As many as 60 percent of deliveries in Nigeria are being attended by unskilled birth attendants. This high proportion, Dr. Muhammed J. Abdullahi, Director of the National Primary Health Care Development Agency (NPHCDA), said is part of the reasons why Nigeria is losing about 52,000 women annually to complications resulting from pregnancy.
According to Abdullahi, Nigeria is striving to meet the United Nations’ Millennium Development Goals (MDGs) on maternal health by next year.
To address the issue of poor access to healthcare services, the Nigerian government —through the NPHCDA is championing initiatives aimed at equipping primary healthcare centers across Nigeria. Essentials such as drugs, tools and manpower will help to manage baseline health conditions, and to provide first aid treatments during emergencies.
Announced by the federal government of Nigeria in 2012, the major route that the country has taken so far in tackling the challenges posed by insufficient skilled birth attendants is the Midwives Service Scheme (MSS). Under the program, the government deployed 2,323 midwives who were unemployed and retired to more than 600 primary healthcare facilities across Nigeria. The initiative serves roughly 11 million people.
Improving the Midwives Service Scheme
A recent visit to Ikereku Primary Healthcare Center in a rural community in Oyo state revealed a lot still needs to be done to make the scheme more successful; it also revealed that on its own, the MSS cannot achieve desired results.
“They work in shifts. Even with the arrangement, they are not always there as we would have loved them to be. They rarely come on time and they are always anxious to leave,” Abass Akinosun, a youth leader in Ikereku, Oyo state told AFKInsider about the midwives.
One of the drawbacks of the scheme is the posting of the midwives as a good number of them were assigned to areas that were far from their places of abode. For instance, even though they were posted to rural communities, some of the midwives live with their families in urban centers.
“If she is lucky enough, she will go into labor when the midwives are around. If contractions begin when the midwives have left, good luck to the pregnant woman,” Akinosun said, noting that the impact of a midwives’ trek depends on how fortunate a pregnant women is.
“We recently had a case of a pregnant woman delivering her baby on the roadside when efforts were being made to transport her to another healthcare facility since the midwives here had left.”
The Issue With Transportation
In Nigeria, there is an evolving referral system in place to take patients to bigger hospitals if their conditions cannot be properly managed or treated at the primary healthcare centers.
This however is not entirely effective as challenges of poor road networks, non-availability of ambulances and several others factors frustrate the system to the extent that some patients are being transported on motorcycles, bicycles and tricycles. Some are even carried on the shoulders of their relatives when in need of urgent treatment.
As of 2013, Nigeria has the highest maternal mortality ratio (MMR) in Africa. According to the World Health Organization (WHO), a Nigerian woman has a 1 in 13 chance of dying during pregnancy and childbirth. Some identified factors responsible for the high MMR are lack of access to quality healthcare, high cost of treatment due to widespread poverty, illiteracy and a limited number of skilled birth attendants.
Retired for a Reason
Nurudeen Ojo is the chairman of the All Progressives Congress (APC), the strongest political party in the community. In addition to his political responsibilities in the region, he is also saddled with the responsibility of overseeing the performances of the midwives. He said the old age of the midwives within the MSS may be the reason for the challenges being encountered.
“You know they are retired and not strong enough to be at the clinic all the time. Furthermore, many of them don’t stay here and they often have to travel which could take time before they get here, and they usually have to leave early too,” Ojo said. “But I always ensure that they work satisfactorily before they get paid, since I have to sign in order for them to be paid from Abuja.”
The limited services being provided by the midwives is further made difficult by the shortage of drugs and other medical supplies. This coupled with the wide belief that healthcare is expensive is making members of rural areas in the Ikereku community — and by extension, several other rural Nigerian communities — resort to traditional medicine, which religious leader, Pastor John Bamidele, said is even more expensive and usually less effective.
Independent Medical Services
“When people go to the primary healthcare center, they are often told there are no drugs and no one to treat them. So they go to the alternative healthcare providers thinking their services are cheap and effective, which often times they are not,” Bamidele said.
Residents of rural communities in Nigeria are now largely dependent on medical outreaches to be able to access good and free healthcare. Osunbunmi Ayokunnumi, medical professional and head of Health Heralds, an organization that provides free medical services to residents of Ikereku community and surrounding villages (about 50), said rural areas are largely abandoned by politicians who often promised heaven and earth while campaigning, but usually end up doing nothing for the rural communities. This he said is part of the reason why there are massive turnouts at his health outreaches.
“We treated over 500 people this time and provided a wide range of services including deworming exercise for the children, dental surgeries, laboratory diagnosis, and treatment of wounds, infections and several other categories of ailments,” Ayokunnumi said.
“I do it because it is what I believe in. I believe in spending my life on something that will outlast it. We make a living by what we get, but we make a life by what we give.”