*LASG is addressing the logistics – Commissioner for Health
Motherhood, for practical purposes, is a fulfilling experience for most women, but this is not to say it doesn’t have downsides. The challenges of pregnancy, birth and mothering are well known and could quite frustrating for the average woman particularly those living in the rural areas/hard to reach communities.
Life saving commodities are essentially medicines, medical devices and health supplies that effectively address avoidable causes of death during pregnancy, childbirth and childhood.
For almost a decade, the United Nations has prioritized promotion of 13 commodities in the interest of reproductive, maternal, newborn and child health (RMNCH) continuum of care.
The 13 commodities in question are oxytocin and misoprostol (for addressing post-partum haemorrhage); magnesium sulphate (for pregnancy complications including high blood pressure); injectable antibiotics (for newborn sepsis); and antenatal coerticosteroids (for preterm respiratory distress syndrome).
Others are chlohexidine – for newborn cord care; resurscitation devices – for newborn asphyxia; amoxicillin – for pneumonia, oral rehydration solution and zinc – for diarrhoea, female condoms, contraceptive implants and emergency contraception all for family planning purposes.
However, significant barriers to the demand, access and utilization of these commodities continue nevertheless. This development negatively affects the primary aims and objectives to increase access to life-saving medicines and health supplies commodities for the most vulnerable people.
In recent times, there have been stockouts of life saving commodities notably magnesium sulphate, misoprostol and oxytocin in several of the Primary Healthcare Centres (PHCs) across Lagos state.
The January-June 2018 Maternal, Newborn and Child’s Health , (MNCH) Scorecard by the Lagos State government in collaboration with MamaYe Evidence 4Action and the Lagos State Accountability Mechanism for Maternal and Newborn Health (LASAM) showed stockout of life saving commodities like magnesium sulphate, misoprostol ORS/Zinc and oxytocin in a number of PHCs from January to June 2018, in the State.
LASAM observed stockout of these commodities across most of the PHCs in the first three months of 2018 and attributed it to lack of the commodities in Lagos state for distribution. For instance, the survey shows that in Ilogbo PHC, there were stock out of magnesium sulphate for three months, misoprostol for two months, ORS/Zinc for three months and oxytocin for three months.
At Igbogbo PHC, there was stockout of magnesium sulphate for two months, misoprostol for two months, ORS/Zinc for one month and oxytocin for three months. At Awoyaya PHC 1, there were stock out of magnesium sulphate for one month, misoprostol for three months and oxytocin for three months. Pota PHC experienced stock out of magnesium sulphate for four months.
LASAM however called Lagos state government to release funds to procure essential life-saving commodities, so it can be provided free at the PHCs.
An investigative trip by LEADERSHIP to some of the affected PHCs located in Badagry, Epe and Ikorodu axis revealed that only the so-called flagship centres that have access to the Sustainable Drug Revolving Fund (SDRF) experienced stockout for few months or none at all stock out of life saving commodities like magnesium sulphate, misoprostol and oxytocin. Some of the non-flagship PHCs that experienced up to four months stockout of these commodities because they lack access to the SDRF.
It would be recalled that the SDRF Scheme was put in place by the Nigerian government as a catalyst for the acute shortages of drugs and medical supplies in public health facilities that were endemic in most states in Nigeria and undermined efforts to improve health care delivery.
LEADERSHIP investigation also confirmed that there has been stockouts of drugs like oxytocin, misoprostol, magnesium sulphate, and established that presently there is stockout of Sulfadoxine-Pyrimethamine (SP) in all PHCs in Lagos state since February 2018.
While the responsibility of ensuring constant supply of drugs and that there are no stock outs lies under the purview of the Local Government chairmen and administrators, circumstances often prove otherwise. For instance, it is not uncommon to experience shortage or lack of funds for procurement of the essential drugs. This has led to frequent stockouts of those life saving commodities.
Health commentators however urged for prioritisation of health at the LGA level . While flagship centres may not experience stock outs, findings revealed that contrary to expectations, these life saving commodities are being sold to patients because under the free treatment initiative of the Lagos State government, free drugs are permanently out of stock. Investigations show that oxytocin is being sold for N2000 – N2400 at the flagship centres. Worse still, SP that used to be free, is no longer available.
According to the Head of Case Management branch, National Malaria Elimination Programme (NMEP), Dr Godwin Ntadom, in an interview with LEADERSHIP, said pregnant women and their unborn children are still at risk of dying from malaria.
Ntadom said the challenge with pregnant women is even alarming because mosquito parasites are living things and as such they feed. He said when these parasites enter the body of a pregnant woman, they might go to the placenta and feed on the baby’s food in the placenta and because the parasites are in a comfortable environment, they multiply and replenish themselves.
“After sometime, there may not be enough food for the parasites, meaning, all the food that goes into the placenta are completely eaten by the parasites, leaving nothing for the baby to feed from. At that point, since there is a separation between the human blood and the foetus blood, the woman herself may not feel anything because what actually make one have symptoms of malaria is the waste material excreted by the parasites.
“Now because all these things are happening within the placenta, the pregnant woman is not aware and she is not sick. At that point, the foetus may die due to lack of food. This can be severe that the woman can lose her life in the process of trying to bring out the dead foetus from her womb,” he added.
The solution according to Ntadom is for the pregnant women to go for early Antenatal Care (ANC), where she would be given life saving commodities that can help prevent complications during pregnancy, adding that they should take at least three doses of SP for Intermittent Preventive therapy (IPT) to prevent malaria.
Some pregnant women that patronise some of the PHCs in question, told LEADERSHIP, that the past few months have not been easy as they struggle not only to obtain the money to purchase the drugs, but also to search for them at pharmacy shops.
In the views of Grace Chibuzor, who is eight months pregnant, it’s been one tale of woe after the other since she registered at the PHC in her community.
“I have been struggling to obtain my medication. When I first registered at the PHC around April 2018, the doctor wrote me a list of drugs to purchase. In total it cost me almost N7,000. Getting those drugs was a big issue for me. I visited nearly all the pharmacies in my community, but they were not readily available.. My husband had to go all the way to Festac Town before he got the drugs for me.”
A mother of three, Grace certainly cannot forget the experience a hurry. “As I speak to you, I am eight months pregnant and the doctor has written another set of medication for me to purchase. I don’t even know if I would buy the drugs because, presently, I don’t have that kind of money.”
Grace recalled her first pregnancy six years ago with nostalgia, narrating how the drugs given to her at the PHC were almost all free. “I spent less than N5000 for the registration, she observed.
She however pleaded with the Lagos state government to provide essential drugs at her PHC, towards alleviating the sufferings of pregnant women.
A source confirmed to LEADERSHIP that several PHCs along the Badagry axis are unable to access the SDRF, hence the main reason for the stockout. “We rely on the local government chairmen to bail us out. Most of them do not see the reason to budget money for drugs,” the source noted.
“The Primary Health Care Board (PHCB) has however assured us that whenever we experience stock out, we should write to them and the fund will be released immediately. Let us hope that works.”
LEADERSHIP also gathered from the affected PHCs that the delay in the implementation of the 2018 Lagos State budget is a major factor to contend with. However there is more to the problem.
An officer in charge who pleaded anonymity stated: “We experienced stock out of life saving commodities for the first quarter of the year. Beginning from May to date, all the life saving commodities are available. We have been able to access the SDRF to procure drugs for the PHC.
“However, the real problem we are having right now is the fact that there is no SP for pregnant women. We are pleading with the government to release funds for that because it is not part of the SDRF. Most of our patients can not even see it to buy. Since February 2018, we have stock out of SP.”
Responding to the issue, the Lagos State Commissioner for Health, Dr. Jide Idris told LEADERSHIP exclusively that the state has been having issues with procurement of drugs.
Nevertheless, Idris said, the state government is working out plans to ensure that the essential life saving commodities and other drugs required by pregnant women are always available at health facilities within the state.
“We had problem with the drug procurement system in the first quarter of the year. There were quiet delay in procuring drugs that period. Nevertheless, it is not all the drugs that we experienced stockouts. Some were available at the medical warehouse, the problem why most of the PHCs experienced stockout of some of the life saving drugs was their inability to pick them up at the warehouse. That is a logistics problem.
“Immediately I found out, I have given them an order not to allow that to occur again. I have also found out that the process of procuring drugs, and then the health facilities picking them up at the storehouse, is quite long, we are looking at ways to reduce that process. We are working on the logistics system, especially the supply process.
“We don’t want people to travel long distances anymore just to pick the drugs. We want to take the drugs to the various facilities in Lagos state. To set up that process requires efforts of government and the private sector, hence the delay. But we are trying to fast track the process. As for the problem within the health facilities, I have given them the order to ensure that they put those things in place.”