Health Architecture Redesign – One End of the Spectrum

Maternal and Child Mortality in Nigeria

For the most part, Nigeria is doing poorly in the health industry. Given its developmental stage however, the country is not expected to perform at the same level of excellence with Industrialized countries. But its poor and jeopardized developmental pathway has retarded its overall socioeconomic progress. The statistics is high for a country that has the amount of human and natural resources Nigeria is blessed with. Loads of institutional patterns of error had plagued the most populous black nation of the world. Malaria, tuberculosis and other third world infectious diseases are still threatening the productivity of the country. With “recovery” system of governance and institutional ignorance, life expectancy in the country is estimated at 47-50 years of age. Nevertheless, life above 50 is characterized by affluence, education, nutritional intelligence or ability to drag on to the end.

As globally attractive as Nigeria may seem, especially in oil and gas drilling, the human development report of 2007/2008 did put the black nation in its place. The UNDP report ranked Nigeria close to bottom in the maternal mortality index. The country was only ahead of low income countries under stress (LICUS) like Rwanda, Angola, Chad, Niger, and Sierra Leone. The political argument behind this ranking is rested on the nation’s population and human density; which allows higher contact rates and rapid spread. As much as that part is true; the nation has no clear view on how to keep its citizens healthy.

There is no shared vision amongst the health care stakeholders. This includes care delivery organizations, clinicians, health care consumers and policy makers. Undoubtedly, with higher population comes increase in disease spread. Nevertheless, for Nigeria, there is no in depth profiling of the health of its citizens. The oil rich nation lacks proper information gathering and dissemination systems. These 21st century multi-dimensional development tools inform a country on required patterns of intervention. Every citizen-within accountability age brackets – should understand how much of health care remains a civil right against what is available.

The country needs to get the politics and economics of the situation right. Health promotion and care delivery in the nation needs audacious, practical and quick impact development projects.

Statistics on Maternal and Child mortality:

According to a national estimate, the Nigerian population is at 140 million; 1 in 5 Africans is a Nigerian. By the same report, 23{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} are women of child bearing age. In 2006, a national report estimated that 65 million Nigerians were females. 30 million of that number is within reproductive age -15-49 years. 6 million Nigerian women are expected to get pregnant every year. In 2007, WHO, UNICEF, UNDP estimated only 5 million of those pregnancies to result into childbirth.

Other statistics emerged in diverse directions. Quickly, these hard numbers may not completely capture the whole picture. And in this writing, they serve as an indicator of what the actual might be. Modern contraceptive prevalence rate is at 8{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} and unwanted pregnancy among adolescent is put at 60{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}. The use of antenatal care, by trained provider is calculated at 64{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}; while proportion of pregnant women delivered by a trained provider is at 37{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}. Proportion of women delivered at home is 57{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}; and almost half of teenage mothers do not receive antenatal care.

On nutrition and drugs; 58{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} receive iron supplements and 30{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} receive malaria drugs. 50{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} receive two or more doses of tetanus. In all, urban women are more on the positive side of things than their rural counterparts. For instance, urban women are 3 times likely to receive antenatal than rural women. Though improvements are recorded in a recent national publication, a lot needs to be done.

Enlarged perspective:

This is what the global mortality rate on women looks like. Globally-536,000 women die annually. Though Nigeria contributes 1.7{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} of the global population; yet on maternal deaths statistics, it represents 10{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} of the world’s population. Here is the scary part. Since Nigeria represents 10{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a} of maternal deaths, it translates to at least 53,000 women dying annually. That is the equivalent of 10 jumbo jets crashing every month and one 737 jet every day or one woman dying every 10-15 minutes. A Nigerian woman is 500 times more likely to die in childbirth than her European counterpart.

On the part of children, about 5.3 million of them are born yearly in Nigeria, that- at least 11,000 every day. 1 million of these children die before the age of 5 years. A total 0f 2,300 children die daily. This is equal to 23 plane crashes daily. More than a quarter (25{c34c06f77d52afff33578e93b7591d6bfac789ab9e1d902f9c4fe14f0d14bf4a}) of the estimated 1 million children who die under the age of 5 years annually in Nigeria, die during the neonatal period. (Source; Academic Report on Improving Maternal, New Born and Child Health)

Granted socio-cultural and economic status of women constitutes major part of this statistics. For instance low status of women, poverty, poor nutrition (in childhood, adolescence and adulthood), ignorance and illiteracy; then again we can also consider religious beliefs-often times this acts as barrier to utilization of available health services-and lastly, harmful traditional practices. Generally there are multi-dimensional causes that contribute to health care difficulties in the country. But if Nigeria can improve on its data generation, collection and distribution, in line with socio-cultural, economic and educational differences; such data management and governance will allow reformers to practically evaluate and monitor intervention programmes. Progress in this format will mean successfully executed intervention procedures against institutional targets and original understanding of crises.

This process can be weighed in the WHO’s aims and objectives for primary health care. The forward thinking organization’s recommendation called for practical, scientifically sound, socially acceptable and technologically empowered system of health promotion and care delivery. It also suggests development methods and strategies for spirited self reliance and determination. Now, data collation will largely involve community participation.

There is no better form of promoting self determination; which is the ability of a group to manage their resources as they see fit: Without countervailing harmful effects on its immediate environment or extended neighbours. Based on their core values and norms, the communities can assist in describing and designing an intervention platform, suitable for their developmental status. With such level of inter-participation, reformers can readily identify what part of a community’s capacity tool-set needs assistance and which requires reorientation. Health promotion and care delivery education and its needs can be communicated easily; in a community’s frame of reference.

Nigeria is a signatory to various conventions and declarations on women. For example the UN conventions on the rights of women and children; as well as the Bamako declaration that adopted the women and children health services initiative as a strategy towards attainment of vision 2010.

But these legal rights issue on women and children should be communicated to fundamentalist communities with ease and cohesive diplomacy. Direct use of any kind of force, intellectual or economic, will reduce the chances of success in such locations. Achieving health care best practices in Nigeria requires robust collaboration, shared vision, competitive market development, technological awareness, consumer profiling, responsive policy prescriptions, corporate alignment between capital spending and corporate goals, and finance. These sets of interaction should target core value proposition, interoperability and reduction in silo effects.

Recommendations:

Across health care market are actors in practice that will determine the trajectory of its institutional future. Health care providers’ current concentrations in Africa are basically on episodic and acute medicine. Expansion on these scales of concern is imperative for public health. However, best practices and competitive global health care market will respond more to enhanced management of chronic diseases and life-long prediction and prevention of illness. On predictive and preventive medicine, consumers will need to assume responsibility for their health, as well as establish demands for a transformed health care system. By this attempt, health care blueprints will showcase higher value delivery.

Given this awareness, product suppliers will find it imperative to collaborate with clinicians and care delivery organizations in the development of products that improve outcomes or provide equivalent outcomes at lower cost. These functions are relatively dependent upon norms and values of a given society. Societies on their part ought to engage realistic and rational decisions regarding lifestyle expectations. They will also need to prescribe acceptable behaviour, and lastly understand how much health care should be a societal right versus market service. Health care governance best practices underline disease prevention, early detection and health promotion as a given. As a result, societies will play a bigger role in enhancing and in carrying the professional message of preventive medicine.

Government on the other hand will need to raise various levels and scales of un-sustainability awareness on national health care system. Best practices assigns governments in leadership the role of establishing political will power needed to remove obstacles. They must encourage innovation through development of competitive health care market place, suitable and conducive for direct foreign investments. This can be achieved with well integrated and robust development pathways. Efforts at rebranding or reimagining Africa’s economic performances may not yield appropriate fruit without strong financial systems.

Financial institutions in Africa have the highest lending interest rates. Consequently, there are all sorts of systematic crises in the region’s economies. Optimized financial systems will reduce systematic corporate and household debt crises. This is an algorithmic pathway to regenerate entrepreneurship, public-private partnership, as well as improved economic security on wellbeing and livelihood. Health care governance best practices points towards “commoditization” of health promotion and care delivery. The health care market is evolving rapidly and like technology, countries that refuse to adapt will continue on dependency syndrome. There is high confidence that businesses who understand the development of health care will lead their industries in the future. Dilatory management decisions against this truth may reduce future corporate profitability. This is particularly true for the financial institutions-bank and non-bank. To really address content issues, health care market development requires the same priority IT was obliged during its emergence.

Mostly, development of successful health care market place is beyond infrastructural and IT introductions. It is far above specialist centres introduction. Successful market development requires coordination and integration across sector-stakeholders. Health care governance best practices cannot be achieved without a competitive market place. Purposely, win-win scenarios should be targeted for all stakeholders, businesses and care delivery organizations. But market leadership and institutional largesse will belong to businesses and CDOs that inform their operational, financial, and management visions of this – globally integrated – emerging market.