УДК 6

Sustainable development goals and maternal and child healthcare in Nigeria

Эмаимо Алисе Джон – ассистент кафедры иностранных языков Института медицины Российского университета дружбы народов

Эмаимо Оттун-Кеми – сотрудник Нигерийского института социальной работы

Abstract: The chances of survival of a newborn should be a common global priority that must never be taken for granted. There are Several Health Ministries, sponsors, uncountable donors and even partners who frequently focus on implementing several special interventions that are mainly targeted at improving the survival and health of a newborn. The partners are also increasingly focused on implementing better practices towards newborns, postnatal care and accessibility to several health facilities. The sustainable development goals 3 which was introduced in 2015 that also formed a blueprint for the year 2030 goals were not only focused and targeted towards the global wellbeing of newborns, mothers and women, communities at large, and also families. The major theme of these sustainable development goals is to ensure that absolutely no one is left behind no matter the circumstances. The objective of this article is to describe programs that are not only available to reduce child mortality but what programs are recognized, what barriers do we encounter? and proffer possible solutions. A survey in form of questionnaires was carried out to also highlight people's opinions especially mothers, awareness of what programs are available and ideas of what could be the challenges that hinders the progress of the sustainable development goals to be obtainable in a country like Nigeria.

Keywords: maternal & public health, child health.

Introduction

The basic component of healthcare for all pregnant women during pregnancy is very crucial, the physical and mental health of a child should and cannot be overlooked also. The health of a mother and their child’s health encompasses the following:

• right to live;
• proper health care;
• proper nutrition;
• combating of disease and infection;
• reduce stunted growth e.t.c.

Increase in child mortality rate could be attributed to many factors such as religion, illiteracy, shortened staff, shortage of hospital equipment, complications during childbirth and so many others. The importance of Mother-child care can never be overemphasized as it guarantees the survival of both the mother and newborn during and after delivery.

The Sustainable Development Goals and Millennium Development Goals are very valid and crucial while playing important significant roles in these sectors. The implementation of these goals are mostly targeted towards maternal and child health care to validate that developing countries also follow suit and emulate developed countries to reduce the mortality rate of children all over the world.

Fig. 1. Diagram indicating the level of awareness of sustainable development goals (SDG).

The foundational blueprint of the Goals was adopted to encourage peace, prosperity, increased partnership for the entire world and also for its likely future. Figure 1 above indicates the level of awareness in a survey that was conducted amongst women. The above diagram illustrates that there is a progress in the awareness of the goals. About 67% of the women are aware while we have 28.4% of women that are not yet informed or ever heard of the developmental goals. These goals were adopted by 193 member states of the UN in 2015. Every society are very much interested in goals. The three major objectives of SDG’s for a society are:

• economic prosperity;
• social fairness;
• environment sustainability.

This strategy is used by united nations to measure not only the growth of the developing states but also these helps gradually to eradicate extreme poverty, hunger, problems of illiteracy, combating infectious and non-diseases, discrimination against and amongst mothers, women which includes girl child, environmental degradation and most of all, the right to life amongst many other things.

However, World Health Organization (WHO), has a 15year progress plan for countries. It views the SDGs and MDGs goals as achieving as well as sustaining universal health care through restructuring primary health care. Its approach is built on strengthening and upgrading the health systems, by promoting adequate intervention to epidemics and pandemic diseases towards universal health coverage and lastly, it is to provide a long-lasting partnership and resources to coordinate and include mobilization to align with regional, national and global health priorities in a nation.

The priority of the WHO is to proffer solutions that can help to mitigate child mortality and combat diseases which was known to be a success for the developing countries only.

Programs targeted to alleviate mother&child health care in developing countries

A lot have been written about Poor maintenance of maternal health and child health since the 1990’s, in Nigeria. Interventions of different sorts have been introduced and several of them have been established to try reverse the pattern and trend to ensure that Nigeria is possibly on track to achieve the Millennium Development Goals like every other developing country.

Several supports in improving health of newborns and mothers have been promoted by the Health Resources and Services Administration (HRSA). They also reinforce the health care workforce while providing affordable health care.

United Nations International Children’s Emergency Fund (UNICEF): undoubtedly one of the most popular and effective programs in developing countries. UNICEF, aids in providing medical immunizations and disease control, they aim at administering health care for mothers and children with HIV/AIDS and also enhancing maternal nutrition and childhood by providing clean sanitation etc.

Fig. 2. UNICEF programs in Nigeria and its popularities among citizens.

The mother child health program aids to alleviate child health care and mother’s health care especially in the countries in need, which begins with NEEDS ASSESSMENT by determining what serious health care needs are required for the families, mothers and children in the society to achieve health goals. They first have to find out what exact problem is related and peculiar to an environment. The pie chart above in figure 2 illustrates that UNICEF is the most popular when we discuss about programs targeted to help pregnant women. About 79.8 percent of the women are very much aware of the UNICEF programs available in their community and 10.7% of the women are aware of the MCH programs. We also asked other women to identify the other programs they are aware of and they listed the above shown in the pie chart above.

In Enugu State for example, an introduction of a programme named (FMCH) free maternal and child health care programme was introduced and initiated in January 2008. The purpose of the programme was designed to be a joint initiative of the state government together with its Local Government Areas (LGAs) to make joint contributions to offset the bill of a free health services for all pregnant women, prospective mothers and also under-5 aged children in the state.

Each MCH is aimed at solving a particular problem. They are:

1. Needs assessment.
2. Intervention.
3. Monitoring.
4. Evaluation.

As the intervention is done, it must be closely monitored to ensure that the target is met. After that is done, Evaluation needs to be done to assess how successful the program was.

United Nations Population Fund (UNFPA) partnering with WHO to support in improving the maternal health and reproductive in worldwide, which aids in developing protocols and strategies in healthcare by enlarging the use of birth controls, providing voluntarily plan to avoid unwanted pregnancy, to have safe pregnancy and childbirth and also by campaigning against child marriages etc. They work together with the governments, international agencies, societies and health expertise all round the world to train health workers, to promote maternal health standards, they also help in providing birth preparedness and complications readiness to help improve increase expertise care on childbirth which could be facilitated by interventions with practices, knowledge, skilled practitioner’s attendant and the effectiveness of the health system.

Maternal, Newborn, and Child Health (MNCH) it is one highest impact areas which focuses on the effective development aid, by providing proper training of expertise to enable the prevention mortality during childbirth and also providing adequate vaccines to aid in proper nutrition for the prevention of stuntedness in a child and also reduce child death. They provide a strategic approach towards interventions for humanitarian purposes which requires skilled and experienced health workers, clinical health workers training i.e., strengthening of expertise and a collaborative partnership.

Fig. 3. Survey showing peoples opinion about the importance of mother and child health.

Mother’s health is indispensable. Figure 3 above identifies that majority of women agree that maternal health is vital for every mother. 98.9% women in the pie chart shows that they are aware there needs to be a change in the way we view mother’s health. The health of every woman is very vital which could be during pregnancy, at childbirth, or even at postnatal period. Innumerable attempts have been made to intervene in the case of the maternal deaths, common genesis and sources of maternal deaths and complications could be from excessive loss of blood, unsafe abortions, obstructed labor, infections to say the least. The WHO have ensured ways of ending maternal deaths as well as promoting good health and well-being, strengthening the health system and also prioritizing on the health-related SDGs to improve and accelerate the progress of maternal health for all women worldwide which includes proper nutrition, prevention of diseases and infections, also supporting women undergoing intimate violence etc.

The WHO is targeted by solving peculiar problems towards the SDGs in reducing the maternal deaths, they implement plans to promote quality health by:

1. Data collection: they perform quick surveys to enable them to collect all the necessary information they need and to know the exact problem and how it is intercepted be tackled in the environment with the help of both public and private sectors;
2. Providing clinical guidelines: they layout consistent information on how the structure of a clinical health system should function, medical assistance in the health institutions etc;
3. Providing strategies for ending avoidable maternal deaths which includes tackling the case of infectious and non-infectious diseases and as well providing humanization care and helping reduce disparities;
4. Strong partnership: the WHO partnership with other institutions such as UNICEF, NGO’s, government and the people of the society and also other multilateral associates for the development, which is essential in terms of financial assessment, strategies and planning and also project execution.

How are they implemented?

Volunteers: Various non-profitable organization, they take a voluntary willingness to take on a service which could be health related, they help in providing medical services and assistance to women and children, information, medical expertise etc., they implement:

• by providing resource mobilization: by recruiting of health expertise, provision of medical equipment etc;
• human resource framework: by conducting training and program for the health workers, skills assessment, by developing funding etc.

Examples of these volunteers are: UN Volunteers, UNICEF, planned parenthood Federation of Nigeria (PPFN), UN Women, UNDP and many others to mention. It could also be implemented by sending volunteers to the various societies.

Awareness and Sensitization: It is implemented through better education, knowledge and awareness for maternal health issues in order for the SDGs goal 3 and MDGs goals 4 & 5 to achieve their aims at reducing the maternal and child mortality rate. The mother’s nutritional and health awareness (MNHA) are based on education on nutritional value and healthcare. There are various ways in which this awareness could be carried out by pamphlets, news, television. It could also be implemented by enforcing adequate educational training to the health workers which includes the midwives and mothers.

Programs

There are also prenatal programs which aid in providing women with proper adequate nutrition or by providing training for the women to acquire proper nutrition. Examples of these programs in Nigeria are WHO, Free Maternal and Child Health Care Program (FMCHCP) help in training the women on family planning, prenatal care and care for newborns, Integrated Maternal Newborn and Child Health (IMNCH) for the implementation of the MDGs to promote the integrational approach towards reducing of maternal, newborns and child mortality etc.

Obstacles in Effective Application of SDGs and MDGs Goals in Nigeria

 

The obstacles to effective application are:

Work Force

Healthcare professionals prefer to work in high-paying urban and private centers because of the high-quality working conditions. The concentration in these high-paying centers leads to fewer available health providers in the primary health care centers. Improving the working conditions and incentives can serve as an attraction to these centers. Also, efforts need to be made on the part of the government to secure high-level equipment for these centers. Figure 4 below shows 92% agree that there is a problem with medical staff shortage in Nigeria which is a challenge.

Fig. 4. A chart revealing the impact of staff shortages.

Poor management of funds: Figure 5 below illustrates that about 97.7% agree that there is lack of fund management challenge. The health care facilities in Nigeria suffer from shortage of finance, this daring situation of have shown beyond doubts to be much worse, particularly in the rural area where electricity isn't enough for laboratory equipment is to function properly, availability and access to clean water, proper storage of medications and low supplies of emergency drugs and medications.

Fig. 5. Opinions on fund management.

Lack of proper medical facilities

This is mostly common in the rural areas in Nigeria, figure 6 illustrates the opinions of people on the impact of lack of proper medical facilities. The chart identifies about 95% agree that it mitigates the maternal child health care. The lack of medical staffs or shortage of staffs, proper facilities and equipment to help in providing good healthcare could lead to overcrowding of other medical facilities where the people will have no option rather than go or travel available healthcare for medical assistance by causing the health workers to overwork.

Security Instability

The poor development system in Nigeria's healthcare unit poses a threat to the medical care system, where the medical management does not provide a safe and comfortable environment, and no properly developed functional medical surveillance system in the healthcare unit.

Possible Solutions

African nations may have been portrayed as not only too dependent but they greatly still rely on foreign aid and could try to move beyond the over-dependence on foreign aids which has failed to bring significant amount of the growth required and development of its nation. According to ODA 2021 statistics, Nigeria’s dependence on foreign aid is more than 60%, with a growing estimated ratio of 45% in healthcare, while 25% is for primary education and we see a staggering low

10% for community development. Due to its insistent constant dependence on aid care, it creates a less unique and innovative mindset for its people. Thus, even the vast resources available are underutilized. However, Nigeria has one of the largest rates of maternal and child mortality in the world reported by the WHO & UN, it is among the top 8 countries that accounts for over 40% of global rates of maternal deaths. Over 34% of maternal deaths are caused by unsafe abortions, diseases and infections, obstructed labor, and malnourishment. Another problem highlighted by this aid is that the assumed experts and educated ones who have the technicality of utilizing the available resources for the betterment of the country also seek greener pastures in other countries of the world because of a better working system and a sustainable lifestyle. However, this amount of mortality could be prevented when there is adequate and proper working equipment, medical care supplies, reproductive health services, and most importantly skilled health workers/ expertise. The varying vast growing population in Nigeria has a major effect in the societies which include:

• poverty;
• heavy pressure on social services e.g education and health care;
• unemployment;

Fig. 6. Chart illustrates illiteracy and penury level – a determining factor for mothers and child mortality.

Which has played a vital role to the high level of fertility as a major factor of the vast growing population in Nigeria which can hinder socio-economic development. The effort of promoting the SDGs, MDGs main targets at the reduction of the maternal and child mortality have also included its attention to strengthening family planning programs to help reduce overpopulation and mortality, also aim at enhancing the health financing, strengthening the rate of Nigeria engaged in health risk prevention, and also by increasing research and development. The pathway to helping the country lies in looking inwards and utilizing the resources within. Nigeria can develop their own sustainable livelihood of their citizens. Funding should be targeted to meaningful programs such as providing medical health expertise, building of proper medical health centers with adequate medical equipment, training of the health workers and also by providing education to assist young persons for example in becoming entrepreneurs and having small to medium enterprises..

As well as centered on reducing poverty levels through on the job training for unemployed youth and so on. This would assist in reducing the disparities between the rich and the poor. Thus, if aid is granted at all, it should be centered or targeted towards these projects rather than being funded for areas that are not a priority for the development of the country, the poor and in the health sectors. This will build capacity as well as development of the general populace and economic condition. In comparison to this, China is the most populous developing country due to its overpopulation and now seen as a developed country due to its steady and vast economic growth and development. There has been a huge progress towards the implementation of MDGs and SDGs by eliminating poverty, hunger, providing healthcare for women and children and also preventing diseases etc. China had integrated stages towards the implementation of these health-related goals:

• The development of an action plan- this action plan ought to encompass a system to mobilize sufficient sources in addressing these challenges. It prioritizes mainly on the intervention for goal populace and health priority. In order to furnish low priced and satisfactory health and long-term care services to obtain healthy growing older and accepted fitness insurance.
• They ought to take a sequence of concerted strikes consisting of on the different hand no longer restricted to extended or prolonged funding in public gadgets and preferences for health, addressing Regional, Urban and Rural Inequities, tackling new rising fitness challenges and also making it especially precise that nobody is left behind.
• Lastly, they ought to manipulate or handle quite a few Cross-cutting troubles i.e., higher regulations, speedy human aid enhancement in order to achieve SDGs health related goals.

One step that could be made to reduce maternal mortality is to promote health education. However, determining the educational level is vital. Knowing the educational level of the target population is critical when designing actions to give knowledge and raise awareness about a particular issue. Women with higher levels of education are more likely to seek preventive treatment, which contributes to a significant reduction in maternal mortality. As a result, education is a social determinant of health that can help people improve their health. The higher the population’s educational level, the greater the need for social and health rights that provide everyone with equal possibilities. The government needs to improve women’s access to education.

Conclusion

 

Fig. 7. Percentage of people who considered healthcare important.

Figure 8 above shows that 100% of women agree that the health of a child is very important. There is a huge gap with a need for increased awareness creation regarding the programs to enhance utilization, especially in the rural areas. A Comprehensive baseline data of the health indices of the affected population are quite paramount to any future comprehensive program assessment and are hence recommended.

The Nigerian State must realize and recognize that to improve the quality of health services entails more than just looking at the quantity of supply of things. According to a report by the National Library of Medicine, even if the quality of services in Nigeria’s primary, secondary, and tertiary health facilities improve, maternal mortality may definitely remain high.

Reducing maternal and child mortality is crucial for the long-term viability of the human race. It is the responsibility of all stakeholders to ensure that all women are protected. There is therefore a need to support and implement well-established and comprehensive public health initiatives for maternal health and death prevention.

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