Globally, the mortality rate of children aged under 5 years has reduced from 90 deaths per 1000 live births in 1990 to 48 deaths in 2012; but the rate still remains very high in sub-Saharan Africa (where figures are estimating between 177 to 98 deaths per 1000 births).


In 2012, approximately half the world's estimated 6.6 million deaths in children aged less than 5 years occurred in sub-Saharan Africa, and Nigeria accounted for approximately 13% of these deaths. According to UNICEF, Nigeria is also the second largest contributor to Maternal mortality rates in the world, with 2013 statistic’s showing that 1 in 13 women are dying due to pregnancy or birthing related causes in this country. Every single day, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age. 

Even more devastating then these statistic’s is the knowledge that, according to recent research, most of these deaths could have been prevented if essential interventions had reached these women on time. Perhaps highlighting more then ever the importance of charitable organisations tackling these issue. 

However, lack of access to roadworthy vehicles and alternative means of regular transportation in Nigeria is only part of the cause for such a significant barrier to women receiving quick and efficient obstetric care. Other restrictions such as limited facilities, unavailability of a safe water supply and poor sanitation facilities also plays a large part in this continuing struggle, and means an even more increased risk for those living in rural areas in Nigeria. Indeed, a website specialising in medical information for global expats, is encouraging anyone seeking serious medical treatment in the country to consider travelling abroad for further assistance. It seems numerous citizens are heeding this advice, as research from Nigeria health found that an estimated three billion Naira ( $13m) is spent by Nigerians every year to pay for healthcare in India, the Middle East, Europe and North America.

Despite painting a very gloomy picture of the state of healthcare in Nigeria, the country is making progress in cutting down infant and under-five mortality rates, A recent study (Ezeh, Agho, Dibley, et al “Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria”) found that under-5 mortality has declined significantly by 37% over a 10-year period after adjusting for individual-level, household-level and community-level factors.  The findings indicated that living in poor households, living in rural areas and having mothers with no schooling are also common significant risk factors for infant mortality in Nigeria. 

As a result of issues such as this, alongside the Inadequate health facilities, insufficient skilled health professionals and lack of modern medical equipment, the Nigerian Government launched and implemented a National Health Policy (NHP) and Ward Health System (WHS) whose core targets include reduction of under-5 mortality rate. Despite all these initiatives, the pace still remains too slow. With Nigeria recently missing out on its Millennium Development Goals of reducing child mortality by a third and maternal mortality by 75% in time for the 2015 deadline.

The Nigerian government are determined to improve on these figures especially with significant recent improvements in other African countries, most notably Ghana, where a national policy to exempt women from paying for delivery care in public and private health facilities led to initial funding by the HIPC initiative (Highly Indebted Poor Countries) and a subsequent establishment of the national health insurance scheme in 2008.

Nigeria itself has recently applied a new healthcare model, which was launched to improve women and childcare in the country. Using the ‘Program for Results’  (PforR) initiative supported by the world bank, Nigeria is aiming to offer incentives to states that improve coverage and quality of all maternal and child healthcare services. The investment of $1.5 million per state, was made possible by the Saving Of One Million Lives (SOML)  initiative, lead by the world bank. PforR tracks performance on multiple levels including rewarding states for improvements in skilled birth attendance, immunisation coverage, prevention of mother-to-child transmission of HIV services, contraceptive prevalence and quality of care. 

It seems that improvements in the transparency of management and budgeting across the states is key for this new initiative. A Look back through Nigeria’s history demonstrates that despite huge investments in health, Nigeria’s health system has nonetheless been known to underperform, relative to countries that spend less on health. By offering rewards available for publishing annual budget execution reports, this is an issue PforR aims to resolve as it hopes to make tracking government health expenditures much more manageable.  

There is undoubtably still a long way still to go for improving the healthcare quality for women and children in developing countries such as Nigeria. However the ongoing work to improve these figures is making a slow and steady progress in the right direction. Dr Ibrahim Kana, National Program Manager for SOML PforR hopes that ‘P for R will help change the trajectory of preventable maternal and child deaths by increasing the coverage and utilization of life saving health interventions across PHCs in the country. It is a venture that comes with enormous rewards. Hopefully for the states, and ultimately for Nigerian mothers and children.” 


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