e-sRC

CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
It is widely acknowledged that healthcare is an important component of human life, it is in
relation to this that, so many conventions, declarations and initiatives have been
undertaken at different times in different places at various levels with a view to foster
cooperation, improve socio-economic situations and resolve emerging problems such as
poverty, child and maternal mortality among others, at National, Regional or Global level
at large. For instance, the Kyoto Declaration of 1997 for the control of atmospheric
pollution, Alma-Ata declaration of 1978 for achieving health for all by the year 2000,
Bamako initiative of 1987 for revitalization of primary health care. Furthermore, a
Millennium Declaration popularly known as Millennium Development Goals (MDGs) was
made by 189 member states of the United Nations in September 2000 at New York. MDGs
are series of eight time-bound development goals, and 18 targets that seek to address issues
of child and maternal mortality, HIV/AIDS, Malaria and other diseases, environmental
sustainability, poverty among others, agreed by the international community to be achieved
by the year 2015. The MDGs give governments a common framework for structuring
policies and programmes which facilitates speed and efficiency in achieving the MDGs
through effective planning, budgeting and monitoring at the implementation level.
The provision of accessible and affordable healthcare services on a sustainable
basis in any country including Nigeria is an important obligation of government and is
part of the rights of the citizens. The health care service delivery in Nigeria is a concurrent
responsibility of the three ties of Government and is divided among the Federal, States and
Local Governments. Provision of adequate funds, infrastructural facilities and personnel
that provide primary health care services, which involve prenatal, antenatal and postnatal
as well creating public awareness are the responsibilities of the Local Government
Councils. The State Governments on the other hand provide secondary healthcare
services, while the Federal Government is providing the tertiary health care services.
In an attempt to tackle the problem of child mortality in Nigeria, all the three tiers
of Governments have adopted various policies ranging from Expanded Programme on
Immunization (EPI), which was launched by WHO in 1974 with the goal of immunizing
the world’s children against six killer diseases; these include Diphtheria, tetanus,
whooping cough/pertussis, poliomyelitis, measles, and tuberculosis. This programme was
later changed to National Programme on Immunization (NPI); the immunization
programme with the same objectives of controlling the six-killer and other vaccinepreventable diseases. The programme assisted in reducing child deaths in the country
where people are fully aware and participate in the immunization programme successfully
(Park, 2002).
Federal Government of Nigeria has been directly participating in health care
delivery system and good legislations on healthcare service delivery through the Federal
Ministry of Health and National Primary Health Care Development Agency. The Federal
Government introduced National Health Insurance Scheme (NHIS) in 2004, with a view
to reduce the level of diseases and mortality rate in the country. A National Health Policy
targeted at achieving health for all Nigerians was also promulgated in 1988; National
Health Policy (NHP) was designed based on Primary Health Care (PHC), which was
conceived at Alma-Ata conference of 1978. The development of Primary Health Care
stemmed from the realization that the existing health care system then has failed to
provide, improve and extend services to a vast majority of people particularly in the rural
areas in developing countries (WHO, 2009).
In September 2004, the new policy, referred to as the Revised National Health
Policy was also launched, which describes the goals, structure, strategy, and policy
direction of the health care delivery system in Nigeria (NPC, 2004). Roles and
responsibilities of different tiers of government, including non-governmental
organizations were outlined. The policy‟s long-term goal is to provide adequate access to
primary, secondary, and tertiary health care services for the entire Nigerian population
through a functional referral system. Moreover, both the Federal and State Governments
have also implemented MDGs with a view to reduce poverty and health related challenges
across the country. The Federal Government also established the National Primary
Healthcare Development Agency in order to facilitate access to primary healthcare
services in the country.
Bauchi State Government has being over the years making various efforts aimed at
reducing maternal and child mortality rate in the state, ranging from adoption of National
Health Insurance Scheme to its workers with a view to ensure healthy citizens. It further
embarked on so many immunization programmes against child related diseases such
Measles. The State Government has also commits itself in the provision of secondary
health care infrastructural facilities, healthcare practitioners, equipment and other health
related organizations/institutions such as Hospitals Management Board, which was
established to manage the healthcare organizations/institutions across the state. Bauchi
State Agency for Control of AIDS, Turbaclosis and Malaria (BACATMA) was created for
controlling HIV/AIDS, Turbaclosis and Malaria in the state, Bauchi State Environmental
Protection Agency (BASEPA), for environmental sanitation. More so, the State
Government has further established School of Nurse/Midwifery and College of Health
Technology in order to provide sufficient healthcare practitioners. The Millennium
Development Goals (MDGs) were also implemented in order to reduce the level of poverty
and Primary Healthcare related challenges the across the state. All the aforementioned
efforts were made by the State Government with a view to reduce child and maternal
mortality in the state, but with abysmal result since the rate of child mortality in the state is
on the high side.
Child mortality is one of the major problems faced by many countries of the world.
Infant and child mortality remains alarmingly high in developing countries despite the
momentous decline in most parts of the developed world. UNICEF (1987), in a report
titled the state of the world‟s children indicated that about 12.9 million children die every
year in developing countries. This problem persists despite commitment made to tackle
the menace of child mortality globally. More so, in 2006, UNICEF reported that every
year nearly 10 million children of under-five years old die globally, of the 4 million
newborns (40% of under-five) die in the first four weeks of life.
Available evidence indicates that Africa accounts for the highest burden of
mortality among women and children in the world. Africa accounts for only 22% of births
globally, but half of the 10 million child deaths annually occur in the continent. Africa is
the only continent that has seen rising number of deaths among children since 1970s. It is
estimated that about 4.6 million (46%) under-five deaths is in Africa (Okonofua, 2008).
The Nigeria Demographic and Health Survey (NDHS) (1990) reported that 87 of
1000 infants born in Nigeria died before their first birthday while 115 of 1000 children
died before reaching the age of five. In the same vein, the report of NDHS (1999), shows
that the child mortality rate in Nigeria was very high in which an infant mortality rate of
75 deaths per 1000 live births and under-five mortality rate of 140 deaths per 1000 live
births for the 1995 to 1999 period. Furthermore, UNCEF (2004) reveals that for five years
immediately preceding the 1999-2003 survey, the infant mortality rate was 100 deaths per
1000 live births, while the overall under-five mortality rate was 201 deaths per 1000 live
births.
In the speech of UNICEF Executive Director, Ann Veneman, “on midway to 2015
deadline for MDGs, Nigeria continues to record unacceptably high maternal, newborn and
child mortality”. Nigeria ranks as one of the 13 countries in the world with the highest
child and maternal mortality rate and is still not listed among the 10 countries seen to have
made rapid progress to meet the MDGs. Under-five mortality rate in Nigeria has been
escalating rather than reducing.
The Multiple Indicator Cluster Survey (MICS) report (2012) indicates that Child
mortality in Nigeria increased from 138 per 1,000 live births in 2007 to 158 per 1,000 live
births in 2011. While in 2012, Nigeria ranks high in the list of countries with high
maternal and infant mortality rates with a ratio of 545 per 100,000 live births on the
maternal mortality index and 75 per 1000 live births on the infant mortality index. The
UNICEF Country Representative, Mrs. Jean Gough in 2013, raised the alarm that Nigeria
has failed to make significant progress in checking the rising mortality rate of children.
She further said that, 20 per cent of child deaths in sub-Saharan Africa occur in Nigeria,
this has increasingly made Nigeria the cynosure of all eyes during global discussions on
child mortality issues. Nigeria constitutes just 1% of the world‟s population, but accounts
for 10% of the world‟s maternal and Child mortality rates.
An estimated 250,000 newborns die annually in Nigeria, the neonatal mortality
rate is 48 per 1000 live births (FMOH and NPHCDA, 2009). Even within Nigeria, there
exist a wide geographical disparity of child mortality rates, the highest rates are seen in the
Northeast and Northwest Zones of the country, while in the Southwest and Southeast, the
rate is very low. According to the survey conducted in February 2010, the record stands at
between 165 per 100,000 live births in the South West and 1549 per 100,000 live births in
the North East (Onumere, 2010).
It is in relation to child mortality and other problems, the United Nation signed
MDGs in September 2000 to reduce the rate of poverty and health related issues, which
include reduction of child mortality and improvement in maternal health as well as
combating HIV/AIDS. Eight interrelated goals were identified and fifteen years target set
for their attainment. At the beginning of this millennium, countries of the world agreed to
reduce by two-third of the under-five mortality rate by the year 2015. In spite of all the
efforts put in place by both the Federal and Bauchi State Government towards the
attainment of MDG 4, why is it that the level of infant and child mortality is still high in
Nigeria and Bauchi State in particular?
1.2 Statement of the Research Problem
Child mortality is a phenomenon that is prevalent in developing countries of the world, it
is a tragedy that carries a huge burden of grief and hurt, which has been described as a
major public health problem in developing countries. Infant and child mortality remains
alarmingly high in developing countries of the world despite the momentous decline in
most parts of the developed countries. The persistent high rate of child and infant
mortality has attracted the global attention in which its reduction has specifically become a
part of the Millennium Development Goals.
In response to the challenges of poverty, illiteracy, child and maternal mortality,
among others globally, the Millennium Development Goals (MDGs) were set by the
United Nations (UN) to forestall these challenges across the countries of the world.
Nigeria as a member of the United Nations (UN) has adopted the MDGs scheme in which
the successive Governments continued to ensure the implementation of the MDGs projects
at the centre, while at the same time encouraging the state governments to partake and
continue to play their roles.
Bauchi State Government has been allocating resources over the years on
provision of health care services across the State. Several efforts were made by the State
Government in this regard, which include establishment of School of Nursing and
Midwifery Bauchi and the College of Health Technology Ningi with a view to provide
adequate Primary Healthcare practitioners such as Nurses/Midwives, Community Health
Extension Workers and Junior Community Health Extension Workers for effective
Primary Healthcare service delivery in the state. In complementing the effort of the
Federal Government towards accomplishment of MDG 4, the Government of Bauchi State
has also established MDGs projects support unit in 2007, and Primary Health Care
Development Agency to ensure and facilitate the implementation of MDGs programmes
in the State. These include provision of Primary Healthcare infrastructural facilities like
Health Centres, Maternities, Dispensaries, Clinics and Ambulances, as well as other tools
needed for effective healthcare service delivery in the state. The Primary Healthcare
Development Agency is also saddled with the responsibility of creating public awareness
on primary healthcare related issues. However, the expenditures made in the provision of
health care services have not translated to qualitative access to health care services,
especially in the rural areas. The state has one of the lowest antenatal attendance and
hospital deliveries compared to national and global indices.
The issue of child mortality is increasing which is seen as one of the major health
challenges in the state, despite the implementation of MDGs by the state government; the
rate of child mortality is very high. For example, in 2009, when T-ship began to work in
the two northern states of Nigeria, Bauchi and Sokoto, the under-5 mortality rate of
Bauchi State was 260 per 1000 live birth while in Sokoto it was 269 per 1000 live birth
respectively (T-ship, 2012).
The healthcare system of Bauchi State is in comatose, few maternities, clinics and
dispensaries with few drugs and inadequate infrastructural support, including electricity,
equipment and trained primary healthcare workers. Delivery of primary health care
becomes a personal affair and dependent on ability to pay for basic laboratory and
physician services; these have exacerbated the level of infant/child mortality in the State.
The persistent high rate of child mortality in the country negates the accomplishment of
the fourth goal of MDGs in Nigeria and Bauchi State in particular.
In spite of the proclaimed commitment by the Bauchi State Government towards
attainment of MDG 4 by reducing the infant and child mortality by two-third between the
year 2000 to 2015, health indicators are showing that the state is unlikely to meet the set
target come 2015.
1.3 Research Questions
In view of the problems identified above, this study seeks to provide answers to the
following research questions;
i. Does Bauchi State Government employ adequate healthcare practitioners for the
implementation of MDG 4 in the State?
ii. Has Bauchi State Government provided adequate healthcare infrastructural
facilities for the implementation of MDG 4 in the State?
iii. Does Bauchi State Government provide sufficient funds needed for effective
implementation of MDG 4 in the State?
iv. What are the measures put in place by the Government of Bauchi State in
promoting public enlightenment 4 in the state?