Why Child-Survival Interventions By Government Fail

Photo Credit, USAid
Photo Credit: USAid

By Chikezie Omeje

On Monday, government officials and health workers gathered at the Area 2 Family Clinic to launch this year’s Maternal, New-born and Child Health Week, MNCHW, in the Federal Capital Territory, FCT, Abuja.

Each of the 36 states of the federation replicates the week at different times of the year, although it is supposed to be done in May and November.

Throughout the week, children under the age of five years will be given essential health care interventions, such as deworming tablets, Vitamin A supplementation and nutritional assessment at any of the 310 designated health facilities in Abuja.

But after this week, some of these services will not be available in the 310 facilities until whenever government decides to organise another health week, thus replacing routine primary health care services that should be provided all year round to eligible children.

Poor implementation, inadequate funding, are some of the reasons why the biannual programme which targets women and children with integrated package of highly cost-effective health interventions in May and November of every year has not made any significant impact on improving child-survival in the country, more than seven years after it started.

The first evaluation of MNCHW by Liverpool School of Tropical Medicine Centre for Maternal and Newborn Health with support from the United Nations Children’s Fund, UNICEF, shows that the programme has not made impact on maternal and child health outcomes as it has not significantly contributed to the coverage of essential MNCHW interventions in the country.

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The report of the evaluation, released in November 2016 indicates that despite the  fact that the programme is designed to reach the marginalised groups, the coverage to groups in rural areas and hard to reach areas is limited.

The report observes that no state has implemented expected MNCHW interventions at any round since 2010 as the programme is often implemented outside of the recommended national dates of May and November each year.

According to the report, the decreased funding of the programme by government since 2013 questions the relevance of MNCHW.

What the MNCHW has rather achieved is that it compromises essential routine primary health care services which are now delivered only during the health week.

A recent story by icirnigeria.org reveals that while these health facilities have been denied Vitamin A supplements for one year, the FCT Primary Health Care Development Board kept 896,000 doses of Vitamin A for the MNCHW.

Parents who sought to give their children Vitamin A to protect them from blindness and boost their immunity against childhood killer diseases like diarrhoea could not get this essential micronutrient in the health centres.

“We found out they are misusing it. They are giving it to adults and selling it,” says the Executive Secretary of FCT Primary Health Care Development Board, Rilwanu Mohammed.

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Mohammed explains that the health facilities are given Vitamin A during MNCHW except in places that record outbreak of measles.

But speaking at the launch of MNCHW, the Acting Secretary of Health and Human Services Secretariat in the FCT administration, Alice Achu-Odey believes government needs to provide all the essential services in the health centres without waiting for the health week.

“We are supposed to provide these services. That’s why government is there. If you go to health centre and the services are not available, you should demand for it. It is your right,” says Achu-Odey to the nursing mothers.

The MNCHW was introduced in 2009 to improve maternal health and accelerate reduction in child deaths by using the campaigns to create awareness for mothers and children to access these services in health facilities but decreased funding over the years has limited these essential interventions to the health week campaigns.

In Abuja, public health facilities get supply of Vitamin A supplements and deworming tablets during the MNCHW which the residents are hardly aware of because of inadequate social mobilisation.

The National Nutrition and Health Survey, NNHS 2015, shows that only 29 percent of households in Abuja receive some services during MNCHW campaign. This, therefore, indicates that more than two-third of 860,000 children being targeted for this week’s campaign will not be reached with these essential interventions.

Already children in Abuja did not receive any of these interventions in November 2016 because the FCT Primary Health Care Development Board was unable to organise the MNCHW due to lack of finance.

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Icirnigeria.org learnt that the programme could not hold last year because the N4 million requested from the FCT administration by the primary health care board was not approved, thereby depriving children these life-saving interventions.

The current MNCHW is being financed through the Saving One Million Lives initiative, a Federal Ministry of Health programme being supported by $500 million credit from the World Bank.

In September last year, the FCT and 36 other states of the federation received $1.5 million each to improve maternal, child, and nutrition health services for women and children. Subsequent funding for states from this World Bank support will be based on their results in improving health outcomes of women and children.

The initiative is based on cost effective interventions to address the leading causes of morbidity and mortality in women and children by ensuring that these essential interventions that are offered during the MNCHW are available in the health facilities all the time.

World Bank says despite huge investments in health, Nigeria’s health system underperforms relative to countries that spend less on health.  Nigeria accounts for 13% of all global deaths of children under the age of five years, second only to India at 21%.

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