A guest post by Kayode Makinde, @kayodemakinde.
Globally, attention is gradually being shifted from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). Despite the measured success of the MDGs in certain regards, it is imperative to introspect, take stock and learn from the success as well as the failures of the MDGs, in order to ensure that the SDGs have a greater impact.
Despite the worldwide reduction in maternal deaths between 1990 and 2014, Nigeria contributes 10% of maternal deaths while constituting just 2% of the world’s population.
As Nigeria joins the community of nations in subscribing to the SDGs, lessons from our seeming failure to attain MDG 5 need to be understood.
Nigeria is a signatory to the Abuja declaration of 2001 where it was decided that 15% of the national budget should be committed to health. However, this is not the case. In 2013 the health budget was 5.6%, 6% in 2014 and 5.5% in 2015. Going forward, if significant improvement in maternal health indices is to be achieved more investment needs to be committed to health.
About 70% of health expenditure in Nigeria is out-of-pocket. The need for universal health coverage to improve outcomes in maternal health is not in doubt. The service of the national health insurance scheme (NHIS) needs to be expanded to include the informal sector which constitute a bulk of the population.
The health system in Nigeria needs to be strengthened.
The dichotomy between federal and state led health service provision and management needs to be clarified and streamlined. The primary health care sector is a far cry from what it should be According to the NDHS 2013 only 38% of deliveries in Nigeria had the presence of a skilled birth attendant. Skilled birth attendants need to be at every primary health care centre that caters to the obstetric population. Basic and emergency obstetric services need to be scaled up at every level of health care delivery.
The adverse role of industrial action by every cadre of health sector workers in Nigeria has been highly detrimental in achieving MDG 5. Most strike actions border on financial and welfare issues. Promises and agreements between health unions and associations and the government need to be honored. Besides this, a conducive, receptive atmosphere needs to be provided for patients and health workers to foster productivity.
Recently, is was estimated that 2,392 and 1,529 Nigerian doctors practice in the United States of America and the United Kingdom respectively. The doctor patient ratio in Nigeria is 39 per 100,000 population. Brain drain has adversely affected the delivery of effective, efficient and live-saving health care services in Nigeria. Trained health care workers need to be incentivized to mitigate against emigrating to other climes.
The National Health Act of 2014 also needs to be implemented fully to enhance service delivery. The National Health Act is a framework for regulation, development and management of a national health system and it sets minimum standards of service in the health sector. With its implementation, the quality of maternal health care is bound to improve.
The importance of the education of the girl-child and women empowerment and participation in the socio-economic and political process in achieving improved maternal health outcomes cannot be overemphasized.
Broadly speaking, the aforementioned ideas cannot come to fruition without political will and commitment. The SDGs have an advantage over the MDGs in that they take into consideration pre-conditions that will foster the actualization of health goals such as democracy, good governance, human rights, empowerment and poverty eradication. All arms of the government need to step up and take up the lead in providing leadership, direction, regulation, legislation and oversight in order to create a wholesome polity resulting in improved maternal outcomes in Nigeria.
Kayode Makinde is a Registrar in Obstetrics and Gynaecology in a busy hospital in South-West Nigeria. You can contact him on Twitter @kayodemakinde.