Political will to reduce maternal mortality in Nigeria

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Nigeria adopted the Safe Motherhood Initiative in 2000 to confront adverse social, health and political conditions that lead to a high rate of maternal mortality (Shiffman and Okonofua, 2007; Bankole et al., 2009). Despite the adoption of this initiative, Nigeria was reported to fail in its achievement of the MDG5, implying that the Nigerian efforts towards safe motherhood were disappointing and underachieving (Bankole et al., 2009; Adinma and Adinma, 2011; Oyewole and Ahmadu, 2014).

In addition to the Federal government policies, some states have implemented their own policies. For instance, in Lagos State (MMR, 400-650/100,00 live births) there is a free antenatal care programme, including intermittent preventative treatment (IPT) of malaria, insecticide-treated nets (ITN) and routine drugs for pregnant women in hospitals (Fabamwo and Okonufua, 2010). In Enugu state (MMR, 1400/100,000 live births), policy on free maternal and child health was also initiated (Okeibunor et al., 2010). In the less wealthy states like Borno state (MMR, 1600/100,000 live births), although the government has a policy on free maternal health care, the programme was not officially gazetted, owing to lack of funds and minimal political will (Mariga et al., 2010). Despite the fact that these states implemented policies, the MMR remains high, so it is increasingly evident that the federal government has to make practical and significant contributions at the national and sub-national levels, to make these promising state policies sustainable (Okeibunor et al., 2010).

Without adequate political will and commitment, Nigeria will be on a downward slope to achieving the Sustainable Development Goals in 2030. One saddening occurrence recently reported is the failure of the Midwives Service Scheme (MSS). The Midwives Service Scheme was launched in December 2009 with the aim of addressing the lack of human resource for health crisis (Abimbola et al., 2012; Okoli et al., 2012). Between 2012-2014, a total of 3,158 midwives were deployed to primary health care clinics in rural and underserved communities, of which the South-South zone of Nigeria was allocated 506 midwives (Okoli et al., 2016)

However, most schemes and policies for maternal health have faced unsuccessful implementation and sustainability due to limited financing, capacity and lack of political will (Abimbola et al., 2012; Cooke and Tahir, 2013).

An Obstetrics and Gynaecologist based in Algiers, Dr. Olakunle Saheed, whose first degree was in nursing, said Nigerian midwives and nurses were not being honoured, despite the sacrifices they make.

“The scheme should be made an Act, duly budgeted for, and then allowed to run year in year out, while more midwives should be recruited. This will greatly bring the health indices further down.”

He said the country’s maternal death rates has increased to 578 per 100,000 live births as against the indices in 2014 during the functioning of the scheme which was below 400 deaths per 100,000 live births. “In saner countries, effective approaches and policies are never allowed to die off,” he added.

It was reported that N1.1 billion was allocated to the scheme in the 2016 health budget, however, the midwives on the “defunct” programme have so far not been identified, paid, and encouraged to return back to their duty posts. Read more here.

Studies have continually reported the lack of political will to implement maternal health policies as a major contributory factor to maternal deaths (Shiffman, 2007; Cooke and Tahir, 2013). To drastically reduce maternal deaths, the Nigerian government and the general Sub-Saharan governmental bodies are encouraged to consider sustainability of policies, implementation capacities and consistency in commitment levels.