Worried over the high incident of maternal, newborn and child death in Nigeria which currently stands as the second highest figures across the globe after India according to World Health report for 2014, Hajiya Amina Kazavre of the MNH-CS Partnership Kaduna, while stressing the poor state of Maternal health services in the northern part of Nigeria, testified from an ongoing evaluative study on Primary Health Care (PHCs) delivery in Kaduna, that there are some rural communities where the PHCs have no doctors in attendants for two months, except Community Health Care Workers (CHEWs) who in some cases are inexperienced. She wondered what would happen to pregnant women and children in need of a doctor’s attention. She further reported that while shortage of funding and skilled manpower still remains a major factor of high maternal and newborn deaths, the element of corruption still poses as a challenge. She confidently reported the confessions of some sampled respondent staffs of PHCs in rural Kaduna villages that some of them have operated for more than four months without a single supply of Panadol pills from the dispersing agency but are compelled by agents or individuals in authorities to sign vouches and documents that testify that such supplies were made. This same trajectory was shared by other participants during the Workshop/Planning meeting on ways to improve funding and management for maternal, newborn and child health in Nigeria, organised by the Centre for Social Justice in Abuja.
According to Dr Lecky of Health Reform Foundation of Nigeria (HERFON) in his presentation titled – “Maternal, Newborn and Child Health (MNCH) in Nigeria; An Accountability Issue”, he stated that Nigeria was clearly off track in the attainment of the MDG targets for MNCH. He noted that with 800,000 under-five child deaths annually which accounts for 11% of total global under-five deaths and over 40,000 maternal deaths in 2013 alone, there is an urgent need to solve the issue. Among the solutions he recommends the need to support legislation to establish accountability mechanism in Rural, Maternal, Newborn and Child Health (RMNCH), improve financing and availability of quality data. Bar Eze Onyekpere the Lead Director, Centre for Social Justice, Abuja (CSJ), added that the annual budget of Nigeria approved for the sector rarely match recommendations and what is needed to improve the level of health service delivery in Nigeria. He urged the government to review the health allocations which have been way below international best practice of 15% for health, ensure early releases of appropriated sums for the quarter and strengthen its monitoring and evaluation in the sector to ensure that what is allocated is optimally utilised. Bar Onyekpere also called for proper harmonisation, recording and reporting of all health funding. According to him, the public seem to have their focus on the annual federal allocation to the health sector, leaving out donations from international agencies to support the health sector. He recommended that all donations and aid to support the sector be captured in the annual budget, and be monitored accordingly. He wondered if reports on the spending of such international donations are made public; and are utilised in a transparent, accountable and value for money manner.
Dr Emmanuel Odu of the National Primary Health Care Development Agency (NPHCDA), while appreciating the concern and contributions of the groups and professional bodies in attendant, during his presentation highlighted the achievements of the agency and called for increased collaboration between the agency and civil society organisation. He noted that while funding and the availability of skilled health manpower are obvious challenges, illiteracy as well as religious and traditional barriers are key factors that have limited the smooth operation and access to maternal health delivery services in Nigeria. He called the civil society groups to expand their sensitization interventions especially in far rural communities on the need to access and adopt good health practices especially as it relates to maternal, newborn and child health. Dr Patricia Medupin of the Paediatric Association of Nigeria (PAN) Kogi state chapter, supporting the need for wider public sensitization, she called for child spacing among couples. According to the expert, effective child spacing can contribute to about 25 to 30% reduction of Maternal Mortality Rate in Nigeria. She also called on the governments, ministry of health and hospital authorities to educate the public and keep them abreast on medical services and provisions which are suppose to be free or paid for. As such ignorance have created huge avenue for public exploitation in the course of delivering health service by some hospital authorities and individuals.
Worried over the incessant strike action embarked upon by medical staffs and the comatose state of health facilities, Dr Chris Agboghoroma of the Society of Gynaecologist and Obstetric Association of Nigeria (SOGON) called for improvement in the work conditions and contracts. He wondered why Nigerians especially the political class continue to spend millions of dollar on health tourism, which could be injected locally, to create more jobs for the teeming unemployed youths, improve health facility and standard, provide a learning ground for aspiring medial students in Nigeria, and also attract other nations into seeking health service in Nigeria. Mrs Nancy Oko-Onya of the Neighbourhood Initiative for Women Empowerment Ebonyi State, while noting that poor work conditions; lack of working facilities and work overload resulting from the limited manpower are partly responsible for the level of aggression and lackadaisicality sometimes displayed by medical staffs. She also noted that medical staffs and authorities should also be monitor and held accountable in cases of negligence.
The group collectively called on the Buhari administration to improve health sector allocation to match international levels of 15%, against the traditional allocation at the average of 5%-6% of the total budget. They pressed that such improvement in health sector funding be centred in MNCH and HIV intervention. They also called for the full implementation of the National Health Act 2014, and urge State governments as well as Local governments to honour the act by ensuring that they make financial provisions as well as put in place proper monitoring and evaluation mechanism to ensure that allocated funds do not go into corrupt private purses. They finally called on other CSOs, professional health organisations, actors, musicians, celebrities and faith based leaders and groups to engage in broad sensitization of the Nigerian public especially communities on the benefits and ways to access quality health services and practices; while ensuring effective demand from the government to do their bid in the provision of these services and ensuring effective health resource management.
Donald Ikenna Ofoegbu,
Centre for Social Justice (CSJ), Abuja