.
It is difficult to escape the conclusion that the political will to deliver “health for all”, including universal health coverage, has been grossly inadequate, due, partly, to the limited ability to effectively demand improved health services in the country by citizens.
As next year polls approaches, many Nigerians are calling for the creation of a new social contract that redefines the relationship between citizen and state.
They argue that health has been neglected by successive governments and must be prioritised as a vital investment in the population, one that will reap political and economic benefits.
Last month, a citizen-led health agenda during a stakeholders workshop organized by the UHC 2023 Forum in collaboration with the Nigeria Governors’ Forum Secretariat and Chatham House was unveiled.
The health manifesto is aimed at shaping the health policy direction of the major political parties and their flagbearers in the forthcoming general elections.
It also contains clear health goals based on national priorities and international benchmarks, and also identifies strategic policy shifts that should be prioritized by the political class toward achieving the health goals.
Dr Gafar Alawode, a Universal Health Coverage (UHC) expert and Project Director, Prevent Epidemics Project called on the political class to incorporate the citizen-led agenda into their manifestoes and ensure they are implemented.
A recent Institute of Economic Affairs report makes the case that Nigeria could do more to partner with high-income countries to secure investment, and do more to attract global investors and international financial institutions to finance its healthcare systems. For healthcare workers to want to stay in the country, they must be supported by better working conditions, training, equipment, and insurance related to workplace risks, and remuneration.
Human Right Activist, Mr Femi Falana started; Issues are not being raised, we are not being told, ‘If this man wins his party primary and the national elections, he will address insecurity, unemployment, illiteracy or remove 16 millions young people from the streets.’
Falana recalled that at a time, Nigeria was the envy of other nations, and witnessed lots immigrants coming to the country to work, but the situation has changed, as the country has retrogressed.
Mrs Gift Phillip, a mother of two, said her experience at a primary health centre during delivery is an urgent reason for revamping the system.
“The PHC, here cannot attend to women with my type of problems. Healthcare is more than an antenatal care, and women giving birth cannot do so in the health facility that does not have all inclusive,” she said.
Philip, who is also a Resident of Waru community in the FCT, said that everyone has an important role to play in helping prevent pregnancy-related deaths in the country.
She said that she was not ready to vote for any politician or political party that has no health on its agenda.
“Political actors have been speaking on issues of unemployment, insecurity, Association of Staff Union of Universities (ASUU) strike and economic downturn, and they have practically ignored health, forgetting that health is wealth. We need to a live to be able to vote.
“The 18 political parties should agree to put improving the health and wellbeing of Nigerians at the core of their party’s priorities and recognise it as the main challenge across the country.
“Maternal mortality in Nigeria is one of the highest in the world. I wonder what proportion of mortality is attributable to the Nigerian obsession with giving birth like the Hebrew woman, ” she said.
According to her, birth Rate surpasses Death Rate leading to overpopulation in Nigeria.
Ebere Okereke, Senior Technical Adviser, Tony Blair Institute for Global Change (TBI) said political manifestos should consider healthcare priorities.
Okereke, who is also a Public Health Expert, said that politicians should be made to recognise that health goes beyond National Health Insurance Scheme (NHIS).
“With improvements in life expectancy flatlining and health inequalities widening, improving public health and prevention should be a high priority in Nigeria’s politics.
” Any politician that is serious about improving health will prioritise public health, leveraging on lessons learned from the COVID-19.
” Genuinely supporting population health and wellbeing requires more.
“If a politician wants to see people’s health improve, Nigerian need to see bold action, using all the levers politicians have at their disposal to improve the health and wellbeing of the population,” she advised.
She said to shift the dial, manifestos could exemplify a ‘health in all policies” approach, look out for commitments to supporting the best health systems for the children, and more.
“The health and care systems need clarity and certainty on funding, and all the parties must be clear about how much money they will provide for the NHIS, social care, public health, the workforce, and capital budgets.
” It is right that the public should be able to understand and compare these commitments,” she said.
It is not necessarily an entirely bad thing if discussions about health are become dominant during the campaign.
Political parties should find common purposes around the challenges that lie ahead around health reform and commit to collectively to help Nigerians better understand them.
This involves being honest about the tough choices that lie ahead.