Tackling Maternal Mortality Through Increased Incentives At Health Facilities

By Lola Seriki- Idahosa, Kaduna, NorthWest, Nigeria.

Poverty is often identified as a major barrier to human development. It is also a powerful brake on accelerated progress towards the implementation of the Sustainable Development Goals.

In Nigeria, especially in the northern region, poverty is seen as a major cause of maternal mortality, as it prevents many women from getting proper and adequate medical attention due to their inability to afford good antenatal care.

Since high levels of poverty limit access to quality health care and consequently human development, this report suggests ways of reducing maternal mortality in Nigeria through increased incentives to health faculties.

Poverty exists when people lack the meant to meet their basic needs. These may be defined narrowly as “those needs necessary for survival, or broadly as those needs reflecting the prevailing standard of living in the community.

Reproductive ill health is both a cause and consequence of poverty. Sexual and reproductive health problems account for approximately 20 percent of the ill-health of women globally, and 14 percent of men due to lack of appropriate sexual and reproductive health services . It is against this background that poverty is seen as a major cause of maternal deaths in Nigeria. (NCBI)

Over the past 60 years, population control has become an increasingly urgent issue in the country, as a growing population strains the already limited resources.

The US Agency for International Development (USAID) defines family planning as activities that “enable couples to determine whether, when, and how often to have children” (USAID, 2011).

Family planning has profound health, economic, and social benefits for families and communities, including protecting the health of women by reducing high-risk pregnancies, protecting the health of children by allowing sufficient time between pregnancies among others.

However, decades of research have also shown that family planning is one of the most cost-effective health interventions in the developing world (USAID, 2011).

Experts opined that the use of financial incentives to promote family planning is an innovative approach that has potential to make a contribution to efforts to better manage population growth.

According to Dr Ahmed Wakili, a consultant Gynaecologist , incentives have been used to promote attendance at contraceptive education sessions, adoption and continuation of contraceptive methods, sterilization, and to limit family size.

At old Afaka community, in Igabi local government area of Kaduna State, North West, Nigeria lack of standard primary healthcare centres is a major challenge that women of the community are contending with. This is coupled with the lack of trained medical personnel to attend to the pregnant women and nursing mothers.

In most cases, majority of the pregnant women do not have the financial resources to transport themselves to the healthcare care centres or pay the bills.

A community health worker, Hajia BilikisuYusuf Wali who spoke with TraceReporter said,

“This is my community and we have no problem with Family Planning or Child Spacing, but poverty is on the high level, sometimes instead of spending just two hundred on motor bike or keke(tricycle) to come for contraceptive , they feel it is better to use it in the kitchen or something else. So my foundation came up with a little strategy last year to give 54 of them Five hundred naira each for transportation, and you have to show evidence that you have been taking contraceptives. Now over two hundred women are showing interest as against the 54 women that I used to assist. Now if the patient is waiting to be giving money to go for free contraceptives , what happens to Health workers who have to travel miles into these health facilities, I think NGOs, and other well meaning stakeholders should help provide little incentives for them”.

“Incentives should be given to health care workers deployed to rural to reach rural communities.

The Kaduna state government is not unaware of this situation, hence it allocated more resources to the State
primary health care development Agency in 2017.

At a one day sensitization workshop with government officials and CSOs in Kaduna, stakeholders in the sector, organized by Kaduna State Maternal Accountability Mechanism (KADMAM) said the amount is a far cry to the huge challenges being faced in the sector.

They are of the believe that all hands must be on deck to see that the over four billion Naira that was budgeted and approved for primary health care development Agency must be fully released to the Agency.

Also, Dahiru Umar of Kubacha in Kagarko LG Kaduna, who worked with National Blood Transfusion Agency in the late nineties said ‘’ incentives is very important, when the issue of blood donation came up and some northerners started kicking against it, it was little incentives that wooed some health workers to go into villages for awareness, and even the people donating blood were also given little items like milk, sugar, soft drinks, bathing soap and others.

“So that was how we gained access to some villages. So NGOs, Stakeholders can look towards incentives for Health Providers and even some little donation of items to women will perform the magic of tripling the number of those taking contraceptives’’

For Anna Christophe, 35,, her inability to raise a token amount of money to purchase contraceptive from healthcare care centre, eventually led her into having eight children that she finds difficult to carter for.

‘’ I am aware of the family planning, but usually when I go for the contraceptives there is a small amount the Health workers will demand sometimes for file, hand gloves and other smaller
items which they told me cannot be given freely, so usually I will
have to pay five hundred naira or six hundred for those materials
before the contraceptives could be administered. So my problem is that sometimes I do not have enough money to transport myself to the venue not to talk of paying five hundred naira for the materials so I could not continue the family planning’’. She said.

At a roundtable discussion between Pathfinder International, an International non- governmental organisation (NGO) in conjunction with Family Health Advocacy Initiative in Nigeria (FHANI) with health correspondents and online editors, to present the global current performance, monitoring and Accountability (PMA) 2020 survey results between 2014- 2017, experts said One of the major barriers was out of pocket expenses (incentives) which about 74% of women pay for family planning services in kaduna state.

According to Pathfinder, why most women don’t do child spacing is as a result of money they pay to the service provider.

“We are working on the issue of incentives, to make it free, we advocate that the Kaduna state government should budget three hundred million naira every year to enable it take care of the incentives and thereby making family planning totally free”.

Family planning has profound health, economic, and social benefits for families and communities, including protecting the health of women by reducing high-risk pregnancies, protecting the health of children by allowing sufficient time between pregnancies, reducing abortions, supporting women’s rights and opportunities for education, employment, and full participation in society, and protecting the environment by stabilizing population growth.

To ensure effective child spacing in Kaduna, experts stressed the need for government, NGOs and other stakeholders to surmount the dilemma of finance and other bottlenecks and provide adequate incentives at the Health Care facilities and improved welfare of the providers.

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