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HEALTH-NIGERIA: Maternal Mortality, a Rural Community’s Example

Toluwa Olusegun

FARASINME, Nigeria, Sep 2 2009 (IPS) - Women, their children strapped to their backs, defy the mid-morning sun and converge on the Primary Healthcare Centre, located on the outskirts of Farasinme village, the Badagry West Council Development Area of Lagos State.

Most of the women, and a few men, have trekked to the centre, about one kilometre from the village, for free diabetes and hypertension screening and eye tests.

They have come here for a free health service, initiated by the Lagos State Government, offered from time to time via various local government offices and health centres in the region.

Two weeks earlier, Farasinme’s Primary Healthcare Centre conducted a similar programme, tagged 'Free Health Mission’, aimed at reaching people suffering from various ailments in the village and nearby communities.

The medical officer in charge of Primary Healthcare Centres in the Badagry West Local Council Development Area (LCDA), Dr Adebayo Akintayo, told IPS that the programme is a deliberate effort to change the perceptions of the rural dwellers about orthodox medicine. According to him, many more people patronise traditional healers than they do orthodox hospitals because of their belief in spiritualism.

During the programme, the visually impaired received free spectacles, while pregnant women got free check-ups and those needing surgery referred to the General Hospital in Badagry for free treatment.

In this and other rural areas in Nigeria, expectant mothers are mostly taken care of by traditional birth attendants (TBAs), and natural birth at home is still the most common method of delivery. As a result, there is a higher risk of both maternal and infant mortality is higher than would be the case with timeous medical intervention. Programmes like ‘Free Health Mission’ is part of this objective.

"The LCDA chairman provided free delivery information kits for the pregnant women who attended, and we encouraged them to tell other pregnant women in their communities to come and register for antenatal care and regular check-ups," Akintayo explained.

Health workers at the centre also provide free routine immunisation to the communities on the border between Nigeria and Benin Republic, to ensure that babies are immunised against six killer diseases, including polio, measles and tuberculosis. As a result of these efforts, childhood killer diseases had been drastically reduced in Badagry area, Akintayo said.

"One of the reasons we are conducting this project and others like it is to try and achieve the Millennium Development Goals (MDGs) target, and one of the key areas is reduction of maternal and child death, as well as alleviating poverty," Akintayo said.

Sidiki Coulibaly, the United Nation’s Population Fund (UNFPA) representative in Nigeria, described maternal mortality rate in Nigeria as "unacceptably high" and stressed the need for active collaboration between all stakeholders to reduce the trend.

Nigeria makes up about two percent of the global population, but bears ten percent of the global burden of maternal mortality, according to UNFPA.

Akintayo explained that maternal and infant mortality, especially in rural areas, is the result mainly of lack of health facilities, and where there are such facilities, poor management of them and the people’s suspicious attitude to healthcare delivery.

Statistics show that close to 80 percent of Nigeria’s population are rural dwellers who do not have access to adequate healthcare delivery.

"In places where health centres do exist, there is a lack of funds to provide the necessary drugs. As a result, some people have decided to adopt spiritualism instead of seeking a medical solution to their health problems," he said.

The situation is compounded by the fact that many health workers have left Nigeria seeking better prospects due to the ailing economy and inadequate remuneration for health workers at home.

The cost of healthcare is another obstacle. "My experience in this environment is that most people are poor and cannot afford to see a doctor. That is why this present state administration has made it mandatory that free healthcare facilities should be spread across rural areas."

Akintayo noted too that most people, including pregnant mothers, patronise herbal or traditional medical practitioners because of cost of healthcare and "because things in the traditional sector are spiritualised and cheaper".

"The average African believes that it is a witch in the village who is casting a spell on him or her and causing the problem. That is why the issue of education or enlightenment is so important. A lot of people, even though they’ve been educated at school, still go back to tradition.

"Alhough there is nothing wrong with that, traditional beliefs can be refined in a way that people are more educated and enlightened. Our educational curriculum does not really address the issue of traditionalism," Akintayo said.

Esther Omolere, a traditional birth attendant in the village, told IPS that she performs only a complementary role to the midwives, and refers women to hospital if there are complications.

"I have never recorded any death in my five years as a TBA because I also encourage my patients to register at the maternity hospital and if I notice any complications, I immediately refer them to the hospital," she said.

She confirmed, however, that pregnant women first seek herbal medicine, "which is what most people are returning to now".

Akintayo, meanwhile, is concerned that government allocation to the health sector is still far from adequate.

"Government allocates a lot to the health sector, but it is yet to meet the World Health Organisation recommendation of 15 per cent of the budgetary provision.

"If the government could recognise the fact that health is wealth, the better it will be for all, as one can not quantify the loss of an individual in monetary terms. An investment in health can never be regretted," he said.

The Nigerian government allocated about $264 million to health in the 2009 national budget.

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