The Association of Public Health, Physicians of Nigeria (APHPN) held its 29th Scientific Conference and Annual General Meeting at the Kwara Hotels Limited, Ilorin from 11th - 15th March 2013. The theme of the conference was "Reducing Maternal Mortality in Nigeria: The Way Forward". According to the Nigeria Demographic and Health Survey of 2008, Nigeria's maternal mortality ratio of 545 per 10Q.OQO live births is one of the highest in Africa. Only 39% of births in Nigeria are conducted by" skilled birth attendants compared with 86% in Gabon, 57% in Ghana and 91 % in SouthAfrica.
The Keynote address was delivered by Dr Ado J. G. Mohammed, Executive Director of National Primary Health Care Development Agency (NPHCDA). After several scientific paper presentations, plenary and strategic sessions on the theme and thematic areas including the state of providing Healthcare in Nigeria, the following observations and recommendations were made:
1) Maternal mortality ratio as well as other mortality indices in Nigeria is still high despite huge investment by Government and other donors. The current maternal mortality ratio in Nigeria is one of the highest in Africa compared with sister countries like Ghana.
2) The best practices of Community and Primary' Health Care in history and worldwide currently have been based on the correct, statutory and disciplinary practices of Community Medicine, Nursing and Midwifery to improve the health status of the citizenry including maternal health.
3). The National Health Policy has recognized Primary Health Care as the cornerstone for the attainment of Health for all Nigerians. However, Primary Health Care has been bedeviled with myriad of problems that mar its delivery of effective, efficient and quality healthcare to Nigerians.
4) There is a disconnect among the three levels of health care delivery in Nigeria as evidenced by weak co-ordination and governance amongst the three tiers of government with the Local Government Areas as the weakest link.
5) There is inequity in the distribution of health resources with about 75% of health resources and services concentrated in the urban area where only about 40% of Nigerians reside and work.
6) That Nigerian Government has invested through several mechanisms, including the UNFPA procurement of $3 million family planning commodities in 20 II towards improving the maternal health indices of Nigeria, but the marginal improvement is not commensurate with the huge investment as modern contraceptive penetration still remains at 15%
7) Annual budgetary allocation to health in Nigeria is still below the 15% recommended by the World Health Organization and as agreed to in the Abuja Declaration of 2000. There is a skewed resource allocation and health spending patterns in relation to the disease burden.
8) There has been an increasing number of vertical (stand-alone) programmes as against comprehensive and integrated healthcare delivery at various levels without ensuring best practices.
9) The free maternal health service is not really translating to reducing the matemal mortality ratio in Nigeria.
10) While there is a dearth of funding for health research, access to the little funds provided is extremely difficult. Moreover, funding for research is poorly coordinated.
11) The low PMTCT coverage (less than 5% of ANC facilities offering PMTCT) in the country contributes significantly to maternal mortality and the progress towards attaining the MDG 5 still remains low.
1) Govemment should demonstrate strong political will in health service delivery by increasing funding to the health sector particularly at the Local Government level to effectively provide PHC services to achieve health-related Millennium Development Goals (MDGs) especially MDG 5 that directly addresses Maternal Health.
2) The Federal Ministry of Health should ,take urgent steps to improve coordination, harmonization and synergy of health care delivery in Nigeria through the commonization and integration of HIV services and all diseases of public health importance into the fabrics of health service delivery in Nigeria.
3) The Federal Government should revert to a unified national health system with strong legislative backing.
4) The Federal Ministries of Education and Health should set up a body similar to the DFID-founded Development Research Uptake in Sub-Saharan Africa (DRUSSA) to mobilize funds in furtherance of research activities and research findings translation into improved health care services.
5) Government should strengthen the existing health funds pooling mechanism for the various health programmes in Nigeria to avoid duplication and enhance accountability and transparency.
6) The President should give speedy assent to the National Health Bill which is imperative in the strengthening ofthe PRC system in Nigeria.
7) The Government should scale up PMTCT services to all PHCs to prevent and ultimately eliminate mother to child transmission of HIV in Nigeria.
8) APRPN endorses the introduction of Community Health Insurance Scheme. Government and private sector (as part of their social responsibility) should demonstrate increasing commitment to healthcare financing protection for the poor by scaling up this Scheme and consequently improving the health indices of Nigeria.
Prof. Obehi Okojie
Dr. A. R. Isara