IMPROVING MATERNAL AND CHILD HEALTH IN NIGERIA

JUNE 09, 2023 Krystal C. Ugwu_Anyanwu Yemisi Olaniyan IMPROVING MATERNAL AND CHILD HEALTH IN NIGERIA Maternal and child health (MCH) remains a significant public health challenge in Nigeria, with high maternal and child mortality rates. This article explores the current landscape of MCH in Nigeria, identifies key challenges, and presents strategies for improving MCH outcomes in the country. It discusses the multifaceted challenges contributing to poor MCH outcomes, including limited access to quality healthcare services, inadequate infrastructure, cultural and socioeconomic factors, and weak health systems. This article offers solutions to the challenges faced in the Nigerian context regarding improving maternal and child health (MCH). It emphasizes the importance of community engagement and empowerment and the need to strengthen health systems. The article also explores the potential of technology in improving MCH. In conclusion, improving MCH in Nigeria requires a comprehensive and integrated approach that addresses the underlying challenges, engages communities, strengthens health systems, and leverages technology. By implementing evidence- based strategies, fostering multi-sectoral collaboration, and investing in MCH interventions, Nigeria can significantly reduce maternal and child mortality, promote equity, and ensure the well- being of its women and children. Krystal, Yemisi

IMPROVING MATERNAL AND CHILD HEALTH IN NIGERIA Maternal health is women's health during pregnancy, childbirth, and postpartum. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and mortality. With high maternal and infant mortality rates, maternal and child health is a significant issue in Nigeria. In 2015, 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. A Nigerian woman has a 1 in 22 lifetime risk of dying during pregnancy, childbirth, or postpartum/post-abortion, whereas, in the most developed countries, the lifetime risk is 1 in 4900. (World Health Organization, 2023) Several factors contribute to the poor maternal and child health outcomes in Nigeria, including insufficient availability of healthcare facilities, inadequate access to quality healthcare services; poor affordability of healthcare services; low maternal education levels, poverty, and cultural beliefs and practices. Additionally, there is a shortage of healthcare workers, particularly in rural areas, where most of the population lives. The Nigerian government has made efforts to improve maternal and child health, such as the implementation of the National Strategic Health Development Plan II (Federal Ministry of Health, 2018), which aims to improve access to quality health services and strengthen health systems, and the Health Policy 2016 (Federal Ministry of Health, 2016) which states that one of its objectives is to improve availability and distribution of functional health facilities across the country to ensure equitable access to health services, especially in underserved areas. Furthermore, several initiatives have been launched, including the Midwives Service Scheme (Seye Abimbola, 2012), which deploys trained midwives to rural areas, and the Saving One Million Lives program (World Bank, 2017), which focuses on improving access to essential health services and reducing maternal and child mortality. However, despite these efforts, progress has been relatively slow, and more needs to be done to address the root causes of maternal and child mortality in Nigeria. This includes investing in healthcare infrastructure and workforce to improve the functionality of the primary healthcare centers, improving education 1

and economic opportunities for women, and promoting cultural changes prioritizing maternal and child health. Numerous non-governmental organizations (NGOs) in Nigeria have played a vital and commendable role in enhancing maternal and child health. These organizations have stepped up to address the gaps and challenges in the healthcare system, working tirelessly to improve access to quality healthcare services and promote positive health outcomes for mothers and children. NGOs in Nigeria have focused on various aspects of maternal and child health, including prenatal care, safe childbirth practices, postnatal care, immunizations, nutrition, and health education. They have implemented programs and initiatives targeting vulnerable populations, underserved communities, and hard-to-reach areas with limited healthcare services. One of the key contributions of these NGOs is their efforts to improve access to healthcare services for pregnant women. They establish and support maternal health clinics, and community health centers, ensuring women have access to prenatal care, skilled birth attendants, and emergency obstetric care. These initiatives have significantly reduced maternal mortality rates and improved maternal health outcomes in Nigeria. Furthermore, these organizations have also played a crucial role in promoting child health and well-being. They have supported immunization campaigns, vaccinated children in remote areas, and conducted health screenings to detect and treat childhood illnesses. Additionally, NGOs have implemented nutrition programs, educating mothers on proper infant and child feeding practices and combating malnutrition among children. NGOs in Nigeria also collaborate with government agencies, healthcare professionals, and other stakeholders to advocate for policy changes, improve healthcare infrastructure, and strengthen the overall healthcare system. Through their collective efforts, they have contributed to policy reforms, increased maternal and child health funding, and enhanced the coordination and delivery of healthcare services. The Centre for Family Health Initiative (CFHI), is one of the non-profit organizations that contribute to the improvement of maternal and child health in Nigeria. In 2020, funded by T.Y Danjuma Foundation (TYDF), CFHI through its Capacity Building and Community Awareness 2

on Maternal and Child Health Program (CCAP) project in Imo state, sensitized 546 women of reproductive age on quality maternal and child health care to increase demand of skilled health services and facilities. And also, provided capacity-building training for 150 Traditional Birth Attendants on Basic Maternal Health Care, documentation, and Effective Referral System (Centre for Family Health Initiative, 2016). Between 2018-2020: Through the Positive Action for Children Fund (PACF) funded project, HIV/AIDS Prevention, And Empowerment Project For Young People And Positive Mothers (HAPPY) Project, CFHI has done extensive work on breaking the silence around HIV/STI; addressing key barriers to accessing HIV/PMTCT Prevention services; increase demand for HIV Testing and Counselling and male involvement in Ante-Natal Care. These were achieved by working with and deploying existing community structures, employing high-impact community sensitization/educational activities, and establishing of an important partnership with over ten (10) government/non-government organizations. Through this education and behavior-change intended activities, we have actively reached over 8000 individuals across Obi Local Government, training about 20 adolescents as 'HIV Prevention Champions' (Peer educators) in the process. Overall, the project has successfully achieved its targets and has taken advantage of unexpected opportunities to further realize its tripartite objectives (Centre for Family Health Initiative, 2016). In 2017, CFHI was contracted by Clinton Health Access Initiative (CHAI) to deliver on a community activation project in 10 Local Government Areas, in Kaduna State, with the aim of increasing awareness for Family Planning (FP) and Post-Partum Family Planning (PPFP) services and creating linkages between the community and health facilities where these services are available in Kaduna State. CFHI reached a total of 921 (Traditional Birth Attendant) TBAs (102%), 513 Traditional and Religious Leaders (101%), 285 Isalmiyah School Teachers (114%), 594 Community Women Organizations (CWO), and Zumuntar Mata members (119%). Also, a total of 217 (99.5%) TBA-led community sensitization and 150 (100%) Isalmiyah school cascading were held in the 109 wards of the target Local Government Areas (Centre for Family Health Initiative, 2016). 3

In addition, CFHI piloted the project Catalyzing Accountability for Maternal Death in Nigeria (CAMDIN) which aimed at developing, testing, and implementing novel approaches that incorporated community voice in maternal death reporting and surveillance, intending to make all maternal deaths count. Also, in 2017, CFHI facilitated Vaccine Accountability Training for HCWs and EPI Managers in Nasarawa State. Immunization is among the most critical public health interventions for preventing and reducing global child morbidity and mortality; the training sought to bridge the capacity gap between HCWs and EPI managers, leading to poor immunization data review systems and accountability performances. The project's goal was to build the capacity of Healthcare Workers (HCWs) and Expanded Program Immunization (EPI) managers in documentation, management, and review of stock and immunization data towards an improved vaccine accountability system. The training, which occurred in 2 phases, developed the capacity of 362 HCWs and 42 EPI State Managers on Vaccine Accountability (Centre for Family Health Initiative, 2016) Furthermore, CFHI, during MNCH - (Maternal, Newborn and Child Health) week, provides free HIV screening, deworming drugs, Immunization, family planning services, Vitamin A supplementation, growth and development monitoring, malnutrition screening, and referrals, food demonstration, distribution of routine pregnancy drugs, and more to mothers and children annually. The dedication and commitment of NGOs like CFHI have made a significant impact on maternal and child health in Nigeria. They have saved lives, improved health outcomes, and empowered communities to take charge of their health. Their work serves as an inspiration and a reminder of the power of collective action and the importance of partnerships in achieving positive and sustainable change in maternal and child health. Recommendations: Increase access to quality healthcare: One of the major challenges in Nigeria is access to quality maternal and child healthcare, especially in rural areas. Improving access to affordable and quality healthcare services can help reduce maternal and child mortality rates. Encourage healthy behaviours: Healthy behaviours such as proper nutrition, hygiene, and regular exercise can significantly improve maternal and child health. 4

Educate mothers and caregivers: Educating mothers and caregivers on best practices for caring for themselves and their children can help improve maternal and child health outcomes. Address socio-cultural factors: Address socio-cultural factors that may affect maternal and newborn health, such as early marriage, gender inequality, and harmful traditional practices. Encourage community engagement and participation to challenge and change harmful norms. Increase funding for maternal and child health programs: Adequate funding is necessary to provide the required equipment, medications, and skilled healthcare professionals to improve maternal and child health outcomes. Government should engage more non-governmental organizations to execute projects, charging them with the responsibility of monitoring and evaluation. Promote family planning: Family planning can help reduce the number of unintended pregnancies, which in turn can reduce maternal and child mortality rates. Strengthen healthcare systems: Investing in healthcare infrastructure and strengthening healthcare systems can help improve the quality of care for mothers and children. Integrating technology into existing Maternal, Newborn, and Child Health (MNCH) initiatives can significantly enhance healthcare delivery and outcomes. One key area where technology could be integrated is using electronic health records (EHRs). EHRs can help healthcare providers to manage patient information better, track patient progress, and identify potential health risks. By digitizing patient records, healthcare providers can access patient information more easily and quickly, enabling them to make better-informed decisions about patient care. EHRs can also help reduce errors and improve communication between healthcare providers, resulting in better patient health outcomes. Another area of how technology can be integrated is in the use of telemedicine. Telemedicine refers to using electronic communication technologies, such as video conferencing and remote 5

monitoring, to provide clinical healthcare services at a distance. In MNCH, telemedicine can provide remote consultations, monitor patients' vital signs, and provide real-time advice to healthcare providers in rural or remote areas. This can help to improve access to care for women and children in underserved areas of Nigeria, where there may be a shortage of healthcare providers or facilities. In addition to EHRs and telemedicine, mobile health (mHealth) technologies can improve MNCH services in Nigeria. mHealth refers to using mobile devices, such as smartphones and tablets, to support healthcare services. In MNCH, mHealth can provide health education and information to women and children, track patient progress, and remind patients about appointments and medication schedules. mHealth technologies can also support healthcare providers by providing them access to clinical guidelines, training materials, and other resources. Limitations: There are, however, some challenges to integrating technology into MNCH services in Nigeria. These include issues related to infrastructure, such as the availability of reliable electricity and internet connectivity, as well as challenges related to capacity building and training healthcare providers to use the technology effectively. There are also concerns about data privacy and security and the potential for technology to widen existing health inequities if it is not implemented in an equitable and inclusive manner. It is necessary for the Nigerian government to overcome these challenges by investing in essential infrastructure, such as reliable electricity and internet connectivity, and providing training and support to healthcare providers to enhance their digital literacy and technological skills. It will also be essential to engage with communities and stakeholders to ensure that the technology is implemented equitably and inclusively and implement encryption protocols, access controls, and regular audits to protect data integrity and confidentiality. Comply with existing data protection regulations to build trust and confidence in technology-enabled MNCH services. Integrating technology into existing MNCH services in Nigeria can improve the quality of care for women and children and reduce maternal and child mortality rates. While there are 6

challenges to implementing these technologies, such challenges can be overcome with suitable investments and community engagement. In conclusion, maternal and child health remains a significant challenge in Nigeria. Despite efforts made by the government, non-governmental organizations, and others, more work still need to be done to enhance access to quality healthcare services and address the root causes of poor health outcomes. Our recommendations should be taken into account and implemented by the Nigerian government. Through technology and implementing these recommendations, Nigeria has the potential to revolutionize maternal, newborn, and child healthcare, resulting in better health outcomes and a decrease in mortality rates, ultimately achieving the Sustainable Development Goals associated with maternal and child health. References Centre for Family Health Initiative. (2016). Completed Projects. Retrieved from Centre for Family Health Initiative: https://www.cfhinitiative.org/completed-projects/ Federal Ministry of Health. (2016). National Health Policy 2016. Retrieved from Federal Ministry of Health: https://www.health.gov.ng/doc/National-Health-Policy-2016-21032019.pdf Federal Ministry of Health. (2018). MONITORING AND EVALUATION PLAN FOR THE SECOND NATIONAL STRATEGIC HEALTH DEVELOPMENT PLAN 2018 - 2022. Retrieved from Federal Ministry of Health, Nigeria: https://health.gov.ng/doc/NSHDP_II_ME_Plan.pdf Seye Abimbola, U. O. (2012, May). The Midwives Service Scheme in Nigeria. Retrieved from Academia: https://www.academia.edu/4341953/The_Midwives_Service_Scheme_in_Nigeria USAID, The Global Fund, Bill and Melinda Gates Foundation, UNFPA, WHO, National population Commission. (2019, October). Nigeria Demographic and Health Survey 2018. National Population Commission (NPC) and ICF International. (2019). Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF. Retrieved from The DHS Program Demographic and Health Surveys: https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf World Bank. (2017, June 27). Saving One Million Lives Project- Financial Statements for the Period Ended 31st December, 2016. Retrieved from World Bank: https://documents1.worldbank.org/curated/en/910491526905973918/pdf/Saving-One-Million- Lives-Project.pdf 7

World Health Organization . (2023, June 9). Maternal health in Nigeria: generating information for action. Retrieved from World Health Organization : https://www.who.int/news/item/25-06- 2019-maternal-health-in-nigeria-generating-information-for-action 8