I enjoyed reading the Nigeria Health Watch well researched piece.
But whenever I read the tragic narration of the deadly fate that pregnant women face in Nigeria, during childbirth, I notice that it appears that many authorities and writers assume that once ‘deliveries happen in facilities’ then the problem is over. But any one who understands the trend of health care in Nigeria in the last few years will know that it is not as simple as that.
Fact 1 - maternal mortality will be less if deliveries happen in weell equipped and manned health facility. But the problem is that increasingly as regulation and inspection is failing to meet expectations more and more facilities are neither well equipped nor manned by well trained and skilled personnel.
Fact 2 – untrained Traditional Birth Attendants (TBAs) should not be taking deliveries. True. But the problem is that too many policy makers still believe that TBAs should be banned outright rather than engage them proactively so that they are trained, equipped and monitored in those rural and difficult to reach human habitations in Nigeria where skilled and trained health workers do not go to. Even if posted they do not stay, understandably because these locations have primitive existence - no modern facility like light, water, at times no roads, no schools and no shops or recreation, etc.
Fact 3 – Nigeria still has no Standards Body to stipulate the minimum standard of care expected in the various levels of the system / facilities: primary, secondary and tertiary. The National Health Act 2014 has prescribed that such a body should be one of its provisions to be implemented by 31st October 2016, but it is yet to happen. There is a dormant National Tertiary Health Institutions Standards Committee (covers only Tertiary Facilities) but even it is not active/ functioning.
The solution to the tragic maternal mortality in Nigeria is well beyond just getting every delivery to happen in a health facility. The quality of the facilities is too varied to guarantee any such expectation. In the meantime, until enough skilled hands are available (and the quality of the facilities more assured), every available resource should be engaged proactively and in a systematic and structured policy route, including TBAs and CHW (Community Health Workers).
AFRICA CENTRE FOR CLINICAL GOVERNANCE RESEARCH & PATIENT SAFETY
@Health Resources International (HRI) WA.
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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group: http://www.hifa.org/people/steering-group
jneana AT yahoo.co.uk