This month, while world leaders gather at the United Nations General Assembly, WRA has called on our members to submit stories and photographs that illustrate progess that is being made to maternal and newborn health, as well as the efforts of advocates to hold governments accountable to commitments that have been made to Every Woman, Every Child. This posting comes from Bridget Nwagbara, WRA Member, Nigeria.
“Under the right to health, those with responsibilities should be held to account so that misjudgments can be identified and corrected. Accountability can be used to expose problems and identify reforms that will enhance health systems for all.” -A UN Special Rapporteur on the Right to Health
As the deadline to reduce the maternal mortality ratio from 1999 by three-quarters approaches, Nigeria is yet to make progress in this direction with a maternal mortality ratio of 1100 per 100,000 live births. The undeniable major contributor to our dallying advance towards this goal is the ailing state of health care facilities and health care delivery system in the country. Consequently, vast investments have been made recently by the United Nations and the donor community to strengthen health systems capacity in Nigeria. In some parts of the country, health facilities are being renovated and furnished with supplies to meet the demand of mothers and their newborn children and health workers are being trained to be better health facility managers as well as health care givers who can empathize and are open to communication.
However, among these uplifting efforts, a centrally germane issue in health systems capacity building yet to be addressed in Nigeria is a framework for accountability. As the preceding quote affirms, communities and individuals have a right to know why and how maternal deaths occur and health care providers and administrators are under obligation to provide reports and explanations for these deaths. This mandate if properly implemented and disseminated has an inimitable role in establishing an inclusive and coherent approach that will bring individuals, communities, advocates and policy makers together to tackle identified causes of maternal deaths. Nevertheless, rising up to this challenge demands a concrete, systematic and bias free monitoring and evaluating mechanisms that will provide a critical analysis of maternal care delivery.
A confidential enquiry into maternal deaths is one of such vital system that entails active scrutiny of pregnancy related and maternal deaths in health facilities, thus aiding in evaluating the levels, causes of and contributors to maternal mortality and to use lessons learned in preventing future deaths. A key feature of a confidential enquiry into maternal deaths is confidentiality and anonymity granted to the women, health providers and health facilities. It involves documenting all maternal deaths which occur in health facilities across the country, providing records on the primary and final cause of deaths as well as detailing avoidable factors, missed opportunities and substandard care. This system necessitates transparency and criticism by health care workers and health facilities involved in the process, a centralized information management system and must be backed by an enforcing legislature.
The United Kingdom as a forerunner has been implementing this system for more than half a century ago and countries like South Africa and Malaysia have adapted their methodology. Implementing countries make reports with recommendations and design realistic indicators for measuring progress in maternal health delivery. Notably, South Africa produces a triennial report with 10 recommendations which usually border on improving health care delivery systems. These recommendations include making health systems more accessible with good transport and referral services, improved antenatal care, abortion care and contraceptive services and increasing maternal health workers and health care equipment among others. Such recommendations mirror the usefulness of confidential enquiries into maternal deaths for x-raying existing health services and identifying gaps in maternal health delivery.
With only four years left to achieve MDG 5, adopting this system in Nigeria is critical at this time. Although various hospital across the federation have an auditing system through maternal mortality reviews and initiatives like the IMPACT implemented by Partnership for Reviving Routine Immunisation in Northern Nigeria; Maternal, Newborn and Child Health Initiative (PRRIN-MNCH) are working to improve maternal health care in Nigeria through quality assessment and recognition, we need a sound mechanism like confidential enquiries into maternal deaths to document and account for maternal deaths.
While donors are investing into maternal health, they should work with advocacy groups to make the federal and state ministry of health as well as private health organizations establish a central health information system and network to account for maternal deaths. Nigerian health workers should be able to own up confidentially and anonymously to what they are not doing right to curb maternal deaths. Policy makers should rise up to create a favorable legislative ambience for this mode of accountability.
Taking these steps will help us explain why our mothers die needlessly during childbirth, avoid future deaths and put Nigeria in the right direction towards 2015 and beyond.