The Politics of Change: Politics, Maternal Newborn and Child Mortality in Nigeria

Nigeria and the MDGs

Goal 4 of the Millennium Development Goals (MDGs) requires the Nigerian government to reduce mortality rate among children under 5 by two-thirds by the year 2015.  Goal 5 requires the state to reduce by two-thirds the maternal mortality rate by the same period.
Based on the discussions above, there is no way that Nigeria can be expected to meet either of these goals.  The country’s political economy remains disarticulated and in deep crisis.  The contradictions are deep and complex and policies remain disjointed and incapable to meeting the needs of Nigerians.

Managing the Politics of Change

It is well known that politics is critical to policy. Purposeful, progressive and democratic politics will precipitate and reproduce people-focused, people-sensitive and progressive policies.  The leadership of the political system is equally critical to the nature, depth, dimension, consistency and focus of public policies.  In Nigeria, as in most of Africa, leadership has been very bad and this has negatively affected public policies.
The pathological fixation on the use of politics to grab raw power and promote primitive accumulation has destabilised political systems, undermined policies, and rapidly eroded public programmes. In fact, in Nigeria, this has become an endemic challenge.
The change that was evident in Nigeria between 1999 and 2007 under the Obasanjo regime was largely due to the push from the pains of the pre-1999 era, the general feeling of failure at all levels of the government, and the personal drive of the President.  As well, there was a team of technocrats around the president that ensured that alternative policies and perspectives were initiated and considered especially between 2003 and 2007.  The initiatives outlined above were brought on stream in that period and the state ensured that the funding and close supervision were provided by the presidency.  However, the question remains: why did the policies fail to substantially or significantly improve the data?  Why was it impossible for maternal and child mortality to improve?  In some cases, why did Nigeria experience a downward slide by 2007?
We advance the following reasons:

  1. Adequate attention was not paid to the extent of systemic decay, institutional paralyses, and levels of efficiency and motivation of staff in existing healthcare delivery institutions;
  2. Bad advice by technocrats and civil servants and some development partners to the EXECUTIVE president resulting in waste, complications and policy failure;
  3. Poor management of partner support and programmes leading to avoidable competition, duplication and waste;
  4. Complex and conflicting bureaucratic structures especially between over 30 priority programmes, numerous agencies and institutions within the Ministry of Health with no streamlined responsibilities and accountability lines;
  5. The lack of effective coordination between the three tiers of governance and communities in the location, operation, management and sustenance of healthcare delivery institutions and agencies;
  6. Poor leadership at all levels, especially political leadership that failed to emphasise priorities, accountability, transparency and service delivery;