Monday, 19 December 2016

Department For International Development (dfid) and Reduction of Maternal Mortality in Nigeria


Maternal mortality is a contemporary global phenomenon which plaques Nigeria and the world at large, claiming the lives of women in the process of bringing forth lives. Consequently, there has being massive cry out to curb the rising rates of death. The scourge of maternal mortality is peculiar to developing countries, Nigeria, Northern Nigeria and even Kaduna State to be precise with a maternal mortality ratio of 1,500 per 100,000 live births and some 55,000 maternal deaths annually. Nigeria accounts for 10% of the world's maternal deaths.

 A population-based study indicated that maternal mortality ratio is worst in northern Nigeria. The majority of these maternal deaths, as in the rest of the world, are preventable.  And as such, for Kaduna State and Nigeria to achieve an accelerated success in improving maternal health care, causes of maternal mortality must be identified and tackled at all levels; assess the existing statuesque of maternal mortality in Kaduna State and also; the role played by Department For International Development(DFID) in curbing maternal mortality in Kaduna State. It is to this fact that this project highlights the effort of Department for International Development (DFID) through its subsidiaries such as the Partnership for Transforming Health Systems II (PATHS II) and The Safe Motherhood Initiative Demand (SMID) intervention. A secondary source was basically adopted for the research methodology and subjected to qualitative content analysis with dully acknowledgement.

Title page                                                                                                                                      
Table of Contents                                                                                                                   

1.0 Background to the Study                                                                                                 
1.1 Statement of Research Problem                                                                                       
1.2 Research Questions                                                                                                          
1.3 Objective of the Study                                                                                                     
1.4 Research Assumptions                                                                                                      
1.5 Significance of the Study                                                                                                 
1.6 Research Methodology                                                                                                     
1.7 Scope of Study                                                                                                                 
1.8 Limitation of Study                                                                                                          
1.9 Definition of Terms and Concepts                                                                                  
2.0.1 Introduction                                                                                                                   
2.0.2 Evolution of International Organizations                                                                      
2.0.3 Definition of International Organizations                                                                     
2.0.4 Purpose of International Organization                                                                           
2.0.5 Types of International Organization                                                                              
2.0.6 Maternal Mortality                                                                                                         
2.1 Theoretical Framework                                                                                                     
2.2 Organisation of Chapters                                                                                                 
3.1 Introduction                                                                                                                      
3.2 Overview of DFID in Nigeria                                                                                          
3.3 Alignment to DFID and Wider UK Government Priorities                                             
3.4 Safe Motherhood Initiative Demand (SMID)                                                                
3.5 Safe Motherhood Initiative Demand (SMID) Process                                                    
4.0 Introduction                                                                                                                    
4.1 Maternal Mortality in Kaduna State                                                                                 
4.2 Risk Factors of Maternal Mortality in Kaduna State                                                       
4.3 Maternal Danger Signs in Kaduna State                                                                          
4.4 An Assessment of the Department For International Development Intervention in Kaduna State                                                                                                                                             
5.1 Summary                                                                                                                           
5.2 Conclusion                                                                                                                        
5.3 Recommendations                                                                                                                        


1.0 Background to the Study
Procreation is a very essential part of human existence as any contrary opinion will bring about the extinction of the human species on the face of the earth. In our African set up, whenever couples are bound by vows of matrimony, it is expected that child bearing is the next step. The birth of a new born baby brings untold joy and blessings to the family and the community at large. This is premised on the  belief that when a woman is pregnant, the baby is hers alone but the moment she delivers, the baby is for everyone as family members, friends, neighbours and even well-wishers rejoice with the arrival of the new addition to the family. But there are peculiar instances in which a woman dies in the course of pregnancy and other man made causes such as crisis, conflicts, insurgency, terrorism and war during delivery or after childbirth which impacts negatively on everyone due to the irreparable loss. 

Also in our African set up, it is believed that when a woman is pregnant, one of her leg is on earth and the other is in heaven which signifies how delicate and sensitive the gestation period can be described. With the increasing numbers of women whose lives are claimed in the course of bringing forth new lives in normal situation and induced situations, a lot of writers and scholars have now taken up the responsibility of finding out why this is the case.

According to World Health Organization (WHO), maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. 

The United Kingdom’s Department for International Development (DFID) describes maternal mortality as a situation in which a woman dies during pregnancy, at childbirth and forty (40) days after delivery. In Nigeria, experts say pregnancy, labour and early infanthood are well recognized as being hazardous in most communities. Every now and then, women get pregnant and are delivered of their children some of whom often die from preventable diseases.

Furthermore, there are growing concerns about the way women die daily as a result of health complications in the country. According to experts, statistics on maternal deaths in the country are so shocking and unacceptable. It is said that a nation which allows her women to die in the process of bringing forth lives only exists on borrowed time.  

Maternal mortality also reflects disparities in socio-economic development. The overwhelming majority of maternal deaths occur in developing countries and the high risk reflects limited quality of care and provision of maternal health services. Maternal mortality is a reflection of women's place in society and their lack of access to social, health and nutrition services, and economic opportunities. Poor maternal and child health indicators have been reported in Nigeria since the 1990s. 

Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. 

Despite the decline observed in almost all regions during the period of 1990–2014, regional variation in the rate of decline of under-five mortality rate (U5MR) was observed. North-central region shows a slight increase from 1999 to 2013 (APC = 0.43%, 95% CI: −13.60 to 16.70%), while the highest decline was observed in the South-south region during 2003–2013 (APC = −6.38%, 95% CI: −17.60 to 6.30%). The regions with consistently the highest U5MRs are the north-west and the north-east.

Kaduna State is the third most populous State in Nigeria. It has an estimated population of 6.4 million people (2009) spread across 23 LGAs and 255 wards. Subsistence agriculture is the dominant occupation of the people. There is a wide diversity in culture and lifestyle between the predominantly Moslem Hausa northern population and the southern Christian population of a variety of ethnic groups.

 The poverty level, though lower than the zonal average, is still very high. Health care services in the State are provided from a total of 1,692 health care facilities; 40.2% of these health facilities belong to the private sector. 96.5% of all the health facilities are primary health care, 3.2% secondary health care and 0.3% tertiary health care facilities. In addition, there is a rich network of traditional healers and patent medicine vendors that provide care. Free maternal and child health services is provided in all the 34 health facilities belonging to the State government and 116 Local Government Area-owned Primary Health Centers facilities.

Health indices are poor as can be seen in the maternal mortality ratio   of 1025/10000 live births, infant mortality and child mortality rates are 114 and 269/ 1000 live births respectively. The prevalence of HIV and TB are on the increase and non-communicable diseases are increasingly becoming public health problems. This, in part is because of low coverage of high impact cost-effective interventions. For example, only 22% of children are fully immunized, less than 20% of women deliver in a health facility and only a fifth have their deliveries supervised by a trained health professional.
Political commitment to health development, especially at the Local Government level is poor. While the State government has articulated a number of policies and laws aimed at reforming the health services, some crucial ones are yet to be operationalised with a whole lot suffering from implementation problems. There is poor coordination and lack of effective health leadership, especially at the Local Government Area level. Health funding is low, unpredictable and not timely. Out-of pocket expenditure remains the dominant method of financing health care in the State. 
 There is gross inequity in the distribution of health facilities and health personnel. Shortages of drugs remain a problem as well as dearth of equipment, especially at the PrimaryHealth Care level. There are gaps in the quantity, quality and mix of health care personnel. Services remain fragmented, not integrated and essentially limited to clinic-based interventions, and referral systems are poorly developed. The health management information system is poorly developed and it excludes the private sector. Community participation is poor and the state public private partnership policy is yet to become fully operational (Kaduna State Ministry of Health, 2009).
1.1 Statement of Research Problem
Maternal mortality is a contemporary global phenomenon which plaques Nigeria and the world at large, claiming the lives of women in the process of bringing forth lives. It is a burden that weighs heavily on everyone since in a bid to ensure generational continuity; women are faced with varying challenges.  Consequently, there has being massive cry out to curb the rising rates of death. 

During the first International Safe Motherhood Conference in Nairobi, Kenya in 1987 as well as the Beijing Conference and International Conference on Population and Development held in 1994 in China and Egypt respectively, maternal mortality was highlighted as a significant health problem. As a result of this prevalent health challenge, over the years, lots of programs and strategies have being designed, developed and even implemented by different International Governmental Organizations as well as Non-Governmental organizations which is also in line with the Millennium Development Goals of 2001. 

Prominent among these organizations are World Health Organization, Society for Family Health and others. It is based on the above, that this research work will evaluate Department for International Development’s intervention in maternal mortality in Kaduna State in Nigeria from 2012-2014 through supported Partnership for Transforming Health Systems-II (PATHS II) and The Safe Motherhood Initiative demand(SMID) in creating a template of interventions that could fill the wide gap between private and public health facilities, especially at the primary levels in terms of maternity rate in the state and to reduce by two thirds the mortality rate among children under five and further reduce by three quarters the maternal mortality ratio.

The various nature of its intervention are done through funding, monitoring and evaluation, rural enlightenment. DFID is helping to build strong and investable business environments in developing countries and improving access to finance for entrepreneurs. Improving the prospects for girls and women in developing countries is a priority. Investing in girls and women is the smart thing to do, as well as the right thing to do. By unleashing their potential, they see returns for girls and women themselves, their families and communities, and for their economies and countries. No country can successfully develop if it leaves half its population behind.

1.2 Research Questions
This research work seeks to ask the following questions;
a.       What is the role of Department for International Development (DFID) in curbing the rising rate of maternal mortality, in Kaduna state and the rest of Nigeria?
b.      What are the causes of maternal mortality?
c.       What is the existing statusquo of maternal mortality in Kaduna state in particular, and the rest of Nigeria in general?

1.3 Objectives of the Study
This research work seeks to achieve the following aims and objectives;
a.       Assess the role of Department for International Development (DFID) in curbing the rising rate of maternal mortality, in Kaduna State and the rest of Nigeria as well as make practicable recommendations.
b.      Identify the causes of maternal mortality.
c.       Assess the existing statusquo of maternal mortality in Kaduna State in particular, and the rest of Nigeria in general.

1.4 Research Assumptions
          This study assumes that:
a.   Developing countries such as Nigeria have a high level of dependency; as such they rely heavily on international support to complement their existing resources.
b.      Maternal mortality is the aftermath of several issues lumped together.
c.    Department for International Development (DFID)’s intervention in Kaduna state has led to a significant decrease in maternal mortality in 2012-2014.

1.5 Significance of the Study
At the end of this study, the research work will serve as an indispensable reference material to students, scholars and various concerned actors as well as add to the existing body of knowledge. It will bring to bear the maternal danger signs and its causes. Also it will enhance the attainment of the fifth Millennium Development Goals and provide better strategies for International Organizations. In addition, it will aid formulation of policies that will tackle maternal mortality as a contemporary social problem in present day Nigeria.

1.6 Research Methodology
Secondary sources will basically be adopted for the research methodology in order to harness the necessary data that will enhance the completion of this work. These sources will include books, published and unpublished works, journals, magazines, annual reports from organizations and internet sources which will be subjected to qualitative content analysis and dully acknowledged. 

These sources will be useful as it will provide the necessary vital material needed for the completion of this research. Apart from that, by virtue of the case study being an on-going intervention, the sources are very recent. Data will be collated from different sources comprising of textbooks, journals, annual reports from organizations, published and unpublished works and internet sources on United Kingdom’s Department for International Development dedication in addressing maternal mortality in Nigeria.

Secondary sources will basically be adopted for the research methodology in order to harness the necessary data that will enhance the completion of this work. These sources will include books, published and unpublished works, journals, magazines, annual reports from organizations and internet sources which will be subjected to qualitative content analysis and dully acknowledged. 

It is then very pertinent to have a general overview of qualitative content analysis. According to Titscher et al (2000), in the 1950s a controversy about research strategies in content analysis was setting off. Berelson (1971) contended that the quantitative orientation neglected the particular quality of ‘texts’ and that it was important to reconstruct texts. According to him, it is not by counting and measuring that ‘patterns’ or ‘wholes’ in texts can be demonstrated but by showing  the different possibilities of interpretations of multiple connotations. 

To this end, several other contentions and critiques came to bear and as a result, led to the development of qualitative approaches to content analysis. Bryman (2004) states that qualitative content analysis is ‘probably the most prevalent approach to the qualitative analysis of documents’ and that it ‘comprises a searching-out of underlying themes in the materials to be analyzed’ but to be more specific, he defines this concept as ‘an approach to documents that emphasizes the role of the investigator in the construction of the meaning of and in texts. 

There is an emphasis on allowing categories to emerge out of data and on recognizing the significance for understanding the meaning of the context in which an item being analyzed (and the categories derived from it) appeared’. Also, qualitative analysis is not just an approach to analyzing documents, but also a sophisticated and concretely described method at the same time. The object of qualitative content analysis can basically be any kind of recorded communication that is transcripts of interview/discourse, protocols of observation, written documents in general, videotapes etcetera.

By the foregoing discourse, the definition of qualitative content analysis has been offered as ‘an approach of empirical, methodological, controlled analysis of texts within their context of communication, following content analytical rules and step by step models, without rash quantification.’

1.7 Scope of the Study
The study basically covers a limited period, from 2012 to 2014 due to the fact that it was the year the intervention was rolled out with emphasis placed on identifying the causes of maternal mortality alongside the maternal danger signs and appraising the place of Department for International Development in reducing maternal mortality rate in numerous local governments in Kaduna State of Nigeria. 

Different interventions have being rolled out by Partnership for Transforming Health Systems II (PATHS II) to alleviate the scorch of maternal mortality but for the purpose of this research; Mobilization for Social Approval/Safe Motherhood Initiative Demand and the work so far achieved will be the bone of contention.

1.8 Limitations of the Study
In this research, a major limitation to the study is the fact that being a new ground that is yet to be harnessed, there are limited materials for accessing relevant and updated data on this particular intervention so a lot of internet sources will be used although more sourcing will be done to overcome the challenge.


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