Open Chat with Buhari’s Transition Committee on Health (1)

The election of March 28^th has been won and lost and now is the time to begin advocacy and engaging President-elect Muhammadu Buhari Transition Committee on health to grasp the challenges and opportunities ahead of May 29^th handing over. In the next 3 weeks, this column will be dedicated in sharing information to the transition committee on various aspect of health and the issues to priorities. I must start by saying that to some extend both the APC and PDP had in their campaign trains health messages, while PDP was talking about implementation of the National Health Act, the APC train was talking about reducing maternal mortality ratio by 70% and combating communicable diseases. Even though none of the parties had mentioned how they would implement policies to lead to the change they promised in health, by putting them in their agendas is something worth commendation.

What does the Nigerian Government specifically committed to?

1. Reduce Maternal Mortality Ratio (MMR) from what it was previously to about 250/100,000 by September 2015.
2. Commit to achieving the goal of a contraceptive prevalence rate (CPR) of 36 % by 2018. Achieving this goal will mean averting at least 31,000 maternal deaths.
3. Ensure the availability of Reproductive Health Commodities including lifesaving drugs for women and newborn in our secondary and primary health care facilities
4. Passage into law the long awaited national health care bill which will boost tremendously financial commitment and allocation to primary health and insurance scheme leading to improved universal coverage.

Permit me to mention that only No.4 among the commitments listed above is achieved but of course the passage and assent are just the beginning of a long process of securing funds to implement the act.

Based on the 2013 National Demographic Health Survey (NDHS) which was officially presented by the National Population Commission on Monday 16^th June 2014 in Abuja, Nigeria. Our MMR is put at 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. This is the time to reflect and begin to ask the hard questions of why and what are we doing wrong and what can be done to reverse the trend of MMR in Nigeria.

W.H.O’s 2013 published maternal death estimates also corroborated the 2013 NDHS as it reported Nigeria’s MMR as 560/100,000. 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 signify that almost half of the women population in Nigeria were disenfranchised and it raises the question of equity and coverage in health care. The % of births attended by skilled health personnel was put at 38.1%, it was poor and a red card for Nigeria being the largest economy in Africa. While many countries were celebrated for their achievements and fulfilment of promises and pledges in this report, regrettably it is not the same for Nigeria. Its contraceptive prevalence rate (CPR) as reported by the NDHS2013 was put at 15.1%. The prevalence has not change over the last 5 years when it was measured by the NDHS2008.  Nigeria on the 11^th of July 2012 at a London Summit on Family Planning tagged FP2020 pledge to “in addition to its current annual commitment of US$3 million for the procurement of family planning(FP) & reproductive health commodities, it further committed to provide  additional US$8,350,000 annually over the next four years ( 2012-2016) , making a total of US$33,400,000.. This is an increase of 300 percent.”  And also committed to achieving the goal of a contraceptive prevalence rate (CPR) of 36 % by 2018.  Achieving that goal will mean averting at least 31,000 maternal deaths and over 700,000 mothers will be prevented from injuries or long-term complications due to childbirth. Can 36% increase be achieved by 2018 looking at the current CPR of 15%?

From available information in-country, funds for the purchase of FP commodities that would improve access were serially not released yearly which made the pledges difficult to be realized. For Nigeria to join the celebrated community of FP2020, it is desired that it speeds up advocacy and sensitization within the finance and health sectors for the release of funds, purchase of FP commodities as well as coordinated distribution of the drugs across the nation.

We need to do more for Health, because of the following reasons;

1. Nigeria is one of the 10 worst places in which to be a mother, and has the second highest number of newborn deaths worldwide.
2. One woman out of every 41 Nigerians faces a lifetime risk of death in childbirth. This is in contrast to Ethiopia, where one woman out of 67 faces such a risk.
3. Currently, only 15% of Nigerians married or in-union aged 15-49 use any modern method of contraception. These numbers are shockingly low, and in stark contrast to Ethiopia where the rate is 27%. In Bangladesh 52% of women married or in-union aged 15-49 are using modern methods of contraception.
4. The estimated number of maternal deaths for 2013 is 40,000.

I use this medium to call on the President-elect and his transition committee of focus on brainstorming over the aforementioned and recommend cogent steps of reversing some of the negative trends. Next week I will focus on the biggest challenge health sector is facing now “finances” and what are the opportunities and challenges expected this year and beyond.

1st published in Daily Trust Newspaper on 7th March 2015 by Dr Aminu Magashi Publisher Health Reporters (healthweekly@yahoo.com)