Maternal Health Accountability (Overview)
Strengthening Legislative Oversight on Maternal Health in Four Northern States in Nigeria
According to the World Health Organization, maternal mortality is the death of a woman while pregnant, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management. It is the death of a woman while still pregnant or 42 days after she ceases to be pregnant for the very reason of her pregnant state and inefficient handling of her condition.
Life for everyone is a basic fundamental commodity. It is the threshold upon which the body of other entitlements: civil and political, economic and socio cultural is realized. International instruments protecting life became the thrust of frameworks as early as in article 3 of the 1948 Universal Declaration of the UN General Assembly. Article 6 of the International Covenant on Civil and Political Rights reaffirms the sacrosanct nature of life, providing that no one may be arbitrarily deprived of it. On the African continent, Article 4 of the African Charter on Human and Peoples’ Rights’ protects life particularly mentioning women of reproductive age. Its importance cannot be over emphasized for simply put, without life, there is nothing.
The ground-breaking Maputo Protocol (which Nigeria was a part of its making), considered as one of the most progressive effort on African women’s health in Article 14 obliges state parties to ‘establish and strengthen existing pre-natal, delivery and post-natal health and nutritional services for women during pregnancy and while they are breast-feeding.’ The Maputo provision has an overarching reach across the three critical stages of child bearing: prenatal, delivery and post-natal, mandating state parties in the same breath to provide health services for women in these stages.
Since the Nairobi Conference on Safe Motherhood of 1987, the global health and development community has not rested on its oars. Several other conferences have been organized in which better maternal and child health have been the thrust. One of such is the 2000 Millennium Summit which was the largest gathering of world leaders, heads of state and government. The Summit set eight top priority goals to be achieved by the year 2015. Goals 4 and 5 are on reducing maternal and child mortality.
Nigeria is signatory to all these protocols on health and promotion of women’s’ rights. For instance, in 2007, Nigeria hosted other nations during which period they came up with the Abuja Declaration (African Health Strategy 2007-2015). If these treaties are domesticated and implemented, maternal mortality rate would have reduced drastically. However, the government pays lip service to implementation of these laws. A number of factors contribute to the poor maternal health services in the country. Some can be attributed to corrupt practices of the political class, who hijack the money meant for health services for the people for personal aggrandizement. Often times, politicians divert funds meant for maternal health to their very own communities to other purposes.
The three tiers of government also have their fair share in the problems identifiable in health care delivery in Nigeria. The Nigerian constitution does not have a clearly defined role of specific health responsibility for the three tiers of government, namely; Federal, State and Local governments. This has become a major challenge in the implementation of the policies which are formulated at the Federal level. The Federal level also has the mandate to mobilize funds for the implementation of the health service delivery. However, the onus falls on the States and the Local Governments to implement these policies at those levels. Unfortunately, there is a huge disconnect among the three tiers of government. This deadly disconnect has cost Nigeria many lives. The Federal government has provided some services through the Maternal Newborn and Child Health programme (MNCH), Midwifery Service Scheme (MSS), Maternal Newborn and Child Health Week (MNCHW), Free MNCH, Scale up Nutrition (SUN), Policy on Free Family planning commodities in Public Health Facilities to end users and Subsidy Reinvestment and Empowerment Programme (SURE-P). The big question then is how effective are these health services? How many Nigerians are aware of their existence and how many women even in the rural communities can access them? There are about 24,000 health centres scattered all around the country within the rural areas, and also health posts. These health facilities are death traps; they are over grown by bushes and serve as den for thieves. Health workers posted to these areas are hardly available. No sane person no matter how ill will want to be found dead in these health facilities. There is no gainsaying that community people prefer the services of unconventional community health workers, drug peddlers and traditional birth attendants because the health facilities are just not there to provide the needed services.
Other efforts by the Federal government to alleviate the health problems of the people include setting up the National Primary Health Care Development Agency which mandate is to stimulate and assist States and Local government Areas to initiate or accelerate primary health care development where none is taking place or is at a very slow pace. This agency can be found in every LGA in the country. The Minister of Finance and Coordinating Minister for the Economy have also developed an approach to support five key ministries to deliver concrete results for girls and women in the 2013 Budget, these ministries are: health, agriculture, works, communication and water resources.
All these efforts by the Federal Government have failed to tackle the issue of maternal mortality in Nigeria and it is understandable since there are many road blocks to their success. The first among other weighty challenges is lack of collaboration among government agencies providing health services to the people. This has caused all their efforts in improving health services for women to crass waste of resources. There are also institutional challenges among the health agencies, for instance, the National Primary Health Care Development Agency identified key challenges to its efficient operation as lack of programme ownership by States/LGAs, and also inadequate supportive monitoring. These are pointers to the fact that there is a dire need for strengthened collaboration among the tiers of government. If all the parties involved in developing health policies (FG) and implementing parties (36 states and FCT), are synergizing, there will be improvement in maternal. The fact is that the Ministry of Health has policies that if followed through with proper implementation can bring about decrease in the death of mothers.
There is also the problem of top-bottom approach to policy formulations. Government’s policies lack input from the citizenry. It appears government health policies are formulated without citizens’ involvement. This issue will be addressed during the cause of implementing this project through wide range of campaigns, to ensure that citizens’ voices are heard and taken into account.
Civil Society legislative Advocacy Centre intends to bridge this gap through our interventions. CISLAC works towards bridging the gap between the legislature and the electorate. CISLAC’s engagement with Federal Ministries, National and State Assemblies, Local Government Administrations, private sector interests, the media, non-government and civil society organisations, and communities across Nigeria has opened a window through which the public and policy makers can interact and collaborate. Our intervention will seek to provide that linkage between the citizens and the State government and beyond, through legislative interventions on maternal health. Advocacy campaigns, Legislative-Executive dialogue sessions, formation of caucus on maternal health and many other interventions as seen below, will be carried out to bring to the fore the debilitation issues on maternal health to the lawmakers to catalyze actions that will lead to reduction of maternal mortality in Nigeria.
Strong measures will be taken to ensure accountability and corrective actions. These considerations should extend beyond state actors and include non-state actors and citizen’s participation in order to strengthen the state obligations. For the purpose of strengthening state obligations to the citizenry, accountability on maternal health becomes very crucial. For Nigeria, there has to be a synergy among the three tiers of government. Citizens’ ownership of their health sector is also very crucial for the purpose of monitoring the activities of health workers and also making informed recommendations to civil society organizations working on legislative advocacy and policy to feed into government’s future health policies.
- To increase law makers’ oversight role on maternal health in four northern states- Jigawa, Kano, Katsina and Kaduna.
- To improve CSO’s and media action on maternal health.
Mac Arthur Foundation
- It is expected that during and after the implementation of the project, Nigerian citizens within the selected states will be more sensitized on the availability of health reforms from the government, and with the effort of CSOs, and the media, begin to speak up and demand for those in charge of maternal health to provide the health services the government has indeed availed the citizenry.
- Most health services are written down as policy framework but never translated into actions since they stop at the national level. This problem emanates from the fact that the Federal government formulates policies but the onus is on the state to implement.
- It is expected that the health policies put in place by Federal government shall come alive through implementation at the state level.