by Deke Abi-Badru
Maternal and child mortality has remained very high in Nigeria despite the efforts aimed at reducing the incidences, and generally improve maternal and child health. The maternal and neonatal mortality rate review by Federal Ministry of Health in 2007 indicated an alarmingly high figure (FMOH, Family Health Division Aggregated data; 2017). According to the review, Nigeria still has the continent’s highest burden of annual maternal mortality of 800 per 100,000 live births and neonatal mortality of 100 per 1000 live births most of which occur in the rural areas which is estimated to attend to about 70% of the nation’s population. This problem highlighted the need for the establishment of the Midwifery Service Scheme (MSS) in 2009, to serve as a link for every pregnant mother to have access to skilled birth attendants during pregnancy and childbirth.
CONCEPT & MODEL OF MSS
The National Primary health Care Development Agency (NPHCDA) is tasked with the mandate of implementing the scheme The initiative sought to provide a stop gap to the human resource shortage of skilled attendance at selected Primary health care centres and to mobilize unemployed and retired midwives for deployment to health facilities in rural communities so as to facilitate reduction in maternal, newborn and child mortality and morbidity. MSS is expected to be implemented by collaborative effort amongst the three tiers of government with support from development partners working on Maternal and Child Healthcare in the country. In the course of implementation of this scheme, a total of 4,000 midwives have been deployed to 1,000 designated PHC facilities, clustered around 250 general hospitals in 426 Local Government Areas in the 36 state and the Federal Capital Territory.
The MSS core indicators include; Proportion of health facilities with midwives offering 24 hours services, Numbers of pregnant women receiving antenatal care 4 times and above, numbers of deliveries attended by skilled birth attendants, Reduction of Maternal Mortality Rate, Reduction of Neonatal Mortality Rate, proportion of women using family planning services and numbers of children fully immunized at one year in the areas covered by the MSS programme.
The concept of the Midwifery Service Scheme (MSS), its justification and responsibilities are no doubt of great essence towards achieving “Health for all” in the nation. Following a review by the National Primary Health Care Development Agency between 2009 & 2012, the impact of the MSS on health indices has been adjudged valuable by national and international bodies. This is reflected in the increase in: Antenatal attendance by +104%, Deliveries by +150%, Family Planning Attendance by +234% and reduction of maternal deaths by -19% and Neonatal deaths by -5%. However, as significant as the achievements of the scheme is, Midwives being employed by the scheme, remains grossly in a precarious form of employment.
MSS AND PRECARIOUS WORK:
Precarious workers are those who fill permanent job needs but are denied permanent employment rights. Globally, these workers are subject to unstable employment, lower wages and more dangerous working conditions. They rarely receive social benefits and are often denied the right to join a union. Even when they have the right to unionize, workers are scared to organize if they know they are easily replaceable. Permanent employment across a number of sectors has shifted to precarious jobs through outsourcing, use of employment agencies, and inappropriate classification of workers as “short-term” or “independent contractors.”
According to a recent case study on “Midwifery Service Scheme retention attrition and sustainability sponsored by Capacity Plus, the working conditions of these Midwives can be described as precarious as several challenges such as uncertainty, job insecurity, lack of social benefits and low wages remains a recurrent event in the lives of these Midwives. The Midwives under the scheme have three employees; the Federal, the state and the Local Governments. At present, counterpart funding allowances supposed to be paid by the state and local governments of over 22 states out of the 36 states & FCT remains unpaid for over six months. Yet, there is no hope of renewal of contract let alone absorption into state/LG service. The midwives are offered minimal health insurance and compensations in cases of injury or death. The few, who have benefitted from this, got their claims after a year or more. Delays in payment of remuneration and allowances by their “three” employers (for the few states/LG that pay) is a recurrent event in the face of diminishing federal government funding and inadequate ownership by state/local governments.
In most of these rural areas, the Midwives are offered very poor accommodation with no security around health facilities resulting to some reported cases of rape and theft, with no means of efficient transportation including poor access roads to facilities, Midwives continue to witness untold hardship in carrying out their assignments in these rural areas. Finally, these Midwives are denied their basic rights of Freedom to Association and collective bargaining due to nature of employment and the ease of lay-offs.
- National Primary Health Care Development Agency (NPHCDA): Ward Minimum Health Care Package 2007 – 2012; Background Information: FMOH, Family Health Division Aggregated data; 2007
- NPHCDA: The MDG-DRG funded Midwives Service Scheme; Concept, Process & Progress. 2nd Edition, August 2012
- NPHCDA: Primary Health Care System Development; OVERVIEW OF THE MSS – A Platform for Equitable PHC Service Delivery – SO FAR, HOW WELL? 20th, September 2014
- Study of Attrition, Availability and Retention of Midwives Service Scheme Officers in Nigeria Between 2009 and 2012 by Dr Emmanuel Ikechuchwu sponsored by CapacityPlus: September, 2014