This question strategically resurrected after we completed a live radio 2 hours chat in WE 106.3 FM stereo Abuja on Tuesday 24th February, 2015. I, Dr Nosa Orobatan and Dr Olayinka Farouk of TSHIP and Dr Abimbola Williams of Save the Children Nigeria were featured as discussants to take a stock of newborn health in Nigeria particularly the role of Chlorhexidine 4% gel in addressing newborn infections and its impact to improve the chance of survival for babies.
During the media interaction we offered lots of useful suggestions and recommendations and one issue that I indirectly mentioned was the need to look back to the outcome of the Nigeria National Every Newborn Action Plan Conference that took place late last year and its outcomes and to ask critical questions regarding implementation. The outcome of the conference was packaged in a ‘Nigeria Call to Action to save Newborn Lives’
The call to action provided useful evidence that Nigeria accounts for nearly one-quarter of the Africa’s maternal and newborn deaths, and is one of ten countries that contributes to two thirds of all newborn deaths worldwide. While mortality rates are decreasing for mothers and children, progress is slow, especially for newborns. Nigeria’s rate of neonatal mortality reduction was an estimated 1.83% per year from 2000 – 2012, while under-five mortality for this same period was nearly twice as fast at 3.47% and maternal mortality declined at 4.1% from 2000 to 2013. Of the 7 million babies born in Nigeria every year, over 260,000 die within their first month of life and nearly 300,000 are Stillborn. With nearly 90,000 deaths in the first 24 hours of life, Nigeria has the second highest burden of first day deaths in the world or 9% of the global total. In addition, 40,000 women die from pregnancy and childbirth complications each year.
What are the Policies guiding Maternal and Newborn Health?
The call to action provides a summary of key policies supporting implementation of programmes.
- 2007 Integrated Maternal, Newborn and Child Health (IMNCH) Strategy.
- October 2012, Nigeria’s President launched the government’s Saving One Million Lives (SOML) Initiative, which serves as an organizing framework for government efforts to accelerate improvements in health outcomes for women, newborns and children.
- The National Health Act that came in to law late last year provides a framework and additional source of funding to implement primary health care, insurance scheme and emergency medicine.
- The Midwives Service Scheme (MSS) and the Subsidy Reinvestment and Empowerment
The call to action also has brought out key and cogent actions to overcome bottleneck to service delivery which are situated in line with the 6 blocks of health system. I will highlight 2 of that.
On Health Finance, it observed;
- Very low coverage of health financing schemes
- No specific line item for tracking financial resources for maternal and newborn health at all levels
Actions proposed are;
- Global backing to support signing of the National Health Bill by the President and implementation at all levels
- to ensure adequate resources for implementation of MNH interventions at primary health care (PHC) level
- High level advocacy to improve financial access to MNH services
- Establish government budget line for maternal and newborn health
- Appropriate legislative bodies to support MOH to track expenditure, to ensure prompt fund release and strengthen accountability on health expenditures
- State government to expand community-based health insurance schemes
On health service delivery, some bottleneck observed are;
- Inadequate funding
- Supervision not regular at sub-national level
Actions proposed to address such are;
- Make funding available for supervision at all levels of the health system
- Ensure regular integrated supportive supervision (ISS) is conducted
- Link Information from ISS with PHC reviews
Synopsis of Nigeria Government Commitments;
- We commit to achieving the goal of a contraceptive prevalence rate of 36% by 2018. We commit to develop the Nigerian Every Newborn Action Plan that will build on post 2015 goals and link with previous government commitments.
- Newborn health continues to be a sensitive indicator of national development. Hence, there is a need to adopt focused strategies which are evidence-based and reflect best practices for the accelerated reduction of neonatal morbidity and mortality in Nigeria.
- Through the SOML Initiative, Nigeria aims to save one million lives of mothers, newborns and children by 2015 through ambitious and comprehensive scale-up of effective MNCH interventions.
- The government commits to ensuring that states review their individual state profiles and commit to working towards ending preventable maternal and newborn deaths, using data for planning and accountability purposes.
- The FMOH therefore strongly advocates to states and LGAs to prioritize resources to improve coverage of MNH interventions.
- The Essential Medicines and Equipment List (EML) has been reviewed to appropriately reflect neonatal commodities and the national EML review committee has granted a provisional approval of the updated EML. The use of multiple Chlorhexidine gel application for cord care has been approved for all levels of care including placement as an over-the counter commodity.
- Nigeria is also initiating maternal death reviews and surveillance. Efforts are underway to include perinatal death reviews at the facility level in order to count deaths and identify avoidable factors that can be addressed and lead to improved quality of care.
In conclusion it is imperative to take a stock of progress in achieving issues raised in the call to action and galvanize actions to fast track implementation.
1st published in Daily Trust Newspaper of 10th March 2015 by Dr Aminu Magashi Publisher Health Reporters (firstname.lastname@example.org)