Expanding National Health Insurance to Rural Communities

The United Nations Children’s Funds has underscored the need for the Nigerian government to expand national health insurance to inaccessible communities, invest in primary health care and promote routine immunisation to save the 8 million babies born yearly in the country while ensuring every pregnant woman survives. Rebecca Ejifoma details other multifaceted approaches of global body.

In Nigeria, just like in most sub-Saharan Africa, having children is the most delicious news almost every couple wishes to spread to families and loved ones. One of the reasons for this desire is fear of the stigma of infertility, not having an heir or keeping the marriage “safe and secure”, among others. However burdensome the delay in conceiving may be, no family wishes to lose a daughter or daughter-in-law during childbirth or to pregnancy-related causes. Hence, globally, women of childbearing ages – 15 and 49 – and children under-five are considered the most vulnerable in society. That is why local and international organisations have made calls, recommendations, suggestions and interventions to save pregnant women and help babies survive and thrive.

One international organisation on the front burner of solution-driven interventions to save pregnant women and children in Nigeria is the United Nations Children’s Funds, UNICEF. Since the 17 Sustainable Development Goals (SDGs) officially came into force on 1st January 2016 following the adoption by the world leaders in September 2015, UNICEF has been intentionally pushing Nigeria to attain zero maternal and under-five mortality daily and prevent the spread of diseases among others by 2030, the target of SDG.

Arguably, UNICEF has outlined numerous approaches to strengthen the nation’s already weak health sector and boost its economic and global status. One of the reasons for this unending push is the nation’s abysmally disturbing maternal and child death rates of 512 pregnant women of every 100,000 live births. This obnoxious rate of maternal deaths places the country among the highest in the world with the worst MMR and a distant touch with the SDG of less than 70 per 100,000 live births by 2030.

Expanding National Health Insurance Scheme against Maternal Deaths
Following the new data from the global MMR trends between 2000 and 2020, which covers the first five years of the SDGs 2016 to 2020, estimates that about 225 women died daily from pregnancy-related causes and childbirth in Nigeria launched weeks ago. This shows that 225 families lost their daughters during childbirth. It also translates to 225 new widowers and possibly 225 motherless babies produced daily in Nigeria.

Consequently, UNICEF has implored the government to expand national health insurance to bend the curve. “Now we have a potent tool to get universal health coverage and reduce maternal mortality, that is national health insurance,” says the Chief of Health, UNICEF Nigeria, Dr Eduardo Celades. He also appealed to the government to “Expand the national health insurance as much as possible. Invest in the most vulnerable so they have access to health insurance. We are appealing to the state governments and partners to allocate resources to that”.

Investing in Primary Healthcare to Reduce MMR
Among UNICEF’s recent recommendations at a media parley in Lagos is the need to reach women and children in hard-to-reach/inaccessible communities like Agboyi-Ketu, Agboyi I, Agboyi II, and Agboye III, Agboyi-Owode, Papa, Ilaje, Okunagbon, Ilashe and Ibeshe among a host of others in Lagos state have continued to struggle to exist with the absence of a working primary healthcare centre each. According to research, primary healthcare centres enable health systems to support a person’s needs, like health promotion, disease prevention, treatment, rehabilitation, improved quality care, and early management of health conditions, among others.

Thus, Celades harped on conscious investment in PHCs across the country. He emphasised, “We need to increase effective investment in primary healthcare at the state level and basic health. Without investments and addressing the right priorities, we won’t be able to bend the curve. I appeal that we target the most vulnerable women in hard-to-reach and inaccessible areas. To do that, we must be clear with the data and invest in getting to the last one.” He insisted that Nigeria should increase effective investment in primary healthcare at the state level and basic health.

Promoting Routine Immunisation
While investing in primary healthcare centres across the country is a plus to win against MMR, the UNICEF health specialist has harped on the need to increase the uptake of routine immunisation for children. “In Nigeria, it is estimated that 8 million children are born yearly, like there are 7 million pregnant women now, for example. So, the critical question is how can we ensure these women and children survive? How can we reduce child mortality, especially newborns? Because we are not managing to do that. How can we ensure no woman dies when she is pregnant?

“The latest report tells us that there are a number of pregnant women who die due to pregnancy-related causes, it’s about 82,000 per year. What we are trying to do as UNICEF and the government is to strengthen primary healthcare and to have enough human resources, commodities and delivery, financial resources, and good data to bend the curve and accelerate progress.”

Lagos, Sokoto Zamfara with High Unvaccinated Children
In the analysis UNICEF conducted, Nigeria had a high number of children who were not vaccinated at all during COVID-19 in the last couple of years. “We estimated that in Nigeria at this moment, there are 2.2 million children with no vaccines. There has been a decrease in immunisation for children, likely because of the bandwidth of the governments to deliver these services. Nigeria has been an exception. Nigeria has been able to progress despite COVID-19. However, the progress has slowed down, and at this moment, we have a big issue,” he warned.

The health specialist cited that three out of 10 children are zero-dosed (never had the Penta 1 dose before). “We have been analysing to find out where they are, and our priority this year is to get these pockets of children who are not vaccinated.” While noting that some of the children could not get the vaccines because the services were not available, Celades confirmed that these children are predominantly in the North – Sokoto and Zamfara states. “It is also across Nigeria. When we look at the 100 priority local councils with many zero-dosed children, the numbers are more in the North. We have two in Lagos, including Alimosho. We have one in Ogun State. We have some in Plateau, Bauchi, and Nasarawa states. We have them in 18 states across the federation.”

Available Vaccines in Nigeria to Reduce Infant Mortality
According to Celades, there are about 18 antigens in the country on the routine immunisation scale, from Rotavirus for Diarrhoea, Pneumococcal vaccine for Pneumonia and vaccines for Measles, Diphtheria, and Tetanus, among others. The UNICEF chief of health is confident that “Vaccines work, and we know that it is one of the most powerful historical tools to reduce child mortality. The challenge becomes ensuring that all the children who need it have access to it”.

Hence, UNICEF’s priority this year is its collaboration with the Federal Ministry of Health and the National Primary Health Care Development Agency (NPHCDA). This is in their attempt to get to these children that “We lost over the last couple of years and are trying to ensure that there are no more zero-dosed children. We are working with all our partners to reach out to them”, says Celades.

Alarming Maternal Deaths in Other African Countries
Comparing MMR among African countries, data available to the Ghana Health Service shows that it recorded 776 maternal deaths in 2020. For other African nations with MMR of 2017 as latest available, Zimbabwe recorded 458 maternal deaths; Gambia had 597 deaths of mothers to pregnancy-related causes; Benin Republic recorded 397 maternal deaths; Togo had 396 maternal deaths; Uganda recorded 375 maternal mortality, and Malawi recorded 349 MMR in every 100,000 live births.

Leveraging Social Media Influencers like Waje, Nuhu Others
UNICEF is strategising. It harnesses every tool possible, including social media and its influencers, to attain SDG 3 through better healthcare for mothers and children and routine immunisation. It was for this course of saving more mothers and babies that UNICEF is working with social media influencers and entertainers like Nigerian singer Aituaje Iruobe professionally known as Waje, Nigerian actor and director Ali Nuhu; social media doctor influencer Dr Chiamaka Nkanno popularly known as Dr Zobo; Nigerian Chess Master, Coach and Founder of Chess in Slums Africa, Tunde Onakoya.

In the succinct words of Waje to THISDAY, she will do a lot of short clips on YouTube to reach women in rural communities regarding the need for immunisation. “I’ve figured out the different means of communication like Instagram, Snapchat, Tiktok is big with the Gen Zs.

With over 1.5m followers on her verified Instagram page @officialwaje and 727,000 followers on Twitter, Waje is leveraging collaboration with other influencers in his clique to reach more young mothers. “In collaborating with these artistes, I plan to spread vaccination awareness in any other language if we have to,” recounting how during Covid-19, “We did a clip where I spoke Igbo; my mother is Igbo. If we have to do that this time, we will.”

For Ali Nuhu, who has over 2.7m followers on his verified Instagram account, @realalinuhu and 452,000 followers on his Twitter, he proposed breaking down the message of immunisation, going to communities to have sessions with the dwellers, doing jingles on radio and TV stations in more local languages to educate society. He added, “By merely hearing your voice, these dwellers wait and listen.”

UNICEF to Reward States Investing in PHCs
As a moral support, UNICEF is collaborating with the Nigerian Governors Forum and other key partners for the Primary Healthcare Leadership Challenge coming up in May. This challenge aims to recognise and award state governments investing resources, time and efforts in revamping primary health care.

“An independent judging panel will give the award based on data,” says the health chief. “We will provide 13 awards in the six geo-political zones to the best state and the most improved, as well as one national champion.” According to Celades, UNICEF is not oblivious to the power of incentives for state governors to invest in primary healthcare.

With Nigeria having the second highest number of unvaccinated children globally and rated among the worst nations with MMR, UNICEF and the UN seek more vital collaborations with the Nigerian government. He added: “We cannot work alone; we need the government; we also need to work with journalists and social media influencers to make the needed change.”

Expanding National Health Insurance to Rural Communities

The United Nations Children’s Funds has underscored the need for the Nigerian government to expand national health insurance to inaccessible communities, invest in primary health care and promote routine immunisation to save the 8 million babies born yearly in the country while ensuring every pregnant woman survives. Rebecca Ejifoma details other multifaceted approaches of global body.

In Nigeria, just like in most sub-Saharan Africa, having children is the most delicious news almost every couple wishes to spread to families and loved ones. One of the reasons for this desire is fear of the stigma of infertility, not having an heir or keeping the marriage “safe and secure”, among others. However burdensome the delay in conceiving may be, no family wishes to lose a daughter or daughter-in-law during childbirth or to pregnancy-related causes. Hence, globally, women of childbearing ages – 15 and 49 – and children under-five are considered the most vulnerable in society. That is why local and international organisations have made calls, recommendations, suggestions and interventions to save pregnant women and help babies survive and thrive.

One international organisation on the front burner of solution-driven interventions to save pregnant women and children in Nigeria is the United Nations Children’s Funds, UNICEF. Since the 17 Sustainable Development Goals (SDGs) officially came into force on 1st January 2016 following the adoption by the world leaders in September 2015, UNICEF has been intentionally pushing Nigeria to attain zero maternal and under-five mortality daily and prevent the spread of diseases among others by 2030, the target of SDG.

Arguably, UNICEF has outlined numerous approaches to strengthen the nation’s already weak health sector and boost its economic and global status. One of the reasons for this unending push is the nation’s abysmally disturbing maternal and child death rates of 512 pregnant women of every 100,000 live births. This obnoxious rate of maternal deaths places the country among the highest in the world with the worst MMR and a distant touch with the SDG of less than 70 per 100,000 live births by 2030.

Expanding National Health Insurance Scheme against Maternal Deaths
Following the new data from the global MMR trends between 2000 and 2020, which covers the first five years of the SDGs 2016 to 2020, estimates that about 225 women died daily from pregnancy-related causes and childbirth in Nigeria launched weeks ago. This shows that 225 families lost their daughters during childbirth. It also translates to 225 new widowers and possibly 225 motherless babies produced daily in Nigeria.

Consequently, UNICEF has implored the government to expand national health insurance to bend the curve. “Now we have a potent tool to get universal health coverage and reduce maternal mortality, that is national health insurance,” says the Chief of Health, UNICEF Nigeria, Dr Eduardo Celades. He also appealed to the government to “Expand the national health insurance as much as possible. Invest in the most vulnerable so they have access to health insurance. We are appealing to the state governments and partners to allocate resources to that”.

Investing in Primary Healthcare to Reduce MMR
Among UNICEF’s recent recommendations at a media parley in Lagos is the need to reach women and children in hard-to-reach/inaccessible communities like Agboyi-Ketu, Agboyi I, Agboyi II, and Agboye III, Agboyi-Owode, Papa, Ilaje, Okunagbon, Ilashe and Ibeshe among a host of others in Lagos state have continued to struggle to exist with the absence of a working primary healthcare centre each. According to research, primary healthcare centres enable health systems to support a person’s needs, like health promotion, disease prevention, treatment, rehabilitation, improved quality care, and early management of health conditions, among others.

Thus, Celades harped on conscious investment in PHCs across the country. He emphasised, “We need to increase effective investment in primary healthcare at the state level and basic health. Without investments and addressing the right priorities, we won’t be able to bend the curve. I appeal that we target the most vulnerable women in hard-to-reach and inaccessible areas. To do that, we must be clear with the data and invest in getting to the last one.” He insisted that Nigeria should increase effective investment in primary healthcare at the state level and basic health.

Promoting Routine Immunisation
While investing in primary healthcare centres across the country is a plus to win against MMR, the UNICEF health specialist has harped on the need to increase the uptake of routine immunisation for children. “In Nigeria, it is estimated that 8 million children are born yearly, like there are 7 million pregnant women now, for example. So, the critical question is how can we ensure these women and children survive? How can we reduce child mortality, especially newborns? Because we are not managing to do that. How can we ensure no woman dies when she is pregnant?

“The latest report tells us that there are a number of pregnant women who die due to pregnancy-related causes, it’s about 82,000 per year. What we are trying to do as UNICEF and the government is to strengthen primary healthcare and to have enough human resources, commodities and delivery, financial resources, and good data to bend the curve and accelerate progress.”

Lagos, Sokoto Zamfara with High Unvaccinated Children
In the analysis UNICEF conducted, Nigeria had a high number of children who were not vaccinated at all during COVID-19 in the last couple of years. “We estimated that in Nigeria at this moment, there are 2.2 million children with no vaccines. There has been a decrease in immunisation for children, likely because of the bandwidth of the governments to deliver these services. Nigeria has been an exception. Nigeria has been able to progress despite COVID-19. However, the progress has slowed down, and at this moment, we have a big issue,” he warned.

The health specialist cited that three out of 10 children are zero-dosed (never had the Penta 1 dose before). “We have been analysing to find out where they are, and our priority this year is to get these pockets of children who are not vaccinated.” While noting that some of the children could not get the vaccines because the services were not available, Celades confirmed that these children are predominantly in the North – Sokoto and Zamfara states. “It is also across Nigeria. When we look at the 100 priority local councils with many zero-dosed children, the numbers are more in the North. We have two in Lagos, including Alimosho. We have one in Ogun State. We have some in Plateau, Bauchi, and Nasarawa states. We have them in 18 states across the federation.”

Available Vaccines in Nigeria to Reduce Infant Mortality
According to Celades, there are about 18 antigens in the country on the routine immunisation scale, from Rotavirus for Diarrhoea, Pneumococcal vaccine for Pneumonia and vaccines for Measles, Diphtheria, and Tetanus, among others. The UNICEF chief of health is confident that “Vaccines work, and we know that it is one of the most powerful historical tools to reduce child mortality. The challenge becomes ensuring that all the children who need it have access to it”.

Hence, UNICEF’s priority this year is its collaboration with the Federal Ministry of Health and the National Primary Health Care Development Agency (NPHCDA). This is in their attempt to get to these children that “We lost over the last couple of years and are trying to ensure that there are no more zero-dosed children. We are working with all our partners to reach out to them”, says Celades.

Alarming Maternal Deaths in Other African Countries
Comparing MMR among African countries, data available to the Ghana Health Service shows that it recorded 776 maternal deaths in 2020. For other African nations with MMR of 2017 as latest available, Zimbabwe recorded 458 maternal deaths; Gambia had 597 deaths of mothers to pregnancy-related causes; Benin Republic recorded 397 maternal deaths; Togo had 396 maternal deaths; Uganda recorded 375 maternal mortality, and Malawi recorded 349 MMR in every 100,000 live births.

Leveraging Social Media Influencers like Waje, Nuhu Others
UNICEF is strategising. It harnesses every tool possible, including social media and its influencers, to attain SDG 3 through better healthcare for mothers and children and routine immunisation. It was for this course of saving more mothers and babies that UNICEF is working with social media influencers and entertainers like Nigerian singer Aituaje Iruobe professionally known as Waje, Nigerian actor and director Ali Nuhu; social media doctor influencer Dr Chiamaka Nkanno popularly known as Dr Zobo; Nigerian Chess Master, Coach and Founder of Chess in Slums Africa, Tunde Onakoya.

In the succinct words of Waje to THISDAY, she will do a lot of short clips on YouTube to reach women in rural communities regarding the need for immunisation. “I’ve figured out the different means of communication like Instagram, Snapchat, Tiktok is big with the Gen Zs.

With over 1.5m followers on her verified Instagram page @officialwaje and 727,000 followers on Twitter, Waje is leveraging collaboration with other influencers in his clique to reach more young mothers. “In collaborating with these artistes, I plan to spread vaccination awareness in any other language if we have to,” recounting how during Covid-19, “We did a clip where I spoke Igbo; my mother is Igbo. If we have to do that this time, we will.”

For Ali Nuhu, who has over 2.7m followers on his verified Instagram account, @realalinuhu and 452,000 followers on his Twitter, he proposed breaking down the message of immunisation, going to communities to have sessions with the dwellers, doing jingles on radio and TV stations in more local languages to educate society. He added, “By merely hearing your voice, these dwellers wait and listen.”

UNICEF to Reward States Investing in PHCs
As a moral support, UNICEF is collaborating with the Nigerian Governors Forum and other key partners for the Primary Healthcare Leadership Challenge coming up in May. This challenge aims to recognise and award state governments investing resources, time and efforts in revamping primary health care.

“An independent judging panel will give the award based on data,” says the health chief. “We will provide 13 awards in the six geo-political zones to the best state and the most improved, as well as one national champion.” According to Celades, UNICEF is not oblivious to the power of incentives for state governors to invest in primary healthcare.

With Nigeria having the second highest number of unvaccinated children globally and rated among the worst nations with MMR, UNICEF and the UN seek more vital collaborations with the Nigerian government. He added: “We cannot work alone; we need the government; we also need to work with journalists and social media influencers to make the needed change.”