Friday, February 3, 2023

How poor access, lack of doctors, facilities across Kano cause maternal mortality

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By Lukman Abdulmalik

Umar Ibrahim, 50, a farmer and resident of Garin-Sheme community, Kunchi Local Government Area, Kano State, has been married three times and at separate times he had to bury his wives due to poor access and non-functional health facilities during childbirth in his community.

Mr Ibrahim’s first wife, Ismaha was 35 years old before she died in 2018 during delivery. She carried the baby to term but died immediately after giving birth. Before she passed away, Mr Ibrahim said the stress of accessing antenatal care was much, as she had to travel long distances to neighbouring communities including Bichi and Shuwaki.

Umar Ibrahim, a resident of Garin Sheme
Umar Ibrahim, a resident of Garin Sheme

Mr Ibrahim married another wife, Amina, 27, who soon got pregnant and also died while in labour before getting to the hospital.

“She really suffered throughout her pregnancy. We didn’t have a functional medical facility that could attend to her needs. On her expected delivery date, I hired a taxi to convey us to the hospital and the driver took long to arrive because of the poor state of our roads. It was too late by the time the driver arrived. While struggling to lift her into the vehicle, she passed away in my hands,” Mr Ibrahim said.

Mr Ibrahim remarried, yet again. This time, the wife, Ummi, died 5 months into her pregnancy in a similar circumstance as the second wife.

“Due to an emergency, I conveyed her on a motorcycle, as we reached Tudun Wulli, a village close to the roadside to search for a vehicle that will take us to Bichi General Hospital, she died,” said Mr Ibrahim, who could barely speak without bracing his face to stiffness.

Pregnant women and children across rural communities in Kano continue to die from preventable diseases due to poor access to quality health care, poor infrastructure and lack of medical equipment and supplies.

“The primary healthcare we have in this community is not standard as no drugs can be found in the hospital, we have only two doctors,” Ibrahim answered when asked why he didn’t take his wives to the health facility in his community.

Garin Sheme ward in Kunchi LGA, alongside 10 neighbouring communities, rely on two non-functional primary healthcare facilities. Pregnant women in these communities have to travel to Bichi, 35km, or Kazaure LGA in neighbouring Jigawa state, which is about 48km, to access any form of quality healthcare.

“We have complained countless times but it has fallen on deaf ears. We are left with two non-functional PHCs with no facilities for maternity care, no doctors and drugs. Many of our women continue to die due to this,” said the District Head, Garin Sheme, Haruna Abubakar.

According to Mr Abubakar, the construction of a general hospital which started 10 years ago during the administration of late president Musa Yar’adua, was abandoned and left uncompleted a year after his death.

“We tried to keep monitoring so that they can complete the project. After some complaints were lodged, the contractor came back to continue the project. They stopped at the roofing stage and have abandoned it again,” he added.

More sordid tales

There are even more harrowing experiences residents of Kunchi LGA are made to go through before they can access quality health care. A 70-year-old resident of Galdanci, Kunchi LGA, Lami Rabiu recounts how she lost her daughter, Maryam after she delivered her baby because she could not access prompt medical attention.

“Due to the lack of a functional hospital in our community, I took her to Birkin Hospital which is far away. After she was examined by the medical personnel at the hospital, they referred us to Bichi General Hospital. By the time we got to Bichi, she was tired and could barely breathe. She went into labour and gave birth. Shortly after that, she passed away,” she said.

Muhammadu Suleiman, resident of Galdanci, Kunchi
Muhammadu Suleiman, resident of Galdanci, Kunchi

Another resident, Muhammadu Suleiman, seems to have pushed his luck too far. In the 16 years of his marriage, Suleiman’s wife, Fatsuma, had given birth to 8 children with the help of traditional birth attendants. Trouble started when they decided to have their 9th child. She died in the 9th month of the pregnancy.

“Early in the morning around 5am after we had prayed, my wife complained that she was feeling sick. I called for help and was asked to quickly take her to the hospital. It took me a long time before I could get a taxi to take us to Bichi General Hospital. On getting there, she was immediately admitted and given 2 pints of blood. She died whilst still receiving treatment,” Suleiman said with tears rolling down his cheeks.

It is even worse in Binturi village in Sumaila LGA. Hamza Salihu, a 50-year-old resident of Binturu village, lost his wife a year after marriage.

“My wife got pregnant the same year we got married and died a year after. I was instructed to bring my wife for antenatal every 5 days and I adhered. I usually ride with her on my bicycle to Sumaila town.

“However, due to the distance from my village to Sumaila, she was living with someone at an apartment in Jinka village, which is close to Sumaila.  Whenever it is time for antenatal, I will then ride my bicycle from my village to Jinka where she resides and we both travel down to Sumaila.

“On one occasion, we already did the trip to and fro Sumaila and I had to journey alone back to Binturi. I had barely settled down in Binturi, when I was informed that my wife had died with her pregnancy,” he said.

Findings showed that Binturi village does not have a hospital, nor community doctors. Pregnant women go through labour and deliver at home without the help of any qualified medical personnel because the nearest PHC is 10km away.

Musa Ali, village head of Binturu, Sumaila LGA
Musa Ali

Another resident, Musa Ali, said accessing good medical services has always been a challenge in the village. He stressed that he is aware that no less than 5 pregnant women have passed away in the village due to lack of maternal and child healthcare in recent years.

Kano state health sector expenditure and its maternal mortality challenge

Over the years, budgetary allocations by Kano state to the health sector has been widely commended. However, analysis of the state health care expenditure showed that there are gaps in its commitment towards reducing maternal mortality across rural communities.

In the last four years, Kano state government budgeted N2,995,554,803 billion towards improving quality health standards. In 2018, N899.55m was budgeted, while in 2019 no fund was released towards primary healthcare in Kano. In 2020, N40m was allocated and 2021, N2,06bn was budgeted.

Out of the 1,200 accredited PHCs in Kano State, 381 have been enrolled on the Basic Health Care Provision Fund, while the others are yet to start accessing the funds which has caused setbacks to the quality performance of primary healthcare facilities in Kano.

The Executive Secretary of the Kano Primary Healthcare Management Board, KSPHMB, Dr Tijjani Hussain said, Kano State needs at least 23,000 frontline health workers to meet the immediate needs of providing quality primary health care services. He said with about 19,000 healthcare workers in the state, only 9,000 were permanently engaged out of which about 6,000 are frontline workers.

On May 2022, Planned Parenthood Federation of Nigeria (PPFN), an NGO, distributed Personal Protective Equipment (PPE) kits worth N12 million to 85 Primary Healthcare Centres (PHCs) in Kaduna and Abuja and Kano. According the Executive Director of the NGO, Dr. Okai Aku, 35 health facilities in Kano benefitted the gesture.

An assessment of 49 PHCS in Kano state by the Nigeria Health Watch and Connected Development revealed that all the PHCs assessed lacked some components of the basic requirements as outlined by the NPHCDA minimum standards for PHCs.

Despite the support and huge spending on Kano PHCs, maternal and child mortality statistics in Kano state are still grim and appalling. Statistics showed that Kano State maternal mortality rates are among the highest in the country. Maternal mortality in Kano is 1,025 deaths per 100,000 live births with only 21.5 percent – two out of ten – of deliveries in Kano State attended by skilled birth attendants.

Kano health ministry, primary healthcare board keeps mum

Efforts to speak with local and state government officials on findings in this report proved abortive. A Freedom of Information, FOI request sent to Kano state Primary Healthcare Management Board, KSPHMB, and Kano State Ministry of Health on August 4, 2022 was greeted with silence despite repeated calls and follow ups made. The FOI request specifically asked for maternal mortality rates in Kunchi and Sumaila LGAs from 2019 to 2022 and an interview with KSPHMB officials to speak on findings of this report.

Experts reaction

Even though maternal mortality, which is a pregnancy-related death, is preventable, it has continued to persist in Nigeria due to a host of factors including a low level of socio-economic development.

Aminu Garba, a health expert at Rahama Yunur Healthcare services said apart from the medical related causes of maternal mortality, certain socio-cultural and socioeconomic factors influence the outcome of pregnancy. Also, a poor health care system, which is a consequence of weak social structure, is a contributing factor. He added it is pertinent for the government to improve maternal health and eradicate poverty to ensure sustainable development.

Maimuna Isyaku, a nurse at Murtala General Hospital, Kano noted that the although the prevalence of maternal mortality is a global issue, most factors aiding it in Nigeria can be addressed. She admonished government and other stakeholders to deploy a mosaic of solutions to address health services, transportation, referral services and medical facilities amongst others at the rural and semi-urban areas.

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