Primary healthcare in Nigeria should be strengthened

Reports that no fewer than 82,000 Nigerian women are lost yearly to pregnancy-related complications should concern health authorities in the country. Accordingto the United Nations Children’s Fund, (UNICEF) Chief of Health in Nigeria, Eduardo Celades, the new death rate arising from pregnancy-related complications is twice the figure released by the Federal Ministry of Health, just in March 2022. “In the last few months and weeks, we got new data. The report is telling us that still, the number of women dying from pregnancy-related causes is very high,” said Celades.

Available reports indicate clearly that there is a link between poverty and this health challenge, especially considering that they happen mostly in low-income countries and in the rural areas. Huge number of stillbirths is attributable to five main causes including childbirth complications, maternal infections in pregnancy, maternal disorders, especially pre-eclampsia and diabetes, fetal growth restriction and congenital abnormalities. Unfortunately, many of the rural communities lack cottage hospitals and medical facilities that will address these challenges. Where they exist, there is shortage of manpower, obsolete medical equipment and skeletal services that worsen the situation. For instance, many a time, pregnant women have had to die in the process of commuting from their homes to a medical facility. 

While about 2.6 million third trimester stillbirths occur every year worldwide, it says a lot that an estimated 1.8 million stillbirths occur in 10 countries including Nigeria, India, Pakistan, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan, and United Republic of Tanzania. What should even be of greater concern to the health authorities in our country is that two-thirds of those stillbirths happen in rural areas where skilled birth attendants, in particular midwives and physicians, are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections. 

It is very much evident that the Universal Health Coverage (UHC) has failed abysmally to tackle the challenge of still births and other hiccups associated with pregnant women and infants. In a recent case, a woman gave birth to a baby inside a tricycle popularly known as ‘Keke NAPEP’. Were it not for the intervention of some passers-by, the pregnancy would probably have ended in still birth.

However, we must put the blame on state governments and the lack of attention by many of them to primary health care system. It is even worse that most of them have rendered prostrate the local government administration in their states, leaving healthcare delivery at that level comatose. The solution therefore goes beyond mere formulation of policies by the federal government in Abuja. There should be a framework where states and local governments are held accountable for maternal child health care services in their domains. 

Research, according to Innocent Ujah, a former Director-General, Nigerian Institute of Medical Research, Lagos, has revealed that the fundamental reason for the high child death rate in the country was the non-utilisation of antenatal services by many of the pregnant women. “We also know that what kills the mother also kills the baby; hence, the high rate of stillbirths in Nigeria,” said Ujah. This is why the National Primary Health Care Development Agency (NPHCDA) should be strengthened in such a manner that enables it to collaborate effectively with the states. There is also a need to go beyond rhetoric and promises, to actionable plans to address all the existing gaps in the primary health sector.

We must end the agony and tears of mothers who carry pregnancy for nine months only for their babies to be dead on delivery. 

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