Roadblock to women’s access to quality health care

Statistics indicate that globally, women constitute 50 per cent of the population and about 70 per cent of the health care workforce. But, only about 20 per cent or less of women are in positions of leadership where critical decisions on women’s health are taken. Saddened by the development, experts and stakeholders in the health sector converged on Abuja recently for this year’s “Future Health Summit” organised by the Nigeria Health Watch to proffer solutions to the challenges of access to quality health care services. MOSES EMORINKEN reports.Unarguably, women play critical roles in the well-being of humankind, including the fully-fledged and the up-and-coming.
In fact, they are naturally saddled with the sacred role of procreation. Their importance in the scheme of things informed their being globally recognised and acknowledged. This much it did by commemorating women on “Mother’s Day” annually.
It is, however, heartbreaking that with these enormous contributions by women, they are still “penalised” for being mothers. Many are penalised in the workplace because they lack the support that they need.
Beyond the workplace, many women lack access to quality health care. One of the Sustainable Development Goals (SDGs) 3 by the United Nations is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.
However, in Nigeria, the 2018 Nigeria Demographic and Health Survey (NDHS) shows that the maternal mortality ratio (MMR) is 512 deaths per 100,000 live births for the seven-year period before the survey.
Again, 29 per cent of women travel long distances to access health care facilities. Only 39.4 per cent of mothers were delivered their babies using the health facility (public and private).
Only 42 per cent of Nigerian women affirm that money is essential to access health care. Therefore, the inability to access health care is one of the problems women, especially expectant women, face, a situation that fuels the yearly maternal mortality rate.
According to the World Health Organisation (WHO), the lifetime risk of a Nigerian woman dying during pregnancy, childbirth, postpartum or post-abortion is one in 22, in contrast to the lifetime risk in developed countries estimated at one in 4,900.
All these, coupled with huge inequality in the representation of women in critical health care leadership roles, frustrate the fight against maternal mortality.
Gathering for solutions
Globally, women constitute 50 per cent of the population and about 70 per cent of the health care workforce. However, only about 20 per cent or less of women are in positions of leadership where critical decisions on women’s health are reached.
Experts and stakeholders in the health sector have thus stressed that this is part of the reasons for the low health indices in the country.
Therefore, addressing and proffering solutions to the challenges of women’s access to quality health care services through bridging the inequality gaps formed the crux of deliberations at this year’s Future Health Summit with the theme: “Breaking Glass Ceilings,” organised by Nigeria Health Watch.
The Managing Director of the Nigeria Health Watch, Dr Vivianne Ihekweazu posited that the “COVID-19 pandemic has heightened the need to accelerate progress in gender equality, especially with regard to women’s health. Gender equality should not just be seen as an issue that affects women alone.
“In Nigeria, our health indices for mothers, especially with regard to maternal mortality are not that great. While we have fewer women dying during childbirth globally, however, Nigeria will need to double the level of progress to meet the Sustainable Development Goals (SDGs). “Our progress in Nigeria has been slow and Nigeria still accounts for over 23 per cent of global maternal deaths. This is an urgent issue that needs attention and we need to elevate it at every possible forum that we can.”
Social determinants of health
For Dr Mary-Ann Etiebet, Lead and Executive Director of MSD for Mothers, bridging the inequality gaps for quality health for women should be a priority.
She explained that culture contributes to the situation where hundreds of mothers die every day.
She said: “When you look at gender equality across the world and you look at the map where there are high levels of gender inequality, those are the exact same places where there are high levels of maternal deaths. “So, these things follow one another. Maternal mortality is not just a vital sign of our health system but a vital sign of our society.
“About 80 per cent of our health outcomes are a result of what is also known as the social determinants of health. These are the conditions we live in, we work in, we get educated in, we worship in, we commune in, and we play in. These are the societal and cultural contexts in which women and girls are brought up.
“Until we value women’s lives and put our money where our mouth is, we are still going to see these issues. About 70 per cent of the health care workforce is made up of women, but when you look at the leadership ranks, it is 10 per cent or 20 per cent depending on where you are.”
A Senior Technical Adviser at Tony Blair Institute, Dr Ebere Okereke added: “I think women in leadership are important because first, we are 50 per cent of the population of the globe, and not just in Africa. We are also responsible for propagating our species. Most importantly, representation results in better policies and better quality health systems because you have the direct involvement of the people for whom the services are being developed in finding the solutions, and in improving the quality and setting the standards.
“It is the absence of women in leadership and decision-making processes in health that result in the fact that we don’t have women’s needs on the front burner.
“The key thing we also need to look at is that globally, 70 per cent of the health care workforce (that is, the official formal paid health care workforce) is delivered by women. If you look at paid social care workforce-caring for the elderly, and children, among others. It goes to almost 90 per cent.
“Yet, the higher up you go in the structure of leadership, the fewer and fewer women there are. This means that people who know best what is needed are not contributing to the decision-making about the system. That does not result in good quality health care.
Improving quality health care for women
“The question here is: how do we improve the quality of health care for women? You improve the quality by first of all hearing from those who know what the needs are – women. You ensure that the needs of the other 50 per cent of your population are represented by ensuring that women are in the spaces where decisions are being made.
“It makes sense that women should be in leadership. Why I do a lot of work to support women in leadership is that, too often, women leaders are isolated. They are the only ones in the spaces they occupy and in the system that we have that is patriarchal and biased against them. And even with the best intentions in the world, the isolation can result in those women who are good actually working away from that leadership opportunity.
“Not only do we actively need to recognise the importance of women in leadership, but we also need to support those that are there so that they will continue to work, while we drive more women and support women to get into those leadership positions.
“We need to move away from a situation where a woman in a health leadership position walks in and she is the only woman in the room. That is not good for anybody and it means that we are actually putting a lot of responsibility and pressure on those small numbers of women who can be overwhelmed by a system that we are not changing.
“This is not a problem for women to solve on our own but it is necessary for all of humanity to recognise the importance of improving the quality of our health decisions and our health systems, by ensuring that 50 per cent of the population are represented.”
The Vice-Chancellor of the University of Global Health Equity in Rwanda, Prof. Agnes Binagwaho emphasised that there is an urgent need to focus on the provision of better general quality health care provision for all.
“With regard to what can be done to increase the quality of health care and deliver the quality of life for women, I think that first, we need to focus on much better general quality of care provision for all. This is because 50 per cent of the overall deaths in low- and medium-income countries are due to poor quality care. This costs a lot – about $1.4 billion to $1.6 billion annually, according to the World Health Organisation (WHO).
“To achieve quality care in the public sector, we need to reinforce inclusivity. We need to focus on the vulnerable and among the vulnerable women who are always the most affected. This becomes worse because women have less access to education. So, we need to improve access to women’s education in order to improve the next generation of women’s access to health care.
“We also need to improve access to work because work is not women-friendly. Nature asks you to deliver babies for the next generation and to the nation, however, for that, you are penalised at work.
“Every woman should be treated like she’s pregnant with the next Albert Einstein because she may be going to be delivered of the one that will change the world.
“However, there are things we can do. For example, in my country, it is important for the private sector to have the money to recruit somebody during the maternity leave of the young woman,” she said.
Continuing, she said: “We can also use tools that we all have which are digital hands which helps to provide quality care to women in the village where they live, to follow the pregnancy, to alert when there is one that is at risk. This is very important and I want to say that 41 out of 54 countries in Africa have national digital strategies but not the internet-covering countries.  “The development of the health sector of tomorrow in Africa and in other low-income countries cannot be achieved without public-private partnership.
“We need to increase the place where women can deliver with quality; women who can afford it can benefit from quality care and those who cannot afford it we need to assure quality care in the public sector.
“There is also manufacturing. The private sector has to manufacture products that women need. It is not normal that our tools for contraception are coming from outside Africa.
“As much as there are a lot of efforts to produce COVID-19 vaccines in Africa, we should also look at the basics we need to produce products so that all the women can be saved.
“In summary, the private sector needs better service, investments, more hospitals, more manufacturing of products that women need, in order to improve the quality of care for women and improve their lives.”
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