Nigeria is the most populous and one of the wealthiest nations in Africa. Yet reproductive, maternal, newborn and child health (RMNCH) is a leading health challenge in the country. While various programs exist at the national and local levels, our RMNCH health statistics have not changed substantially over the last decade. Indeed, they remain devastating:
- One in 13 women die during pregnancy or childbirth
- The infant mortality rate is 74 deaths per 1,000 live births
- One in eight children die before reaching the age of five
- Only 60 percent of women are protected against neonatal tetanus
- Only 43 percent of year-old babies have been immunized
These tragic realities have been of great concern to me and to most Nigerians. As a 20-year veteran in the field of public health in Nigeria, I long ago grew weary of witnessing relatives, friends, neighbors and loved ones die during childbirth. I tired of seeing women, girls and newborns die because they lacked access to basic reproductive health services, and my anger escalated accordingly.
A decade ago, my colleagues in public health and I decided to act by advocating for the Nigerian National Health Bill which, among other actions:
- Mandates funding for primary health care and minimum health-care packages for all Nigerians
- Provides free public health services for vulnerable groups such as children, women, elderly and persons with disabilities
- Ensures that children up to age five and pregnant women are immunized against infectious diseases
- Establishes village health committees to enhance community participation and ownership in healthcare delivery
Progress to pass the bill was painfully slow. After seven years of intensive advocacy and major public protests, the Nigerian Assembly passed a consolidated version of the Bill in 2011. We were elated. But the president did not sign the bill, for reasons never formally communicated to citizens.
My fellow advocates and I did not relent; we continued to work with the legislature to reintroduce the bill in 2012. Based on our previous experience, advocates closely tracked the numerous legislative stages in both the Senate and the House to ensure that a consolidated version was passed. We also engaged the media to educate the public, and held discussions with health professional groups and religious institutions to reach consensus, especially around contentious provisions of the Bill.
During this time, I also became the country representative for Champions for Change – an initiative supported by the Bill and Melinda Gates Foundation and based at the Public Health Institute—that is dedicated to improving reproductive, maternal, child and newborn health in Nigeria. Champions for Change follows the model of its sister initiative, Let Girls Lead, which has contributed to improved health, education, livelihoods and rights for more than 3 million girls globally.
In December 2014, our collective advocacy efforts finally proved successful when the president signed the National Health Bill into law. The new law will entitle underserved families to free, comprehensive healthcare services, and accelerate efforts to reduce the high rates of maternal and infant mortality.
But after an exhaustive 10-year political and legislative gauntlet, we cannot yet celebrate. My fellow advocates and I know that implementation of the law and adherence to its tenets will take equally undaunted efforts. The critical challenge now is communicating with geographically and economically marginalized Nigerians who are probably unaware of their new rights to free and comprehensive healthcare services, including reproductive health care for women and girls. This will require a new set of strategies to disseminate details of the law and build tracking systems both inside and outside of the government.
Nigeria’s government has taken nearly 10 years to codify healthcare for all of its people. And yet we are only halfway there. Despite the success of our advocacy, the challenges of implementation are just beginning.