CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

The World Health Organization (2010) defines maternal death as “death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. This definition therefore allows identification of maternal deaths, based on their causes as either direct or indirect. The statistics on maternal mortality ratio in Nigeria is not only mind-boggling but pathetic. More so, because evidence abounds that successive administrations both military and civilian have put rhetoric before action in mitigating the effect of this scary public health issue. Importantly, we must recall that battling the scourge of maternal mortality was one of the critical issues that took the forefront burner at the Beijing Conference held at the instance of women activists from across the globe in 1995. Other issues inclusive at the conference were the need to address escalating household poverty, ensure economic empowerment, improve on women’s health-care status, promote girl-child education and uphold their human rights. Five years after the Beijing conference, precisely at the millennium summit of the year 2000, maternal mortality yet was a subject of discourse depicting its magnitude and the need for nations to abate it by year 2015.

Most countries both developed and Developing countries in pursuit of basic macroeconomic goals of sustainable economic growth, full employment, price stability and balance of payments equilibrium rely so much on government for the provision of capital-labour intensive project(s). Policies and programmes designed to advance human development emanate from, and are implemented by the public sector. In market-based economies, growth is generated by the private sector (hence it is often called the “engine of growth”), but facilitated by government through productive and strategic public investment and creation of an enabling environment. It is on this particular function of public sector that the role of Nigerian government in the health sector is analyzed. The under performance of certain sectors of Nigerian economy like the health sector therefore needs to be addressed because of it role in economic growth because health sector performance has a long-run effect on any economy. Government most often are more attached to those sectors with short-run effect to the negligence of some other sectors like health and education with long-run effect. This can be vividly seen in the well constructed health policies that are not adequately implemented. Government often forgets that a healthy nation is a wealthy nation. A healthy mother for

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instance begets a healthy child and if mothers for instance are not properly handled with care before and after pregnancy, they may end up begetting unhealthy children who in the long run affect both the quality and quantity of labour force.

The effectiveness and efficiency of health system of any country determine her health outcomes. The neglect of the health sector had caused many developing countries like Nigeria to fall far short of the standard set by the WHO on the issue of Safe motherhood. The dismal state of health sector in the country particularly primary health-care contributes to these adverse health outcomes like maternal health. The Federal Ministry of Health document (2004) acknowledges that “the health system in Nigeria and the health status of Nigerians are in a deplorable state” and notes numerous problems including, low motivation for health professional workers, an annual budget preparation process the report calls a ‘ritual, ’a culture of corruption and little consultation between the Federal and state health authorities and between the Federal ministry of Health and other ministries. A study edited by Nwosu et al (2009) affirms mal-administrative nature of health care in Nigeria as lamented by former minister of health Professor Babatunde Osotimehin who lamented that “our competence as health-care professionals are not in question. What is in question is our ability to administer our country better than the ways we are administering it now. How did we end up in a situation where we spend about 70-80% of the resources available for health care on less than 5-10% of the population?”

External evaluation of Nigerian health system on the other hand affirms the foregoing assessment. Nwosu et al (2009) for instance opined that an estimated an estimated 500,000 women die each year throughout the world from complications of pregnancy and childbirth. About 55,000 of these deaths occur in Nigeria. Nigeria with only 2% of the world’s population accounts for over 10% of the worlds maternal deaths. In 2003, the WHO and Federal ministry of health of Nigeria reported that about 145 women die everyday in Nigeria as a result of causes related to childbirth. They went further to assert that the risk of a woman dying from childbirth is 1 in 18 in Nigeria compared to 1 in 61 for all developing countries and 1 in 29,800 in Sweden. It may not be a surprise from the foregoing that WHO (2000) ranked the performance of Nigeria’s health-care system 187th among 191 United Nations member states in the year 2000 and presently Nigeria still occupies this ignoble position .The fact that Nigeria is ranked second to India as the country with highest maternal mortality ratio is a confirmation that her health system is in a shambles. Empirical evidence suggests that maternal mortality in Nigeria is not uniform across the country but varies markedly across geographical zones. National Demographic and Health Survey (2003) recorded that maternal

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mortality ratio is high in the northern region compared to their southern counterparts. For instance, it recorded that in 2003 the ratio in North-West was 1025, in North-East it was 1549, in South-West it was 165 while in South-East it was 285 respectively. The poor performance of health sector in Nigeria evidenced in high maternal mortality ratio brought Nigeria under recent focus with respect to Millennium Development Goals. In September 2000, the United Nations Millennium Declaration was signed by 189 countries. Its aim was that poverty eradication and sustainable development be achieved in the world by 2015. This resolution listed a total of eight goals of which Goal 5 directly addresses the issue of maternal mortality. The current rate of maternal mortality ratio of 545 per 100, 000 (FMoH, 2011) put Nigeria way off-track to achieve Millennium Development Goal 5 and this aligns with NDHS (2003) discovery which that even though maternal mortality in Nigeria is high yet unappreciable progress has been made in reducing it since the first Safe Motherhood programmes were launched in the late 1980s. However, with the current rate of reduction, Nigeria is projected to achieve a maternal mortality ratio of 540 per 100,000 by 2015 which is far more than twice the Millennium Development Goal target of 250 per 100,000 for Nigeria. The ratios and ranks of maternal mortality and other closely related health outcomes to maternal health from National Demographic and Health survey, The United Nations and Institute for Health Metric and Evaluation are recorded in tables 1 and 2 below.

Table 1.1: Maternal Mortality Ratio and other Closely related health outcomes in Nigeria

1990

1995

2000

2005

2008

NMR