“GOVERNMENT IS NOT INVESTING IN SEXUAL AND REPRODUCTIVE HEALTH”-Dr Kole Shettima

At the 3^rd Nigerian Family Planning Conference that held at the Ladi Kwali Hall in Sheraton Hotel, Abuja, Dr Kole Shetima, Co Chairman of the 3^rd Nigerian Family Planning Conference and Chair of Annual Population Series, spoke with Rural Reporters on issues affecting population growth, youths, Maternal Mortality Death and HIV/AIDS.

Below, we serve excerpts from the chat:

INTRODUCTION

My name is Kole Shetima. I work with the MacArthur Foundation. I am also the Chair of Annual Population Series.

KINDLY EXPLAIN TO US THE DIVIDEND OF DEMOGRAPHY

Well, the whole idea is, ‘how do we see our large population as a source of energy, creativity, imagination, something that is positive for the people of the country, for the individuals rather than being a source of problem?’

Now, for this to become an asset, we have to think of the kinds of investment to make in order for that to happen. And therefore, this will include investment in terms of education, health, qualitative job, good governance, and investment in terms of improved macro-economic situation in the country.

WHAT ARE THE KEY THINGS THAT THE COUNTRY NEEDS TO DO IN ORDER TO MAXIMIZE THIS POPULATION PYRAMIDS TOWARDS THE YOUTH?

As you say it, ‘How do we turn the conversation away from youth as a problem to youth as a solution?’ Usually, when you hear people talking about young people and youths, they always tend to think of the youth as cultist, drug addict, trouble makers, yahoo-yahoo, and 419. That is the image we get about the youth.

So the issue then is, ‘Can we turn the conversation away from that to a positive one?’ In order to do the positive thing, we need to also make that required investment. It means investment in the qualitative education that they need to have, investment in their health especially their reproductive health, investment in terms of the macro-economic situation in the country, and investment in terms of good governance in the country. If we can make those key important investments, then I think that is the context in which we would be able to turn the tide and shift the public image of the youths as a problem into a solution for the country itself.

HOW FAR DO YOU THINK NIGERIA HAS GONE IN ACHIEVING OR NOT ACHIEVING THIS?

I think we have a very long way to go. It is true that there are some attempts to see youths as solution. For example, some of the YouWin competition that the government has been doing; I think there is also attempt to do something in the creative industry-in terms of the film industry or other kinds of things you know the youths deal with.

If we look at the fact that at least about 10 million of our kids are out of school, then that is certainly a major challenge. Even those who are able to go to school and graduate are either underemployed or unemployed. So you find out that we are not adequately utilising the skills they have. To that extent, I would say that we have not really done great in that direction.

Same thing with access to reproductive health, information or services; we know that less than two per cent of our young people really have access to those services as well. So in many of the indicators, I will that we have a very long way to go.

LOOKING AT THE SITUATION IN THE NORTH-EAST PART OF THE COUNTRY, HOW DO YOU ACCESS THE SITUATION FOR THE COUNTRY IN SOME YEARS TO COME IF THERE IS NO CRITICAL CHANGE?

Data now tells us that about 10 million kids are out of school, and that is a time-bomb because these kids will have to eat, drink and want to live the kind of life that every one of us want to live. They have the right because as citizens of the country, we should give them whatever we can.

But I think the situation has also been complicated by the insecurity that we have found ourselves, whereby Boko Haram has attacked schools, killed teachers, and have made it impossible for state governments to operate or to open schools in that situation. So you find out that the situation in the North East is actually getting worst.

What we are doing is digging a well-that is going farther down. That is the process I think we have now found ourselves with the insecurity. At this, insecurity is now challenging us all to think about modules on how to deliver education in a very insecure environment, or how to provide health services in a very insecure environment. Are we going to use radio as a method of educating people? Are we going to use cell phones in order to run schools or tablets on order to send classroom notes, questionnaires and all kind of things that we need to do? What are the methods that have been tried in other places that we may also have to use?

As a people and country, the insecurity has compounded the already challenged environment that we have found ourselves and therefore, we have to overcome that by thinking differently so that we don’t think that we have to wait until normality returns before we can deliver education to those people who have already been deprived.

A LITTLE SHIFT TO THE MDGS; 2015 IS CLOSEBY, WHAT DO YOU HAVE TO SAY ABOUT NIGERIA’S PACE TOWARDS ACHIEVING REDUCTION IN MATERNITY DEATH?

It is a sad reality. In the year 2008, it was 545 but now they are saying we are 575 or so. It shows that instead of us reducing maternal mortality, we are increasing maternal mortality in this country which is a very bad situation we have found ourselves.

Obviously, we are not going to reach the goal. I think the target for Nigeria, if we are supposed to meet the Millennium Development Goals (MDGs), is about 173. If you compare the gap between 173 and 575, it is getting wider than reducing and that is going to be a big challenge for the country.

WHAT FACTORS DO YOU THINK ARE RESPONSIBLE FOR THE MATERNAL MORTALITY DEATH?

That I cannot even comprehend. I thought that we have done a lot of work in this country on this issue, and therefore really surprised and shocked that it is increasing instead of decreasing.

But I think the other reality also is that, as our population keeps growing, even if you reduce it more than the level of the population increase, you still see the increase in terms of maternal mortality unless you have a very significant decrease because the nominal increase in the population will wipe out whatever gain that you might have made.

I know questions are up about the current methodology and the MDGs have come up with a study on maternal mortality survey.

HOW WOULD YOU JUDGE THE COMMITMENT MADE ON REDUCING MATERNAL MORTALITY DEATH?

Data shows that we have not done what we are supposed to do. On our side, we have not released the money meant for commodities. The pledges that we have made, we have not fulfil any of those ones. The government said it is going to increase spending on commodities and other things but none of these has happened.

A SHIFT FROM THE GOVERNMENT, HOW CAN OTHER PEOPLE AND PRIVATE SECTOR GET INVOLVED TO REDUCE MATERNAL DEATH?

What can we do as individual, communities, states, federal and local government? For me, we have to understand why even where there are services people do not go for those services. For example, about 60 per cent of our women go for ante -natal services, but only 30 perr cent deliver in those facilities. So the question is, why that significant gap?

We have to look at what the reasons are, attitude of the health workers in terms of how they treat people when they come for services, opening and closing hours of service providers, and the quality of service that are being provided in many of those places.

Nigerians go to India and Niger to deliver babies. Why should they go to Niger to go and deliver? Probably it is the kind of services that are being provided. They spend all kinds of money to go to America, India and South Africa to deliver babies.

The question is why would they do that? Then it means we have to be thinking about the kind of health service to provide to make it possible for them to come to us rather than going to Niger, Chad or Cameroun to go and deliver. Not that those countries are richer than Nigeria anyway, but maybe there are certain things that they do there- either the convenient of services or attitude of the health workers.

The security guard in our clinics and hospitals may think that their own job is just only to put on and switch off the generator. They don’t link what that means to saving somebody’s life. For them that do not really ring in their mind; what they know is that there is a security guard who put on and switches off the generator.

And a lot of these improved services will not cost money really; they are just things you need to adjust in the system. I think those kind of things are what we should work on to improve the health system. That is, making the health system accountable to the citizens and making it possible for them to work.

There are all kinds of little things that could contribute to the death of a pregnant woman but if we could have a confidential inquiry that shows a clear report on what led to the death of a pregnant woman, not to punish the workers, but stopping it from reoccurring, maybe that will help us to prevent the system from failing in the future.

HOW DO YOU HOPE TO REPLICATE THESE IN RURAL COMMUNITIES IN NIGERIA?

The truth of the matter is, Non-Governmental Organizations (NGOs), and others can only do a pilot, government is the one that have the resources to do bigger things. As NGOs, you have some small resources, you can show example of what can be done and then you hope the government will take it up as its own project and run it.

We can show small successes, but it is government that can only bring about big successes. Government is the only one that has the big resources and huge significant.

The money Nigeria receives from international donors is certainly less than five per cent of our budget. So Nigeria is not like an aid dependent country.

This is coming out because government is not investing a lot in sexual and reproductive health. Almost all the participants at the 3^rd Nigerian Family Planning Conference are supported by USAID. If you ask how many people were supported by the government, maybe few or none. And if there is, it will be very few.

This creates the impression that international donors are actually at the forefront of sexual and reproductive health. For example, on the HIV/AIDS work, almost 90 per cent of people who are on Anti-Retroviral (ARV) are funded by USAID.

PRESENTLY, THERE IS REDUCTION IN FUNDING OF HIV/AIDS

Yes. It is a question of utilization of resources at the end of the day. All the big names that are showing as if they are doing everything is probably because their resources are effectively used.

WHAT WILL BE THE EFFECT OF REDUCTION IN FUNDING OF HIV/AIDS?

It may backfire and create more problems for everybody.