Reducing maternal mortality in rural areas is currently one of the most important, yet-to-be-met public health needs in Nigeria. It is not only a matter of equity and gender equality but one of 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 giving birth. It’s a lot for any woman to handle in Nigeria.
Mrs. Hadiza Musa, 39, shared her experience with her first pregnancy. After carrying the baby for nine months she lost the baby because she and her husband could not keep up with the stream of expenses for delivery.
Poor maternal health indicators have been reported in Nigeria since the ‘90s. Advocacy and awareness programmes 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, programmes 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 bureaucracy are some of the key reasons Nigeria’s health system has remained unimproved.
A lack of political will, however, stands as the biggest obstacle 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, affordable healthcare without financial burden, health experts have agreed.
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 the world further exposed Africa’s most populated nation’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 prioritise health.
Politicians across the party divide 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 draw 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, getting health at the top of the to-do list 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 toward improving the health system.
An analysis by civil society organisation BudgIT shows that nearly half of the states are struggling to pay workers’ salaries and fulfil election promises such as road construction and job creation – issues that have absorbed many governors more than improving the quality of health centres.
But Nigeria’s staggering health indices cannot be undermined by the dynamics of priorities.
Nigeria is ranked the fourth worst country with a high maternal mortality rate. Also, Nigeria is 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 pregnant women die in Nigeria are unsafe abortions, high blood pressure in pregnancy, convulsion from high blood pressure and a lack of proper antenatal care, heavy bleeding during/after pregnancy and infections during pregnancy/after delivery.
The life expectancy of a Nigerian, according to the Union Nation World Population Prospects, is 55 years; Egypt is 72, Tunisia is 77. Many other African countries including Ghana, Togo and 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 accountable.
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’s polls approach, 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 stakeholder’s workshop organised 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 prioritised by the political class toward achieving the health goals.
A universal health coverage (UHC) expert and project director, Prevent Epidemics Project, Dr. Gafar Alawode, 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 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 rights activist, Mr Femi Falana wondered why issues are not being raised and the polity is not being told “If this man wins his party primary and the national elections, he will address insecurity, unemployment, illiteracy or remove 16 million young people from the streets”.
Falana recalled that, at a time, Nigeria was the envy of other nations and witnessed lots of immigrants coming to the country to work, but the situation has changed, as the country has retrogressed.
A mother of two, Mrs. Gift Phillip, said her recent experience at a primary health centre during delivery called for an urgent revamp of the system.
“The PHC cannot attend to women with my type of problem. Healthcare is more than antenatal care and women giving birth cannot do so in a health facility that is not 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 to prevent maternal mortality 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 and insecurity, the Association of Staff Union of Universities (ASUU) strike and economic downturn. They have practically ignored health, forgetting that health is wealth. We need to be alive 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.”
Senior technical adviser, Tony Blair Institute for Global Change (TBI), Ebere Okereke, 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, leverage lessons learned from the COVID-19. Genuinely supporting population health and wellbeing requires more.
“If a politician wants to see people’s health improve, Nigerians 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 an entirely bad thing if discussions about health become dominant during the campaign.
“Political parties should find common purposes around the challenges that lie around health reform and commit to collectively help Nigerians better understand them. This involves being honest about the tough choices that lie ahead,” she said.