Strengthening Health System Governance for Improved Quality of Maternal Health Care in Nigeria

Gaps in availability and quality of maternal health care services constitute a major obstacle to achieving the desired maternal health outcomes in low- and middle-income countries such as Nigeria. Initiatives aimed at improving quality of maternal health care tend to address quality of care issues in isolation, without considering wider system-level issues that lead to nonexistent or impaired quality of services. The governance of health service delivery – including health care financing, knowledge and information, human resources and commodities and equipment – largely determine the availability and quality of care.

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Using an adapted version of the World Health Organization governance actions, the Partnership for Transforming the Health System II (PATHS2) Project led by Abt Associates and implemented between 2008 and 2015 illustrates the role of governance in improving the quality of maternal care by increasing access to skilled birth attendants who can provide active management of the third stage of labor (AMSTL).

Policymaking

One of the first steps towards improving quality of maternal health care is to define quality improvement objectives, set standards and establish clear guidelines, treatment protocols and indicators. Clear policy direction defines quality and sets the stage for effective implementation of a quality improvement plan. Policy directions for other aspects of the health system also play an important role in improving quality of maternal health care. For instance, clear human resources for health (HRH) policies that place a premium on improved density, equitable distribution and performance in terms of reduced absenteeism, competence, productivity and responsiveness are critical. The PATHS2 Project in Nigeria supported select states to develop and implement HRH policies and strategies, recruiting additional staff and redistributing staff where necessary. In addition, skilled health workers were trained in the AMSTL. The availability of skilled health workers as a result of this policy change contributed to a greater than 60% reduction in cases of postpartum hemorrhage referred from primary health care centers (PHCs) in these states.

Institutional capacity strengthening

As part of maternal health care quality improvement, stakeholders should clearly articulate the roles of different institutions and address institutional weaknesses that hinder effective design and implementation of a quality improvement initiative. Health systems need well-functioning institutions to enact reforms related to HRH, health financing and commodity management that improve maternal health care quality. In Nigeria, Kaduna State created a HRH unit within the State Ministry of Health and introduced a Supplementary Midwife Service Scheme to recruit, train and deploy midwives to PHCs. Due to the increase in personnel, these PHCs experienced a subsequent surge in facility births and delivery of other maternal health services.

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News credit: Maternal Health Task Force

Family planning a development imperative in Africa

Marie Josee Mukankuranga stood before international health and development experts in her home in the Rwamagana District of Rwanda, talking about her community’s need for family planning.

Ms. Mukankuranga, a community health worker, explained that villagers visit her to learn about modern contraception. “I am following up with 35 to 40 clients,” she told them.

Programmes like these receive little attention, but they are critically important. Voluntary family planning empowers women to choose if and when to have children, and how many. It enables women to finish their educations and join the labour force, helping families rise out of poverty and securing better futures for their children.

Human rights and development imperative

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Family planning is not only a human right; it is also a development imperative. In Africa, which has large numbers of young people, family planning can play a central role in helping to harness a so-called “demographic dividend”.

A demographic dividend is a massive economic boom that can take place when there is a decline in fertility rates, yielding fewer dependents relative to income-generators. Voluntary family planning programs, information and services are essential to this process. Investments are also needed to create a better access to education and decent employment, and to help ensure gender equality.

“If you don’t have a working family planning programme, it is unthinkable to reap the demographic dividend,” Dr. Babatunde Osotimehin, Executive Director of UNFPA, said at a high-level event organized at the margins of the 2017 Summit of the African Union in Addis Ababa, Ethiopia.

The event, which focused on the importance of ensuring access to voluntary family planning, was jointly organized by UNFPA, the United Kingdom’s Department for International Development (DFID) and the Federal Ministry of Health of Ethiopia.

There has since been significant progress in providing access to voluntary family planning throughout Africa since 2012. That year, governments and partners committed to reaching 120 million more girls and women with modern contraceptives by 2020, a promise known as FP2020.

But the continent still has the highest rate of adolescent pregnancy in the world, with some five million girls lacking access to modern contraceptives, according to a 2013 UNFPA report. 

Complications of pregnancy and childbirth also remain a key cause of death for girls aged 15-19 years in Africa.

Priti Patel, Secretary of State for DFID, emphasized that an estimated 225 million women globally want to avoid or delay pregnancy but are not using modern contraceptives. These women, she said, must be reached with voluntary family planning. She also announced that a family planning summit will be convened this summer in London, a joint effort between the UK government, UNFPA, the Bill and Melinda Gates Foundation, and other key partners. Continue here...

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Restoring reproductive health access for millions in Boko Haram affected areas (Nigeria)

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A brutal attack by Boko Haram forced Zainab Abubakar, 28, and her six children to flee their home in northern Nigeria. “I was one month pregnant when I left Gamboru Ngala,” Ms. Abubakar told UNFPA from the Dalori displacement camp in Maiduguri. “During my escape, I lost my pregnancy.”

Ms. Abubakar’s tragic miscarriage took place in 2014, but the Boko Haram crisis continues to drive women and girls from their homes – and from access to basic health care.

An estimated 26 million people live in conflict-affected areas of Nigeria, according to the 2017 Humanitarian Needs Overview, and some 14 million people are in need of humanitarian assistance. In the three states worst affected by the insurgency – Adamawa, Borno and Yobe – some 1.64 million people have been displaced from their homes, according to recent UN reports

UNFPA estimates that, among the vulnerable population, 1,725,000 women of reproductive age will require life-saving reproductive health services in 2017.

“For women and girls – especially pregnant women, who may face life-threatening childbirth complications, as well as lactating women, caring for newborns throughout the chaos – whether they live or die in a crisis often depends on their access to basic sexual and reproductive health services,” said Dr. Babatunde Osotimehin, the Executive Director of UNFPA, during a recent mission to northern Nigeria.

Restoring access to reproductive health care

Nigeria has one of the highest rates of maternal death in the world. The risks are compounded for women and girls living through humanitarian crises, which undermine community support mechanisms and limit access to health facilities.

UNFPA is working to reach people whose live has been turned upside down by the Boko Haram insurgency. There is ongoing support to 155 health facilities and clinics in Adamawa, Borno and Yorbe states, reaching 1.2 million people. Some 300,000 people were reached in October and November of 2016 alone.

Read more here 

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News : IVF Babies and the Stigma: Finding a Way Out (Nigeria)

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Surprisingly, a group of parents who have benefitted from Assisted reproductive technology (ART) at various points in time have done something very rare. They have chose not to carry on with secrecy any more, like many have done. Rather, they have collectively agreed to break out of the cubicle by coming together to boldly talk about it openly without shame, so as to create awareness in the society, through an established organisation called, Fertility Awareness Advocate Initiative (FAAI), that IVF babies and their parents need not be stigmatised. This action, they say will help many out there who are also in need. Mary Ekah writes

Would you rather remain childless in your entire life than have a child through a modern technology and be stigmatised by the society? Well, for many it’s assumed they would rather have children of theirs through a contemporary means and be stigmatised than not having one at all. And that is where In-vitro fertilisation (IVF) and other options come in and then the accompanying stigmatisation by the society. Most parents who got their babies through Assisted Reproductive Technology (ART), which may be either through In-vitro fertilisation (IVF) or Intra uterine insemination (IUI), usually feel very reluctant to talk about it.

Even though IVF, process of fertilisation by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus, is growing fast in Nigeria, a lot of people who go through it do it with high level of secrecy. In a country like Nigeria one’s inability to have a child is seen a social failure, especially for women and more so, it is like a taboo to disclose that your babies are IVF babies. They fear they would be stigmatised and their babies labeled unforeseen names. They also feel families and friends will look upon them as lacking in certain capability. And so they chose to keep mute about it even when they are aware that their outspokenness will help a lot of couples having fertility challenges but do not know how and where to get help.  Read more here….

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