- Email: [email protected]
Maternal and child health and family planning in Nigeria
PubL Hhh. Lond. (1981)95.-. 344-346
Maternal and Child Health and Family Planning in Nigeria Muriel A. Oyediran Associate Professor. Department of Community Health. College of Medicine. University of Lagos. Nigeria. There are many'problems facing Nigeria in the provision, management and utilization of maternal and child health services. Researchers have helped to identify some of the problem areas such as the delays which occur in seeking 'medical care for the ill child and the difficulties experienced in increasing family planning acceptance in rural areas where the infant mortality rate is still high. However, acoeptance of family planning services appears greater in urban areas and may be related to the easier availability of health services for both mothers and children. The development of the Basic Health Services Scheme by the Federal Government of Nigeria should provide solutions to these problems by the provision of comprehensive care at the rural level, provided it is possible to co-ordinate these activitiesat the State and Local Govermnent levels.
The m a t e ~ a l and child health services available in Nigeria provide care to only a very small percentage o f the population, who are mainly those living in the urban areas. Over 85~,~ of the population live in rural areas where medical facilities and coverage are sorely lacking, consequently, the maternal and infant mortality rates for Nigeria as a whole remain very high. 1 The problems facing Nigeria involve not only the inadequate provision of trained medical and paramedical manpower and facilities but also the inefficient utilization by the community, o f the services provided. M a n y mothers are unwilling to use the services or use them inefficiently because o f various factors such as the distance o f the service from their home, the length o f time they have to wait before receiving attention and treatment, a n d the attitudes of highly trained and educated staff towards illiterate and ignorant women. In a study perforxned in Lagos in 1970, the inefficient use of services was demonstrated by the fact that alt~hough 53% of a sample of 526 ill children were seen at the Casualty Department o f the Teaching Hosptial within 2 days o f the onset o f their illness, 12% were not seen until 2-3 weeks had elapsed since the onset o f their illness? in addition, many of the infant welfare services are short staffed and ill equipped, so that minimal services can be offered to the mothers with regard to preventive and promotive health care for their children. This in turn leads to disillusionment with the service and a consequent reduction in clinic attendance. With the high infant mortality rate o f over 150 deaths/1000 live births which still exists in the rural areas, mothers are unlikely to accept family planning on its own as a desirable contribution to the improvement of their health and their family's health. However, it must not be "forgotten that a traditional taboo o f sexual abstinence while lactation is in progress is still actively practised. In 1975, out o f a sample o f 200 women interviewed from the Shomolu low-income area o f Lagos, 8 9 ~ o f them had practised sexual abstinence after delivery. The mean duration o f lactation was 13-1 months and the mean length of abstinence 18.-1 months. It was also found that 18% o f them had used modern contraception in the past. ~ 0033-3506/81/060344+03 $01.00/0
t~) 1981 The Society of Community Medicine
Maternal and Child Health and Family Planning
345
Another study performed in the Ishan division of Bcndel State, over a 4-year period from 1969 to 1972, showed an increase in contraceptive practice from less than 1% in 1969 to 24% in 1972, in an esscn!ially rural area. This increase resulted from the initiation of a family planning programme in the area by the Zuma Memorial Hospital at Irrua. 7 The Department of Community Health College of Medicine, University of Lagos has been running a family planning clinic since 1967, which not only provides a service to the community but also acts as a training centre for doctors and nurses as well as a research facility. At present the department is involved in the family planning training of the Community Health Officer who is the new cadre of health worker for the Basic Health Services Scheme (B.H.S.S.). The experience of the family planning clinic of the Department of Community Health appears to show that non-educated women accept family planning services more easily in urban areas than in rural areas. An analysis of the educational status of women attending our family planning clinic in 1972, showed that 42% of the acceptors had no education, while only 8,% attending the clinic had professional or post-secondary education? The ready acceptance of family planning by non-educated women in Lagos is probably related to the ease of availability of that service and also to the availability of health care services for their children either through private practitioners or local, state and federal services and institutions. The experience of the Lagos Family Health Clinic, organized by the former Institute of Child Health of the University of Lagos {now the Institute of Child Health and Primary Care) has shown that a community approach to the provision of a comprehensive maternal and child health and family planning service can be most successful in improving the health status of women and children in an urban ~ t t i n g ) The use of nurse practitioners, specially trained and working with standing orders, to provide care in this service, has helped to increase the efficiency of the provision and delivery of health care. This type of clinic has been emulated in various parts of Nigeria with varying degrees of success dependent on the efficiency of implementation) The Federal Government is well aware of the problems stated and as far back as 1975 the 3rd Development Plan for Nigeria for 1975-1980 proposed the B.H.S.S. as a means of providing comprehensive family health care for Nigcrians, using a tier system. The main objectives of the scheme are to provide a nationwide integrated health scheme by: (1) adopting a'health care system best suited to local conditions. This should correct the imbalance of location and distribution of health facilities and the imbalance between curative and preventive medicine and would include nationwide programmes for community health schemes and preventive programmes including the control of communicable diseases; (2) standardizing the organization, administration and management of health scrvices throughout the country and integrating existing health services into the scheme; (3) planning for and training o f new cadres of health personnel and then staffing and equipping of the scheme by the early 1908s) The emphasis on the provision of maternal and child health services in the B.H.S.S. is very encouraging, especially as family planning has been included to complete the triad of care. This should enable doctors, nurses, other paramedical personnel and the community to co-operate with each other in improving the delivery of health care to mothers and children. The provision of the new cadre health worker (the Community Health Officer) has commenced with the first training programme initiated in 1979, and the first set of graduates are already available to assume their role as leaders of the health team for the B.H.S.S.
346
M. A. Oyediran
The scheme is however still in its infancy, as m a n y o f the health centres and clinic outposts still remain to be built and equipped. Many o f the teething problems being experienced are, as mentioned earlier, related to the diversity o f authorities involved in the provision of health services and care for the community. It is hoped that these problems will be resolved at the earliest opportunity to enable the scheme to take off smoothly and to achieve its objectives by the early to middle I980s. ~
Acknow|edgements My thanks go to the Carl Duisberg Gesellschaft e.v.. the organizers of the Seminar, which led to the writing of this paper, to Professor O. Ransome-Kuti. Department of Pacdiatrics, and to Dr A. P. Curran, Visiting Professor, Department of Community Health, College of Medicine, University of Lagos. for their critical appraisal and advice. References 1. Akinkugbe, O. O., Olatunbosun, D. & Fo~ayan Esan. G. J. (Eds) (1973). Priorities in National Health Planning. Ibadan: The Caxton Press (We~t Africa) Limited. 2. The 3rd Development Plan for Nigeria 1975-1980. (1975). Lagos: The Central Planning Office, Federal Ministry o f Economic Development. 3. Pagan, A. (1976). Derelopment and Basic Health Sere'ices in Nigeria, London: Department of Health and Social Security. 4. News Item (1980). Nigeria's P.H.C. Scheme gets off the ground. Africa 1tealth 2, May. 5. Oyediran, M. A. (1974). Utilisation of medical facilities in Lagos by pre-school age children Nigerian Medical Journal 4, 63-71. 6. Bamisaiye, A., De Sweemar, C. & Ransome-Kuti, O. (1978). Developing a clinic strategy appropriate to community family,planning needs and practices. An experience in Lagos, Nigeria. Studies in Family Planning 9, 2-3, 44-8. 7. Faroog, G. M. & Adeokun, L. A. (1976). Impact of a rural family planning programme in Ishan, Nigeria 1969-72. Studies in Family Planning 7 158-69. 8. Oyediran, M. A. & Ewumi, E. O. (1976). A profile of family planningclients at the Family Health Clinic, Lagos, Nigeria. Studies in Family Plamffng 7, 170-4. 9. Ransome-Kuti, O. (1979). Innovations in child health services in Nigeria. World Hospitals 15,
194--8.
Maternal and Child Health and Family Planning in Nigeria Muriel A. Oyediran Associate Professor. Department of Community Health. College of Medicine. University of Lagos. Nigeria. There are many'problems facing Nigeria in the provision, management and utilization of maternal and child health services. Researchers have helped to identify some of the problem areas such as the delays which occur in seeking 'medical care for the ill child and the difficulties experienced in increasing family planning acceptance in rural areas where the infant mortality rate is still high. However, acoeptance of family planning services appears greater in urban areas and may be related to the easier availability of health services for both mothers and children. The development of the Basic Health Services Scheme by the Federal Government of Nigeria should provide solutions to these problems by the provision of comprehensive care at the rural level, provided it is possible to co-ordinate these activitiesat the State and Local Govermnent levels.
The m a t e ~ a l and child health services available in Nigeria provide care to only a very small percentage o f the population, who are mainly those living in the urban areas. Over 85~,~ of the population live in rural areas where medical facilities and coverage are sorely lacking, consequently, the maternal and infant mortality rates for Nigeria as a whole remain very high. 1 The problems facing Nigeria involve not only the inadequate provision of trained medical and paramedical manpower and facilities but also the inefficient utilization by the community, o f the services provided. M a n y mothers are unwilling to use the services or use them inefficiently because o f various factors such as the distance o f the service from their home, the length o f time they have to wait before receiving attention and treatment, a n d the attitudes of highly trained and educated staff towards illiterate and ignorant women. In a study perforxned in Lagos in 1970, the inefficient use of services was demonstrated by the fact that alt~hough 53% of a sample of 526 ill children were seen at the Casualty Department o f the Teaching Hosptial within 2 days o f the onset o f their illness, 12% were not seen until 2-3 weeks had elapsed since the onset o f their illness? in addition, many of the infant welfare services are short staffed and ill equipped, so that minimal services can be offered to the mothers with regard to preventive and promotive health care for their children. This in turn leads to disillusionment with the service and a consequent reduction in clinic attendance. With the high infant mortality rate o f over 150 deaths/1000 live births which still exists in the rural areas, mothers are unlikely to accept family planning on its own as a desirable contribution to the improvement of their health and their family's health. However, it must not be "forgotten that a traditional taboo o f sexual abstinence while lactation is in progress is still actively practised. In 1975, out o f a sample o f 200 women interviewed from the Shomolu low-income area o f Lagos, 8 9 ~ o f them had practised sexual abstinence after delivery. The mean duration o f lactation was 13-1 months and the mean length of abstinence 18.-1 months. It was also found that 18% o f them had used modern contraception in the past. ~ 0033-3506/81/060344+03 $01.00/0
t~) 1981 The Society of Community Medicine
Maternal and Child Health and Family Planning
345
Another study performed in the Ishan division of Bcndel State, over a 4-year period from 1969 to 1972, showed an increase in contraceptive practice from less than 1% in 1969 to 24% in 1972, in an esscn!ially rural area. This increase resulted from the initiation of a family planning programme in the area by the Zuma Memorial Hospital at Irrua. 7 The Department of Community Health College of Medicine, University of Lagos has been running a family planning clinic since 1967, which not only provides a service to the community but also acts as a training centre for doctors and nurses as well as a research facility. At present the department is involved in the family planning training of the Community Health Officer who is the new cadre of health worker for the Basic Health Services Scheme (B.H.S.S.). The experience of the family planning clinic of the Department of Community Health appears to show that non-educated women accept family planning services more easily in urban areas than in rural areas. An analysis of the educational status of women attending our family planning clinic in 1972, showed that 42% of the acceptors had no education, while only 8,% attending the clinic had professional or post-secondary education? The ready acceptance of family planning by non-educated women in Lagos is probably related to the ease of availability of that service and also to the availability of health care services for their children either through private practitioners or local, state and federal services and institutions. The experience of the Lagos Family Health Clinic, organized by the former Institute of Child Health of the University of Lagos {now the Institute of Child Health and Primary Care) has shown that a community approach to the provision of a comprehensive maternal and child health and family planning service can be most successful in improving the health status of women and children in an urban ~ t t i n g ) The use of nurse practitioners, specially trained and working with standing orders, to provide care in this service, has helped to increase the efficiency of the provision and delivery of health care. This type of clinic has been emulated in various parts of Nigeria with varying degrees of success dependent on the efficiency of implementation) The Federal Government is well aware of the problems stated and as far back as 1975 the 3rd Development Plan for Nigeria for 1975-1980 proposed the B.H.S.S. as a means of providing comprehensive family health care for Nigcrians, using a tier system. The main objectives of the scheme are to provide a nationwide integrated health scheme by: (1) adopting a'health care system best suited to local conditions. This should correct the imbalance of location and distribution of health facilities and the imbalance between curative and preventive medicine and would include nationwide programmes for community health schemes and preventive programmes including the control of communicable diseases; (2) standardizing the organization, administration and management of health scrvices throughout the country and integrating existing health services into the scheme; (3) planning for and training o f new cadres of health personnel and then staffing and equipping of the scheme by the early 1908s) The emphasis on the provision of maternal and child health services in the B.H.S.S. is very encouraging, especially as family planning has been included to complete the triad of care. This should enable doctors, nurses, other paramedical personnel and the community to co-operate with each other in improving the delivery of health care to mothers and children. The provision of the new cadre health worker (the Community Health Officer) has commenced with the first training programme initiated in 1979, and the first set of graduates are already available to assume their role as leaders of the health team for the B.H.S.S.
346
M. A. Oyediran
The scheme is however still in its infancy, as m a n y o f the health centres and clinic outposts still remain to be built and equipped. Many o f the teething problems being experienced are, as mentioned earlier, related to the diversity o f authorities involved in the provision of health services and care for the community. It is hoped that these problems will be resolved at the earliest opportunity to enable the scheme to take off smoothly and to achieve its objectives by the early to middle I980s. ~
Acknow|edgements My thanks go to the Carl Duisberg Gesellschaft e.v.. the organizers of the Seminar, which led to the writing of this paper, to Professor O. Ransome-Kuti. Department of Pacdiatrics, and to Dr A. P. Curran, Visiting Professor, Department of Community Health, College of Medicine, University of Lagos. for their critical appraisal and advice. References 1. Akinkugbe, O. O., Olatunbosun, D. & Fo~ayan Esan. G. J. (Eds) (1973). Priorities in National Health Planning. Ibadan: The Caxton Press (We~t Africa) Limited. 2. The 3rd Development Plan for Nigeria 1975-1980. (1975). Lagos: The Central Planning Office, Federal Ministry o f Economic Development. 3. Pagan, A. (1976). Derelopment and Basic Health Sere'ices in Nigeria, London: Department of Health and Social Security. 4. News Item (1980). Nigeria's P.H.C. Scheme gets off the ground. Africa 1tealth 2, May. 5. Oyediran, M. A. (1974). Utilisation of medical facilities in Lagos by pre-school age children Nigerian Medical Journal 4, 63-71. 6. Bamisaiye, A., De Sweemar, C. & Ransome-Kuti, O. (1978). Developing a clinic strategy appropriate to community family,planning needs and practices. An experience in Lagos, Nigeria. Studies in Family Planning 9, 2-3, 44-8. 7. Faroog, G. M. & Adeokun, L. A. (1976). Impact of a rural family planning programme in Ishan, Nigeria 1969-72. Studies in Family Planning 7 158-69. 8. Oyediran, M. A. & Ewumi, E. O. (1976). A profile of family planningclients at the Family Health Clinic, Lagos, Nigeria. Studies in Family Plamffng 7, 170-4. 9. Ransome-Kuti, O. (1979). Innovations in child health services in Nigeria. World Hospitals 15,
194--8.