Why is Maternal Mortality High in Nigeria?
It is true that successive governments in Nigeria have paid attention, to varying degrees, to improvements in the area of maternal and infant mortality. It is also true that over time significant successes have been achieved especially when national campaigns have been organised as in the cases of polio and malaria. Yet, all indicators in this critical area, on a comparative global basis remain very low. In fact, in the context of what is actually achievable in the country, the results have been very disappointing. Some of the reasons can be found at the level of policy and leadership and others at the level of societal contradictions.
The literature and Government statements have identified the factors responsible for high rates of maternal mortality as including: lack of maternal care, very poor medical facilities, inadequate skilled birth attendants, unorthodox traditional practices, superstition, delays in attending to complications of pregnancy and delivery, high cost of treatment and drugs, poverty and thus poor diet.
Also, the very large proportion of women that deliver their babies at home with very little or no access to skilled or professional care, low or poor use of antenatal and postnatal care, unsupervised use of contraceptives and fertility drugs, and poor sex education leading to unwanted pregnancies especially by adolescents. It is not unusual therefore that dirty feeding bottles and utensils, serious respiratory infections, measles, and low maternal education contribute to morbidity and mortality in Nigeria.
There are also institutional and policy factors. The inconsistency in government policy especially in the area of primary health care delivery, insufficient staffing of health facilities, lack of the necessary infrastructure resulting in avoidable delays- lack of beds, water, drugs, doctors, electricity, and other equipment to aid childbirth, high cost of well-equipped private hospitals, poor salary to hospital staff leading to a rather lukewarm or lackadaisical attitude of staff, and poor hospital or healthcare administration.
It is not unusual for monies budgeted for healthcare projects to be diverted to other purposes in the national or personal interests of the official in charge or for approved funds to be poorly utilised due to poor supervision and monitoring. There are instances where sub-standard, fake and dangerous drugs and equipment have been imported at the expense of mothers and infants. Also, the reliance on non-professionals to provide leadership in the health sector is equally a problem. By the time the appointee, Minister or Director-General begins to understand the Department or Ministry so much damage has been done at the expense of health care delivery.
Professor Friday Okonofua, has argued that delays in treatment of pregnancy complications constitute about 90% of mortality in Nigeria. He breaks these delays into three: Type I- “when a pregnant woman with complication fails to get to a hospital in time; Type II- “when the delay is due to difficulty with transportation”: and Type II- “when there is delay in treatment after the patient has reached the hospital.” According to Okonofua, Type I delay is responsible for 30% of deaths, Type II is responsible for 20% of deaths while Type III accounts for 40% of deaths. This is very frightening statistics.[3]
When further analysed, Okonofua points out that the causes of Type III delays include: the high cost of antenatal, delivery and postnatal services; frequent union organised industrial action in the health sector; delays occasioned by patients not being able to see a nurse or attendant within the hospital; poor supplies and consumables; delay in referral of patients; absence on basic but very much needed obstetrics care; refusal by health care professionals to work and/or live in the rural areas where most Nigerian live; poor transportation including lack of ambulances; fuel shortages or the lack of funds to fuel ambulances; and the massive brain drain of doctors, nurses and other technicians to Europe, North America, the Middle East and South Africa with direct impact on the quality of available health care delivery.
The problems in Nigeria’s health system are legion and it is difficult to excuse any regime or administration since political independence in 1960. Overall, it would appear as if leaders at all levels- Federal, State and Local- have taken the people for granted and relied more on rhetoric, palliatives, half-measures and opportunistic interventions. They wait for a disaster to occur then rush to do a few visible things that often become moribund within a few months. It is not amazing therefore that on a comparative study of 191 nations of the world, Nigeria ranked very poorly on all factors that were considered: Responsiveness-149; Fairness in financial contributions- 180; overall goal attainment- 184; health expenditure per capita- 176; impact on level of health- 175; and overall health system performance- 187.[4] These data speak for themselves and for an oil-rich nation like Nigeria, much more needs to be done to consolidate current or recent achievements, introduce new intervention schemes and improve overall performance.
In Nigeria’s health sector, the policy environment is wrong, the institutional reforms initiated in 1999 have stagnated, and the operational mechanisms have become corrupted. Without doubt the health sector requires a very radical or far-reaching restructuring, more resources, prioritisation, and better and more productive partnerships.