By Charles Kumolu
Following the controversy that trailed its emergence in 2012, there were doubts that the Subsidy Reinvestment Programme ,SURE-P, would achieve the objective it was was seeking to achieve.
Assurances that it had come to make up for some areas where the government had failed to largely meet popular expectations, did nothing to change the perception that it was a conduit pipe of sorts.
It was in the face of this apprehension that SURE-P kicked off across the country.
Specifically, the programme, from inception, implied that money saved from the removal of subsidy from petroleum products would be channeled towards programmes that would impact the lives of poor and vulnerable Nigerians.
The Federal Government pledged to invest its own share of the subsidy in programmes designed to stimulate the economy and alleviate poverty through the provision of critical infrastructure and social safety net projects.
Nearly three years after, indications have emerged that virtually all areas of the nation’s life have attracted the attention of SURE-P.
Of note is the health sector which had, for a long time, struggled to deliver efficient health care services to the citizenry.
In the light of that, maternal mortality gave Nigeria the image of a country where too many mothers lost their lives in the throes of child birth.
Statistics in that regard suggested that Nigeria’s maternal mortality ratio was 576 deaths per 100,000 births in 2013.
That rate was rated among the worst in the world by experts.
To arrest this trend, the initiators of the programme conceived the Maternal and Child Health,MCHP, Project, a component of SURE-P.
Findings showed that MCHP has offered a unique opportunity to increase access to maternal and child health services through the continuum of care for pregnant women and their new born.
In four years, the project has a nationwide coverage and focuses on rural communities.
It also seeks to increase the availability of skilled health workers to provide maternal and child health services at the Primary Health Centres across the country.
In addition, efforts have been targeted at the provision of infrastructural renovations to PHCS and increasing the supply of essential service commodities at PHC facilities to improve service delivery.
Knowing that there is the supply and demand side to the maternal health question, the MCHP has also explored the possibility of increasing the demand for MCH services in rural communities through the use of Conditional Cash Transfer ,CCT, and community engagement at the grassroots.
The supply aspect is concerned with increasing and improving both infrastructure and human resources to improve health service delivery at the primary health care level.
Prominent among the successes achieved in this regard are the refurbishment of PHC infrastructure, the scale-up the number of trained health workers (midwives, community health extension workers ,CHEWs,and village health workers ,VHWs.
This is with the aim of guaranteeing adequate antenatal attendance, skilled delivery at birth, routine immunization and postnatal care for women and their babies.
Also, the shoring up of the human capacity in the health sector is one area in which the project has recorded resounding success.
The National Primary Health Care Development Agency, in its report, stated that, as at August 2014, the SURE P MCHP has increased the supply of manpower for health and created jobs by recruiting 11,912 health care workers.
It added: “They have now been deployed to provide quality antenatal, skilled birth delivery at birth and post-natal services for previously underserved rural, poor women accessing maternal, neonatal and child health services in 1,000 SURE-P supported primary health care (PHC) centres spread across the 36 states and FCT.”
It was further gathered that no fewer than 3,000 midwives and community health extension workers have been trained on life saving skills like basic emergency obstetric care, and helping babies breathe.
3072 village health workers ,VHWs, also received, induction course on key household practices in December 2012.
In order to establish a referral system between primary health care and referral general hospitals, the National Primary Health Care Development Agency observed, in its report, that SURE-P MCHP procured 50 ambulances for distribution across SURE P clusters throughout the country. SURE P MCH has also entered a Memorandum of Understanding with the National Union of Road Transport Workers ,NURTW, so that its members can help to convey pregnant women in need of referral from communities to where SURE-P facilities are located. All referrals from SURE-P MCHP CCT sites are treated at the referral general hospitals free of charge.
Chairman of of SURE P, Major General Martin Luther Agwai (rtd), speaking on the initiative’s giant strides, said the goal of the CCT is to reduce maternal and infant mortality by encouraging pregnant women to go through the full continuum of maternal and child care.
The project has successfully rolled out CCT pilot programme in 37 primary health facilities across eight states and the Federal Capital Territory (FCT). As at June 30, 2014, a total of 25,954 women have been enrolled into the CCT pilot programme.
Similarly, a total of 10,000 women have completed the continuum of care and exited the programme. SURE-P MCH Programme has disbursed over N40,000,000 to CCT enrolees in all eight states and the Federal Capital Territory (FCT) as at the end of March 2014.
The gains from this creative touch have been phenomenal.
The data from SURE-P shows that 217,131 pregnant women have completed focused antenatal care.These milestones have led to commendations and calls on government to explore ways of sustaining the programme.
Stakeholders, comprising representatives of the Abia Council of Traditional Rulers, as well as professionals in the health sector, however, called on government to surmount some challenges regarding some aspects of the project. These aspects include the distribution of drugs, as well as the location of health centres for ease of access. These areas that have experienced hitches notwithstanding, the stakeholders called on the government to ensure the project does not die.
The role of the civil society in helping to take the project to the people at the grassroots was also described as crucial. The stakeholders therefore called on SURE-P to empower civil society organisations to embark on aggressive advocacy and sensitisation to create the desired awareness about the programme.
In the end, the SURE-P MCH programme has a timeline, within which it should ordinarily wind down. But many Nigerians who have seen the benefits of the programme want government to consider extending it. This is no doubt a manifestation of the enormous good will the project has generated among the ordinary citizens. There is no doubt that what makes the project resonate is the possibility it has shown on how to transform primary health care centres to enable them deliver better health services to Nigerians.
To sustain this however will require state and local governments, with whom the responsibility for primary health care actually reside to step up and provide the leadership required to transform system in a sustainable way for Nigerians.