A draft report assessing Nigeria's progress towards saving millions of women and children by 2015 has said more transparency and accountability could produce better results for health spending.The draft Country Accountability Framework, prepared by the group Accountability Mechanism for Maternal and Newborn Health in Nigeria (AMHiN) ahead of a national report due next year, scored Nigeria in seven thematic areas, including advocacy, review processes, resource tracking, e-health and innovation, maternal death surveillance and response, vital registration and monitoring.
However, Dr Tunde Segun, Country Director of MamaYe! (Evidence for Action), a member of AMHiN coalition says,
“What happens in Nigeria is that we are not budgeting using evidence,”
adding that Nigeria should imbibe the culture of using evidence to budget so as to respond adequately to issues.
From this scorecard, it is clear that there are shortages in funding
Funding is a challenge across board, but if you look at the overall score, it is less than 50% for last year and this year. It shows that in terms of resources, we aren’t doing enough. Even from the aspect of those who are dying and those who are surviving, you realise we are still not doing enough. Newborns die, not because we don’t know where or why they are dying but because there are not enough resources to address the reasons they die.
Why do you think saving lives of women and children does not command the same level of attention as Ebola, for instance?
Ebola is an infectious disease. Understandably, there should be attention or else it will result in an epidemic that will ravage the country. Maternal, infant, child deaths are not infectious. There’s no competition. But see what has happened: a journalist is hit by a car, as anybody can be, and he dies because there’s not enough health response to arrest the bleeding and he’s even taken from facility to facility, with everyone rejecting him until he dies. If the health sector was well funded, this is the kind of thing we say, ‘Oh, something happened, they responded and he survived.’ That’s an aspect of response in emergency.
Maternal and newborn health are not infectious diseases, neither are they things that happen once in a while. Once a woman gets pregnant, it takes her nine months. There should be preparation: antenatal care services, delivery at afacility by skilled healthcare providers, and if complications develop, there should be people equipped to take care of those complications. Women don’t die because they become pregnant, they die because they develop a complication and there is no one to address it. Pregnancy is a physiological issue. If a woman gets pregnant, the natural thing is to deliver the baby eventually. But when there are problems, there should be a response from the health sector to take care of them.
How should government budget for maternal health to be more efficient?
If you are to budget a trip from Lagos to Abuja, you check out airlines and their prices, and you ask around for hotel prices. You have parameters you are budgeting for. In reality what happens in Nigeria is that we are not budgeting using evidence. People just say, ‘ok health sector, one million naira’; they just give a ceiling. You don’t know the specific parameters that are needed to budget for health and get them. You need to know each aspect: how many drugs, how many numbers for this, in this particular area of maternal and newborn health do you need eye drops? Though a pregnant woman can have eye problems, but the primary thing she needs are drugs that can take care of pregnancy.
The issue is government can begin to adopt evidence based financing, and make annual budget based on evidence.Kano government recently announced N145m to ensure mothers, babies and children under five receive free services, which is commendable. We took the statistics, first the number of women in Kano State, then the percentage that will be pregnant at any time in the 44 local government areas, with 36 secondary health facilities. When we broke it down, the money that comes per woman was about N100. If you really want to do that, you will need almost N1 billion.
What I’m telling you, we are packaging it as an advocacy tool and we are going to present it to the governor.He will realise that the N145m, in terms of this evidence, is not enough. But if anybody hears he has released N145m, it is a lot of money, but it will not address what he wants to do. But if you go and meet him and say, ‘oh, we just need one billion, 145 million is not enough’, I’m sure he would just abuse you. But if you shown him evidence - as we have broken it down, from the number of women pregnant to facilities to drugs they will use - I’m sure he will realise he needs more money. If government can imbibe the culture of using evidence to budget, then we will address specific issues, and be able to respond adequately to issues.
This interview was conducted by Judd-Leonard Okafor of Daily Trust Nigeria. It first appeared on www.dailytrust.com.ng