By Patrick Egwu
ENUGU, Nigeria —- On a sweltering afternoon in January, more than a dozen women, clutching their children in their arms, sit patiently in a waiting room at a community health centre in Enugu, a state in Southeast Nigeria.
Across other communities in the 17 local government councils of the state, the situation is the same where health centres offer free services. Young mothers with their infants came from different rural communities around the region to carry out free routine medical tests and receive recommended drugs.
Pregnant women regularly visit the health centres during antenatal, delivery or routine medical checkups. These clinics provide extensive and comprehensive maternity services and treat difficult childhood illnesses such as malnutrition, diarrhea and malaria. For cases that the health centers cannot handle, they are referred to the state general teaching hospital in the capital.
“Whenever my child is sick, this is where I bring him for medical care,” said Nnedi Okafor, one of the women at the clinic who brought her nine-month-old baby for medical attention.
Okafor’s baby had a fever the previous night. At 8 a.m., the next day, she entered a local taxi and rushed to the hospital to see a doctor. Okafor was attended by one of the nurses. The doctor arrived 20 minutes later to attend to her.
“She is feeling better now,” she said, with an expression of relief on her face. “When I gave birth to my first child three years ago, they brought me here and apart from what we bought before coming here, I didn’t pay for anything else.”
Nigeria, a nation of more than 220 million people, has maternal health issues. Most women, especially in the rural areas with lack of access to quality healthcare, are at risk of dying during pregnancy, childbirth or postpartum complications.
The World Health Organization (WHO) says every day in Nigeria, about 154 women between the ages of 15 and 45 die from preventable causes linked to pregnancy and childbirth.
Nearly 20 percent of all global maternal deaths happen in Nigeria, according to a report by WHO. The global health organization said between 2005 and 2015, an estimated 600, 000 maternal deaths and no less than 900,000 maternal near-miss cases occurred in the country. The report added that Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100,000 live births, with approximately 58,000 maternal deaths during that year.
To end this, the state government adopted the free maternal and child healthcare program more than ten years ago as a way of reducing maternal and child mortality.
The program removed user fees at the point of service delivery for pregnant women and under-five children based on a minimum services package.
“The idea is that secondary and primary healthcare facilities provide services for free,” said George Ugwu, the executive secretary of the Primary Health Care Development Agency, the agency administering the program.
“The number of women that register for antenatal care in Enugu is very high (compared to others) in the country and our record of the number of women that delivered under the care of skilled birth attendants is also high,” he said.
According to a 2019 data from the National Primary Healthcare Development Agency in the Reproductive, Maternal Newborn and Child Health Lots Quality Assurance Survey, of all the 36 states sampled in 2019, Enugu state was rated best in the proportion of sampled women that attended antenatal clinics during pregnancy. The data also showed that the state was in third place in the survey of women that attended four or more antenatal care clinics.
The free maternal health program in the state, which has been commended by WHO, is funded by state and local government contributions and is delivered mainly through public primary and secondary health facilities. For instance, the state approved counterpart funding of N8.5 million (about $19,000) monthly to augment the contributions of the 17 local councils who jointly contribute the same amount (N8.5 million) monthly, for a total funding basket of N17 million (around $38,000).
For community health facilities in bad shape with infrastructural deficits, the state government has stepped up to embark on renovating, equipping and upgrading them to provide efficient services for the urban and rural communities.
Meeting SDG 3 targets
The free maternal health program in the state is aimed at meeting the United Nations Sustainable Development Goals (SDGs) 3 which seeks to ensure healthy lives and promote well-being at all ages. An estimated 303,000 women mostly from low-and middle-income countries around the world died due to complications of pregnancy and childbirth in 2015.
“Access and utilization of health services has improved in Enugu state over the last decade following the free maternal programme despite seeming challenges in the health sector,” Ugwu says. “The program has seen an increase in health access especially at the rural areas in the state.”
Ugwu noted that delivery with skilled birth attendants is one of the interventions that limit maternal death during delivery.
“So our maternal and newborn child health indices are on the good side. In fact, we are one of the best in the country,” he said.
A study on the impact of free maternal and child healthcare programs in the state published in the National Library of Medicine, found that it has led to increased antenatal bookings and hospital delivery and has also decreased maternal and perinatal mortality rates in the state by 16.4 and 34 percentage points respectively.
“Visits to traditional birth attendants which often result in the death of mothers during delivery has significantly reduced over the years,” Ugwu said. “Pregnant mothers will have access to these health centres for qualitative and affordable care whenever the need arises.”
Challenges to maternal health programs
While the free maternal health program in the state has largely been successful in reducing maternal deaths, some challenges such as funding challenges, poor quality of health service delivery and low doctor to patients ratio still exist.
“Funding is a challenge affecting the success of the program in the state,” said Edwin Okechukwu, a public health expert. “Funding is not steady and this derails some activities. Also, we don’t have enough health workers at some of these health centres. Some health centres have only two or three health workers and this affects service delivery.”
Okechukwu added that some of the health workers at the health centres are retired while some are deceased and there has not been recruitment for their replacement.
While maintaining that some challenges such as low doctor to patients ratio, irregular power supply, and non-conducive working environments exist, Ngozi Adonu, a nurse at one of the health centres said that over the years, the program has improved the lives of young mothers and their children.
“We used to run out of supplies like antibiotics but we now receive them when we make such requests because women often come here for routine medical services,” said Adonu, who has been working at the clinic for five years. “But you know the environment and the level of medical personnel you have also contributed to the success of any health program.”
Ugwu says improved access to healthcare services for women and newborns is reducing maternal and child mortality in the state. The most recent National Demographic and Health Survey, he said, showed that 94.7 percent of the women sampled in the state were delivered by skilled birth attendants while 88.1 percent of them attended antenatal clinics at least four times during pregnancy. This is above the national averages of 89 and 83 percent for skilled birth attendants and antenatal clinics respectively.
Ugwu says the program is still going on across the state amid the COVID-19 pandemic and the agency is working to sustain all maternal health services. Additionally, personal protective equipment have been distributed to the healthcare centres as more than 2,000 workers have also been trained on how to respond to the pandemic.
“The program is functioning better than when it was established,” Ugwu said, adding that it’s still a work in progress. “We are trying to make sure that it is reaching those who need it and it is one of the finest policies that the government has for the poor and vulnerable.”
For the women in the rural areas and local communities who mostly access these health facilities and free maternal programs, it has been a huge relief for them because they no longer have to worry about the financial burden that comes with utilizing private health services.
Okafor wants continuity. “We have benefited from this program and want it to keep going,” she said. “Young mothers like me and their infants won’t have to die anymore because of lack of adequate care.”
