Accessing high-quality healthcare usually comes with a price tag. The cost differs from place to place and from individual to individual. For some, they pay little or nothing. For others, it costs nearly all they have. And for still others – like several pregnant women in Nigeria – they pay with their lives.
According to the World Bank (2016), the lifetime risk of dying from complications of pregnancy and childbirth in Nigeria is 1 in 22. With 576 maternal deaths in every 100,000 live births, the country accounts for 40,000 maternal deaths annually or 14% of the total global burden of maternal deaths. Nigeria also accounts for 6% of newborn and under-5 deaths globally – all a huge price to pay for health-related needs.
Fortunately, the major causes of maternal, newborn and child mortality in Nigeria (such as postpartum hemorrhage, birth asphyxia and diarrhea, respectively) are preventable. Moreover, the price for accessing high-quality healthcare services can be affordable.
USAID’s flagship Maternal and Child Survival Program (MCSP) is working with other health stakeholders to make this a reality in Nigeria. One key way the Program is realizing this goal is through women’s savings and loans clubs, which it introduced in Ebonyi and Kogi states.
Despite gradual improvement in service delivery at Nigerian health facilities, many women still do not go to routinely check their pregnancies or to deliver. From the 2013 Nigeria Demographic and Health Survey, only about 34% of deliveries take place at health facilities, and only 38% are handled by skilled birth attendants.
One of the reasons often cited by pregnant women and mothers for shunning health facilities is the inability to pay for needed healthcare services. According to findings from a study on household cost of antenatal care and delivery services in a rural community in northwestern Nigeria (2013), although the total average cost of antenatal care and delivery services did not seem huge (about US$22), it was nonetheless a barrier to accessing antenatal care and facility-based delivery services in the study area.
This is not surprising given information in a 2016 Health Financing Profile (Nigeria) report by the African Strategies for Health, a USAID initiative. The report shows that in Nigeria – where government expenditure is less than a quarter of total expenditure on health and where public health facilities are weak – many people seeking care have no option but to pay out-of-pocket. But with pervading poverty, especially in rural communities, out-of-pocket expenses are unattainable for many. And if poor, rural women with no means of livelihood are involved, the effect on maternal, newborn and child health can be tragic.
However, there are now women’s savings and loans clubs being formed in Ebonyi and Kogi states that provide members with alternative health financing to seek high-quality healthcare. Introduced by MCSP in these two states, the aim of the clubs is to reduce the inability of women members to access needed healthcare.
Members are encouraged to contribute a very small amount, in some cases less than half a dollar, into a “community pot” every week or fortnightly that can then be accessed by members as loans. Usually, loans drawn by members for health purpose attract no interests, while loans drawn for business attract a small percentage interest. Each club also sets aside a proportion of their savings for health emergencies such as during pregnancy or delivery.
In addition to loans and emergency funds, members also benefit from health services provided by nearby health facilities. For instance, members of a club in Ebonyi were sensitized on handwashing and sanitation by community extension workers at one of the club’s meetings. Four women in another club in Ebonyi State adopted long-acting reversible contraceptives (implant and injectable) after their club received health talks from family planning providers.
The biggest benefits have been for women without previous means of livelihood. A few months after the club was introduced in Ebonyi and Kogi, multiple clubs had been formed, enabling their members (over 200 in total) to raise and loan out US$1,300.
One loan beneficiary was Esther Folorunsho, a 40-year-old widow and mother of two children. She was always seeking help from relations until she received a US$48 from the club, which she used to start a palm oil business.
“I thank God for joining this club because it has helped me to start a business,” she said. “My children are happy because I can feed them now.”
MCSP does not fund the clubs, but helps to form and incubate them. The Program initially sponsored 10 community women and leaders from Ebonyi and Kogi to learn from the thriving women’s savings clubs in Zamfara State, where USAID’s predecessor Maternal and Child Health Integrated Program launched a series of community programs in 2009 with similar aims.
These women and leaders were also trained on the modus operandi of the clubs (from club formation to choosing management committees to managing savings and loans and sharing profits) at a workshop facilitated by MCSP. The women later helped form the first sets of clubs in Ebonyi and Kogi states.
By June 2014, more than 163 savings clubs had been established in Zamfara State, and more than US$159,235 collected for the benefit of over 5,000 women. The clubs are now a way of life in the state, helping members to start or grow their businesses and get out of poverty, and to pay for health emergencies.
MCSP focuses on improving the quality of maternal, newborn and child health services that are available at public and private health facilities in Kogi and Ebonyi states. Midway into its five-year project life, the Program has empowered about 1,500 frontline healthcare workers (including doctors, nurses, midwives and community extension workers) with lifesaving skills to provide basic emergency maternal and obstetric care for pregnant women and newborns.
MCSP also donated essential medical tools and equipment to several facilities to aid the work of the health workers. The trained workers in turn supervised and delivered more than 20,000 women and resuscitated about 200 newborns who could not breathe at birth – and who would have died if the health workers had not acquired the new skills and tools.
At the community level, MCSP will continue to support the formation of more clubs in Ebonyi and Kogi. The Program will also introduce an Emergency Transport Scheme in selected communities within these two states to enable the quick transfer of pregnant women to health facilities during emergencies.
The hope is that more community women and institutions, governments and other stakeholders will recognize the impact of the clubs on the health and livelihood of mothers, and replicate them across the states.
Tolase Olatinwo, Knowledge Management Advisor, Jhpiego/Nigeria
This blog is part of the Institutionalizing Community Health Conference blog series. We encourage those unable to join the conference to stay virtually connected and to add your voice to the conversation at #HealthForAll. As part of this series, we are posting blogs from our staff and partners around the world highlighting the necessity of community health in reaching those not currently accessing key health services.