W4H: saving mothers’ lives

He said ‘within the hour in which you read this article, nearly 20 women will die in Africa. Those deaths will not occur from road accidents or flooding.  They will not arise from sickness or war.  Instead, they will happen to women in the prime of their lives through complications of pregnancy and childbirth. Sadly, […]

He said ‘within the hour in which you read this article, nearly 20 women will die in Africa. Those deaths will not occur from road accidents or flooding.  They will not arise from sickness or war.  Instead, they will happen to women in the prime of their lives through complications of pregnancy and childbirth. Sadly, those 444 women will lose their lives on the way to giving life; a carnage that is even more remarkable because it is avoidable. These deaths are taking place despite the fact that every African nation made a solemn commitment to reduce maternal death when they pledged their support to the United Nations Millennium Development Goals (MDGs).
Nigeria’s maternal death rate of 545 per 100,000 births is Africa’s highest. It is second in the world only to India’s. In fact, while Nigeria represents only 2 per cent of the world’s population, it accounts for over 10 per cent of the world’s maternal deaths. UNFPA and its partners are working together to help African leaders deliver a future where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.
In line with this, the federal government has launched Nigeria’s Saving One Million Lives (SOML) initiative is improving health outcomes by facilitating the delivery of life-saving medicines. Advocates are however demanding more budgetary allocation to health. The current allocation of 5.4% of total budget to health falls below the 15% that the Governments of Africa promised to allocate to health when they agreed on The Abuja Declaration. Advocates want government at all levels to devote 15% of their budget to health, upgrade infrastructure at Primary health care centres, and provide the human resources to deliver health services.
To achieve this, the government has continued to work in collaboration with partners to support maternal and child health at all levels to achieve its goals and to advance efforts to achieve MDGs 4, 5 and 6. One of such partnerships is the Women for Health W4H project. Advocates for maternal and child health are excited about this timely and relevant initiative that is being implemented in five states of Northern Nigeria. It is designed to provide human resources for health and supported by UK Aid.
The Women for Health (W4H) programme aims to increase the number of female front-line health providers and support their deployment to rural health facilities where they can have greatest impact on maternal, infant and child mortality. The programme is being implemented in support of the government of Nigeria’s efforts to achieve MDG targets 4, 5 and 6. The programme is working in five states of Northern Nigeria, namely Jigawa, Katsina, Yobe, Zamfara and Kano.
In providing human resources for health, increasing the number of female students entering and graduating from health training courses is part of the challenge. Student drop-out and failure rates are currently very high and hence there are major challenges around improving the quality of training and ensuring a supportive learning environment for students. Another part of the challenge relates to the fact that the gap in the female health workforce is largely a rural phenomenon, hence the need to attract students who are more likely to accept and stay in a rural posting, and to devise incentives that will keep these health workers deployed.
In order to achieve these objectives, intervention is required on a number of fronts, to improve the quality, accessibility and affordability of health training; to address governance bottlenecks, particularly the lack of accountability and transparency around course entry; and to change hearts and minds about the appropriate role of women in Northern Nigerian society, creating space for a new vision about the desirability of women working to improve women’s and children’s health. This can only be achieved by reframing concepts of female modesty, respectability and honour. W4health has created its rationale and point of entry into the communities to ensure success.
Part of the strategy for creating a new vision of women in the health workforce is to engage with key decision- and policy-makers, opinion leaders, health providers, communities, including the traditional authorities and parents and husbands so that they become proactive advocates for change. Societal views as a whole need to shift dramatically if women are to be able to successfully pursue a health career with the full support of their husbands, families and the wider community, and not feel compromised by conflicting views about the appropriate role for women within Muslim society. The challenge before us all is to work together if we are to improve the well-being of women and children and help ensure Nigeria reaches the MDGs by 2015.
As an advocate, I have been commissioned to visit all the five states where W4H projects are being implemented. In most of them, I have found encouraging and impressive performance of the Governors and their health team. Most of the states have a vibrant network of committed advocates who support W4H work and the network is making progress with its advocacy activities.  In some, there are outstanding issue to address as the states try to meet requirements for accreditation of their health training institutions. The states are facing these challenges and making immense contributions to providing the much needed human resources for health in Northern Nigeria.