The Co-chair, Bill and Melinda Gates Foundation, Mrs. Melinda Gates, in this interview with BUKOLA ADEBAYO says good leadership and increased funding of health sector, especially northern Nigeria, is what the country needs to reduce poverty rates and improve its present health indices. Excerpts…
In Nigeria and many other parts of Africa, family planning is seen solely as a woman’s need. As a family planning advocate, how can we change this perception?
I think one of the things that I’m seeing in other places in West Africa that are working, for instance in Niger, and which Bill and I highlighted in our report, is cultural change. To get people to use a tool like a new form of birth control, you actually have to get cultural change.
And one of the things Niger did was they actually started with a husband school. They taught the husbands first why the women would be healthier, would die less in childbirth, and why their children would be healthier if they allowed their wives to use family planning. And so, by starting with the men first and getting them onboard, it became not just women’s problem, it became a family problem.
And so, I think Nigeria needs to do some of that cultural work. When I was in Nigeria in January, one of the groups I met with were the local religious leaders, and talking to them about how they had taken the cultural issues around polio, if they think they can do much the same with family planning in the north. If they can talk about how the Koran actually allows for family planning, and that if they can time and space their births, the women will be healthier, the children will be healthier, and the family overall will do better.
So, I think there are several cultural ways it can be tackled, so it doesn’t just stay as women’s issue.
What local efforts can be made to increase funding for family planning and contraceptive uptake to sustain the progress made so far?
Yes, I’m glad you’re asking about this. I think domestic resources are one of the most critical things that we need if we’re going to improve women’s health and children’s health. And so, one of the places that I’m very optimistic about, quite honestly, is West Africa.
We did a London Family Planning Summit in 2012 where we brought the world together to commit to family planning. And in West Africa they set their own goal for what they thought they could achieve between 2012 and 2020. They actually have already met their goal and exceeded it, and now they’re increasing their goal by another million women to give them access to contraceptives.
And it’s because they came together as a set of West African nations in something called the Wagadu Partnership to say how do we break through the cultural barriers, how do we learn about supply chains, how do we learn from what Senegal’s done — breaking apart their public and private part of their supply chain, and spread those ideas and best practices.
What I see is when I see great work at a regional level and I see domestic resources moving towards an issue, that’s when you know you’re going to make progress.
Nigeria is putting some of its own money in family planning, and some of its own money in health, but quite honestly that amount of money needs to go up substantially if we’re going to really tackle the health needs of Nigeria.
In the “Goalkeepers – The Stories Behind the Data” report, you and Bill shared how Ethiopia and Rwanda had reduced poverty rates in their countries. What lessons or policies can Nigeria take from these countries to reduce poverty levels among her citizens?
So it all starts with health. It has been proved that if people can start by living a healthy life, that is their children are not dying in childbirth, they can space the births of their children, then they have a chance of breaking that cycle of poverty. So exactly what a place like Ethiopia has done, second largest, most populous country, second most populous country in Africa, or Rwanda, which is tiny, but the lessons are the same in both places, and it’s the same lesson of what allowed Sri Lanka over a decade ago to lift themselves out of poverty. You start with health, and you build out these tiny, little what they call health posts. It’s a tiny, little health clinic that a family can go to for immunisations, when the woman is pregnant and when she’s delivering.
You build those services out countrywide, and then you have what’s happened both in Rwanda and in Ethiopia. If you have these health extension workers, these women who are part of the village, they get basic training, they teach women and men and families the appropriate things to do in health, and they make sure they get to the health clinic. These clinics also need to be well- equipped by the government so that when a child needs to be immunized or a women’s giving birth, the facilities and drugs needed are on ground.
If you invest as a country in basic health infrastructure, you get a long way down the curve on reducing maternal and child mortality. And that’s why we highlight those two countries in the report.
And quite honestly, that’s what a place like Nigeria needs to do, and particularly in the north. They’ve got some of those health clinics, but they are not well-staffed, they aren’t well-supplied with stock, and it takes leadership.
I mean, why we highlight both Ethiopia and Rwanda in the report is the leadership of their governments saying, we’re going to do this, we’re going to build it step by step, and we’re going to be consistent about it and learn the lessons from around the world. That’s what needs to happen in many, many countries across Africa if we’re going to make progress.
Speaking of Sri Lanka, the country has been able to eradicate malaria, yet Nigeria with more resources is still struggling to reduce the transmission of the disease, what new technology or strategy can she adopt to tackle her malaria burden?
It’s taking the tools that exist — so what Sri Lanka did was they looked at the tools that were available, for instance bed nets, and they looked at treatment for malaria, and they made sure that they applied the tools and applied them very systematically and very consistently.
Again, it took government leadership to say this is a priority for our country, people should not be dying of malaria at this rate, they shouldn’t be dying at all of malaria. And so it took leadership, it took putting the resources in, and then it took learning the lessons again from around the world to say, you know, how do you make sure that every woman who’s pregnant gets a bed net, that every child sleeps under a bed net, and that you follow up and you make sure that the women not only get a bed net, they’re sleeping under them.
Every five years you make sure that the bed nets are re-dipped so that they are effective. You make sure that when people have an episode of malaria, the clinics are well-stocked with the medicines so they get treated while you’re also tamping down malaria in the community.
So it’s being systematic about the application of the tools that really brings down malaria deaths. And that’s why we see malaria deaths have come down substantially around the world in the last seven years. And again it’s because of bed nets and the right application of the tools . If Nigeria would step up and do that, they would see a big decrease in childhood mortality.
International donors are the biggest funders of many of the immunisation, HIV, malaria and polio prevention programmes in Nigeria, and these resources are dwindling. What can be done to increase domestic funding of these projects that affects the lives many Nigerians?
Well, specifically one of the things that Nigeria is looking at, thank goodness, is they finally have been really realistic about the data and the immunization rate in the country. Given the country’s population and its birth cohort, immunization is key. And so they finally have really looked at the data and said, you know what, our immunization rate is not as high as what had been reported, it’s actually 45 per cent.
And so it was fantastic that they came out with that clarity, because now the community can say, okay, we need to drive immunization coverage up substantially in Nigeria.
And if that happens, you will start to see fewer childhood deaths, because we know it worldwide and we have great data that once you know what your immunisation rate is and you start to increase it, fewer children die.
The other thing that is encouraging is some of the partnerships. Like we have a partnership with the Dangote Foundation. And both Aliko Dangote and my husband in July sat on a conference call for several hours with the heads of six key states, Bauchi, Borno, Sokoto, Kano, Kaduna, Yobe, really going through immunization and child health, what the coverage is, what things need to be done in terms of nutrition, what other services can be delivered at the time of immunization. That’s why immunization is so key, because you can also at the same time talk to women about the health of their children and their nutrition and what else needs to get done.
So all of those are things that I think that government at the federal and state level can move money to get things done are key to this.
Source: Punch News