Policy and Programs for Reducing Maternal Mortality in Enugu State, Nigeria
Abstract
Using in-depth and key informant interviews, and review of literature on maternal health in Enugu State, this study focused on describing and analyzing the extent to which the State government is committed to reducing maternal mortality ratio (MMR) in the State. The results revealed that the reported MMR of about 1,400/100,000 live-births in the State is attributable to preventable medical causes, and is fueled by socio-cultural factors, including poor access to skilled medical personnel. In response to the challenges of high MMR in the State, the Enugu State government initiated a policy on free maternal and child health (FMCH) care in 2007, as a flagship of its maternal health programmes. The FMCH provides free medical, antenatal, delivery and post-natal care for poor women and children in primary and secondary hospitals, and those referred to tertiary hospitals in the State. However, the ratio of doctors to pregnant women in the State (1:1,581) remains abysmally low. Funding of the FMCH also remains inadequate as Local Government Councils (LGCs) demonstrate weak commitment to making contributions to the FMCH programme. We recommend a series of proactive approaches, including high level advocacy as ways to improve political commitment for reducing maternal mortality in Enugu State (Afr. J. Reprod. Health 2010; 14[3]: 19-30).
Résumé
Politiques et programmes pour la réduction de la mortalité maternelle dans l’état d’Enugu, Nigéria: Rapport sur l’évaluation des besoins. A l’aide des interviews en profondeur et des informateurs et de l’analyse de la littérature sur la santé maternelle dans l’état d’Enugu, cette étude a concentré sur la description et l’analyse de jusqu’à quel point le gouvernement de l’état s’engage à réduire le rapport de la mortalité maternelle (RMM) dans l’état. Les résultats ont révélé que ce que le RMM a signalé à l’égard des 1400/100,000 naissances vivantes est attribuable aux causes médicales évitables et encouragés par des facteurs socioculturels y compris le pauvre accès au personnel médical qualifié. Comme réaction aux défis du RMM élevé dans l’état, le gouvernement de l’état d’Enugu a lancé une politique concernant le service de la santé maternelle et infantile gratuit (SSMI) en 2007 comme un produit de ses programmes de santé maternelle, Le SSMI assure les services de soins médicaux, prénatals, d’accouchement et post-natals pour les femmes pauvres et les enfants dans les hôpitaux primaires et secondaires et ceux qui ont été adressés aux hôpitaux tertiaires dans l’état. Pourtant, le rapport médecins-femmes enceintes dans l’état (1:1581) reste atrocement bas. Le financement du SSMI reste inadéquat comme les Administrations Locales (AL) font preuve d’un faible engagement au financement du programme SSMI. Nous préconisons une série d’approches proactives, y compris un haut niveau de plaidoyer comme des façons d’améliorer l’engagement politique pour réduire la mortalité maternelle dans l’état d’Enugu (Afr. J. Reprod. Health 2010; 14[3]: 19-30).
Key words: Maternal Mortality, Enugu State, Needs Assessment Report, Policies and Programs.
Full Text:
PDFReferences
National Population Commission (NPC). Nigeria Demographic and Health Survey. Calverton, Maryland: NPC and ORC Macro/USAID, 2003:1
Daily Champion. Nigeria: Kampala Conference and Maternal Mortality. http://allafrica.com/stories/200912090674.html, Accessed, Dec. 08, 2009.
Abdul’Aziz I. HEALTH-NIGERIA: Little Progress on Maternal Mortality. http://ipsnews.net/africa/nota.asp?idnews, 2008. Accessed: 03/08/2009
Onah H, Okaro J, Umeh U, Chigbu C.. Maternal Mortality in Health Institutions with Emergency Obstetric Care Facilities in Enugu State, Nigeria. J. Obstet. Gynaecol. 2005:25 (6): 569-574
Ezugwu E., Ezegwu FO, Okafor II. Maternal Mortality in a Transitional Hospital in Enugu, Southeast Nigeria. Afr. J. Reprod. Health, 2009:13[4]:67-72
Ministry of Human Development and Poverty Reduction. The Enugu State Economic Empowerment and Development Strategy. Enugu State Government, 2004.
Ministry of Health. Strategy for Health 2008-2013. Enugu State Ministry of Health, 2008.
NPC and ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria, National Population Commission and ICF Macro, 2009.
Bankole A. Barriers to Safe Motherhood in Nigeria. New York, Guttmacher Institute, 2009.
Federal Ministry of Health. National Integrated Maternal, Newborn and Child Health Strategy. Federal Government of Nigeria, 2007.
Odimegwu CO. Emergency Obstetric Conditions, Health Seeking Behavior and Spousal Role in Southwest Nigeria: Mothers’ Perspectives. Second Research Report submitted to Program Coordinator Takemi Program in International Health Dept of Population and International Health Harvard School of Public Health Boston, MA, 2007.
Isiugo-Abanihe UC. Correlates of Maternal Health Care in Nigeria, Paper Presented at the Conference of Population Association of Nigeria, University of Benin, Benin City, 1995:1.
Chukwudebelu WD. Preventing Maternal Mortality: Overview of Activities of Enugu PMM Team, Paper Presented at the National Workshop of Carnegie
Sponsored Health Research Groups in Nigeria, Ibadan, Nigeria, 1994:1.
Shehu DJ. “Prevention of Maternal Mortality Project: Sokoto and Kebbi States”, Paper Presented at the National Workshop of Carnegie Sponsored Health Research Group in Nigeria, Ibadan, Nigeria, 1994. 15. Nwakoby FU. “Improving Maternal Health in Nsukka Environs”. In Omeje, K. ed. Reproductive Health in South-Eastern Nigeria. Enugu, Institute of Development Studies, 2000:20-39.
Okeibunor JC. “The Sociological Context of Sexuality and Family Planning in Nsukka Area”. in Omeje, K., ed., Reproductive Health in Southeastern Nigeria, Institute of Development Studies, UNEC, Enugu;
:40-49
Omeje K. “National Policy on Population and Reproductive Health: Challenges Facing Nigeria”. In Omeje K. (Ed.). Reproductive Health in South-Eastern Nigeria. Enugu, Inst. Devt Stud. 2000:1-14.
Editorial. Worrisome Maternal Death Records. Daily Sun. Monday October 29, 2007:8
National Population Commission (NPC) Nigeria Demographic and Health Survey 2003. Federal Republic of Nigeria and ORC Macro, Calverton, Maryland,
USA, 2004
Okeibunor JC. “Trend in Birth-Spacing Practices in Enugu State: Implications for the Realization of Population Policy Targets in Nigeria”, J. Sociol. Anthropol. 2003, 1 (1): 65-77.
Federal Republic of Nigeria (FGN). Legal Notice on Publication of the Details of the Breakdown of the National and State Provisional Totals 2006 Census. Official Gazette 2007; 94 (24): B 178-198
Okeibunor JC. Threat of AIDS and Condom use in a Nigerian Community: Implications for Fertility Regulation in Nigeria. Senegal, Union for African Population Studies, Senegal, 1999:1-99
Nwaorgu OC., Onyeneho NG., Onyegegbu N., Okolo
M., Obadike E., Ugochukwu G., Mbaekwe C. “Family Life and HIV/AIDS Education (FLHE) in Schools in Enugu State: Baseline Study of Reproductive Health Issues among In-School Adolescents in Enugu
State”. Afr. J. Reprod. Health, 2009; 13(2): 17-32
Obikeze DS. and Okeibunor JC. “Age-at-first Marriage and Fertility in Nigeria”, Intl. J. Contemporary Sociol. 2002; 39(1): 104-117,
Onyeneho NG. “Response to Childhood Fevers among Mbaise Parents and Caregivers: Does Child Sex Matter?” Tanzania Health Res. Bull. 2006; 8(2): 62-69
Government of Enugu State. Policy Brief on Free maternal and Child Health Care Services in Enugu State. Enugu, Ministry of Health; 2007.
Okafor CB., Rizzuto RR. “Women as Health Care Providers: Views of Maternal Practice and Services in
Nigeria”. Stud. Fam. Plann. 1994; 25(6):47-54
Onah BN. Socio-Cultural Factors affecting Maternal Mortality in Nsukka Senatorial Zone of Enugu State: Implications for Safe Motherhood Initiative in Nigeria. PhD. Thesis Submitted to the Department of Sociology/Anthropology, University of Nigeria, Nsukka; 2009
Jhpiego. MCH Programme Spotlight: A Few Steps Forward On a Long, Winding Road: Jhpiego’s Work in Malaria in Pregnancy in Nigeria”. Available at http://www.jhpiego.jhu.edu/maternal, 2005.
United Nations. The Millennium Development Goals Report 2008. New York: United Nations, 2008.
Chukwunweike, M. Enugu Spends N160 Million on Free Health Care, http://enuguppphousing.com/news2008-1.html, 2008, accessed February 18, 2010
Milke Mark. Canada’s Doctor’s Shortage: Comparing Canada with the World http://www.fcpp.org/publication.php/2249, accessed 19 February, 2010 The Frontier Center for Public Policy. 2008:1-8.
Uzochukwu BSC, Onwujekwu OE. and Akpala CO. Community Satisfaction with the Quality of Maternal and Child Health Services in Southeast Nigeria. East African Medical Journal, 2004; 81 (6): 293-299.
Akin JS. and Hutchinson P. Health-care facility choice and the phenomenon of by-passing. Hlth Policy Plann. 1999; 14:135-151.
Malata M. First-time Mothers' Satisfaction with Labour and Childbirth Information Received: A Malawian Perspective. Clin. Excellence in Nursing Practice. 2000; 4:83-89
Whitworth J., Pickering H., Mulwanyi F., et al. (1999). Deterrninants of Attendance and Patient Satisfaction at Eye Clinics in Southwestern Uganda. Hlth Policy Plann., 1999; 14:77-81.
Speitzer IS. and Bollen KA. How well do Perceptions of Family Planning Service Quality Correspond to Objective Measures? Evidence from Tanzania. Stud. Fam. Plann. 2000; 31:163-177.
Ziller E. and Lenardson J. Rural-Urban Differences in Health Care Access Vary Across Measures. Research and Policy Brief. Maine Rural Health Research Center, 2009.
Lenardson JD., Ziller EC., Coburn AF., and Anderson N. Profile of Rural Health Insurance Coverage: A Chart book. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center, 2009.
Ayanian JZ., Weissman JS., Schneider EC., Ginsburg JA., Zaslavsky AM. Unmet Health Needs of Uninsured Adults in the United States. JAMA; 2000; 284:2061-2069.
Amazigo UV., Okeibunor JC., Bump, J., Matovu, V., Seketli, A. Performance of Predictors: Evaluating Sustainability in Community Directed Projects of the
African Programme for Onchocerciasis Control, Soc. Sci. Med. 2007; 64 (10): 2070-2082
Okeibunor JC., Ogungbemi MK., Sama M., Gbeleou
SC., Onyene U., Remme, JHF. “Additional Health and Development Activities for Community-Directed Distributors of Ivermectin: Threat or Opportunity for Onchocerciasis Control? Trop. Med. Intl. Health, 2004; 9 (8): 887-896.
Audu LR, Ekele BA. A ten year review of the maternal mortality in Sokoto, Northern Nigeria. West Afr. J. Med. 2002; 21(1):74-6.
Refbacks
- There are currently no refbacks.