Ten low and middle-income countries (LMICs) were celebrated for the significant progress in their efforts to save the lives of women and children during the recently concluded 3rd W.H.O/PMNCH forum in Johannesburg, South Africa. They were reported to have invested in high-impact health interventions such as quality care at birth, immunization and family planning. They also made significant progress across multiple health-enhancing sectors, including for education, women’s political and economic participation, access to clean water and sanitation, poverty reduction and economic growth.
While we are at it in celebrating the 10 countries, it is imperative to know what they did and the strategies they implemented to significantly reduce maternal and child deaths. And above all to know why Nigeria couldn’t join the list of the 10 fact tracked countries.
Nigeria’s national average for immunization coverage in comparison between 2008 (23%) and 2013 (25.3%) has increased by just 2%. This means only 25% of targeted children were fully immunized. 2% increase in 5 years is poor considering the billions of naira expended in immunization programmes. The 2013 National Demographic Health Survey (NDHS) reported our Maternal Mortality Ratio (MMR) of 576 maternal deaths per 100,000 live births which wasn’t significantly different from the ratio reported in the 2008 NDHS of 545/100,000. It has even gone up rather than gone down. In trying to understand the high unaccepted MMR, one need to also know some of the outcome indicators that affect MMR. The antenatal coverage for at least one visit was put at 60.6% and for four or more visits was put at 51.5%. These Percentages signifies that almost half of the women population were disenfranchised and it raises the question of equity in health care. The % of births attended by skilled health personnel was put at 38.1%, it is very poor and a red card for a country that is bless with avalanche of donor funded projects on maternal health and a country boasting of being the largest economy in Africa.
The contraceptive prevalence rate (CPR) was put at 15.1%. This is amidst our pledged to “in addition to our current annual commitment of US$3 million for the procurement of reproductive health commodities, we are now committed to provide an additional US$8,350,000 annually over the next four years, making a total of US$33,400,000 over the next four years. This is an increase of 300 percent.” We also committed to achieving the goal of a contraceptive prevalence rate (CPR) of 36 percent by 2018. All these are unrealistic.
The above examples underpin Nigeria’s progress in a reverse order and why Nigeria weren’t celebrated.
In celebrating the 10 countries, the international community shared an overview of the Success Factors for Women’s and Children’s Health studies. It is observed that “there have been substantial achievements towards MDGs 4 and 5 (to reduce child mortality and improve maternal health) from 1990 (the baseline for the MDGs) to date. Child and maternal deaths both decreased globally by around 50%, and contraceptive prevalence increased from 55% to 63%. There is consensus on evidence-based, cost-effective investments and interventions and on enabling health and multisectoral policies.”
The Success Factors study series included statistical and econometric analyses of data from 144 LMICs over 20 years, qualitative comparative analysis (QCA) across all LMICs, a literature review and country multistakeholder policy reviews in 10 LMICs that were on the fast track, ahead of other comparable countries, in 2012 to achieving MDGs 4 and 5a (hereafter referred to as fast-track countries.
The celebrants are Bangladesh, Cambodia; China, Egypt; Ethiopia, Lao PDR, Nepal, Peru, Rwanda and Viet Nam.
What are the Shared strategies, unique approaches: Lessons learned from fast-track countries?
The Success Factors studies show us that maternal and child mortality can decline rapidly in low- and middle-income countries when different actors across society collaborate to improve women’s and children’s health. Remarkable results can be achieved when this approach is underpinned by robust data and strategies tailored to countries’ unique situations – especially if the political will and resources exist to maintain long-term focus. All the 10 fast-track countries in this report have demonstrated some or all of these qualities and strategies. In each country the mix has been different, depending on local context and priorities. However, the clear message is that coordinated multistakeholder partnerships, multisector action, guided by sound data and strategic vision, delivers results. We’ve summarized the three main elements of this approach as:
1. Multisector progress – progressing on MDGs 4 and 5 as well as most of the other MDGs (e.g. reducing poverty and hunger and improving education and gender equality).
2. Catalytic strategies – optimizing the use of resources and maximizing health outcomes through effective leadership, evidence-informed decision-making and partnerships across society.
3. Guiding principles – using widely accepted principles, legal frameworks – including for human rights and development effectiveness – and political and economic models to shape policies and focus action. In practical terms, this breaks down into a number of broad strategies that characterize fast-track success.
Fast-track countries focus first where they know they can make a difference quickly and sustainably. Often this means strengthening the capacity of the health system to provide basic RMNCH services that people in high-income countries might take for granted. Since 1990, investments in proven high-impact interventions, such as skilled care at birth, immunization and family planning, have accounted for about 50% of the reduction in child mortality.
Looking at where we are in Nigeria with respect to poor maternal and child health indices, there are a lot to learn from the 10 celebrants.
This article was 1st published in Daily Trust Newspaper of Tuesday 5th August 2014 by Dr Aminu Magashi