Protecting maternal, newborn and child health rights (2)

Beyond the legal provisions, key National Development Plans in the sector include Vision 20:2020 and its First National Implementation Plan, National Health Policy, National Strategic Health Development Plan, National Policies on Maternal and Child Health and Reproductive Health and the Transformation Agenda. All of these have made provisions for addressing the challenges in MNCH. However, there is no alignment between the fiscal projections in the NDPs and the federal and state governments’ budgetary health allocations. The allocations have been very low and have averaged 5 percent of the budget between the years 2009 and 2013. The released figures come lower than the budgeted and the cash-backed portions of the released sums are much lower. At the end of the day, the actual utilised sum further lowers the funds available for health. For instance, between 2009 and 2013, the percentage of approved federal health capital budget utilized was 48.2 percent, 33.4 percent, 58 percent, 55.3 percent and 31.8 percent, respectively. This gives an average of 45.4 percent over the five years. This budgeting trend is against the commitment of the Abuja Declaration of African leaders to set aside not less than15 percent of the budget for healthcare.

In the defence of the right to life of all Nigerians irrespective of their sex, age and gender, including mothers and newborn children, the state has three levels of obligations, viz: the obligations to respect, protect and fulfil. The obligation to respect requires states to refrain from interfering with the enjoyment of MNCH rights. The state is enjoined to refrain from acts that directly violate MNCH rights. States should refrain from limiting access to contraceptives and other means of maintaining sexual and reproductive health, from censoring, withholding or intentionally misrepresenting health-related information, including sexual education and information, as well as from preventing people’s participation in health-related matters.

The obligation to protect requires states to prevent violations of such rights by third parties. Thus, failure of the state to ensure that public and private employers comply with basic labour standards on maternity leave may amount to not just violations of MNCH rights but the right to just and favourable conditions of work. Also, traditional practices which insist on male consent before a pregnant woman gets care which is unchallenged by the state may engage the state’s responsibility. States are also obliged to ensure that harmful social or traditional practices do not interfere with access to pre- and post-natal care and family planning; to prevent third parties from coercing women to undergo traditional practices, e.g., female genital mutilation; and to take measures to protect all vulnerable or marginalized groups of society, in particular women, children, adolescents and older persons, in light of gender-based expressions of violence. States should also ensure that third parties do not limit people’s access to health-related information and services.

The obligation to fulfil requires states to take appropriate legislative, administrative and budgetary, judicial and other measures towards the full realisation of MNCH rights. Thus, the failure of a state to provide primary health care to those in need may amount to a rights violation. Public health infrastructures should provide for sexual and reproductive health services, including safe motherhood, particularly in rural areas, as well as information campaigns, in particular with respect to HIV/AIDS, sexual and reproductive health, traditional practices, domestic violence, etc.

The obligation to fulfil brings us back to the starting point where it was stated that Nigeria is under obligation to use the maximum of available resources for the protection and promotion of MNCH. The poser is whether the state is deploying this maximum of available resources. Available evidence will answer the questions in the negative. Even our conception of resources is a bit defective as there is the temptation to think only of financial resources. Resources include information, human, natural/environment or ecological, technological and financial which we often mistake as the only one. How has the state used the media to disseminate information on basic hygienic conditions to support improved MNCH outcomes?

Happily, the delayed National Health Act has become law and it provides, inter alia, for not less than 1 percent of the Consolidated Revenue Fund to be set aside for the Basic Healthcare Provision Fund. 1 percent is the minimum floor; it could be more if the executive and legislative authorities prioritise healthcare.

A country where massive corruption is the order of the day and the government distinguishes between corruption and stealing cannot be heard to plead lack of resources to fulfil its minimum core obligation to women, newborn and children. It is only a question of plugging the leaking pipes of corruption and resources will be freed to where they are most needed.

There has been a multiplicity of interventions to improve MNCH but the results are not encouraging. In recent years, beyond the normal budget, there have been interventions from the MDGs and Subsidy Reinvestment Programme. These interventions have focused on human resources for health and service delivery, conditional cash transfer schemes and health facility upgrade. Other areas of intervention include drug and equipment supplies and communications and advocacy. Essentially, our health indicators on MCNH do not match our resource profile. The country can afford to do much better with the resources at its disposal.

EZE ONYEKPERE