Morocco

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Midwife Catherin Ojo shows mother Halima Abubakar, 22, how to care for her newborn baby. Photo credit: Jane Hahn / Panos

Catherine Oluwatoyin Ojo works in Northern Nigeria. She is chief nursing officer at the Special Care Baby Unit (SCBU) of Ahmadu Bello University Teaching Hospital. Some years ago Catherine cared for a preterm baby who nearly died many times, and because of this, she started the SCBU. She now trains other nurses and midwives on essential newborn care techniques such as Kangaroo Mother Care and how to prevent mother-to-child transmission HIV. Catherine was the winner of the Save the Children’s EVERY ONE Midwife Award in 2011.

Catherine says: “Nigeria is a hard place to be a mother. As a midwife there, I should know. Too many mothers and babies are dying by the thousands every year, but dying needlessly.

Many women who are in need of medical care in Nigeria don’t get it for a variety of reasons. Either they can’t afford it, they live too far from a health facility, or their husbands haven’t allowed them to go. Some women literally die waiting for this permission.

It’s no surprise then that, by and large, Nigerian women are choosing to deliver at home, sometimes with the help of a trained birth attendant, but too often without one. The health workers that are trained are not paid well, which gives them little incentive to stay in the communities where they’re needed most. Compound this with bad roads, lack of electricity and poor water supply and you can appreciate why our maternal and child health figures aren’t better.

A big part of the solution is to train more community midwives and health workers, which I’m pleased to say Nigeria has already started doing. These women are being taught life-saving skills such as neonatal resuscitation, infection control, Kangaroo Mother Care and family planning so that women can have babies by choice, not by chance. We also need stronger health systems to ensure health care is accessible for all, especially those living in rural communities. And more than anything, we need greater political will and commitment to ensure that the health of mothers and children is a top priority for governments around the world.”

Neonatal mortality rate  (per 1,000 live births) (2011) 39
Under-five mortality rate (per 1,000 live births) (2011) 124
Maternal mortality ratio (per 100,000 live births) (2010) 630
Number of doctors, nurses and midwives per 10,000 people (2010) 18
Births attended by skilled personnel (2008) 34.4%
Total expenditure on health as a percentage of gross domestic product (2011) 5.3%
General government expenditure on health as a percentage of total expenditure on health (2011) 36.7%

Nigeria has one of the largest stocks of health workers in Africa but the densities of nurses, midwives and doctors are too low to effectively deliver essential health services to the whole population. States in the north have a particularly acute shortage of health workers and some of the worst maternal and child health indicators in the world. Programmes like the Women For Health Consortium are supporting more women and girls to acquire the necessary skills and qualifications to become nurses and midwives in the most underserved areas.

The processes for the adoption of a National Health Act have been ongoing since 2004. A National Health Bill, which is yet to be passed, seeks to clarify the roles and responsibilities of the Federal, State and Local Governments in relation to health care in the country. If the Bill is fully funded and implemented, it would lead to significant scaling up the coverage of basic life-saving healthcare services.

The previous National HRH Strategic Plan (2008-2012) sought to improve equity in staff distribution and access to quality care but financing and implementation of this plan varied across states. It has been recognised that there is a need to improve coordination between States to ensure a more harmonized approach to HRH strengthening.

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