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Gender gaps in Ogun healthcare leadership hinder maternal and child health

By Royal IBEH

IN Ogun State, Nigeria, a critical battle for maternal and child health rages, transcending the mere provision of healthcare. Despite the rollout of the Basic Healthcare Provision Fund (BHCPF), critical healthcare gender disparities within Ward Development Committees (WDCs) cast a dark shadow over efforts to reduce maternal and under-five mortality rates. 


Reality in its starkness

entering the first Primary Healthcare Centre, (Legacy PHC), in Ward 1, Shagamu Local Government Area, Ogun State, one encounters not just statistics and percentages, but the vivid narrative of Ogun State’s healthcare system, where women’s voices strive to rise above entrenched disparities.

A visit to Shagamu, Remo North, Odeda, and Abeokuta North Local Government Areas (LGAs) revealed men occupying the majority of Ward Development Committee (WDC) leadership positions, in a system designed to deal with healthcare issues that concern mostly women.

The women, who are the ones that truly feel and can comprehend the brunt of practical maternal health issues, are left to man the floor serving proverbial regular office tables.

In Shagamu, only one of the 15 wards is chaired by a woman.

Legacy Health Centre, Isale Oko, Sagamu
Legacy Health Centre, Isale Oko, Sagamu

Similarly, in Odeda, the ratio of male to female chairpersons is 9:1 making male dominance routine.

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This is despite evidence suggesting that female leadership in WDCs could significantly improve maternal and child health outcomes, particularly in rural communities.

Back in 2014, the Basic Healthcare Provision Fund (BHCPF) was established under the National Health Act to provide free basic healthcare to the poorest and most vulnerable Nigerians, including pregnant women, via accredited Primary Health Centres (PHCs).

Ogun State joined this initiative in October 2021, with 169 out of 237 wards verified to receive funds. However, improvements under its maternal and under-five health remain inadequate.

Data from the Nigeria Population Commission (NPC), and the State Central Department of Statistics (SCDS) indicate that 179 out of every 100,000 women in Ogun State die from pregnancy-related complications. Also, 56 out of every 1,000 children die within their first 11 months.

The 2021 Multiple Indicator Cluster Survey (MICS), a household survey programme developed by UNICEF in the mid 90’s to assist countries in filling data gaps for monitoring the situation of children and women, highlights that Ogun State has the highest child mortality rate in the Southwest region.

Admission ward, Agbero Health Center
Admission ward, Agbero Health Centre.

For illustration, the survey revealed that nearby Lagos State has the lowest neonatal mortality rate in the South West region, with 11 deaths per 1,000 live births. Osun State follows with 12 neonatal deaths per 1,000 live births, and Ondo State reports 18 per 1,000.

The highest rate was recorded in Ogun State, with 56 neonatal deaths per 1,000 live births, followed by Ekiti State with 53, and Oyo State with 31 per 1,000 live births.

The systemic issues contributing to these alarming statistics include the lack of healthcare facilities, inadequate healthcare providers and poor road infrastructure.

Central to addressing these challenges are the WDCs, established by the National Primary Health Care Development Agency (NPHCDA) to empower local communities and get them involved in the healthcare delivery system.

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But this has been overwhelmingly led by men in variance to the BHCPF’s mandate that women should comprise at least 40 percent of the membership in effective, decision-making roles.

In an interview with  the WDC chairperson for Ward 1 in Shagamu, Ajani Adebola, affirmed that the overall leadership of WDCs remains male-dominated and thereby limits potential for widespread improvements if women had been allowed to hold the sway.

Photo of Mrs. Ajani Adebola, the WDC chairperson for Ward 1 in Shagamu
Photo of  Ajani Adebola, the WDC chairperson for Ward 1 in Shagamu

Despite these glitches, she pointed out how she has implemented significant improvements at the Legacy Health Centre by ensuring proper utilisation of BHCPF funds.

She said she often advocates for necessary infrastructure like solar power as well as actively supporting pregnant women in accessing antenatal care, adding that her efforts have led to noticeable improvements in maternal and child health in her ward.

Other Stakeholders

Stakeholders like the  Project Manager, Governance, at the Justice Development and Peace Commission (JDPC), Olumide Olaitan, and Cristian Munduate of UNICEF Nigeria, asserted the need for more female leaders to run the affairs of the centres so that they can effectively address the specific health needs of women and children.

The JDPC, in partnership with the International Budget Partnership (IBP), has reportedly launched initiatives to ensure women hold viable leadership positions within WDCs, Olaitan stated.

These initiatives aim to facilitate effective communication between WDCs and state actors and ensure the proper use of BHCPF funds to improve maternal health outcomes.

“One of these initiatives is to ensure that women are adequately represented within the WDC structure and hold strong leadership positions, enabling them to amplify their voices and influence decisions related to maternal health.

“We also focus on empowering WDC members to effectively perform their oversight functions, which are crucial for improving maternal outcomes and, by extension, primary health care services.

“Additionally, we aim to create dialogue spaces to foster better communication between the WDCs and relevant state actors. This effort supports the Ogun State Government’s plan to reduce maternal mortality and enhance primary health care services,” Olaitan added.

Olaitan added that a new guideline will soon be introduced. He stated that the guideline focuses on the role of WDCs at the grassroots level. Its essence would be to mandate periodic leadership changes and ensuring at least 30 percent of WDCs are led by women.

He added that the intent is to break longstanding gender barriers in particular as a strong measure to drive improvements in maternal and child health in the state.

“We are actively working to strengthen WDCs in Ogun State. These efforts include advocating for increased female representation, enhancing the capacity of WDC members, and facilitating better communication between WDCs and state actors,” he stressed.

On her part, Munduate gave her nod saying that steps are underway to ensure the corrections are duly achieved.

“We are taking steps to strengthen WDCs in Ogun State by advocating for increased female representation, building the capacity of WDC members, and improving communication between WDCs and state actors,” she said.

State actions and prospects for progress

On the quest to know the state’s position on the disparity issues towards promoting gender equity within WDCs, the health commissioner, Oluwatomi Coker, acknowledged the challenges.

She said, “facts cannot be denied as everyone can see what’s presently seen.”

Counselling Room, Agbero Health Center
Counselling Room, Agbero Health Center

She added that the state is committed to supporting initiatives that will enhance improvement and underscores the importance of female leadership if they must achieve better health outcomes.

“Recent government initiatives, such as training midwives and providing free health insurance for pregnant women, reflect this commitment,” Coker stated.

She further admitted that most of the responsibility for improving maternal and under-five health in the state rests on her shoulders.

She then vowed not to rest until the health system is fixed, highlighting some of her recent efforts, including training midwives, offering free health insurance packages for pregnant women, and establishing essential structures at the PHC level.

“We have trained midwives in Ijebu-Ode, Abeokuta, and other LGAs. I left my well-paid job in India because I don’t want women to die anymore. I am committed to achieving this goal,” she affirmed.

Continual pursuit

Based on the observed conditions at the four scrutinised PHCs, the struggle for effective maternal and child health in Ogun State is intricately linked to the male-dominated leadership.

And, like the women admitted, this calls for gender equity within the Ward Development Committees (WDCs).

Many women at these centers believe they should be at the helm of these committees and are urging the state government to address this critical issue.

Funmilayo Adeniyi, from Ward C, Shagamu LGA, PHC, Ajaka, near Awolowo Market, told LEADERSHIP that she shares the same vision as Mrs. Ajani Adebola, WDC Chairperson for Ward 1 in Shagamu, to transform her ward. However, as a WDC member, her influence is limited.

Funmilayo Adesanya, from Ward C, Shagamu LGA,
Funmilayo Adesanya, from Ward C, Shagamu LGA,

“I am passionate about helping pregnant women, children, and People with Disabilities (PWD) in my ward. During immunization campaigns, I ensure all children receive their vaccines. That is the extent of my current role as a WDC member,” she said.

Adeniyi affirmed that if given the opportunity to serve as chairperson of her ward, she would direct the BHCPF funds to improve the health facility, ensuring that pregnant women, PLWD, and all community members have access to quality healthcare services.

Mrs. Toyin Amusa, a photographer and member of Ward 8 in Sagamu, believes that becoming the chairman of her ward would enable her to make significant changes at Latawa Health Center, which she cannot make as an ordinary member.

“As an indigene of the area, I am aware of the challenges at the health centre. If I become the chairman, I will change things,” she affirmed.

Amusa explained that the health center is too small to admit pregnant women for longer than one day after delivery.

“Most newborn deaths occur within the first 28 days. At Latawa Health Center, new mothers are discharged a few hours after giving birth due to the limited space,” she disclosed.

Inside the counselling room, Agbero Health Center
Inside the counselling room, Agbero Health Center

To address this issue, Amusa said she plans to contest for the chairperson position in her ward.

“I want to become the chairperson to influence political leaders to expand the center, as there is unused land available. I will also ensure the government deploys more health workers, as there are currently fewer than five at the center. Pregnant women will receive the care they need, and children will be immunized on time because I will campaign for participation.”

Amusa also highlighted the lack of drugs at the facility, which she aims to address through the BHCPF if elected as chairperson of her ward.

The women unanimously argue that achieving gender fairness in WDC operations is essential for resolving the state’s healthcare challenges and lowering maternal and under-five mortality rates.

Advocates like Olaitan and Munduate emphasize that empowering women to assume leadership roles within these committees will enhance healthcare support and service delivery.

They also note that strengthening WDCs with increased female representation is expected to create more equitable and effective committees, ultimately reducing maternal and child mortality rates in Ogun State.

Other Health Centres’ struggles

Amidst bustling streets and daily routines in the heart of Remo North Local Government Area (LGA), Ogun state, lies Agbero PHC.

It is a healthcare facility that serves as a lifeline to over 5,000 residents in Ode-Remo community.

Though its signpost reads “Basic Healthcare Provision Fund Centre, Remo North LGA”, Agbero PHC renders services ranging from ante-natal care, infant welfare care, family planning, treatment of minor ailments, referral services, and immunization, and it still grapples with a myriad of challenges that threaten its ability to provide adequate care to those who really need it. It can be best described as a sick clinic itself.

This reporter found out that the structure housing the present Agbero Health Center is actually a temporarily donated building from Alaye-Ode Library since 2008, owned by the then Alaye-Ode of Ode-Remo, Oba Olufunso Adeolu, popularly known as “Chief Eleyimi of the TV Village Headmaster series”.

Alaye Ode Library, Remo-North government
Alaye Ode Library, Remo-North government

The health center is a three-bedroom apartment building with three beds and less than five healthcare workers. Its waiting area, although intended to provide comfort, offers no respite as it has few chairs that are glaringly insufficient for the number of patients that visited there. At the time of the reporter’s, there were only two long benches in the waiting room.

The health centre also shares the same structure with the Alaye-Ode Library, built by Remo North Local Government.

Prince Juwon Opayemi, Chairman, WDC, Ward 10, Remo North LG had this to say about the facility’s state. “Yes, it is indeed not conducive as the health facility lacks major essential infrastructures like water and electricity, with inadequate bed space and health personnel, I admit”.

“However, putting these challenges aside, the PHC has been able to prioritise the drugs of pregnant women and the vaccines for children in the community,” he noted.

Photo of Prince Juwon, Ward 10, Remo-North LGA
Photo of Prince Juwon, Ward 10, Remo-North LGA

He added:”Kabiyesi, Oba Dr. Adetunji Amidu Osho, Alaye of Ode Remo, approved the one plot of land, and the present Remo North Local Government Chairman, Prince Dapo Odunsi, gave official approval. They have provided us with land to build a functioning Primary Health Centre. The project will commence soon, I assure you.”

The reporter made attempts to speak with some of the patients seen navigating through the obvious challenges.  One of them, an expectant mother, Mrs. Kehinde Adeyemi, 27, who resides in Wasimi Street, Agbero, said “it has been a struggle, but what option do we have, when the private healthcare centres in the community are too expensive for us and the next functioning PHC is far.”

Mrs Kemi Adeyemi, Remo-North LGA
Mrs Kehinde Adeyemi, Remo-North LGA

She said though she receives ante-natal treatment at the Agbero Health Center twice a week regardless of the unsatisfactory ambiance at the facility, she continues to visit the clinic because of her financial situation.

“It will cost me N1,000 to get to the nearest functioning PHC. I just run a small shop that barely gets me some modest coping sum. Most days, I don’t even make up to N500 in profits. I know how important antenatal care is to my health and that of my unborn baby. Rather than sit at home or go to traditional attendants, I decided to manage what we have,” she stated.

Adeyemi, however, expressed the hope to see a day when a new and functional health center will be commissioned.

“Look around you, there are just few beds in the centre. This has been of great concern to few of us women coming here. I always wonder what will happen if more than five women go into labour at the same time!

Delivery room, Agbero Health Center
Delivery room, Agbero Health Center

“That is why if a new health structure is built, it will not only attract more pregnant women who will always come for their ante-natal medication, among others, but also assist less privileged patients who cannot afford transport fares to faraway places for their medication,” she said.

“We are getting the drugs we need as pregnant women in the community, all thanks to the BHCPF. The nurses are also trying their best to cater to our health needs. However, the pressing challenge we have is inadequate bed space.

“We believe that if the government builds the new facility as we have been hearing, we might have enough bed space and a conducive centre,” said Mrs. Oyinkansola Adejo, 26 years, living at Oke-Ola compound Ode-Remo, who was also at the center for her ante-natal care.

Mrs Oyinkansola Adejo, Remo-North, LGA
Mrs Oyinkansola Adejo, Remo-North, LGA

Hope amid despair

In the course of the investigation, LEADERSHIP reporter explored the claims that the Adetunji Amidu Osho, Alaye of Ode Remo and the Remo North Local Government Chairman, Prince Dapo Odunsi had provided land for constructing a new PHC building.

This claim was affirmed by Prince Juwon Opayemi, Chairman of WDC Ward 10 in Remo North LG, who guided the reporter to the land and allowed a video recording of the site.




     

     

    He also said,There is hope that the building of the new facility will soon commence. This intervention is anticipated to address the infrastructural shortcomings currently plaguing the centre.”

    As findings further reveal, Agbero Health Centre’s story is a microcosm of a broader narrative about Ogun State PHCs’ struggle and gender disproportion in terms of offering quality healthcare provisions to teeming women seeking adequate maternal health and child care.

    From the situation on ground, the larger narrative highlights the importance of tackling gender disparities in healthcare leadership, ensuring adequate infrastructure, and securing the necessary resources to improve maternal and child health outcomes in Ogun State.

    This report republished from Leadership newspaper was made possible with support from the International Centre for Investigative Reporting, ICIR. 

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