Building Resilient Maternal Health Systems through Private Sector Integration

Experts at the recently held webinar organised by the Nigeria Health Watch, with funding from ‘MSD for Mothers’, themed, ‘Building Resilient Maternal Health Systems through Private Sector Integration’, harped on the importance of private sector integration in building a resilient maternal health system in Nigeria. Sunday Ehigiator reports

According to the World Health Organization (WHO), 800 women died every day in 2020 from preventable causes related to pregnancy and childbirth, which means that one woman died every two minutes which is far higher than the Sustainable Development Goal (SDG) 3.1 target of reducing Maternal Mortality Rate (MMR) to less than 70 per 100,000 live births by 2030.

Maternal health is a critical issue that impacts the well-being of women, families, and communities worldwide. Nigeria’s maternal mortality rate remains a significant public health concern and is one of the highest in the world at 512 deaths per 100,000 live births.

High mortality

Nigeria’s maternal mortality rate is one of the highest in the world. The United Nations Economic Commission for Africa says that one in seven global maternal deaths occurs in Nigeria, meaning that more than 50,000 women die per year in Nigeria.

A 2023 report by the World Health Organisation (WHO) also shows that Nigeria accounts for the second-highest number of maternal and child deaths globally.

According to the report, Nigeria, Africa’s most populous nation, is only behind India in the ranking. The report noted that in 2020, 788 women and children died ‘per thousand’ in India, and 540 women and children ‘per thousand’ died in Nigeria.

Approximately 99 per cent of these maternal deaths took place in low- and middle-income countries with over half of them in sub-Saharan Africa. By providing timely and high-quality access to evidence-based maternal healthcare interventions, including contraception, a significant number of maternal deaths could be prevented.

According to a Bloomberg School of Public Health model, the cost of ending preventable maternal deaths in 120 low-and-middle-income countries, including Nigeria is estimated to be $115.5 billion from 2020 to 2030.

Therefore, it is the opinion of health experts at the webinar that cooperation, ongoing investment from different stakeholders and innovative partnerships and collaborations are crucial requirements and consolidating solutions for women who most need them at an adequate scale, as this is also crucial to achieving the SDG 3.1 target of reducing the global maternal mortality ratio by 2030.

The webinar

The webinar sought perspectives on ensuring quality standards while integrating the private sector and how it can be achieved; strengthening governance in the inclusion of the private sector in healthcare delivery; policy options to advance the inclusion of the private sector in a mixed health system; and how best can coordination of the private sector be achieved.

It was attended by a diverse audience of stakeholders, including policymakers across the 36 states and Federal Capital Territory (FCT) Abuja, and private sector representatives.

Participants include representatives of the Federal Ministry of Health (FMOH) and the States Ministry of Health (SMOH); National Primary Health Care Development Agency (NPHCDA); development partners, and the Private Sector Health Alliance of Nigeria (PSHAN).

Others are the National Association of Nigerian Maritime Students (NANMS); the Society of Gynaecology and Obstetrics of Nigeria (SOGON); the Health Maintenance Organisation (HMO); and the National Health Insurance Authority (NHIA), among others.

Private sector integration in reducing MMR

To address this anomaly, Nigeria Health Watch with funding from MSD for Mothers organised the webinar to provide policymakers with actionable steps to effectively engage the private sector, to build resilient and sustainable maternal health systems that deliver quality maternal health care services in the country, with the end goal of reducing MMR in Nigeria.

Speaking during the session, the Managing Director of Nigeria Health Watch, Vivianne Ihekweazu, said the fact that the private sector provides over 60 per cent of healthcare services in Nigeria highlights the important role it can play in improving maternal health outcomes.

According to her, “The Private Sector6 has played a significant role in delivering maternal and newborn health services, particularly in low and middle-income countries, where public health care systems are often poorly funded.

“Private sector innovations and involvement can improve access to healthcare, increase the quality of services, enhance the efficiency of the healthcare system and bridge existing gaps in healthcare financing to improve maternal health outcomes.

“Private health care is one of the fastest growing sectors of the health system, and private providers (such as non-government providers for private individuals, facilities, and businesses) are a vital source of healthcare for families in the lower wealth quintiles in the Low-and Middle-Income Countries (LMICs).

“One in five births in LMICs was carried out in the private sector. In Nigeria, the private sector delivers 60% of healthcare services, especially to underserved populations and they are heavily patronized due to their easy access, low waiting time and offer more respectful care to patients.”

She, therefore, noted that private providers include licensed and unlicensed providers, midwives, pharmacists, and traditional healers.

Also speaking, the President of the Healthcare Federation of Nigeria (HFN), Dr. Pamela Ajayi said the private sector has lots of opportunities to play roles in maternal health care as over 70 per cent of the health care and facilitation given yearly is from the private sector.

“So, maternal health is a sector that needs this improvement to enhance effective care, they have a crucial role to play and with collaboration with the new government, progress will be accelerated. Collaboration with the government is key, the need to invest, and alignment of interest.”

In his remark, Former Honourable Commissioner for Health, Kaduna State, Dr Amina Baloni said “Kaduna state is one of the states with the highest maternal and infant mortality rates in Nigeria, a society where we have 60 to 70 per cent of people living the rural area and the traditional practices of patriarchy which prevent women from accessing care and the resistance to the change of women having deliveries in the facilities. So, with such a background, the government will be the biggest player in the health sector.

“The only private care the rural people access is the Patent Medicine Vendors (PPMVs), chemists and medicine shops that are very often managed by people that are not healthcare professionals and Kaduna state has more than a thousand Primary Health Care centres (PHCs).

“So, what the state needs is for the government to strive to vitalise and put in health education and of course in collaboration with the traditional leaders to make sure that we change the narrative and improve healthy seeking behaviour.”

The Covid-19 model

In his remark, the Chief Executive Officer of the Delta State Contributory Health Commission (DSCHC), Dr. Ben Nkechika emphasised the positive outcomes of collaboration with the private sector during the Covid-19 pandemic.

He stressed the need for participatory cooperation among stakeholders to improve the health outcomes of Nigerians.

Nkechika cited the Delta State model, which successfully integrated private firms such as the PharmAccess Foundation to provide a resilient health system for citizens. He highlighted the importance of stakeholder engagement and the implementation of beneficial concepts based on their responses.

Nkechika said DSCHS has enrolled 1.4 million with 5011 accredited health facilities. He said building a resilient healthcare system in the private sector, that is integration, is pertinent.

“Healthcare system is a system in which the patient gets the care they need when they need it which is sustainable and not with financial and logistic consequences. It is lucid to say that the government has not been able to provide adequate finance to facilitate this resilient care over the years,”

The Harvard-trained health economist concluded that a collaboration amidst the private and public health sectors is perceived to be the best effective way to achieve better health outcomes, which was a concept which “we decided to follow-up in the DSCHS; though we spent lots of time determining the model and skills to implement in other to achieve the outcome within the stipulated time.

“Now situating it to the maternal healthcare concept, we have a baseline assessment to determine the status of healthcare service delivery.”

Objectives towards reducing MMR

While speaking, the Global Advocacy Director of MSD for Mothers, Mr. Temitayo Erogbogbo discussed the initiative’s objective to reduce maternal mortality rates in low-income countries with high statistics.

Erogbobo said there is an urgent need to integrate the private sector to aid the financing of health systems and improve the health outcomes of Nigerians. He said a lot of attention has not been given to the quality of care and the outcomes, and that has to change.

He said MSD for Mothers is helping reduce maternal mortality across the globe, especially for high-burden countries like Nigeria with the highest world burden of maternal mortality.

He further explained that “Private care providers play a vital role in providing care across the country, so it is pertinent that we pay attention to the enhancement of the sector. We need to pay attention to the quality of care provision to the public in general, as life loss is high.

“Currently, equipping the clinics with health infrastructures, development and quality health care is a routine for the private sector. Issues around transportation, electricity and water sanitation have a major impact on healthcare delivery, which is a huge burden that requires a huge amount of resources for developing countries like ours. It is a huge investment.

“The need to draw capital from other sources, the critical aspect is on the lack of structural policies that enable the integration of the private sectors into the health systems, which is one of the issues many of which some of our panellists are working on strategies by which this dynamics can be curbed.”

Role of the WHO Connector

Speaking on the role of the WHO Country Connector in working to improve country governments’ capacities to create ecosystems for effective public-private partnerships, Acting Unit Head, of Health Systems Governance and Policy, WHO, Dr. David Clarke, said  “The Country Connector for Private Sector in Health has recorded impact in ensuring governments achieve Universal Health Coverage (UHC) and health security for their population by harnessing the public and private health sector’s collective national expertise and resources.”

He also reaffirmed the commitment of the WHO Country Connector to evolve from supporting countries with COVID-19 support to helping governments improve their capacities to improve health systems and outcomes.