Anambra free maternal care policy sparks hope despite challenges

WHAT YOU NEED TO KNOW TODAY| SEE THE IMPORTED RICE THAT HAS KILLED 935k PEOPLE IN NIGERIA JUST NOW. SEE THE FULL NAMES OF VICTIMS HERE.FOR many women in Anambra State, pregnancy used to feel like a looming financial storm. “How will I afford the next antenatal visit?” and “Can we pay for a safe delivery?” were questions that haunted the minds of expectant mothers, particularly as Nigeria’s economic situation continued to deteriorate. ...Tap To Read The Full Story Here | ..Tap To Read The Full Story Here...

In September 2023, the state government launched an initiative, the Free Antenatal and Delivery Programme, aimed at addressing this crisis head-on. The programme mandates government-owned hospitals and Primary Healthcare Centres (PHCs) to offer free antenatal care and delivery services. The policy, aimed at curbing maternal mortality and alleviating the financial burden on struggling families in the state, was a welcome relief at a time of growing uncertainty.

The Commissioner for Health, Afam Obidike, who shed further light on the programme stated: “The manifesto of our governor is that we’re able to give people of the state and people residing in Anambra state quality and accessible healthcare system and one of them being maternal child health. Then, we looked at the indices in the healthcare system, analysed the maternal mortality, people dying when they are giving birth and most of them die as a result of inability to access care because of the finance involved.

“Also, the hardship in the country even continues to worsen the outcome. So, the Governor resolved that anybody that is pregnant should go to public hospitals – primary and secondary care facilities for free drugs, free ante-natal, delivery and cesarean sessions,” Obidike said.

The policy targeted at further strengthening the capacity of the 329 PHCs across the political wards in the state, already enrolled under the Basic Health Care Provision Fund (BHCPF), is primarily to improve maternal and child health care in the state.

For the first time in a long while, expectant mothers could access healthcare without the crippling fear of what it would cost them and their families.

A year after the programme’s launch, the results have been promising. In healthcare facilities where the initiative was rolled out, patronage surged, with many more women now accessing care.WHAT YOU NEED TO KNOW TODAY| SEE THE IMPORTED RICE THAT HAS KILLED 935k PEOPLE IN NIGERIA JUST NOW. SEE THE FULL NAMES OF VICTIMS HERE.

A lifeline for expectant mothers

For Ifeoma Nwosu, a market trader from Nise, Awka South Local Government Area (LGA), the programme has been a lifeline.  She said women like herself now speak of relief rather than anxiety when discussing their pregnancies.

“I was worried about how we would manage,” she recalled. “But this programme allowed me to have my baby without worrying about the costs or opting for other unsafe practices.”

Another resident of the area, Praise Okon, shared a similar story.

“My husband manages someone’s shop and earns so little. If I had been asked to pay, I wouldn’t have attended antenatal care regularly,” she explained, grateful for the free services that have become a necessity given the current economic climate.

Joy Okeke; pregnant with her second child, also shared her relief.

“It is a big relief for me as a struggling mother. The money saved from not paying for my care can now be spent on equally important things like school fees of my children and feeding,” she noted.

Another beneficiary of free antenatal care and delivery services at the Maternal and Child Health Clinic in Amawbia, Awka South LGA, Nwanneka Nwalieji, expressed her gratitude during a visit by Radio Nigeria. She had brought her one-month-old baby girl for immunisation and reflected on her pregnancy journey.WHAT YOU NEED TO KNOW TODAY| SEE THE IMPORTED RICE THAT HAS KILLED 935k PEOPLE IN NIGERIA JUST NOW. SEE THE FULL NAMES OF VICTIMS HERE.

“I joined ANC from the first month of my pregnancy and never had any difficulty until I delivered my baby,” she said, visibly contented.

Healthcare workers have also noted the increase in activity. The Officer-in-Charge (OIC) at Nise PHC, Awka South LGA, Ifeoma Obi, said that attendance at antenatal care sessions had increased to 25 women from the previous 10.

“Formerly our facility couldn’t boast of 11 deliveries in a month. But in September it was 11. The month before that (August) was 10. Previous months was about nine. But formerly, we used to get two, three or four deliveries in a month. There is a great difference,” she said.

Princess Ayomide resides in Mgbakwu, Awka North LGA and regularly visits the PHC in the area. “I feel greatly relieved,” she said. “If I had to pay for all these services, it would be too much to bear. Let the government sustain it.”

According to the OIC of Mgbakwu PHC, Virginia Nduka, many women who had not attended antenatal care started showing up for deliveries once they heard about the programme.

“In June, we had 20 deliveries, in July 22, and in August 24. The numbers keep increasing,” she said. “Antenatal registrations have jumped from around 100 last year to between 150 and 200 currently.”

Chidinma Nnaluo, in her early 20s, had just delivered her baby boy hours before Radio Nigeria visted Mgbakwu PHC. Nnaluo, who hails from the community, said she joined the programme in January 2024 and it helped her cut cost and rely on credible medical information concerning her pregnancy, which led to her safe delivery. She said she does not joke with participating in antenatal care sessions every Mondays.WHAT YOU NEED TO KNOW TODAY| SEE THE IMPORTED RICE THAT HAS KILLED 935k PEOPLE IN NIGERIA JUST NOW. SEE THE FULL NAMES OF VICTIMS HERE.

“I registered immediately after discovering I was pregnant. I’ve attended antenatal care here without any cost,” Nnaluo remarked.

In Oyi LGA, similar stories abound. Ujunwa Igwe-John shared how thorough the care has been, “The first day I came for antenatal, they conducted HIV tests, checked my blood pressure, blood levels, and more. Now, I only worry about school fees and feeding my children.”

Women across other facilities including Amansea PHC, Ogba Mbaukwu PHC, Nibo PHCs 1 and 2, and Umuwaulu PHC share similar good tidings about the programme which have taken a huge financial burden off their shoulders.

Commenting on the policy in July 2024, Governor Chukwuma Soludo reported that over 60,000 women have benefited from the initiative while the State Health Commissioner, Dr. Afam Obidike, had earlier in May 2024 shared similar tidings, adding that 120 cesarean sections had been performed since its launch in September 2023.

In an exclusive interview with Radio Nigeria in October 2024, the Commissioner again reported that between 63,000 and 70,000 women had benefited from the free ANC and nearly 11,000 safe deliveries without any maternal death from the benefiting facilities.

This, for him, also points at the potential of the programme to reduce maternal mortality currently put at 286 per 100,000 live births among 1.3 million women of reproductive age in the area.

Tension between success and shortcomings

While the state’s free maternal care initiative has delivered undeniable benefits, it has also exposed deep-rooted systemic challenges that continue to plague Anambra’s healthcare sector. The increased patronage is straining an already overstretched system, with healthcare workers struggling to cope with the rising demand. Chronic understaffing is a persistent issue, with many PHCs heavily reliant on volunteers to fill the gap.

At the PHC in Umuawulu, Awka South LGA, for example, infrastructure improvements have not led to higher patronage due to the shortage of healthcare workers. “People complain that there is only one nurse available,” said OIC Juliana Nnaemena.

“I’ve been the only government staff here since last year. Although, a nurse midwife was briefly assigned, she was reposted without replacement.”

The OICs who would not want to be mentioned for fear of being victimized faulted the government for not making adequate preparations for the programme. “They should have recruited more midwives. Before this programme, we got money to run the facility from ANC and delivery.

“But now, everything is free and we no longer generate money. Yet, I do not have staff to work with. So, I engaged four volunteers each of whom I pay N25,000 monthly salary. Every month, I run helter-skelter to get enough money to pay them. Sometimes, I pay from my salary,” one of them lamented.WHAT YOU NEED TO KNOW TODAY| SEE THE IMPORTED RICE THAT HAS KILLED 935k PEOPLE IN NIGERIA JUST NOW. SEE THE FULL NAMES OF VICTIMS HERE.

Earlier this year, 500 healthcare workers were recruited by the state government, but this has barely made a dent in addressing the long-standing workforce shortages. According to the minimum standards for PHCs in Nigeria, each facility ideally requires up to 24 staff members. The recent hires are, therefore, just a drop in the ocean, and complaints about manpower shortages persist across many centres. Going by this standard, the state ideally will require up to 14,832 to efficiently run all its 618 PHCs.

However, this standard has been described as too ambitious and unrealistic as many secondary facilities in the state and other parts of the country cannot boast of more than a few health workers, explained Obiora Agbakwuru, Coordinator of the National Primary Health Care Development Agency (NPHCDA).

“This, for me, is not realizable. What we will be looking at is to have at least four nurse-midwives in each health facility with a record officer who takes and keeps data, which is still currently done by the OICs. There should be distinction between who takes data, who gives vaccines or injections so that the OICs can pay attention to administrative matters.

At the moment, most of the officers in charge of facilities in the state are Community Health Extension Workers (CHEW). According to the minimum standard, each PHC needs four qualified midwives to take safe delivery.

The uneven distribution of staff is another concern. For instance, findings revealed that Umunya PHC in Oyi LGA, which has only handled 18 deliveries since the programme’s inception, has four staff members, while busier facilities like MCH Amawbia and Nise PHC are severely understaffed.

Maternal and Child Health Care Clinic Amawbia, Awka South LGA.The Programme Officer, Justice Development and Peace Caritas (JDPC) Nnewi, a not-profit organization committed to promoting holistic development highlighted other pressing challenges Onyekachi Ololo, said “The referral system needs strengthening, particularly the transportation network between PHCs and general hospitals. In addition, staff should be incentivised to improve service delivery.”

Ololo also raised concerns about women arriving at PHCs without basic supplies.

“Because the services are free, many come empty-handed without sanitary materials, tissues, or other essential items. There’s a need for greater awareness about what the programme covers.”

Investigations also revealed that since most PHCs rely on volunteers to sustain their operations and they no longer generate money from ANC and delivery, some OICs have devised other survival strategies such as directing patients to get items not provided by government from shops where they have an interest. At other times, they get the pregnant women or their families to keep sealed lips about the amount paid for services rendered.

This was confirmed from the conversation between Radio Nigeria and one of the women. “When it requires for you to pay money and all that, definitely now,… you understand. You can’t just get some drugs without payment. I am talking about those ones not provided by the government,” she said responding to a question on whether they still pay for anything under whatever guise.

Complementary effort to the BHCPF

The free antenatal care (ANC) and delivery programme complements the Basic Health Care Provision Fund (BHCPF), a national initiative under the National Health Act aimed at improving access to primary healthcare for vulnerable populations, including pregnant women, children under five, and people with disabilities.

However, according to the Coordinator, National Primary Health Care Development Agency, (NPHCDA) Obiora Agbakwuru, only 329 out of Anambra’s 618 functional PHCs are enrolled in the BHCPF, leaving many facilities without crucial quarterly disbursements.

This gap is yet unfilled as the state government’s free maternal care programme still runs in the same facilities that are already under the BHCPF. Be that as it may, under-funding of many facilities remains a significant challenge more especially in facilities left out of the box.

Even in PHCs taking part in the two programme, Ololo said, “Some OICs disclosed that they are contemplating laying off their volunteers despite being short-staffed because they no longer charge fees for ANC and delivery services. Otherwise, they continue to pay them from their salaries,” Ololo stressed.

Although PHCs are technically the responsibility of local governments, many local authorities have neglected their duties, due to financial dependence on the state government. However, with the Supreme Court’s recent ruling granting financial autonomy to local governments, there is renewed optimism for significant improvements in the future.

Experts believe that both the BHCPF and Anambra’s free maternal care programme are critical to achieving Universal Health Coverage (UHC) by 2030, ensuring that people can access a full range of quality health services when needed, without facing financial hardship.

Agbakwuru, offered further insight, “BHCPF funds the Basic Minimum Package of Health Services, which includes ANC and delivery services, to ensure that all Nigerians, especially the poor, have access to healthcare. This aligns directly with the free ANC service provided by the Anambra state government.”

“The financial burden on families is reduced, allowing indigent families to access crucial services that prevent maternal and child mortality at no cost,” Agbakwuru added.

Impact on the ground: mixed results across LGAs

The initiative’s impact varies across the state. Data from the District Health Information System (DHIS2) shows significant improvements in some council areas. In Aguata, antenatal care (ANC) registrations increased from 6,832 in 2022/2023 to 7,500 in 2023/2024. In the same period, Awka South saw a sharp rise from 14,715 to 23,593 while Idemili South recorded an increase from 6,617 to 9,270.

However, Onitsha North LGA experienced a decline, with ANC registrations dropping from 38,307 to 29,011, Anambra East saw a decrease from 7,551 to 6,774. Idemili North also recorded a slight reduction, from 13,489 to 13,291.

These disparities in ANC and delivery rates between facilities highlighted gaps in healthcare access, which according to Ololo, are driven by factors such as location, awareness, and lingering distrust between the public and government.

Many of the facilities not offering the free ANC and delivery as well as BHCPF are still in pitiable state and in dire need of attention with negative impact on patronage.WHAT YOU NEED TO KNOW TODAY| SEE THE IMPORTED RICE THAT HAS KILLED 935k PEOPLE IN NIGERIA JUST NOW. SEE THE FULL NAMES OF VICTIMS HERE.

Shortcomings acknowledged, solution in progress

When reached for comments, Obidike said the state government was aware of the programme’s limitations and has begun addressing them. First, he said, the government approved the upgrade of the facilities to address the infrastructural decay and make them attractive to residents. Indeed, some of the facilities visited such as PHC Mgbakwu, Umuawulu PHC are beneficiaries of this upgrade.

Commissioner for Health, Anambra speaking on free ANC and delivery programme.“Up to 100 facilities have been renovated, and more are set for upgrade. Solar power installations are being rolled out to improve energy supply, and modern equipment is being distributed for safer deliveries.

“We will soon embark on the second phase where other essential items will be distributed to 326 facilities,” the Health Commissioner said.

Regarding the need for more healthcare workers, Obidike said there are plans for further recruitment.

“Maybe next year, we will recruit again,” Obidike said while also promising to look into the alleged lopsidedness in postings of health workers.

“I have noted it especially the facilities you mentioned. We will look at the nominal role and redistribute.”

He also spoke on irregular supplies of drugs and consumables.

“We provide 10 packs of delivery kits for 10 deliveries. When they have used up to eight, the OICs are expected to make a request for more. But they must provide data showing how the previous supplies were used. Delays happen when requests are not made on time.”

According to him, robust monitoring and supervision mechanisms are in place to boost success rate of the program. “We post signs in all facilities that say, ‘If you’re asked to pay anything, call these numbers.’ One of the numbers is mine,” the Commissioner explained.

“We also collect beneficiaries’ contact details for follow-up. Staff caught collecting money under any pretense have been made to refund the beneficiaries and were sanctioned. Compliance has steadily improved.”

Obidike said there are also plans to incentivise healthcare workers. “For every caesarean section, the government pays the hospital an extra ₦50,000 for staff involved. We are considering incentives for PHC workers too.”

Notwithstanding Obidike’s comments, sustaining the momentum of the programme requires more than vigilance. As the initiative grows, so does the need for consistent resources and deeper community involvement to reach its full potential, said Obiora Agbakwuru, Coordinator of the NPHCDA.

For optimal results, Agbakwuru emphasized the need for consistent provision of essential drugs and active community engagement to promote the program and gather feedback.WHAT YOU NEED TO KNOW TODAY| SEE THE IMPORTED RICE THAT HAS KILLED 935k PEOPLE IN NIGERIA JUST NOW. SEE THE FULL NAMES OF VICTIMS HERE.

“Regular monitoring and evaluation will help identify areas for improvement,” he added...Tap To Read The Full Story Here.