As doubts mount over whether the federal government will end the Subsidy Reinvestment and Empowerment Programme (SURE-P), Daily Trust examines the performance so far of the programme’s maternal and child health components.

 

The Subsidy Reinvestment and Empowerment Programme (SURE-P) was launched in 2012 when subsidy was removed from fuel sales. The federal government set up the SURE-P, which has the social infrastructure and safety net components, to relieve the burden of the poor over health, education, roads, and other social amenities. 

 

The maternal and child health project is part of the safety net component. The project director, Dr Ugo Okoli, said the programme is supposed to reduce maternal and child deaths in the country, focusing on four key objectives - to engage skilled birth attendants and community health extension workers and post them to rural areas where they are needed to support about a thousand facilities across the country. 

 

“The second goal is to supply them with drugs and all the consumables they need. The third is to make the environment conducive for them to work, so we do renovations, supply them with water and electricity where they work. The final goal is to create demand so that women use the facilities. That’s why we do the conditional cash transfer,” Okoli said.

 

But then even before the SURE-P component of the maternal and child health project, the National Primary Health Care Development Agency had launched the Midwives Service Scheme (MSS) to boost human resources which was lacking.

 

The executive director of the NPHCDA, Dr. Ado Mohammed, said the SURE-P maternal child health project was to consolidate on the gains of MSS by ensuring better impact in saving the lives of women.

Okoli explained that: “It is actually the lessons we learnt from MSS that we built into SURE-P. MSS is supporting a thousand facilities, while SURE- P is intervening in another 1000 facilities. However, there are some slight differences in the two projects though they complement each other. 

 

“The difference is that in MSS we only did the supply side - which is to provide midwives and Community Health Extension Workers (CHEWs) - but we found out that women use the facilities and still went to deliver at home. We also had the demand side in the SURE-P programme which is the Conditional Cash Transfer (CCT).”

 

According to her, the SURE-P MCH worked in the 36 states and the FCT, intervening in 32 facilities each in the North-east and North-west because it had the greatest burden of maternal and child health, while in other zones in 24 primary health care facilities, except Ebonyi, which also has a big burden, so they worked in 32 PHCs chosen by the states.

 

On the CCT which over the years has been trailed by controversies because it has to do with payment of some token to encourage women visit the facilities to access care, Okoli threw some light on it saying, “We have learnt from other countries like Mexico, Kenya, Brazil. It was actually devised by a former minister of state for health, Dr. Muhammad Ali Pate. The whole idea is that women are attracted to the facilities to use the whole continuum of care. So they just don’t come for antenatal, but stay put till they have their baby and bring their baby back. 

 

“We incentivise them with some cash support. As they register their baby, we give them N1000. If they complete the four ANC, we give them another N1000; if they deliver at the facility we give an additional N2000; if they bring their baby for immunisation, we give another N1000. It doesn’t matter where they started; wherever they started we give them the pro rata of what they’ve achieved through that process. We paid out over N120 million to these women across the pilot states. In terms of ANC attendance, we have had 80 percent above the base-line, and 84 percent of people remaining on the continuum of care till postnatal.”

 

But then despite these few interventions, women still die and Nigeria is still known as one of the countries with the highest maternal and child mortality rates, and the MCH project director said a lot more still needs to be done.

 

 

The Permanent Secretary, Ministry of Women Affairs and Social Development, Dr. Ezekiel Oyemomi, said empowering women was key but enlightening them on their rights and how to access care for their families will reduce deaths. 

Okoli said that Nigeria is quite huge, and the project was unable to reach every nook and cranny.

 

“My suggestion would be to increase it so that we are in every ward. And that’s how we will be able to reach all these women we are talking about, because we have 84 percent reduction in maternal deaths compared to baseline. We have reached over two million women in this programme. But it is just a proportion of the population of the country that we are reaching,” she narrated.

 

Unfortunately, the SURE-P project is set to wind down this year, then what happens to those employed to work in the project? Dr. Ado was quick to say the government was still understudying the project and hopefully will make the right decision. He added that the present government was committed to the survival of women and children. 

 

Meanwhile, the fate of over 12,000 healthcare workers lies in limbo as most states are unable to employ them to work in the health facilities. And despite the avowed successes, the project had it setbacks. The NPHCDA boss said: “State and local governments were unable to keep to their own agreements of providing accommodation, paying the health workers their stipends and employing the staff once the project winds down.”

 

But the project director has her own concerns which include non-release of funds: “The funds were appropriated but not released on time. Sometimes you see us owing midwives for a couple of months, sometimes you see us not paying beneficiaries of CCT at the right time. The other challenge is getting skilled birth attendants to agree to go to rural areas. 

 

“They have to look for schools for their children and start all over. Another is the poverty level in the areas we intervened. Education helps people to know what to do in terms of accessing the facilities and not insisting on delivering at home.”

 

Speaking on some of the achievements on the supply side, Ugo said: “In 2012, the budgetary allocation was N15.9 billion but N3.8 billion was released. We recruited midwives and paid them N40,000 a month, CHEWs at N25,000 a month and village health workers N10,000 a month. When you calculate how much we paid in 2012 to 12,110, it is huge. 

 

“In 2013, N16 billion was appropriated, and we received all. That’s when we really went out-we did almost 625 boreholes across the country, more than 600 facilities were renovated. We also built over 145 two-bedroom units of accommodation for midwives.  

 

“In MSS, we did the one-off supply of drugs, but in this one we constantly supplied drugs whenever they ran out, particularly the common ones: iron and folic acid and malaria drugs. We also supported the government by supplying UN life-saving drugs-chlorhexidine, zinc and ORS and misoprostol, because our biggest problem is bleeding in pregnancy.

 

“In 2014, we got N12 billion, repeated the same thing and enhanced the referral system by purchasing ambulances to send to rural areas. In 2015, we were given N3.5 billion and that’s what we used to pay off everybody, even contractors till April.”

 

By Ruby Leo

Daily Trust