The birth of a boy, who is third in line
to the English throne, has attracted global attention. Everyone likes a
fairy tale and this birth seems to present a happy one. However, while
we celebrate this distant prince, it is difficult to resist the
opportunity to compare birthing conditions here in Nigeria and in the
United Kingdom. An unfair comparism, no doubt, but this story has thrown
up some interesting indicators that can be a pointer for possible
growth in Nigeria’s health sector.
The newly-born English Prince George,
comes with all the paraphernalia of wealth. Even the media attention
regarding the birth method the mother chooses, has been massive. Some
6,718km from this celebrated event, Risikat gives birth to a bouncing
baby boy in Lagos, Nigeria. But here, she struggles for survival. A
story that is familiar to many families. Often, we talk about child
birth experiences — costly hospital bills; the attitude of birth
attendants and nurses to the women in labour; and women we know who
nearly died or died in childbirth. In fact, at a recent conversation, I
was surprised that issues of childbirth seemed to resonate well with
men, who were willing to share horrifying stories of their wives’
experiences as well. An informal census of the incidence showed that in
that small room, out of five women and men involved in a discussion,
only one had not experienced complications in childbirth — and she gave
birth abroad.
Nigeria has one of the worst maternal
mortality indices in the world. With a ratio of 545 women who die out of
100,000 live births, the country has been ranked alongside Liberia,
Sudan, Chad and Somalia. Effectively, this indicator translates to 75
women who die on a daily basis during childbirth in Nigeria – almost the
equivalent to a plane crash of a Boeing 727 every couple of days.
The indicators are not much different in
Lagos State, Nigeria’s commercial hub. In the state, 555 women die out
of 100,000 live births. This means that out of every 40 women, one will
die during gestation, childbirth or during six weeks after the end of
pregnancy or delivery. This index is higher than the national average
and with a population almost hitting 21 million, more women are likely
to die in Lagos State than in other state in the country.
One way to understand the reason behind
the alarming maternal deaths is to appreciate health care at the Primary
Health Care facilities in the state. The PHCs are critical to women’s
survival because they are located at the ward level in the local
government areas and perceived to be closer to the people and therefore
easily accessible. For many of Lagos State’s poor especially the over 10
million people who live below the poverty line and are unlikely to pay
for expensive health care at private hospitals, the PHCs represent a
viable option for childbirth.
However, a 2013 state-wide assessment of
flagship PHCs in Lagos State conducted by InnovationMatters in
partnership with the Lagos State Civil Society Partnership, found some
interesting drivers of maternal mortality at this level. The assessment
identified the non-availability of protocols, and supporting equipment
to handle Post-Partum Hemorrhage, a leading cause of death
resulting from excessive blood loss after birth, was largely absent. In
other words, the study found that a good number of the PHCs assessed
were not adequately equipped to handle such cases.
An instance can be taken from the
availability of ambulances for women who suffer PPH. Even though 13 out
of the 20 PHCs assessed have ambulances to handle emergencies or to
transfer critical cases to the General Hospitals, seven of these
ambulances are not fully functional having had challenges of maintenance
and even imprest for fuelling the vehicle. In effect, out of the 20
PHCs assessed, only six have functional ambulances to handle
emergencies. In one instance, a nurse at the Palm Avenue PHC, Mushin,
stated that the ambulance was not available for 24 hours and that in
some situations, “the patient is told to tell the husband to go with his
car or use the taxi park close by.” In emergency cases like excessive
bleeding, the chances of survival, can be slim.
This is not the only situation where
cash-strapped patients are made to bear the cost of treatment. In the
event of power outage, patients are made to contribute to the cost of
fuelling a generator in eight out of 20 PHCs assessed. The assessment
found that only six out of 20 PHCs have fully functional power supply
back-up. For eight of the PHCs assessed, generators are not fully
functional as a result of lack of imprest to purchase fuel to operate
them. In some others, generators are not even available. A nurse in
Ilasamaja remarked during the exercise, “… It is irregular! The last
time we had light was two weeks ago and there is no imprest for fuel, so
we make use of candle or torchlight even during delivery and since
there is no light, no water; we fetch from the well.”
So, going back to our story, on July 22,
2013, the day the English Prince was born, Risikat died. She is
survived by a husband and a bouncing baby boy.
This story is not an empty criticism of
the health care system in Nigeria but is aimed at inspiring change and
repurposing the true essence of local governance. Nigerians need to
begin to ask questions. However, questions in connection with the
appalling state of the PHCs and the increasing number of deaths must be
directed to the correct channel – the local governments. This is because
by virtue of the 1999 Constitution, the PHCs fall under the purview of
the local governments. They have the responsibility to fund and equip
the PHCs so that they meet the health needs of citizens within their
jurisdictions.
Importantly, attention must be drawn to
the fact that inadequate funding of ambulances and irregular power
supply appear to be critical factors influencing poor quality of health
care at the PHCs. Ultimately, poor funding can potentially lead to the
deaths of many Nigerian women. Consequently, in addition to adequate
budgetary provision by the LGAs, close budget monitoring is urgently
needed at this level to check corruption and improve fiscal
transparency. Without doubt, the commitment to reducing maternal
mortality has to begin from the local government level and a process to
ensure that LGA funds are prudently managed must be established if
women’s survival is to be guaranteed in Lagos State.
•Mrs. Kadiri is Executive Director, InnovationMatters Limited, Lagos. dede@inmattersng.com, www.inmattersng.com
0 Comments