PROVIDING special budgetary allocation for the private health sector to upgrade their services to world standards and enough medical teams with operating theatres at most hospitals in the country has been recommended as key to preventing maternal and child deaths and the loss of foreign exchange earning due to frequent overseas medical trips.A consultant obstetrician and gynaecologist and medical director of Optimal Specialist Hospital, Surulere, Lagos, Dr. Ugochukwu Celestine Chukwunenye, told The Guardian that the Federal Government's intervention programme, the Midwife Service Scheme (MSS), provides only limited solution since the midwives cannot help in most of the complications that lead to mother and child deaths.MSS provides skilled birth attendants and community health workers in villages and remote settings to help reduce maternal mortality in the country. Chukwunenye blamed the limitations of the MSS on the poor referral system in the country.Why has maternal and child mortality remained high in Nigeria' He said, 'in Nigeria, because of certain limitations it has not been possible to reduce this calamity on a national scale to a minimal level, and the factors are mainly the same over these years. The most important is having good access to the services that are available. Many times the women that die don't have access to available services either out of ignorance or poverty or poor standards of education or poor awareness on what is available in the environment or because of traditional or cultural practices or religious beliefs. These things hinder them accessing the available care.'The other important factor is that even when some of these people get to the hospitals, the hospitals are not in a position to immediately address their needs. Some come in very bad condition and require urgent attention.'Meanwhile in that setting there is only one operating team and they are engaged already in the theatre. Then the patient will have to keep waiting until that first case is sorted out before she could have her own chance to be helped. Now that delay called secondary delay is what results to a lot of deaths in our general hospitals and teaching hospitals. It is not because the personnel on ground are not competent, they are very competent but they can only take a case at a time. It has been about limited facilities and limited staff as compared to the volume of patients they are addressing.'How best can the country ensure that no woman dies during childbirth'The gynaecologist said, 'government at every level must look at what is going on at their facilities and ensure that they provide adequate operating units in the maternity section, have adequate number of operating teams depending on the number of emergencies they tend to receive in a day because no life is more important than the other. The fact that a woman arrived first does not mean that the second woman should be allowed to die.'So it is either they provide enough operating teams or operating theatre or the other thing is that they should get into a kind of arrangement with good private hospitals in the environment where if they cannot immediately treat any patient that has just been rushed into a government hospital, good private hospitals can be contacted and they can immediately take such a patient to that facility for the operation to save the life of mother and baby.'But the MSS with skilled birth attendants and community health workers has been hailed as the solution'Chukwunenye said, 'well I will say the MSS will definitely make some contributions down the line. It is a relatively new scheme but the improvement cannot just be attributed to MSS and to extension workers alone. I think what has happened over the years is that we have continuously had well-trained hands leaving the teaching hospital setting and going into the communities and they are gradually changing the landscape. A lot of the patients that die in pregnancy and childbirth, midwifery cannot help them. The only thing midwifery can do is that if they see such patient on time they can encourage a referral to where they can be helped but they cannot help them.'Why should the government care about allocating resources to develop private hospitals' Chukwunenye explained, 'why should they then expend public resources to go overseas for treatment'Why should Nigerians be flown to South Africa at government expense because they are very ill for treatment in private hospitals' They are not going to government hospitals in those places.So you see government funds being utilised in private businesses in other lands. So why not develop our own so that nobody is thrown out'' Now the other time I read the statistics it was well over $120 million that is involved in flying Nigerians to seek treatment in other countries from U.S to India and Israel annually. If we can help our hospitals to get there it is a lot of savings for the country, it will help the economy to reflate.'The best way will be a kind of revolving loan scheme which has extremely low interest rate. There are so many things we want to do for instance each time we look at the 25 per cent interest the banks are asking us, we tell ourselves we cannot go through it.
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