Political will to reduce maternal mortality in Nigeria

www.un.org

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.

Job of the day

Job title: Maternal new born health advisor 
Closing date: 31st January 2017

Chemonics seeks a maternal and newborn health (MNH) advisor for an anticipated five year USAID MNH project in Indonesia. This flagship project aims to improve essential MNH services, particularly for the poorest and most vulnerable, through a total market approach that leverages resources and catalyzes stakeholders across all sectors. The ideal candidate will have experience working on international donor-funded health programs, preferably with a focus on maternal and neonatal health. The MNH advisor will provide MNH expertise and advise the chief of party and technical team across all aspects of the project, including designing interventions, assessing technical assistance needs and identifying experts, providing technical assistance throughout the innovation fund process, securing partnerships to engage and link up key MNH actors (from the public and private sectors), and help establishing and tracking MNH-related indicators. The advisor will report to the chief of party. We are looking for individuals who have a passion for making a difference in the lives of people around the world.  

Responsibilities include:

•       Provide overarching programmatic guidance to chief of party and technical staff on MNH issues and serve as an expert resource to staff, partners, and stakeholders


•       Actively participate in the innovation fund process and provide strategic and technical support to refine approaches to improve MNH


•       Draft reports capturing lessons learned and best practices in MNH and support the development and dissemination of programmatic information with key stakeholders


•        Provide capacity building support to local partners working in MNH in Indonesia


Qualifications:

•       Medical doctor, midwife, or other professional with a minimum of two years of recent clinical MNH experience


•        Experience providing technical assistance in the MNH sector


•       Experience working with diverse teams and varied stakeholder groups in a complex environment


•        Demonstrated skill in conducting critical analysis and evaluation of technical and programmatic aspects of MNH projects


•       Excellent understanding of current issues in MNH in Indonesia


•        Strong interpersonal, cultural, and communications skills


•       Experience working on USAID programs preferred


•       Demonstrated leadership, versatility, and integrity 


•       English fluency required; Bahasa Indonesia language skills preferred


Application Instructions: 

Submit electronic submissions, including a CV, cover letter, and three recent professional references to https://ghdrecruit.formstack.com/forms/indonesia_mnh. Applications will be considered on a rolling basis and only applications in English will be accepted. No telephone inquiries, please. Finalists will be contacted.

Video of the week: A thin line: Addressing the challenge of women's healthcare in Africa, Postpartum Haemorrhage (PPH)

Every year 7 million women who survive childbirth suffer serious healthcare consequences, mainly due to anaemia and PPH. Haemorrhage is also the largest cause of maternal death, killing almost 100,000 women each year – even though it is preventable and manageable with the right knowledge, skills and resources.

Told in their own words, this film follows the stories of a number of survivors of PPH in Ghana, highlighting the need and benefit from investing in maternal health, including training and education of health care workers, women themselves – rather than just saving one life, this is making an investment in future generations.

Film by Medical Aid Films, Yann Verbeke, Simon Sticker, with footage from the World Health Organisation (WHO)

Please feel free to post your comments and discuss.

$22.2 billion humanitarian appeal by the United Nations for 2017

One of the purposes of the United Nations, as stated in its Charter, is "to achieve international co-operation in solving international problems of an economic, social, cultural, or humanitarian character."  The UN first did this in the aftermath of the Second World War on the devastated continent of Europe, which it helped to rebuild. 

The Organization is now relied upon by the international community to coordinate humanitarian relief operations due to natural and man-made disasters in areas beyond the relief capacity of national authorities alone.

The United Nations needs a record $22.2 billion to cover humanitarian relief projects next year, covering the needs of 93 million people in 33 countries, U.N. humanitarian chief Stephen O'Brien said on Monday. 

"This is a reflection of a state of humanitarian need in the world not witnessed since the Second World War," he told a news conference, adding that 80 percent of the needs stemmed from man-made conflicts, such as those in Syria, Iraq, Yemen, Nigeria and South Sudan.

News Credits to http://mobile.reuters.com

Citizen participation in developing countries

In the context of developing countries, the situation of the mostly rural, poor, and needy people is particularly acute, since the policy makers and experts may have excluded the people’s voices in their decision-making process.

This post is about power structures in society and how they interact. Specifically it is a guide to seeing who has power when important decisions are being made.

The concepts discussed in the Arnstein (1969) article about 1960's America apply to any hierarchical society but are still mostly unknown, unacknowledged or ignored by many people around the world.

Most distressing is that even people who have the job of representing citizens views seem largely unaware, or even dismissive of these principles. Many planners, architects, politicians, bosses, project leaders and power-holder still dress all variety of manipulations up as 'participation in the process', 'citizen consultation' and other shades of technobabble.

As humanitarians, we need to work to help people understand the difference between 'citizen control' and 'manipulation'. If you are reading this then thank you for your interest in empowering people to take charge of their lives and their surrounding.

 Types of participation and "non-participation"

A typology of eight levels of participation may help in analysis of this confused issue. For illustrative purposes the eight types are arranged in a ladder pattern with each rung corresponding to the extent of citizens' power in deter-mining the end product. (See Figure 1 below)

Figure 1. Eight rungs on the ladder of citizen participation (Arnstein, 1969)

The bottom rungs of the ladder are (1) Manipulation and (2) Therapy. These two rungs describe levels of "non-participation" that have been contrived by some to substitute for genuine participation. Their real objective is not to enable people to participate in planning or conducting programs, but to enable power holders to "educate" or "cure" the participants.

Rungs 3 and 4 progress to levels of "tokenism" that allow the have-nots to hear and to have a voice: (3) Informing and (4) Consultation. When they are proffered by power holders as the total extent of participation, citizens may indeed hear and be heard. But under these conditions they lack the power to insure that their views will be heeded by the powerful. When participation is restricted to these levels, there is no follow-through, no "muscle," hence no assurance of changing the status quo.

Rung (5) Placation is simply a higher level tokenism because the ground rules allow have-nots to advise, but retain for the powerholders the continued right to decide.

Further up the ladder are levels of citizen power with increasing degrees of decision-making clout. Citizens can enter into a (6) Partnership that enables them to negotiate and engage in trade-offs with traditional power holders.

At the topmost rungs, (7) Delegated Power and (8) Citizen Control, have-not citizens obtain the majority of decision-making seats, or full managerial power.

Obviously, the eight-rung ladder is a simplification, but it helps to illustrate the point that so many have missed - that there are significant gradations of citizen participation.

Knowing these gradations makes it possible to cut through the hyperbole to understand the increasingly strident demands for participation from the have-nots as well as the gamut of confusing responses from the powerholders.

One solution to this problem would seem to be based on the progressive involvement of the ‘have-nots’, which implies effective citizen participation and control to achieve self and mutual-help.  Transferring Arnstein’s rungs of the ladder of participation to developing countries is however, an idea that is in theory the cornerstone of democracy in principle, but sadly not the true case, perhaps it is a distant prospect but nonetheless worth aiming for.

Note

For more information on the citizen ladder of participation, please read full article here 

Arnstein, Sherry R. "A Ladder of Citizen Participation," JAIP, Vol. 35, No. 4, July 1969, pp. 216-224.  and here

Please feel free to send in your comments.