One key challenge to the health goals and outcomes of any modern nation is the dreaded killer of women and children in the name of maternal and infant mortality. Dating back to many centuries, the challenge of safe births has always been with mankind. However, with advancements in the field of medicine and public health, mankind especially in developed countries has been able to reverse this ugly trend, ensuring that a high ratio of pregnant women deliver safely without any form of complications. The battle thus has shifted to the developing world where the ratio of maternal death burden in several of them remains scandalously high.
For example, Nigeria’s maternal death burden before 2012 was said to be on the high side with at least 33,000 women dying annually. The figure for children was most outrageous with 947,000 children under the age of five years succumbing to the cold hands of death, of which about 241,000 were newborns. Such figures should naturally serve as indictment of our government and the health sector, thankfully the emergence of SURE-P Maternal and Child Healthcare has done more than enough to mitigate such indictment.
Established in 2012, following the partial removal of fuel subsidy, SURE-P MCH’s mandate simply put was to accelerate progress towards reducing Nigeria’s maternal and child mortality. Ugo Okoli, a trained medical doctor, who rose to the heights of medical practice in the United Kingdom, serving as medical director and public health director of Enfield Primary Care Trust in London, was appointed the project director by Ado Muhammed , the executive director of NPHCDA. Under the supervision of Ali Pate, the then minister of state for health, the SURE-P MCH began its task of pushing back maternal mortality rates.
As a social safety net, SURE-P MCH zeroed in on ordinary Nigerians; permit me to say the lumpen proletariat, the unreached mass of Nigerian women residing in rural areas. The wisdom in this was to serve the ordinary Nigeria in the hard to reach villages, without hospitals and other functional health facilities. This is also as a result of the fact that due to the tyrannies of little education, culture and poverty, a huge number of Nigeria’s maternal death burden naturally come from these rural areas. Using this as a criteria and partnering with the 36 states of the federation and the Federal Capital Territory, SURE-P MCH selected over a thousand PHCs spread in 393 out of the 774 local governments.
SURE-P MCH as an intervention was confronted by problems such as the poor state of such facilities and a lack of skilled midwives in all the PHCs. Swinging into action it recruited and deployed over 12,110 health care workers across the 36 states and FCT, ensured regular supply of drugs, consumables and commodities needed by pregnant women, renovated a number of these PHCs and constructed over 600 boreholes to provide clean water to the PHCs as well as the host communities.
Asides these, SURE-P MCH brought in an innovative approach unknown in past interventions in Nigeria. A close look at past interventions in the Nigerian health sector would reveal that a lot of them were more or less majorly supply side interventions, an aspect of erroneous thinking that government providing the health centres, the skilled midwives and drugs would immediately translate to increased visits which sadly did not. This challenge therefore led to the conceptualization of the ‘Conditional Cash Transfer’ (CCT) which was envisioned to rally round poor households in order to increase their use of maternal and child healthcare services in the SURE-P supported communities. Using cash grants of N5,000, most women in the communities were encouraged to go through the full continuum of MNCH from the first antenatal visit to postnatal care for both mother and newborn.
The ensuing outcome of CCT has been tremendous upping the ante in the number of pregnant women who have used such facilities since its introduction.
The big question still remains: with all these interventions and monies spent, have we been able to solve the problem of high maternal and child mortality in Nigeria? Figures available suggest that since 2012 the number of women who have died from complications related to pregnancy or childbirth in communities receiving SURE-P MCH intervention has ebbed by 50 percent, together with a reported increase of antenatal visits to 42 percent and 56 percent in facility deliveries. These figures should be celebrated. However, it will never be enough without expanding the intervention to more communities.
Can we imagine the gains of a Nigeria with a minimal maternal death burden? Can we envisage the gains of all women not only having access to healthcare as they seek to bring new life into this world but also having a right to quality healthcare that is free and within reach? SURE-P MCH has already done so, I say kudos!
Arinze Igboeli
