An estimated 7.4 million babies are born in Nigeria every year but 94,000 of them die on the first day of birth while 240,000 others die before they are one month old, according to the Federal Ministry of Health.
Policymakers in Abuja have launched over 28 policies, plans, strategies, guidelines in the past 10 years to end the preventable deaths of Nigeria’s youngest citizens who do not live beyond one month. But these documents that are generated yearly in Abuja are just like pouring water in a basket; they are rarely implemented.
While the policymakers are busy with generating and launching policies, the fundamental causes of these avoidable deaths are never addressed.
The quality of healthcare services has been mainly responsible for newborn deaths, as less than 35 per cent of the babies are delivered by skilled birth attendants. Only about 20 per cent of over 30,000 primary health centres meet the minimum standard, according to the 2016 national health facility survey.
Despite the policies and strategies, Nigeria has made a very slow progress in reducing neonatal mortality in the past 25 years. Neonatal mortality in Nigeria was 50 per 1,000 live births in 1990 but still remained at 34 per 1,000 live births by 2015, according to estimates by the UN Inter-Agency Group for Child Mortality.
Nigeria’s effort to reduce newborn deaths is an abysmal failure when compared to other countries’. The country’s neighbour, Niger, had a neonatal mortality rate of 55 per 1,000 live births in 1990 but reduced it to 27 per 1,000 live births by 2015.
The neonatal mortality rate in Nigeria is above the African average, which stands at 29 per 1,000 live births as well as 27 per live births in low-income countries.
Nigeria currently has the second highest number of neonatal mortality in the world after India.
Last year, the Ministry of Health launched every newborn action plan to end preventable newborn deaths in the country. This plan was adopted from the every newborn action plan endorsed by the World Health Assembly in 2014.
However, this was not the first initiative that Nigeria had taken to end preventable newborn deaths. Within the past decade, the ICIR identified 28 policies, strategies, guidelines and plans that the federal government had launched to preserve the lives of this extremely vulnerable group but the deaths keep occurring.
Since 2006 when the child health policy was launched, the country has launched other 26 policies, strategies, guidelines, and plans.
|2006||· Child Health policy
· Essential Equipment List
|2007||· Integrated Maternal, Newborn and Child Health (IMNCH) Strategy
· Ward Minimum Health Care Package
|2008||· Essential Newborn Care Course|
|2009||· Newborn health in the context of IMNCH (Situation Analysis Report)
· Communication for Behaviour and Social Change on MNCH
· Midwives Services Scheme
|2010||· National Strategic Health Development Plan 1 (2010-2015)
· National Essential Medicine List
· Maternal, Newborn and Child Health Week
|2011||· Newborn health in the context of IMNCH 2nd revision (Situation Analysis Report)
· Community-Based Newborn Care
|2012||· Saving One Million Lives|
|2013||· Newborn Bottleneck analysis
· UN Commission on Live Saving Commodities: Country Implementation Plan
· Integrated Community Case Management
· Subsidy Reinvestment and Empowerment Programme
|2014||· National Task Shifting and Task Sharing Policy
· Minimum Standard for Primary Health Centres in Nigeria
· National Newborn Health Conference
· National Health Act
· Helping 100k Babies Survive and Thrive Initiative
|2015||· National Guideline for the Maternal and Perinatal Death Surveillance and Response
· UN Commission on Live Saving Commodities
|2016||· National Strategy for Scale up of Chlorhexidine in Nigeria
· Nigeria Every Newborn Action Plan
‘EVERY DAY, THERE IS A WORKSHOP’
In 2006 when the child health policy was launched, neonatal mortality was 41 per 1,000 live births but after a decade of initiatives by different administrations, neonatal mortality only reduced to 34 per 1,000 live births.
Ben Anyene, Chairman of Health Sector Reform Coalition, told the ICIR that the major problem in neonatal health is the failure of the government to plan.
“There is no system. We are a short-term people,” Anyene said.
“We don’t do long-term planning. It boils down to the fact that everybody wants to cut corners and make money. Every day there is a workshop. Every day, there is one meeting or training. Training to achieve what result?
“There are things that are not being done and they need to be done. In this modern world, nothing will happen by wish. It will happen not by miracle but by thinking through it, designing it, costing it, finding the money and implementing it to the latter without leakage, and then you see the result.”
The usual case is that each new government or administration will rather waste resources on putting new programmes than sustain what has been in place.
Aminu Magashi, Project Director of Community Health Research Initiative, noted that frequent change of policies and programmes makes it difficult to achieve meaningful results.
“A programme can take you two years to create and start implementation. After the long process to establish structure, another government comes but does not use the existing structure, and then creates another one. It takes the new government another series of meetings and resources to put another one,” Magashi said.
The policies and strategies are generated by the Federal Ministry of Health but the implementation is hardly carried out by the state and local governments.
Nigeria operates three tiers of government: the federal structure, the 36 states and the 774 local government areas.
Often times, the Ministry of Health generates the policies and plans without realistic means of implementation in the states and local governments.
Michel Arrion, Head of European Union (EU) delegation to Nigeria, told the ICIR earlier this year that neonatal mortality rate is very high in Nigeria because of poor governance, weak and complex democratic institutions.
In February, EU supported five states in the country with N40 billion to improve maternal, newborn, child health, but Arrion said the solution to preventable deaths is not about having policies but the policies must be translated into concrete actions and deliverables.
Nigeria has received hundreds of billions of naira in foreign aid to end preventable newborn deaths but there is a situation where implementing partners carry out their activities without proper coordination by the Federal Government.
“If you really want an efficient development of the country, first, you need the country in the driving seat with full ownership,” Arrion said.
“So the Ministry of Budget and Planning is the right body to do so. It is not for the World Bank or the UN or the EU to coordinate others. It is for the country. It has to have a plan in place.”
IMPLEMENTATION ALWAYS THE PROBLEM
After decades of chaotic policies in the health sector, the National Health Act was signed into law on December 9, 2014.
However, the law, expected to change the healthcare system, has not been implemented after more than two years.
One of the key provisions of the Act is that within two years of enacting the law, all health facilities, both public and private, must obtain a certificate of standard. The penalty for operating without this certificate of standard is a shutdown.
Another key provision of the Act is the establishment of a Basic Health Care Provision Fund (BHCPF) to provide a basic package of care for all Nigerians.
The Act provides that BHCPF will be financed through yearly release from the federal government of not less than one per cent of the Consolidated Revenue Fund. Other means of funding will come from international donors. States and local governments are also expected to contribute 25 per cent counterpart funding for primary healthcare projects.
“The mindset is that it should not be implemented,” Ben Anyene, Chairman of Health Sector Reform Coalition said.
Anyene played an active role in drafting the Act that is meant to correct the anomalies in the healthcare system but the implementation has been frustrated by the government.
“It hurts people like us because I know how much productive energy and productive life we spent on this,” Anyene said.
“Right now, they have corrupted the whole thing. They don’t want to implement the Act. It is wrong for a country to make a law and refuse to implement it. They go into all kinds of conventions and refuse to implement.”