It was on a Saturday morning when I (reporter) visited polo-Jiddari community, Jere local government area of Borno, northeast Nigeria, where I encountered women with a strong yet weary faces etched with resilience, as they continue to face a daunting challenge on poor access to health care services.
In a community where women struggle to make ends meet after experiencing a decade-long insurgency, devastating market inferno, and a recent flood disaster, other challenges unfold concerning access to health services especially for maternal mothers, considering the ripple effect of these tragic incidents on livelihood, increased poverty and overall economy of Borno state.
A 2023 report by UNICEF shows that out of the 17 million people who are food insecure in Nigeria, 3 million are in the North-East, particularly Borno, Yobe, and Adamawa.
“I lost my sixth baby because of the complications I had during labour; I only went to antenatal twice because I don’t have transport money to access the free health care facility.” These are the words of 38-year-old Kellu Bunu, trying to explain how she lost her baby to a poor routine check while she was pregnant.
“There is a health facility close to where I am staying here at Polo- Jiddari called ‘Jiddari clinic’ (Jere LGA). I can trek to the place, but I don’t have ₦1,000 to pay for a file. I even went to beg when my pregnancy was five months, but they said no”. Kellu alternatively identified another primary health care centre in Simari community which is far from her home, as she has to pay ₦300 to and fro to access the facility.
“I know the importance of going to the antenatal. I was worried that I couldn’t go, so someone mentioned the one at Simari. I went there twice and everything is free, but I don’t always have transport money. Things are hard for me and my husband, so I laboured at home throughout the night, and the baby came out upside down, the head refused to come out. Tt wasn’t easy for me and the baby couldn’t endure the stress, so we lost him.” Kellu lamented.
A World Health Organization report shows that 2.3 million children died in the first 20 days of life globally which is approximately 6,500 newborn deaths every day, often caused by preventable and manageable issues such as premature birth, birth complications (birth asphyxia/trauma), neonatal infections and congenital anomalies.
More women lament money constraints
The plight of maternal mothers like Kellu is becoming alarming, as more women continue to miss antenatal classes as a result of money constraints.
A number of women at Ajiri (an informal IDP camp) in Jere Local government area who are striving to get food on a daily basis, lamented on their inability to afford the ₦1,000 for antenatal care during their pregnancies, leading to many of them losing their babies before or after child birth.
This reporter observed that some women who are displaced persons barely have money to pay for their antenatal classes, which has made most of them lose hope in visiting the primary health care centre in their communities.
A recent report by the World Health Organization shows that the high number of maternal deaths in some countries reflects inequalities in access to quality health services and highlights the gap between rich and poor. A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high income countries, this risk is 1 in 5300, versus 1 in 49 in low-income countries. The difference is a hundred fold.
Hauwa Adamu, 38, narrated how she suffered at home during labour because she could not go to the hospital. “They would not attend to me because I didn’t do antenatal, so I laboured at home, I laboured for about three days and unfortunately lost the baby as a result.” She said.
Also, Jamila Mohammed, 36, described her experience during pregnancy as a battle, as she continues to struggle through her cap weaving business to raise money to feed her children and pay for antenatal care. “I was sick as a result of the pregnancy, so, it takes me about 4 months to finish one cap. I sold it for 7,000 naira, and I used ₦1,000 for my antenatal at Jiddari Clinic. I was seven months pregnant when I went there”. Jamila noted that she only went to have herself registered so that they can attend to her during labour.
The 2023 UN report on Trends in Maternal Mortality from 2000-2020 revealed that nearly 28.5% of global maternal deaths happen in Nigeria, identifying the North East zone as experiencing some of the country’s worst MNH outcomes after suffering from ongoing conflict, primarily driven by Boko Haram.
A visit to the Gwange community which is under Maiduguri Metropolitan Council (MMC) LGA showed that the trend of pregnant women not accessing health facilities due to money constraints is related to high charges during childbirth.
Falmata Mustapha, mother of 9 children, lamented how delivery charges forced her to labour and deliver the baby at home. “I have paid the ₦500 naira to register for antenatal, and I was able to go for my monthly routine checks at the Gwange Clinic, but they said I would pay ₦2,000 when it’s time for me to deliver, so I had to give birth at home because I don’t have money.”
Continued resource investment in PHCs
The Sexual and Reproductive Health Officer at Borno State Primary Health Care Development Agency, Hajja Jalo Ahmad, stated that all services pertaining maternal health which incorporate antenatal are free, because the state has international partners like World Health Organisation, UNICEF and International Rescue Commission (IRC) among many others who are supporting the state to ensure that women get to access those services free.
According to the approved budget of the Borno State Government, the state has invested over ₦7 billion in its Primary Healthcare (PHC) program from 2020 to 2023, with significant allocation towards infrastructure and additional midwife recruitment in 2021.
In May 2023, Leadership reported that Borno State won a $1.2 million award for ‘PHC leadership’. The award, funded by the Bill & Melinda Gates Foundation and Aliko Dangote Foundation, aims to strengthen the state’s healthcare sector.
Government officials react
Speaking to Borno state government officials from the health sector, the Director, Health Planning Research, Monitoring and Evaluation of the Borno State Primary Healthcare Development Agency, Yerwama Tijjani, acknowledged that the main objective of establishing primary healthcare is to achieve universal health coverage. “The Borno state government under this administration has shown commitment and declared free maternal services across all PHCs in the state, which is why we established the suggestion and complaint boxes across the PHCs where people drop their problems and concerns”.
The Director while responding to reports of money charges attached to the health services emphasised that the agency only works with facts “We only work with what has been forwarded to us, and such a complaint has never reached my desk. I have never received an official complaint about such”. He also stated that there are established policies against anybody who is found wanting “It is an offence, and anybody who’s found guilty will face a severe punishment for going against the government’s policy.”
A similar investigation on PHCs in some of the Borno communities published by Premium Times, uncovered how some of the facilities have beautiful structures but poor staffing and lack of drugs continued to hinder their operations.
It is vital for the Borno State government to do its own investigation and ensure that women all over Borno State can benefit from free maternal health services that have already been provided for.