The Politics of Change: Political Constraints to Reducing
Maternal Newborn and Child Mortality in Nigeria
By
Professor Julius O. Ihonvbere, OON
Chair Designate, ACOSHED/CHESRAD
Paper Delivered at the Save the Children/Wilton Park Conference on “Maternal, Newborn and Child Survival” Conference, UK, December 10-14, 2008.
Introduction
It is very well recognised that developing countries have problems with managing their healthcare delivery systems to the benefit of the majority of citizens. When resources are scarce, without careful management of available funds, the healthcare system falls into even more dislocation and decay. What is more, the situation could be complicated by the lack of facilities, adequate information, political instability, corruption and institutional inefficiency. In other instances, a nation may have comparatively adequate resources and yet, have its health system in a state that makes it very difficult to deliver effective healthcare services to the people. In addition to the factors and forces above, the situation could be complicated by the existence of a political elite that has carved out an alternative “state” to cater for its needs. In this situation, the elite, rather than develop the public sphere in terms of facilities, institutions, and services, concentrates on the construction of private alternatives and heavy reliance on foreign alternatives. So, while the public sphere decays, the private sphere expands and gets all the benefits. Scarce resources are deployed to foreign trips for either medical tourism or to take advantage of better services.It is not unusual to hear of political elites that fly abroad for ailments like toothache and have their spouses go abroad for childbirth. When the custodians of state power and the elite lose confidence in existing healthcare and other institutions, it usually culminates in deeper disregard for issues that affect the populace, policy dislocation, and institutional crises. In developing societies like Nigeria, while is it important to promote the growth of private sector initiatives, the state owes the poor majority a responsibility to invest in, and maintain public services and facilities.
Clearly therefore, the political and policy environment can have a direct impact on maternal, newborn and child mortality (MNCM) with far-reaching implications for other sectors of society. While it is true that societies and regimes are never stagnant, and at times, even dictatorial regimes are compelled by internal and external factors and forces to adopt a few pro-people policies and programmes especially in the area of MNCM, such gains are often episodic and ephemeral. They fade away as such ineffective, repressive, and corrupt regimes return to their original political and ideological positions. It has been contended that there is often a direct relationship between the character of regimes and leaders and the state of MNCM. In Africa in particular, countries with non-democratic forms of governance have often done very badly with MNCM. It is therefore not an accident that some changes became noticeable with the so-called “third wave” of political liberalisation, multiparty elections, and steady democrataisation of society. In large measure, this has been the experience of Nigeria.