•Scene behind govt’s freebie
By Fred Ezeh, Abuja
Stakeholders in Nigeria’s healthcare sector recently gathered in Abuja, for the maiden edition of the Joint Annual Review (JAR) meeting of the sector by the Sector-Wide Approach Office of the Federal Ministry of Health and Social Welfare.
JAR provided an opportunity for the stakeholders to critically evaluate the sector vis-a-vis the performance, achievements and possible challenges that might be slowing down the wheel of progress as regards quality and affordable health care service delivery.
Some policy pronouncements were made by the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, while some adjustments were initiated on some existing policies, all geared towards better and improved health care systems in Nigeria.
He declared that henceforth, Cesarean Sections (CS) in hospitals would be done free of charge, but only to deserving women. The pronouncement generated mixed reactions from the expected beneficiaries, the pregnant women.
While there was jubilation among some of them, others pointed to the fact that the pronouncement needed some more explanations, particularly on the conditions attached.
The policy
Over the years, the rising cases of maternal mortality have been a source of concern for the government and international development partners. Several interventions have been initiated to tackle the challenge, but the expected results have not been achieved, even some progress has been made.
For instance, data from the ministry indicated that the 172 local governments accounted for over 50 per cent of maternal deaths in Nigeria, annually. This, perhaps, formed part of the reasons for the development, and recent launch of Maternal Mortality Reduction Initiative (MAMII), for which the free CS was a key component. Also, the Emergency Ambulance Services boasted to improve efficient and effective ambulance services.
Some stakeholders described the document as a groundbreaking effort by the ministry that will assist in tackling maternal and neonatal mortality rates in, according to data, seems to be among the highest globally.
Pate, said the pivotal feature of the MAMII was the provision of free CS for poor and vulnerable women in health care facilities, as well as other auxiliary services and removing the financial barriers to the life-saving procedure, is to ensure that no woman in need is denied critical care due to cost:
“Maternal mortality remains unacceptably high in Nigeria. By focusing resources on these high-burden areas, MAMII will address the greatest areas of need. Relevant agencies have been directed to ensure the efficient and effective implementation of the policy, ensuring that providers deliver these essential services sustainably.”
The National Emergency Medical Service and Ambulance System (NEMSAS), was also revitalised to provide timely transport for emergencies, bridging a key gap in both maternal and newborn care by bringing emergency services closer to those who need them most.
Free with conditions
Though, the CS service was declared free of charge for pregnant women, but sadly, so many pregnant women who might need the services would not access it due to some undisclosed conditions attached to the service.
The minister failed to add that the service is passed through the National Health Insurance Authority (NHIA), hence anyone particularly those in the informal sector who are not captured in the NHIA database won’t benefit from the service.
This is because the reimbursement for the services is done through the NHIA platforms in collaboration with the National Primary Health Care Development Agency (NPHCDA) and State Health Insurance Agencies (SHIAs). They will be expected to manage the reimbursement process, ensuring that providers across both sectors can deliver these essential services sustainably.
Implementation kicks off
Few days into the pronouncement, and even before the implementation modalities could be finalised for efficient and effective implementation, pregnant women at the Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, have begun to benefit of the policy.
It was gathered that the management and workers at the ATBUTH had embarked on “a free cesarean section” outreach across the hospital community, informing them about the policy even though with limited information.
Being implemented under the Maternal Mortality Reduction Innovation Initiative (MAMII) coordinated Sector-Wide Approach Office of the Federal Ministry of Health and Social Welfare, the ATBUTH said they needed to inform and educate the public, particularly hospital community on the intervention vis-a-vis the process and condition for accessing the services.
Prof. Pate in a post on his verified X account the development marked a significant step in the Ministry’s efforts to save lives, adding, “barely two weeks after the signing of a Memorandum of Understanding (MoU) with the National Health Insurance Authority (NHIA), outreach has already started to deliver free, lifesaving care to women, removing the financial barriers that often cost lives.
“No doubt, we are at the early stages that often come with teething challenges, but we are optimistic that we can expand the intervention carefully and rapidly in the periods ahead. Undoubtedly, MAMII is central to our fight against maternal mortality, particularly intensely targeting 172 high-burden local government areas that account for over half of all maternal deaths.
“By providing free cesarean sections for poor and vulnerable women who meet eligibility criteria, and ensuring these services are accessible in both public and private facilities empaneled by NHIA, this initiative demonstrates how health equity can become a reality.
“This outreach at ATBUTH exemplifies MAMII in action, reinforcing the government’s commitment to reducing maternal and newborn deaths across Nigeria. We commend the health workers and partners for making this possible and reaffirm commitment to ultimately delivering care that reaches every mother and child in need.”
Women speak
In an interaction with Daily Sun in Abuja, pregnant women described the intervention as a life-saver for women, particularly those who often face life-threatening challenges during childbirth.
Shamsiyya Umar said: “I don’t believe in the credibility of the information because people in government have ‘deceived’ the masses in different ways in the past, hence the lost trust and confidence in government and political leaders.
“I am carrying my third child and will soon put to bed in a few weeks’ time. I would love to give birth through CS. That’s when I will test and confirm the authenticity of the pronouncement. I am an NHIA enrollee.”
Kendra Mfom said her friend almost lost her life during childbirth because she couldn’t afford the cost of CS service in a particular health facility in Abuja, she also had no strength to do normal delivery:
“But another major challenge I had with her was that she is too ‘churchy and religious’, which is not a bad thing, but she doesn’t apply wisdom in doing that. She believes in ‘Hebrew Women’ delivery and never accepts CS as an option even when all medical evidence has shown that it’s unsafe for her to engage in normal delivery.
“In addition to that, she is the type that listens and swallows, hook, line and sinker, all what the spiritual fathers say. While this is not wrong, she needs to ‘sieve’ some of the information sometimes and apply wisdom in the belief.”
