High maternal and child deaths, multidimensional poverty, incessant strike action by health workers, a high number of out-of-school children, poor implementation of the Basic Health Care Provisions Fund (BHCPF), high malnutrition level, as well as a weak primary healthcare system, will define President Muhammadu Buhari’s 8 years administration as he leaves office Monday. Kazeem Akolawole reports
Despite the global decline in maternal mortality rate, Nigeria is far from meeting its maternal and child-related goals. According to the 2018 National Demographic Health Survey, Nigeria’s maternal mortality ratio increased from 545 per 100,000 in 2008 to 556 per 100,000 live births in 2018.
In 2015, President Muhammadu Buhari’s administration promised to introduce several interventions to address maternal and child mortality rate in Nigeria, part of which is the Saving One Million Lives – Programme for Results, National Primary Health Care Revitalization Initiative, Community Health Influencers Promoters and Services (CHIPS) Programme Basic Healthcare Provision Fund, Accelerated Reduction of Maternal and Neonatal Mortality and National Emergency Maternal and Child Health Intervention Centre (NEMCHIC)
A World Bank survey has described the maternal mortality ratio as the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births.
The data are also estimated with a regression model using the information on the proportion of maternal deaths among non-AIDS deaths in women ages 15 to 49, fertility, birth attendants, and GDP.
The World Bank data also showed that Nigeria’s maternal mortality rate for 2017 was 917.00, with just a 0.86% decline from 2016.
However, in 2021, Nigeria experienced a decline in infant mortality rate as statistics showed that the country recorded 70.6 deaths per 1,000 live births since 2020.
Therefore, 2021 marks the lowest infant mortality rate during the observed period. Notably, the infant mortality rate is continuously decreasing in 2022.
Meanwhile, the World Bank data also showed that Nigeria has the highest maternal mortality ratio as the country recorded 917 deaths per 100,000 child births.
Mauritania is the closest with 766 followed by Lesotho with 544, Cameroon with 529, Eswatini with 437, the Republic of Congo with 378, Kenya with 342, Ghana with 308, and Sudan with 295.
Countries like Ukraine and Moldova seem to have gone far in the fight against maternal and child deaths as they both recorded as few as 19 deaths per 100,000 births.
Also, countries like West Bank and Gaza have 27 followed by Uzbekistan 29, Sri Lanka 36, Vietnam 43, Tunisia 43, Mongolia 45, El Salvador 46, Cabo Verde 58, Kyrgyz Republic 60, and Honduras 65 deaths per 100,000 births
Basic Health Care Provision Fund (BHCPF)
The Basic Health Care Provision Fund aimed to ensure the Basic Minimum Package of Health Services (BMPHS) to all Nigerians and strengthen the Primary Health Care (PHC) system, based on the NHAct 2014.
In 2022 the federal government claimed that the BHCPF, which is derived from 1% of the Consolidated Revenue Fund of the Federal Government and any other sources, where available, is a bold step towards achievement of Universal Health Coverage, and to demonstrate the commitment of the Administration of President Muhammadu Buhari to population health of Nigerians, implementation began in 2019 with a total release to date of N85.95 billion, 65% of which has been disbursed to the 36 States of the Federation and the FCT”.
The minister of Health, Dr Osagie Ehanire also disclosed that the BHCPF has begun providing operations funds to nearly 7000 Primary Health Center’s in 34 states of the Federation, while about one million poor and vulnerable citizens now have access to a Basic Minimum Package of Health Services, in 24 States.
Nigerians Enrolled in Health Insurance
Only about 5 million Nigerians, representing 3% of the population, have insurance coverage through the NHIS and these are mostly members of the formal sector, particularly federal civil servants.
To that end, in 2014, the NHIS decentralized the implementation of the country’s social health insurance program to the states in the quest to accelerate progress toward universal health coverage (UHC)
Poverty Indices in Nigeria
According to the 2022 Multidimensional Poverty Index survey, 63% of persons living in Nigeria (133 million people) are multi-dimensionally poor.
The National MPI is 0.257, indicating that poor people in Nigeria experience just over one-quarter of all possible deprivations.
It also showed that 65% of the poor (86 million people) live in the North, while 35% (nearly 47 million) live in the South.
Poverty levels across States vary significantly, with the incidence of multidimensional poverty ranging from a low of 27 per cent in Ondo to a high of 91 per cent in Sokoto.
Over half of the population of Nigeria are multi-dimensionally poor and cook with dung, wood or charcoal, rather than clean energy. High deprivations are also apparent nationally in sanitation, time to healthcare, food insecurity, and housing.
Generally, the survey showed that the incidence of monetary poverty is lower than the incidence of multidimensional poverty across most states.
Across the country, 40.1 per cent of people are poor according to the 2018/19 national monetary poverty line, and 63 per cent are multi-dimensionally poor according to the National MPI 2022.
Multidimensional poverty is higher in rural areas, where 72 per cent of people are poor, compared to 42 per cent of people in urban areas.
Child Poverty in Nigeria
The National MPI reported a linked Child MPI, which provides additional information on Multidimensional Child Poverty in Nigeria. According to the report
Two-thirds (67.5 per cent) of children (0 to 17) are multi-dimensionally poor according to the National MPI, and half (51 per cent) of all poor people are children.
The highest deprivations are in the indicator of child engagements – where over half of the poor children lack the intellectual stimulation that is pivotal to early childhood development. Child poverty is prevalent in rural areas, with almost 90% of rural children experiencing poverty.
Doctors and health strike
Between 2016 till 2023, the National Association of Resident Doctors and the health workers under the umbrella body Joint Health Workers Union (JOHESU) have gone on warning and indefinite strike no fewer than 10 times over poor welfare packages and nonpayment of benefits.
Recently, NARD embarked on a five days warning strike to press home their demands and it was called off after the federal government signed a Memorandum of Understanding with the body.
Currently, the Joint Health Workers Union (JOHESU) is on strike as it declared total and indefinite industrial action over poor welfare and poor healthcare delivery to Nigerians.
Malnutrition
According to the United Nations Children’s Fund (UNICEF), Nigeria has the second highest burden of stunted children in the world, with a national prevalence rate of 32 percent of children under five.
An estimated two million children in Nigeria suffer from severe acute malnutrition (SAM), but only two out of every 10 children affected are currently reached with treatment and seven percent of women of childbearing age also suffer from acute malnutrition.
Out- of -School Children Numbers
According to UNICEF, one in every five of the world’s out-of-school children is in Nigeria. Even though primary education is officially free and compulsory, about 10.5 million of the country’s children aged five to 14 years are not in school.
Only 61 percent of six to 11-year-olds regularly attend primary school and only 35.6 percent of children aged 36-59 months receive early childhood education.
In the Northern part of the country, the picture is even bleaker, with a net attendance rate of 53 percent. Getting out-of-school children back into education poses a massive challenge.
Genders, like geography and poverty, are an important factor in the pattern of educational marginalisation. States in the northeast and North-west have female primary net attendance rates of 47.7 percent and 47.3 percent, respectively, meaning that more than half of the girls are not in school.
The education deprivation in northern Nigeria is driven by various factors, including economic barriers and socio-cultural norms and practices that discourage attendance in formal education, especially for girls.
PHCs Revitalisation Failure
In 2016, President Muhammadu Buhari promised that his government will revitalise about 10,000 primary health centers across the country.
However, the Minister of Health, Dr. Osagie Ehanire in his speech at the 2023 World Health Day commemoration, said, the federal government, in a bid to reverse poor health indices and provide universal health coverage, initiated the revitalisation of about 10,000 primary healthcare centers nationwide.
The Minister disclosed that only 4,000 PHCs have been revitalised which means well over 6000 PHCs across the country are currently in need of federal government attention. President Buhari and his health minister, Ehanire will be leaving office without achieving the revitalization of the PHC proposal they made with the Nigerian people.
