Strengthening Maternal And Child Health Care Delivery System: Celebrating Impacts, Imbibing Key Lessons

I am pleased to welcome you to this Close-out Press Briefing, marking the end of an important phase in our project on the ‘Promotion of democratic Participation in 2 Local Government Areas in Kano State, Nigeria’. Launched in May 2021, this project focused on advocating for improved Maternal and Child Healthcare through Accountability Interventions. Our target areas were the Gwale and Kumbotso Local Government Areas in Kano State, with the objective of contributing to a sustainable solution to addressing maternal and child mortality in the state. In doing this, we had to think deeply about our approach and strategy in dealing with maternal and child health issue, which has emerged as one very big development issue in Nigeria, and Kano State in particular.

Our Approach and Strategy

Our strategy revolved around mobilizing women and other important stakeholders to actively participate in addressing the pressing issue of maternal and child deaths. We recognized early on, through extensive research, that women bear the brunt of this problem, but they are not the only ones affected. Therefore, we made the decision to involve a wide range of stakeholders, including men, youths, people with disabilities, religious and community groups, political leaders, healthcare managers, practitioners, associations, professional bodies, and the media throughout the entire duration of the project. Our focus at CHRICED was to ensure that marginalized individuals in rural and hard-to-reach areas, who are most impacted by the lack of adequate healthcare facilities, take the lead in finding effective and sustainable solutions. As catalysts, our role was to empower citizens to view themselves not as helpless victims of the governance system, but as influential stakeholders with a voice.

Our intervention was to facilitate a platform for the people on the demand side of the maternal health system to engage with decision makers on the supply side, ensuring that their voices are heard as citizens and their needs are addressed. This level of accountability is fundamental in a democratic governance system. I am pleased to announce a significant achievement of this project, which is the successful implementation of a strategy that empowers people to advocate for their social conditions using their civic voice. During the project, our team recognized the importance of visiting all the Primary Healthcare Centres (PHCs) in the project communities to gain a deeper understanding of the challenges faced by the local population. We noted that despite the efforts made by the Kano State government in terms of policy development and implementation in the health sector, there is still much more work to be done in improving the PHC facilities.

Distinguished guests, in line with our sustainability strategy, CHRICED has enlisted, trained citizen monitors carefully chosen from project communities, and equipped them with the necessary skills and knowledge to monitor maternal and child health expenditure budgets in selected Primary Healthcare facilities within the state. Apart from these citizen monitors and community actors, the project has also provided training and established strong connections with media and CSO practitioners, who are expected to continue supporting citizens in the project communities in demanding accountability by amplifying their voices, even after the conclusion of this project.

However, we would like to note that although this project is primarily based in Gwale and Kumbotso Local Government Areas, its influence extends throughout all 44 local government areas of the state. Through strategic activities like statewide consultative meetings, advocacy efforts, press releases, and public awareness campaigns on radio and social media platforms, we have successfully expanded the reach of this project and cascade the impact beyond Gwale and Kumbotso LGAs.

The Project’s Impacts

Our evidence-based and citizen-centered approach has had a significant impact on fostering maternal and child healthcare in Kano State. This is evident through the successful advocacy efforts and engagements carried out by CHRICED with various stakeholders. Through strategic outreach initiatives, CHRICED was able to gain the support of key stakeholders such as the legislature, executive, media, fellow CSOs, international development partners, agencies, social influencers, and the beneficiaries in our project communities. Continuous advocacy to stakeholders like the Kano Emirate Council, Ministries of Health, Information, Women Affairs, and Budget has led to significant achievements in various areas.

CHRICED has played a pivotal role in strengthening maternal and child health, generating increased public support, enacting favorable legislation, improving healthcare accessibility, and fostering a more inclusive and responsive healthcare system for mothers and children in Kano State. Through its comprehensive approach, the project has not only achieved immediate impact but has also laid the foundation for long-term sustainable change in the healthcare sector.

Mrs. Loveth Metiboba, the external evaluator, will provide a brief presentation via Zoom discussing the successes and challenges of the project based on her independent assessment. Additionally, a copy of the evaluation report will also be shared with you for comprehensive understanding of the project.

In summary, the key accomplishments of the project are as follows:

1. Through coordinated and concerted efforts, t he Kano State Free Maternal and Child Healthcare Bill, which had been pending for approximately eight years, was successfully passed by the Kano State House of Assembly in May 2023 and signed into law by former governor Abdullahi Umar Ganduje.
2. The effective advocacy carried out by CHRICED and other cohort CSOs in this initiative has resulted in a consistent increase in budget allocations for the health sector in Kano State, often meeting or exceeding the 15 percent threshold outlined in the Abuja Declaration on healthcare funding.
3. Under this project, CHRICED has persistently pushed maternal and child health issues to the forefront of public discourse through sustained public awareness campaigns in the media, press releases, social media engagements and other communication channels to educate citizen and constantly remind decision-makers of their responsibility to the people in curbing the scourge of maternal and child deaths.
4. Notably, CHRICED has vigorously pushed the debate around transparency and accountability in the health sector, through citizen action, informed demands and analysis of interventions in the health sector, especially the maternal and child health sector.
5. This project has proven to be a valuable asset for women in our project communities, empowering them by greatly enhancing their understanding of family planning, child spacing, as well as antenatal and post-natal care.

Key Lessons from the Project    

Despite the progress and accomplishments made by the project, the objective of eliminating maternal mortality in Nigeria’s most populous state remains far from being accomplished. According to Bill Gates, a prominent figure in the global fight against maternal and child mortality, Nigeria still ranks among the worst countries for women to give birth. Although we cannot claim that our commendable aspirations as a community of activists and development practitioners have been fully realized, it is crucial that we maintain hope. We should take inspiration from the numerous initiatives and collaborative efforts that are already producing positive outcomes, bringing us closer to our goal of eradicating preventable maternal deaths in our beloved Kano State.

As advocates and catalysts for transformative change within societies, we are well aware that the desired transformation in governance systems and society cannot be achieved overnight. We firmly believe that persistence is key, and we must continue to persevere until our goals are realized. This is why, on every occasion, we have consistently emphasized that the tragic and widespread loss of women’s lives during childbirth is a violation of their fundamental rights, as outlined in international human rights instruments and our country’s Constitution, Nigeria. The irony of maternal mortality lies in the fact that a woman, on the brink of bringing new life into the world, tragically loses her own life in the process. Throughout this project, we have steadfastly maintained that our women should not have to sacrifice their precious lives during the challenges of childbirth.

However, despite the numerous accomplishments, there were multiple valuable lessons learned. For example, our field work has revealed that the issue of maternal mortality is influenced by various other factors. These factors include inherent power imbalances between genders, as well as disparities in the distribution of social resources such as education and employment. These inequalities place women at a disadvantage, making them susceptible to poor decisions, which eventually impact on their maternal health. Related to this is the need to open the political space to foster the participation of women in decision making. Women are the ones most affected by the reality of maternal mortality. It is an aberration if they are not part of the process where decisions on issues affecting them are made at the level of governance. This calls for deep reflection on the need to provide space for women for women to take up the challenge of fighting for issues that directly affect them.

Likewise, the significance of the local governance structure is crucial in tackling the issue of maternal mortality. In addition, we have consistently emphasized the importance of a strategic reassessment of Kano State’s maternal health objectives throughout the project, in order to align these objectives with the necessary methods and resources for their accomplishment.

Conclusion

I am confident that there are some of you in this audience who may be wondering if this conclusion will signify the end of our involvement in maternal and child health. Let me assure you that the conclusion of this phase does not signify the end of our advocacy efforts. CHRICED is determined to capitalize on the momentum generated from this phase of the project by collaborating with relevant stakeholders to ensure the complete implementation of the Kano State Free Maternal and Child Healthcare Law. It is widely known that the main obstacle to effective governance in Nigeria is not the absence of sufficient laws and policies, but rather the failure to implement them. This has greatly hindered our development endeavors. Therefore, I would like to take this opportunity to appeal to the Executive Governor of Kano State, Engr. Abba Kabir Yusuf, and his executive cabinet members to demonstrate the necessary political will and allocate the required resources for the comprehensive implementation of this crucial law.

Esteemed guests, distinguished members of the press, I would like to conclude this briefing by sharing the words of Henrietta Fore, the Executive Director of UNICEF. She emphasized that “Around the world, birth is a joyous occasion. Yet, every 11 seconds, a birth is a family tragedy. A skilled pair of hands to help mothers and newborns around the time of birth, along with clean water, adequate nutrition, basic medicines, and vaccines, can make the difference between life and death. We must do all it takes to invest in universal health coverage to save these precious lives.” 

Finally, I cannot end this address without profusely thanking our partners, Misereor/KZE, Germany, whose generous and consistent support ensured the success of this phase of the project. Our immense gratitude also goes to the Kano State Government, the Kano State House of Assembly, traditional and religious leaders, community men and women, health workers, international development partners, our media partners, and colleagues in the civil society, for the support, which led to the successful completion of this phase of the project. Finally, I must thank the CHRICED Board of Directors, the CHRICED Advocacy Committee led by Hon. Alhaji Musa Garuba, our esteemed staff and all CHRICED Volunteers for their indispensable contribution to the success of this project.

Thank you for your kind attention and God bless you all.