Nigeria    

Dr  Nnenna  Ihebuzor,  Director  PHC  Systems  Development,  NPHCDA  Dr  Joy  Ufere,  Head  Newborn  Care,  FMoH  

Dr  Abimbola  Williams,  Senior  MNH  Manager,  Save  the  Children  Dr  Manuel  Oyinbo,  Senior  MNH  Advisor,  Save  the  Children    

Dr  Garba  Safiyanu,  Health  Specialist,  MNCH,  UNICEF  Mrs  Catherine  Ojo,  Chief  Nursing  Officer,  ABUTH  

 

Regional  Global  Every  Newborn  Ac4on  Plan  Dakar  09-­‐11  July  2013  

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Nigeria’s  profile:  Epidemiology  and  demography  

•  FederaOon  of  36  States  and  FCT  

•  PopulaOon:  167  million  +    

•  WCBA  38m  (NDHS  2008)  

•  U5  pop:  33m  •  Large  birth  cohort:  

6m+  per  year    

Rivers

EkitiOsun

Lagos

Ogun

Oyo

Delta

Bayelsa

OndoEdo

Kogi

Sokoto

Niger

Kwara

Kebbi

Kaduna

Zamfara

Adamawa

AbiaImo

AnambraEnugu

Cross River

Akwa Ibom

Ebonyi

Benue

Taraba

Jigawa

FCT, AbujaNassarawa

Katsina

Kano

Gombe

Plateau

Bauchi

YobeBorno

Zone Southsouth Southeast Northcentral Southwest Northeast Northwest

Map of Nigeria Showing the Six (6) Geo-Political Zones

ChadNiger

Cam

erou

n

Atlantic Ocean

Ben

in

2  

0  

100  

200  

300  

400  

500  

600  

700  

800  

900  

1990   NDHS  2003  

NDHS  2008  

MDG  Targets  

NMR  

U5MR  

MMR  

Child  deaths  (<5  years)  are  declining    BUT  s4ll  liQle  progress  for  neonatal  deaths...    

Now  34%  of  under  five  deaths,  up  from  24%  (in  2008)  

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Nigeria’s  profile:  Epidemiology  and  demography  

•  Inequality  in  coverage  for  MNCH  interven4ons  is  greatest  for  skilled  birth  aQendant,  family  planning,  antenatal  care,  and  immuniza4ons    

•  NMR  also  varies  by  region  (36-­‐50  in  southern  states  vs  40-­‐53  in  northern  states  

   

Nigeria’s  s4llbirth  rate  remains  high  at  42  /  1000  live  births  

     

Child  and  neonatal  mortality  by  wealth  quin4le    

The  poorest  Nigerian  women  have  significantly  less  access  to  MNCH  services  than  richer  women  

SOURCE:  World  Bank:  Socio-­‐economic  Differences  in  Health,  NutriOon,  and  PopulaOon  within  Developing  Countries  

91%  

+196%  31%  

Mul4ple  antenatal  care  (ANC)  visits  %  of  pregnant  women  

Skilled  aQendant  at  birth  %  of  live  births  

+555%  13%  

85%  

Contracep4ve  prevalence  %  of  women  of  reproducOve  age  

21%   +469%  

Richest  20%  

Poorest  20%    

4%  

MCH  service  access  by  the  poorest  and  richest  women  in  Nigeria,  2003  

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•  Per  capita  total  expenditure  on  health:    $59  (2010)  •  Official  development  assistance  to  maternal  and  

newborn  health  per  live  birth  :      $14  (2009)  

Nigeria’s  profile  -­‐  Health  system:  policy,  leadership,  finances  

Government  Tier  

Responsibility  

Federal   NaOonal  policy;  Monitoring;  TerOary  hospitals  

State   PopulaOon  health  in  State;  Referral  State  hospitals  

Local  Government  

Primary  Health  Care  FaciliOes    

•  DeconcentraOon  –  SMoH  •  DelegaOon  –  NPHCDA,  NASCP  •  DevoluOon  –  LGAs  for  PHC  •  Health  on  the  concurrent  list  

–  Some  States  and  LGAs  do  not  prioriOze  health  resulOng  in  inconsistent    health  services  across  states  and  local  government  areas      

•  Generally,  health  services,  uptake  and  indicators  in  southern  States  befer  than  in  northern  States  

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Scaling  up  maternal  &  newborn  health:  MNCH  policies  •  Child  health  policy;  RH  policy;  IMNCH  strategy  with  MNCH  

targets  –  NMR  target  12/1000  live  births  by  2015  •  Vital  registraOon  by  NPopC  but  coverage  about  30%  •  NaOonal  HRH  (2007/8)  policy  and  plan.      

–  To  ensure  adequate  numbers  of  skilled  and  well-­‐moOvated  health  workforce  are  available  and  equitably  distributed  for  quality  health  service  

–  MSS  and  SURE-­‐P  MCH  ensure  availability  in  underserved  areas  (4000  +  4800  respecOvely  by  end  2013)  

–  Long  term  –  increased  producOon  from  SoM  and  SoN  •  InternaOonal  Code  of  MarkeOng  of  Breastmilk  SubsOtutes  policy  

enforced  •  Postnatal  home  visits  in  first  week  of  life  for  maternal  and  

neonatal  health;  coverage  low  •  NaOonal  standard  clinical  treatment  guidelines  2010  

(comprehensive,  not  specific  for  MNCH)  

0  

10  

20  

30  

40  

50  

60  

70  

2003  DHS  

2008  DHS  

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Scaling  up  maternal  &  newborn  health:  Situa4on  analysis  /  coverage  

Variable  coverage  along  the  con4nuum  of  care  for  most  intervenOons  

The  Midwives  Service  Scheme  has  delivered  visible  results  within  two  years  of  implementa4on  

911

-­‐22%  

584789

-­‐26%  Maternal  mortality  ra4o        Deaths  per  100,000  live  births  

Neonatal  mortality  rate    Deaths  per  1,000  live  births  

Use  of  family  planning  methods  %  of  reproducOve  age  women  

Pregnant  women  with  focused  ANC  %  of  pregnant  women  

Skilled  aQendant  at  birth  %  of  births  

50%  +22%  41%  

16%  +33%  12%  

2%  +100%  

2011  2009  

1%  

SOURCE:  Midwives  Service  Scheme  8  

Scaling  up  MNCH:  Ongoing  ini4a4ves  

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EWEC  

NSHDP  

APR  

• UNCoLSC  –  Nigeria  is  co-­‐Chair  • Framework  for  COIA  

•  NaOonal  Health  Bill  •  PHC  fund  for  HRH,  commodiOes,  equipment  

•  Health  insurance  •  RH  commodiOes  security  –  US$3m/year    

• Saving  One  Million  Lives  Ini4a4ve  (6pillars;  2  cross-­‐cufng  )  • Delivery  of  integrated  package  of  MNCH  intervenOons  to  increase  SBA,  ANC  coverage  • Increase  RI  /  eradicate  polio  • eMTCT  • Scale  up  access  to  essenOal  medicines  and  RMNCH  commodiOes  • Control  of  malaria    • Improved  child  nutriOon  

• 2  cross-­‐cumng  enablers  • ICT  and  innova4on  /  unlocking  private  sector  poten4al  • Logis4cs  and  supply  chain  management    

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The  SURE-­‐P  MCH  programme  will  build  on  the  impact  of  MSS  through  supply  and  demand-­‐side  interven4ons  along  

the  con4nuum  of  care  

SOURCE:  PIU  team    

Supply  Inputs   Demand  Inputs  Con4nuum  of  care  

Recruitment   Deploy-­‐ment   Training   Ident-­‐ificaOon  CondiOons  Payment  Antenatal  visit  1  

Antenatal  visit  4  

Skilled  afendant    at  birth  

Postnatal  care  

Family  Planning  

Human  Resources  for  Health   CondiOonal  Cash  Transfer  

▪  Midwives  and  CHWs  recruited  from  school  or  unemploy-­‐ment  database,  VHWs  from  commu-­‐niOes  

▪  Midwives  and  CHWs  deployed  aner  enrolment,  VHWs  deployed  aner  training  

▪  All  cadres  receive  a  one-­‐week  training  

▪  Women  who  meet  condiOons  are  paid  a  set  incenOve  value    

▪  Women  are  encour-­‐aged  to  meet  programme  condiOons  (i.e.  to  access  MCH  services  at  PHCs)  

▪  Pregnant  women  in  the  community  idenOfied  by  VHW,  CHW,  or  midwife  

•  Health  system  blocks  –  Leadership  and  governance  –  HRH  -­‐  density  of  doctors,  nurses  and  midwives  (per  10,000  populaOon)  is  20.1  (2008).  Main  issue  inequitable  distribuOon  

–  Finance  –  CommodiOes  and  Service  delivery    

•  SBA  including  EONC,  ANCS  •  ENBC  including  CHX  

–  Demand  creaOon      •  Con4nuum  of  care  –  Delivery  plaporms  

•  Access  to  care  –  geographic,  financial,  socio-­‐cultural  •  Community  based  care    •  QoC  at  faciliOes  

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Scaling  up  maternal  &  newborn  health:  challenges,  boQlenecks  

Thank  you  

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