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Will Nigeria benefit from the new “Health Investment Framework?

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The answer to this question could be YES or NO, depending who is answering the question, whether it is a minister of health leaving in denial of all poor health indices in Nigeria, or a President who is being fed with incorrect health indices or an advocate who is interested in seeing Nigerian on the right track to solve its myriad of health challenges. The poor indices are all over the places, Nigeria’s national average for immunization coverage in comparison between 2008 (23%) and 2013 (25.3%) has only increase 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 NDHS has also reported that our Maternal Mortality Ratio (MMR) is 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. 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. Let’s also check our contraceptive prevalence rate (CPR) which is about 15%. This is amidst our pledged to increase it by 300 percent; 36% by 2018. A big dream with nothing on ground to make it happen.

Looking at all of the above, I will say YES, Nigeria will benefit from the new “Investment Framework for Women’s and Children’s Health. Despite being the “largest economy” in Africa, Nigeria is yet to be on the right track on funding properly its health sector and it will be of significance if we all put our thinking caps regarding new investment framework.

What does the new “Investment Framework for Women’s and Children’s Health in Africa promises?

A new Global Investment Framework for Women’s and Children’s Health (Investment Framework) demonstrates that investing in women’s and children’s health in Africa could save millions of lives and yield an eleven-fold return through social and economic benefits. Onaverage, across 46 African countries, investing an additional US$ 8 per capita per year during one generation (i.e. from 2013 until 2035) could prevent up to 4 million maternal deaths, 90 million child deaths (including 30 million newborn deaths) and 17 million stillbirths.

Compared to maintaining current coverage levels of essential reproductive, maternal, newborn and child health commodities and services, the Investment Framework shows that the eleven-fold return in economic and social benefits would be realized throughGross Domestic Product (GDP) growthfrom increased productivity and higherlabor participation rates (of millions of female workforce directly affected by acombination of maternal and child mortality, and morbidity  and also men affected) – increased savings, as well as theintrinsic and social value of lives saved andmorbidity averted for the women and children themselves, as well as their families and communities.

The paper proposes what to invest in to help inform country investment strategies, as follows;

  1. Improving maternal and newborn health.
  2. Improving child health.
  3. Increasing immunization coverage.
  4. Making family planning services and commodities available.
  5. Addressing HIV/ AIDS challenges.
  6. Tackling malaria related mortality and morbidity.

What are the results?

Additional investments to increase and improve the coverage of essential RMNCH interventions will result in high reductions in child mortality (90 million, including 30 million newborns), stillbirths (17 million) and maternal mortality (4 million). Along with a reduction in the maternal mortality rate, total fertility rate, number of unintended pregnancies, and improved nutrition status of children, additional investment would result in a significantly higher quality of life for millions who not only escaped death, but also lifelong disability.

Where are the opportunities?

The paper emphasizes that the Investment Framework may either assist countries to know that they are on the right track, or serve as a guide to countries to support investments in women’s and children’s health in the context of their national health and development plans. Investing in the six packages of health interventions alone is not enough to eliminate preventable child and maternal deaths. It will require a multi-sectoral approach, including investments in water and sanitation, education, and other sectors.

 Where are the Delivery points?

Interventions contained within each of the packages are delivered at the following four delivery points:

  1. Hospital: The intervention is delivered at a district, regional or national level hospital.
  2. First level facility: The intervention is delivered at a primary level health facility with mainly outpatient services.
  3. Outreach: The intervention is delivered by a health worker travelling from a health facility into the community to provide services for a few hours per day, either at a health post, or through a mobile vehicle.
  4. Community: The intervention is delivered by a family member advised by a community health worker (e.g., oral rehydration salts (ORS)) or directly by a community health worker.

 This new framework was presented during the Conference of African Ministers of Finance, Planning and Economic Development held 25th – 30th March 2014 in Abuja, Nigeria. It presents an opportunity for Nigeria to be innovative and explore new ways of addressing its health challenges.

This article is  written by Dr Aminu Magashi  and 1st published in  Daily Trust Newspaper (09/09/2014) . He can be reached at  healthweekly@yahoo.com and follow him on @HReporters





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