Will advocacy help in tackling maternal mortality in north?

One of the strategies adopted by the centre to tackle the growing figures of death of women and under five children is building the capacities of health workers, Non Governmental Organisations (NGOs), media practitioners, traditional rulers and other stakeholders by enlightening them on how to give their quota toward arresting the situation. Since 2006, the […]

One of the strategies adopted by the centre to tackle the growing figures of death of women and under five children is building the capacities of health workers, Non Governmental Organisations (NGOs), media practitioners, traditional rulers and other stakeholders by enlightening them on how to give their quota toward arresting the situation.

Since 2006, the centre gets the support of the David and Lucile Packard Foundation to implement advocacy project. The Advocacy on Reproductive Health (ARH) project was aimed at strengthening and supporting Packard Foundation Reproductive Health Leaders or Fellows to formulate, organise and deliver an advocacy message for increased allocation and expenditure in reproductive health programs and projects.

The advocacy in reproductive health project was also “designed to capitalise the gains of the Packard Foundation’s Future Leaders Strategy. The project was conceptualised as a post-training leadership development activity to prepare and facilitate RH fellows to build coalitions and conduct advocacy activities.” In other words, the goal of the advocacy project is to influence the policies of the decision makers toward making them committed to reproductive health issues.

Already those supported by the centre to carry out the advocacy projects have already sprung into action, conducting advocacy visits to those concerned, or rather those who can change the present trend. The quadruple advocacy targets of the centre are governors, their wives and deputy governors; members of the parliaments, especially chairmen of the health committees; senior civil servants implementing health policies and; traditional and religious leaders in the wider policy environment.

But one of the problems the reproductive health advocates face is lack of cooperation or rather access to the policy makers. This reporter was part of an advocacy team of Community Health and Research Initiative (CHR) who visited Tudun Wada local Government of Kano State. During the visit, only the district head of the Local government was available to receive the team.

The message of the team was to bring to fore the plight of maternal mothers in the area and proffer solutions on how best the situation would be addressed. During the next visit, the team was met the council chairman and discuss the maternal issues relating to his area. One of the issues he promised to improve on was the fact that only two female staff carry out antenatal care service at the town of more than 100,000 dwellers.

However, through the training drill given by the centre, those in the media circle are also contributing their quota by enlightening the people on the imperatives of seeking regular antenatal services, while at the same time informing government on the plight of the people.

Long before late last year’s leadership training and subsequently capacity building workshop, the centre organised an executive course for Gender-Based Budgeting for Maternal Health in August 2006. With the dRPC’s collaboration with the National Institute for Policy and Strategy (NIPSS), Kuru, the workshop observed that the “preventable causes of maternal mortality and morbidity include poverty, ignorance, illiteracy, cultural factors, lack of access to health services and facilities, and poor road networks.”

However, lack of access to health service facilities, specifically, is certain problem that whose answer specifically lies squarely on governments’ shoulders. In Kano State, for example, the state governor Malam Ibrahim Shekarau had said during the 2009 budget presentation that “more than 500,000 have benefited from our free maternity program and this helped in reducing our maternal mortality rate”. Yet, observers still believe that much need to be done for millions instead of thousands (as is the case currently) to benefit.

Perhaps such a call was what made the government to slightly hop up its budgetary line in health sector in 2010 to N8.8 billion.

“Out of this amount (the N8.8 billion) about N2.94 billion will be spent to construct and or improve on healthcare infrastructure particularly hospitals and equipments. We are proposing to also expend the sum of N838.9 million in the provision of drugs and medicaments while the sum of over N5 billion will be committed to human capacity building and staff welfare,” the governor said.

Although in this year’s budget, reproductive health issue, on a specific note, was not mentioned by the governor, advocates argued that substantial amount of the total sum should be committed specifically to reproductive health issues so that the mortality and morbidity rates would reduce.

The focus of the dRPC on the northern states was borne out of the fact the northern part of Nigeria is one of the areas with highest rates of maternal deaths. In Kano particularly, it is estimated that 1 in every 65 women giving birth to a live infant dies during childbirth.

Findings however show that the problems of maternal health do not only lie with the service providers, they are also due to socio-cultural as well as economic factors. Dietary taboos and restrictions, harmful traditional practices (called yankan gishiri in Hausa), harmful modern practices (e.g. self-medication), fear of hospitals, fear of male providers in public hospitals, and poor antenatal attendance are all identified as manifestations of these problems.

In addition, the poor maternal health status of the women in the state is due to an over reliance on Traditional Birth Attendants who are inadequately trained and remain outside the referral network of the orthodox health system. Frequent conception, early conception and late conception coupled with low contraceptive acceptance rates exacerbate the problem of maternal health in the state.

Also contributing to the burden of maternal deaths is the under-financed, overburdened, under-staffed and ill-equipped nature of the orthodox pubic health care system. According to the centre’s research, the referral system is ineffective, ambulances are not road worthy and access roads are inadequate.

The role or goal of the dRPC in this perspective appears explicit. Thus, to build the capacity of stakeholders and empower them to conduct advocacy visits to the policy makers so that the budgetary allocation to specifically maternal health issue will be jerked.