Nigeria: Expanding Access to Sexual, Reproductive Health Services

(File photo).
24 June 2021

Ugo Aliogo writes on the need to expand access to sexual and reproductive health services for women and girls

Young people face a number of obstacles accessing sexual and reproductive health services. These barriers relate to availability and accessibility as well as the quality of the services provided. For example, laws and policies may limit young people's access to services and contraceptives, and health centres may only address the needs of married women, a study by PLAN international has stated.

The study also noted that entrenched social norms and gender inequality around young people and girls' sexuality implies that young people's behaviours are controlled and they may be stigmatised for being sexually active.

The study noted that due to their age, young people's ability to make decisions or express an opinion may not be respected, adding that these make it difficult, "and often prevent young people from accessing sexual and reproductive health services."

In line with expanding access to sexual and reproductive health services for women and girls, Non-Governmental Organisations (NGOs), a notable one is Action Health Incorporated (AHI).

Action Health Incorporated is working in alliance with civil society organisations and governments to improve and expand sexual health services that respond to the needs of young clients.

AHI is presently running a project that seeks to reduce maternal and infant mortality and morbidity by increasing the access of women and girls in Gwoza and Damboa Local Government Areas, Borno State to primary health care services including sexual and reproductive health services.

The implementation strategy includes the provision of integrated primary health care services and coordinated humanitarian response with a specific focus on emergency sexual and reproductive health care services at the facility and through the mobile health, teams accessing hard to reach areas in host communities.

The project aims to provide life-saving and life-sustaining humanitarian health assistance to affected Internally Displaced Persons (IDP) and host community populations.

THISDAY gathered that 1804 women and 1565 girls were reached during the mobile medical outreaches, while adding that a total of 6520 (5,171 females and 1,349males) have been reached during community awareness sessions.

THISDAY also learnt that 1327 women and 923 girls have been reached with reproductive health kits commodities as of the third week in May 2021, while 303 Women and 89 Girls have been assisted by Skilled Birth attendant for safe delivery.

Reacting to the development, the Senior Programme Officer, Action Health Incorporated, Funsho Bukoye, remarked that the Nigeria Demographic and Health Survey (NDHS) 2018, showed that the lifetime risk of maternal death indicates that one in 34 women in Nigeria would have a death related to maternal causes and maternal mortality ratio: is estimated at 512 maternal deaths per 100,000 live births.

She also stated that cases of maternal and infant mortality and morbidity in the North East Nigeria can be traced to delay in reaching basic delivery care due to insecurity and road terrain, lack of access to skilled birth attendance different form of medical complications, obstetric fistula and others.

She said: "Several efforts have been put in place to improve healthcare delivery in Nigeria. However, poor manpower planning, poor healthcare infrastructure, insufficient healthcare providers have continued to pose as challenge in attaining the optimum level of healthcare in the country.

"Take for instance, the National Health Insurance Scheme (NHIS) which was design with the potential to promote access to needed quality health care among Nigerian populace; yet, the scheme covers less than 5% of Nigerians. The enrollee population in the scheme is largely made up of Federal Government employees and their dependents."

Bukoye who referred to a survey by PricewaterhouseCoopers (PwC), hinted that the National Health Insurance Scheme (NHIS), the scheme covers less than 5% of Nigerians.

She further explained that the enrollee population in the scheme is largely made up of federal government employees and their dependents, "while a survey by the Lagos Bureau of Statistics also revealed that only 11 per cent of household members in the state have their healthcare costs covered by any form of health insurance."

However, the PwC survey noted: "To bridge the coverage gap, several states have commenced the establishment of State Health Insurance Schemes. Presently, about 19 States are at various stages of their implementation journey.

"These schemes typically involve the establishment of a governing agency to oversee the implementation and management of the scheme. They have also defined benefit packages to cater to the most common healthcare occurrences.

"Of significant note though; state governments commit to dedicate a percentage of their consolidated revenue to the scheme to fund premiums for the poor and vulnerable in the state. These schemes, if successfully implemented and operated, could prove to be a significant tool in making affordable healthcare more accessible throughout the country especially to the poor and vulnerable in society.

"As with any large scale endeavor of this nature, there are several key success factors which need to be in place to ensure the schemes are successful and sustainable."

Continuing, she posited that government needs to improve in the implementation of health policies and strengthen the structure, noting that there was need to ensure that primary healthcare system is operational and gets to the farthest and rural communities in Nigeria.

She added: "One of the key strategies to strengthen the health sector coordination is to ensure that our Health policies are in tune with the needs of the people and are implemented after development.

"Most times, the policies do not transcend into actions and we end up not achieving the desired outcomes at the end of set target period. A clear policy direction defines quality and sets the stage for effective implementation of a quality improvement plan.

"Also, there is need for health systems strengthening which include capacity building, well-functioning health facilities, health financing and availability of life saving commodity and essential drugs.

"Furthermore, there must be effective partnership and collaboration between various health actors in attaining the optimum healthcare delivery in the country."

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