Health is of paramount concern to every society. Over the years, there has been a great dearth of maternal health care in the sub-Saharan Africa and child mortality has a reoccurring decimal in Nigeria. With the various programmes and initiatives, theseissues seems to be raring it ugly head yearly. In 2019, the world witnessed a globe pandemic which brought the world to her feet, affected the civil liberty of people, limited businesses, affected economy of the world, and governmental policy. A lot of issues seem to be of great concern, but less emphasis has been placed and maternal and child health care. In 2020, COVID-19 struck Nigeria and restrictive measure were imposed to curtail the spread of this contagion. During this period, the medical sector in Nigeria faced a problem majorly which was the lack of protective gear and as such , many health practitioners dreaded attending to patients as their lives were on the line. Of all these patients, women and children bear the brunt of this more than any other group. This research work is geared towards accessing the challenges faced by mothers and health care workers in Nigeria in the Covid-19 pandemic.
METHODOLOGY
An investigation was carried out in Ondo west Local in Ondo state, Southwest Nigeria. Conducting a face to face exit interview with the respondents and an internet based interview with women of reproductive age who had recently had a reason to seek reproductive, maternal and pediatric medical care. In-service and active health workers were also interviewed and respondents who were not disposed physically were interviewed using the zoom and whatsapp applications. Out of the 53 health care facility in Ondo West Local government, 23 was visited with 27 health workers been interviewed both at the primary, secondary and Tertiary levels. A group interview was held these health facilities especially days scheduled for antenatal care for expectant mothers, weeks scheduled for babies vaccination and a one-on-one interview was conducted for women who have sought reproductive care in these facilities. In the course of the interview, a cross-examination was carried out to ascertain the facts in these accounts given by the respondents. The Ondo State Health Board situated in Akure gave their approval which made this research work seamless and hitch-free. Every respondent gave their consent before the interview was conducted, while some of the respondents chose to remain anonymous.
OBJECTIVE
The goal of this study is to examine how the COVID-19 pandemic and related lockdowns has impacted on provision and utilization of essential reproductive health, early childhood development, and teenage health programs in primary care clinics, as well as the challenges in service delivery in Ondo west local government, Ondo state Nigeria.
Keywords: COVID-19, Pandemic, Primary Health Facilities, Reproductive Health, Maternal and Child Health, Nigeria
INTRODUCTION
Since the late 1980s, there has been significant progress in reducing maternal mortality and morbidity globally. In spite of this, in 2017, 284,000 women died of pregnancy and childbirth complications, with majority of the deaths about 99% occurring in low- and middle-income countries. These low income countries constitute Africa, South America and Asia. In Africa, the sub-Saharan region is attributed with high political instability, gender inequality, war, unemployment, maternal and child mortality, and poverty. According to records, Nigeria accounts for 25% of the global maternal deaths. Yet, the world was dealt a huge system shock in 2019—Coronavirus Disease (COVID-19). Following its declaration as a global pandemic by the World Health Organization (WHO) in March 2020, there has been an unprecedented disruption of health systems globally, including their capacity to provide health services as per usual. As of 8th of August there was 628,361 confirmed cases, and 8,997 deaths worldwide. Specifically, as it relates to maternal heath, modelled estimates published during the earlier phase of the COVID-19 pandemic had already predicted that 8·3–38·6% increase in maternal deaths should be expected per month, as a result of direct and indirect causes.
Nigeria, a resource constrained country, is generally classified as a low-medium income country, with a population of about 200 million and almost half (40%) of her population currently living below poverty line. Nigeria’s fragile health system suffers largely from health inequalities, both between and within her regions. This stems largely from deep seated corruption at all levels and poor political will in matters pertaining to the health system, evidenced by persistent poor budgetary allocation to health. Some core drivers of Nigeria’s poor health indicators include the following: the increasing rate of poverty, limited National Health Insurance Scheme (NHIS) coverage and high rate of out-of-pocket health care financing, declining proportion of functional primary health care, and increasing rate of vertical health intervention. Reproductive health indicators in the country are below par and progress has been slow despite numerous interventions, hence the fear of the possible effect of COVID-19 on reproductive health indicators in the country which may worsen the health status and set the country back in the few areas with seeming progress. If adequate measures are effectively taken, it would affect the nation’s capacity to meet up with the sustainable development goals, especially goals 3(good health and wellbeing) and 5(gender equality).
Prior to the pandemic, 2030 was set as a year to eradicate poverty which has greatly affected women and a year to achieveUniversal Health Coverage with women been the focus. The World Health Organization stressed on the need for women-centred care for mothers. Recommending clear quality standards set for the sort of care expected at heath facilities for mothers and their newborns. This goal required that health systems did not only focus on reducing the high burden of maternal deaths, stillbirths, and neonatal deaths that occur among women of reproductive age, but also ensure that the needs of the women are met so that they are satisfied with the care that they receive.
With the outbreak of COVID-19, women have been greatly affected and these has had an exponential increasing impact on their access to health care through access to health care.cognizance should be taken that COVID-19 has pose a challenge to women’s access to sexual and reproductive health and rightsBetween March 2020 and August 2021, there have been a drastic drop in the attendance of antenatal sections and home birth/delivery has become popular amongst the women of Ondo west Local government. There are many trigger to this, which include the economic situation of Nigeria, mass poverty, unavailability of health workers, frequent strikes by health workers and lack of public health awareness. All these has contributed to the drop in health care service in Ondo west Local. The skilled health personnel (nurses, midwives and doctors) are not also left out in these abyss. They were affected by the large-scale lockdowns, restructuring of health services, increased cost of service utilization, and lack of enumeration, no payment of salaries, brain drain and limited access to medical supplies. These occurrences have resulted in a pressing need to assess the challenges in Reproductive, maternal and child health care in Ondo west Local government during a pandemic.
CLINICAL CARE
In March 2020, the World health Organization (WHO) declared the COVID-19 a global pandemic. Restrictive measures were employed globally to curb the spread of this pandemic. Major Lockdown took places in Abuja, Lagos and Ogun state which were the epicentres of the contagion in Nigeria. Ondo state being close to Ogun state one of the epicentres of the pandemic was equally struck by some measures which hinged on the civil liberty of the people. There were curfew between the hours of 9pm to 5am daily, educational institutions went on hiatus at the primary, secondary and tertiary levels. Lower cadre civil servant had to sit at home, most private institutions had to downsize, while some had to work from home. In the face of this the Health sector in Ondo state was looming for an industrial action as a consequence of their demands not been met, while the resident doctors nationwide were on strike.
This had an adverse effect on clinical care. Many who were in need of clinical care often met a facility with few skilled health personnels, who were overwhelmed with work and in most cases were adamant to attend to patients. In the course of this research on of the end-users of Reproductive care services; Agnes Olugbenga a 25 years old woman stated that in the month of June 2020, she had difficulty accessing reproductive health from medical facilities as the health workers were not disposed at the time as a result of administrative issues. She further stress that she had to consult a private health facility which was costintensive for a petty trader like her. Another engagement with Jade a breast feeding mother portrayed the negligence COVID-19 has birthed in the reproductive health. Jade a breastfeedingmother, shared her experience when she got pregnant still breast feeding her baby Samson, a 6 month old baby. Considering the situation, she opted for an abortion, but the clinics were not sufficiently equip to undergo such as operation. She stated that a tablet was prescribed to her by a friend and she nearly lost her life in the process. And post-abortion care was scarce as most reproductive health care personnel were not disposed to attend to her.
It should be noted that clinical case management like sexually transmitted infections, post-abortion care, skilled obstetric care at birth and essential care for neonates, prevention of mother to child transmission of HIV, emergency obstetric care and immediate emergency care for newborn babies, case management of childhood and neonatal illness, care of children with HIV; Outpatient and outreach services: family planning, prevention and management of sexually transmitted infections and HIV, antenatal care, postnatal care, childhood vaccination, nutrition and growth monitoring have all been affected greatly by the emergence of COVID-19.
Evidence gathered, it indicate that COVID-19 has brought disruptions in sexual and health reproductive services occasioned by the pandemic. From the survey carried out in Ondo west Local government it shows that contraceptives and abortion services has been given less emphasis due to a diversion of attention by the government and health facilities to COVID-19. From the demand side, barriers during the lockdown such as lack of finances, fear of infection, lack of transport, and closure of clinics among others were reported. A study in China reported evidence of disruptions in antenatal, delivery, andpostnatal care, abortion services, and stock-out of contraceptives. Based on the information gathered, there was a significant need for contraceptive among married women and women who lived with their lovers during the early stage of the pandemic. From the evidence gathered, there were disruption inchild and maternal health services.
FAMILY PLANNING
30 health care facilities in Ondo west offered family planning services before to the COVID-19 outbreak and lockdown. During the lockdown, the health personnels took a break from family planning service as their attention was diverted to COVID-19 (emergence/pandemic health care). After the lockdown there were restrictions which equally affected family planning. According to nurse Simbi a health worker, she stated that family planning services reduced as the health workers did not have adequate PPEs. Based on this, there have been a hike in uncontrolled births in ondo west local government. Adeola, Olagunju who is a health work at the general hospital in Ondo west, stresses that home delivery has heightened with the outbreak of COVID-19. A lot of women who cannot afford decent health care services have resorted to the use of local midwives who are stack illiterates, with traditional medicine knowledge. Many of them uses unsterilized equipment during delivery. The informant cited an event where a mother in labour had severe complications as a result of home delivery. He stated that the woman in view whom he refused to disclose her name was in labour for 48 hours non-stop and the local midwives had to refer her to the hospital when they ran out of ideas. He equally emphasized on the high rate of self-medication which has proved to be more disastrous in recent times in Ondo west.
In summation, COVID-19 has greatly affected reproductive and maternal health care in Ondo and it is a consequence of the government inactiveness to health matters in Nigeria and Ondo state. COVID-19 has shown that the Nigerian health care system is in ruins and needs serious attention, to make life better for women and children. In as much as the government has designed initiatives that would make the economy boom, quality health care system should also be a priority to the government, for health is wealth. The government should also make it accessible and pocket-friendly to enable low income earners subscribe to it. Salaries and wages of health care workers which be pay as at when due, the Ondo state government should consider paying her health workers their full salary instead of paying in percentage. Public health should be reactivated in Ondo west to enable health workers sensitize the locals on the need for antenatal health care and other reproductive health care services. Finally, political leaders should put an end to health tourism for this has contributed to the stunted growth of health facilities in Nigeria, for such would make them more dedicated to enhancing the Nigerian health care system.
