Nigeria and many other African countries are struggling to end preventable maternal and child deaths due to the acute shortage of skilled health professionals, a UNICEF report has shown.
The report, released this month, showed that although much progress has been made globally in the last two decades, most Africa countries are still struggling to achieve this feat.
The report titled: “healthy mothers, healthy babies: taking stock of maternal health” said the shortage of skilled human health resources – doctors, nurses and midwives – in Africa has been slowing down the progress in maternal health.
According to the report, the shortage of well-trained health workers and midwives hinder lifesaving emergency decisions such as cesarean section which can save both mother and child.
The UN agency said globally, the number of women and girls who die each year due to issues related to pregnancy and childbirth dropped by 43 per cent in 2015, compared to what was obtainable in 1999.
“The figure dropped from 532,000 in 1999 to 303,000 in 2015. However, more than 800 women still die every day from pregnancy-related complications,” it said.
Shortage of Skilled Workers
UNICEF said as of 2017, Africa had an estimated combined health workforce of 1.9 million doctors, nurses, and midwives.
“This is 3.7 million short of the total 5.6 million needed if each country on the continent were to meet the World Health Organisation’s minimum standard,” it said.
According to the report, WHO standards call for a minimum of 44.5 doctors, nurses and midwives per 10,000 populations.
“But for sub-Saharan Africa, in 2017 this value was 12 per 10,000 populations with almost no change since 2010,” UNICEF said.
The UN agency said one of the strategic ways of reducing maternal and newborn mortality in any country is ensuring that every delivery is attended to by skilled providers – a doctor, nurse or midwife.
“Although global coverage of skilled birth coverage of skilled birth attendance has shown impressive gains in recent years, wide gaps in coverage across countries persist. The lowest coverage level tend to be in the poorest countries where mortality level are highest.” it said
Unfortunately, Nigeria’s mortality and new-born/child mortality rate are among the highest in the world. As at 2015, Nigeria has an estimated maternal mortality rate of 576 deaths per 100,000 live births.
Also, the 2016/2017 Multiple Indicator Cluster Survey (MICS) puts Nigeria’s newborn mortality rate to 37 per 1000 births.
UNICEF in another report on Nigeria said the ratio of maternal deaths has not improved over the last decade. Most of the death, it said, occurs in the northern part of the country where the health indices are poorer.
Many of the babies are born in the rural areas where there are no well-equipped health facilities and skilled human health resources to assist with the deliveries.
An investigation by PREMIUM TIMES also shows that Nigeria is in dire need of doctors to meet the health needs of its citizens, official statistics show.
Data from the Medical and Dental Council of Nigeria (MDCN) showed that as at December 2017, Nigeria had 42,845 registered doctors, dentists and alternative medicine practitioners working in the country. Of these numbers, 39,912 are medical doctors.
Nigeria’s population, according to the Nigerian Bureau of Statistics, was estimated at 193.4 million in 2016. With the official data of medical doctors available in Nigeria, the country has an average of one doctor to cater to every 4,845 Nigerians. This translates to about two doctors per 10,000 citizens.
UNICEF said, “Doctors, nurses and midwives provide the core frontline skilled personnel for health systems.
“The number of skilled health personnel per 10,000 populations is a proxy measure for the provision of maternal health services and strong indicator of the strength of systems and commitment of the government to the health of its citizens.”
Unfortunately, the external and internal “brain drain” in Nigeria is having a negative effect on health services. The distributions of health workers in Nigeria are not evenly distributed as it is skewed in favour of the urban areas.
This leaves the rural area where most of the birth occurs at the mercy of half skilled health workers or traditional birth attendants.
Like hospitals, The primary health care centres are poorly staff, badly equipped and lack resources to function effective.
Effect on emergency maternal health
UNICEF said the acute shortage of skilled health care givers in most health facilities in Africa is having a toll on maternal health.
It said a caesarean section (C-Section) can be a life-saving intervention and is an essential part of comprehensive emergency obstetric care, preventing maternal and perinatal mortality and morbidity when medically justified.
Although C section deliveries have increased in all regions, the amount of increase and level of use vary globally.
“Globally around 29.7 million c sections deliveries occurred in 2015- almost double the number in 2000 (around 16 million) – an increase from 12 to 21 per cent.
In Latin America and the Caribbean, C-section accounted for 44 per cent of all deliveries in 2015, more than 10 times higher than the percentage in West Africa and Central Africa (close to four per cent)”.
It said the excessive high average in Latin America and the Caribbean’s suggests over-medicalisation of childbirth; conversely, the low percentage of C section in West and Central Africa is alarming, suggesting a dire lack of access to intervention.
Call to action
With the striking evidence, The UN agency has called on governments across the world to use the available evidence on the number of leading causes of maternal deaths, demographic trends to strengthen the health system including human resources.
“Policies that ensure all women have access to affordable, high quality maternal health services, and improve the status of women are also essential for ending preventable maternal deaths and improving lives of mothers and their babies,” it said.