MATERNAL HEALTH CARE DELIVERY IN NORTHERN NIGERIA: AN ASSESSMENT OF ROTARY INTERNATIONAL’S INTERVENTION PROGRAMME (2000-2007)

ABSTRACT

Health is a basic human right that is vital to sustainable development, but this right appears to elude the majority of women, according to a 2003 World Bank Report. This is because as was reported by the United Nations Fund for Population Activities (UNFPA), “every minute, another woman dies in childbirth. In Nigeria, one in 13 women face a lifetime risk of maternal death while another estimated 2 million women are faced with other pregnancy-related diseases such as Fistula. Nigeria is only 2 percent of world’s population but accounts for over 10 percent of the world’s maternal deaths. This dismal situation informed a 1987 International Conference in Nairobi, Kenya, where nations all over the world made a commitment to reduce maternal mortality by taking measures to improve the health of mothers through the “Safe Motherhood Initiative”. In spite of this, the problem did not abate. This led to the United Nations to include a 75 percent reduction in maternal mortality as one of its Millennium Development Goals (DMGs). In order to give support and supplement the efforts of governments in Nigeria, especially in the north, where maternal deaths were 1,549 per 100,000 as against that of 165 per 100,000 deaths in the southwest. Consequently, the Rotary International embarked on a maternal health project, which took place during 1995-2000 with a pilot Project in two Local Government Areas, and later scaled up to cover six States from year 2000 to 2007 (child spacing, Family health, and HIV/AIDS education). This study aimed to know the objectives of the Rotary Project, its strategies and outcomes. The two hypotheses were to test whether the Project contributes significantly to improvement of maternal health care service delivery; and whether the management structure of the Project contributed to its success. Data were gathered from both primary and secondary sources, which include interviews, questionnaires, Project documents and reports. Data from the six Project sites, namely, Adamawa, Jigawa, Kaduna, Kano, Katsina and Plateau States, were tested and they confirmed that the Project had contributed significantly to maternal health care service delivery in the states, and that the way the Project was organized and managed also contributed to its overall success. Findings revealed that strong advocacy and sensitization as well as involvement of Project host communities in the implementation of Project can further enhance its success and sustainability. Some of the weaknesses of the Project include the fact that Rotary allocated personnel, funds and other materials equally to the Project States, apart from Kano State, without giving due cognizance to the disparities in physical terrain, size and other peculiarities of each state. This affected the Project staff, especially the Liaison Field Workers (LFWs), such that they had to put in extra efforts in order to enhance the positive outcomes of the Project. Recommendations include, among others, that future projects should consider the peculiarities of each state while planning a project. Future research should also consider investigation into areas of finance and personnel management of Non-Governmental Organizations (NGOs) such as the Rotary International 3-H Project.

Background to the Study

Maternal Mortality or maternal death is defined as “the death of a woman while pregnant, or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to, aggravated by the pregnancy or its management, but not from accidental cause” (WHO, 1993).

The death of a mother is more than a personal tragedy; it represents an enormous cost to her nation, her community and her family. When a mother dies, her children lose their primary care giver, communities are denied her paid and unpaid labour and countries forego her contributions to economic and social development (Fathala, 1992).

An estimated 585,000 (over half million) mothers die each year from causes related to childbirth, ninety-nine percent (99%) of these in developing countries (Maine, 1987). In Nigeria, 1 in every 13 women face a lifetime risk of maternal death. Yet, most maternal deaths are preventable mainly through medical intervention and political will by the government (Shiffman and Okonofua, 2007).

Maternal mortality has received global attention. The reduction of maternal mortality is one of the Millennium Development Goals (MDGs), specifically, it is number five (5th MDGs) of the MDGs. The target is to reduce it by 75% by the year 2015. The state of maternal and child health is one of the indicators of a society’s level of development, as well as an indicator of performance of the health care delivery system.

According to Goulet (1992:470), development is “a two-edged sword which brings benefits but also produces losses, and generates value conflicts. One of the benefits is the improvement in maternal well-being. But the gains or benefits of development will be felt differently according to factors such as: ‘who are you’ and ‘where you live’, among others” (Turner and Hume, 1997: 10). Development administration was created in the post-war period to play a major role in facilitating development through a system of bureaucracy. Bureaucracy has however been found to be affected by a number of issues such as: size of bureaucracy, poor administrative capacity, a nation’s culture, bureaucratic bias against the rural poor, corruption, and issues of gender, to mention a few.

Maternal mortality is certainly a gender issue. Awareness to gender issues were brought to the fore in 1981, when the then UN Assistant Secretary General stated that women would not make full contribution to development ‘until there were more women involved in the planning process, in the administration at all levels, and in all sectors’. And that this would increase women’s participation in decision-making in public bureaucracies leading to “increase in overall productivity, to increase in public sector responsiveness to women’s needs…” (Turner and Hume, 1997:97). One of the needs of women is certainly to live in good health, and for maternal mortality to be eliminated. But as Goetz (1992: 6) has argued, “public administration is in itself a gendered and gendering process, such that the outcomes, internal organization and culture reflect and promote the interests of men. And so long as researchers treat men as the norm, the medical care of women continues to be compromised”(Women’s Global Network for Reproductive Rights, 1994, 4: 27-28). Since constraints on public sector spending obviously affect both sexes, but in conditions of poverty, it is usually women who face the greatest problem in acquiring adequate health care (Ibid). And it is in the poorest parts of the world that women’s lack of access to health care is at its most acute (Jacobson, 1993; Timyan, Measham and Ogunleye, 1993).

Health, a basic human right, that is vital to sustainable development, eludes the majority of women (World Bank Report, 2003). Harmful cultural practices perpetuated on women and girls… particularly during pregnancy; certain birthing practices … result in the mitigation of their health or their quality of life (Dawitt, 1994).

In a community-based study of women who delivered and are resident in northern Nigeria, it was reported that home delivery was still the norm throughout the zone, with 1791 (85.3%) deliveries at home; and that up to 80.5% of the deliveries were supervised by personnel with no verifiable training in sanitary birthing techniques (Galadanchi, Ejembi, Iliyasu, Alagh and Umar, 2007). They therefore concluded that “maternal health care as evidenced above is far from the ideal, and likewise, the achievement of the 5th Millennium Development goal is totally far-reaching; to reduce the maternal mortality ratio by 75% by the year 2015 with this level of maternal care (ibid:448).

The challenge of development according to the world Bank in its 1991 World Development Report is to improve the quality of life, especially in the world’s poor countries. It is in an attempt to foster development that the 189 member countries of the United Nations adopted a total of eight (8) Millennium Development goals (MDGs) in September 2000. They committed themselves to making substantial progress towards the eradication of poverty and achieving other human development goals by the year 2015.

One of those eight MDGs, goal number 5 is “Improvement of Maternal Health”. The target for this goal was to “reduce by three-quarters, that is to achieve a seventy-five percent (75%) reduction in maternal mortality between1999 and 2015.

Awareness to the appalling condition of women’s health was drawn by the United Nations Fund for Population Activities (UNFPA) when it reported that “every minute, another woman dies in childbirth (UNFPA, 2008). The World Bank Report (2003) also reported that about half a million women die every year from the complications of pregnancy and childbirth, and that most of these deaths are preventable with simple technologies that have been available for decades.

The International Conference on Population and Development (ICPD, Cairo, 2004) also called the attention of the world to the magnitude of maternal mortality, and the necessity for its reduction. Maternal mortality ratios (Maternal deaths per 100,000 live births) are, on average, 30 times higher in developing countries than in high-income countries (The World Bank Report, 2003).