Reducing maternal mortality in the FCT through primary healthcare services

BY DORCAS EDET

According to the World Health Organisation, maternal health refers to the health of women during pregnancy, childbirth and the postnatal period. It is expected that each of these stages would be a positive experience so as to ensure that both mother and child are in optimum health at the end of the day. To achieve this, amongst other things, mothers need to be able to access quality health services rendered by health professionals during the stages involved in motherhood.

In Nigeria, statistics released by the WHO in 2020 indicate that the chances of a Nigerian woman dying during pregnancy, childbirth, postpartum or post-abortion is 1 in 22. This shows that maternal mortality is quite high in the country. Major causes of death cited include, high blood pressure during pregnancy, severe bleeding after childbirth, complications from delivery, infections following childbirth, as well as other indirect causes like malaria, heart disease and anaemia; all of which can be prevented or treated with proper medical care.  This is where primary health care (PHC) comes in.

Primary health care centres should be the first healthcare providers that patients can contact when they have medical needs. The nature of PHC is such that they are mandated to offer preventive, promotive, curative and rehabilitative services to members of the community regardless of their age, gender, social class or any other social difference.  A distinguishing component of the PHC is that it is an essential health care service for persons at the grassroots level and the health care provided is typically based on the peculiar health needs of the people in the community to the end that communities and the nation generally, can maintain good health. Nigeria has a total of over 30,000 PHC facilities, over 50 of which are located in the FCT.  Also, there are about 14 basic components of PHC in Nigeria and maternal and child health care services form part of them.

In the area in focus: the FCT, with only a few PHC facilities open 24 hours a day, a walk into many of these facilities, especially those located in the suburbs, will reveal reasons why they cannot sufficiently render the services they were established for. From dilapidating and collapsing buildings set in surroundings where sanitation and hygiene have been long neglected, to unavailability of hospital equipment and drugs, medical personnel who show up infrequently, rain-drenched, dirt-stained and about-to-collapse walls which look like they would give way any moment. There is no doubt that many pregnant women in need of urgent medical attention would have lost their lives in these facilities due to one or more of the challenges mentioned above. One can only imagine how dire the situation would be in the more remote and interior communities where roads are bad and transporting mothers with complications to the more equipped city-centre hospitals would take a while. The possibility of losing both mother and child in a case like that would be even higher. Besides, how many families in these remote villages can afford to pay the exorbitant amounts for medical care in city-centre hospitals, even those that are government-owned?

It is also noteworthy that most of these interior communities are where the highly disadvantaged and maligned original inhabitants of Abuja have their chiefdoms and reside. These areas are generally marked by poor social amenities and a lack of basic infrastructure. Some of these communities do not even have a PHC facility which means that where these facilities do exist, they are overburdened with the responsibility of providing health care services for various communities when they were originally built and equipped to cover just one or two communities.

This also means that pregnant women in communities without PHC centres would either have to rely on patent medicine store owners popularly known as “chemist”, or untrained traditional birth attendants (TBAs) or have to travel some distance in order to access medical care that may even be subpar with the unavailability of drugs, basic medical equipment and even hospital beds. Looking at all these, is it any wonder that Nigeria still tops the list of countries with high maternal mortality rates? A case point will be the people living in Shere community in Bwari Area Council. According to villagers and some medical personnel working at the PHC, they do not have enough equipment to handle some complications arising from child birthing and would have to refer their patients to Bwari General Hospital which is kilometres away. The road leading to Shere is in deplorable condition and during rainy seasons the community is completely cut-off.

There is therefore a need for the government, especially the FCTA and the National Primary Health Care Development Agency to invest resources in building more PHC facilities to ensure that most communities are covered and health care services are easily accessible and very affordable. Government should also give existing PHC centres the facelift and refurbishing they deserve. They should ensure that these health facilities are adequately funded, hospital equipment, drugs and other medical consumables of good quality are made readily available, and more medical personnel employed to meet the demands in respective communities. According to a field study conducted by HipCity Innovation Centre across the 17 Chiefdoms; most PHCs are largely manned by volunteer community health extension workers (CHEWS), Medical personnel already in employ should be monitored to ensure that they are always at their duty post when they should be in order to prevent complications and loss of lives that may occur as a result of their absence or delay in reporting to work. Also, it is imperative to mention that many PHCs in rural communities of the FCT do not have staff quarters and the few that have quarters, it is rarely maintained, with no water or electricity to make their stay comfortable.

Health care is a basic human right and as such should be made available, accessible and affordable to all members of the society at every level. Failure to do so amounts to an infringement on the rights of the populace. And even more so, when we consider the plight of the original inhabitants of Abuja who suffer gross neglect from the government in not just the area of availability of health care service delivery, but in the general provision of social amenities and services necessary for their wellbeing and advancement as a people.

In conclusion, by not giving proper attention to the health sector with a view to stemming the high rate of maternal mortality, the government is not only threatening the lives of women who are the bedrock of families and communities, they are also threatening the future of these communities and the nation at large. Children are precious and it is the responsibility of those of us who have come before them to ensure that they are protected and that they come into an environment that enables them to thrive holistically. The children of the original inhabitants of Abuja deserve these and should not be denied. The government owes them a duty to provide these basic services and that duty should not be neglected anymore.

Dorcas Edet works with HipCity Innovation, an organisation with a mission to reduce all forms of inequality, and currently working to promote the rights of the original inhabitants of Abuja.