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Beyond The Children’s Mortality Data (Part 1) By 'Kunle Oyekanmi
The United Nations Children’s Fund (UNICEF) recently released some rankings and basic indicators on the State of the World’s Children for 2009. The list is a reflection of children’s well being around the world. It should help parents or parents-to-be make a decision about where they would prefer their children to [or not] be located in the first 5 years of their existence. Nigeria was ranked 8th in the world for under –5 mortality (http://www.unicef.org/sowc09/docs/SOWC09_U5MR_rankings.pdf). The data drew remarks from senior public officials including Dora Akunyili (Minister of Information) and Babatunde Osotimehin (Minister of Health) both of whom questioned the validity thereof. In addition, the wife of the President, Turai Yar’Adua, complained publicly about the UNICEF figures and pointed out that Nigeria had spent “a lot of money” on various programs with positive outcomes. They all felt that Nigeria was not being portrayed well by the UNICEF basic indicators. The information, which is about 2 years old (2007), revealed Nigeria to have under-5 and infant mortality rates of 189 and 97 respectively. The country fared better than Sierra Leone, Afghanistan, Chad, Equatorial Guinea, Guinea-Bissau, Mali, and Burkina Faso. Life expectancy at birth is reported to be 47 years at birth and of the listed countries, Nigeria is better than Sierra Leone, Afghanistan, and Guinea-Bissau with 42, 44, and 46 years respectively. Others got into the early part of the golden years. The data for the whole world can be reviewed at http://www.unicef.org/sowc09/docs/SOWC09_Table_1.pdf.
It seems unimaginable that Nigeria would find itself in the company of these and other countries with very poor basic indicators. However, repeatedly in every area of national life that touches on health, welfare, and social issues, basic indicators have always been poor or at best mediocre. Figures (2006 data reported in 2008) from the World Health Organization (WHO) are not very different (http://www.who.int/countries/nga/en/). Such indicators serve as markers for the state of development of Nigeria in comparison to the rest of other developing countries and the world at large. Nigeria has proposed an ambitious goal of achieving a life expectancy of 70 years for its citizens by the year 2020. It remains unclear whether this is feasible in the absence of some miracle. Aha! Miracle, what Nigeria and Nigerians love so much and place their faith and hope in almost always. Not that there is anything wrong with miracle, faith, and/or hope; they have their roles in society, which should be outside the boundaries of public policy and national development. The needed tools in the arena of public policy and national development are appropriate goal setting, focus, hard work, and perseverance.
Image is very important to Nigeria and Nigerians. The country has spent substantial amounts of money over the years trying to launder its image. A substantial number of Nigerians, probably the majority, operate under the assumption that image is very important and that perception and reality are the same. Such notions have found very secure spots in public policies and programs. In most developed countries and in the sphere of international organizations, perception is not reality. Perception, which is correctly interpreted, constitutes reality. On the other hand, perception, which is wrongly interpreted, amounts to an illusion. Illusion is very pervasive in Nigeria and its effects are so profound that it passes off as reality in almost every sphere of our national consciousness. Reality is based on fact, not fiction. In Nigeria, based on the prevailing sense of what ought to be or is desirable, public policies and programs are set. A significant effort is usually deployed in promoting such policies and programs. While implementation, in the initial stages, tends to be with a lot of zeal and fanfare, sustaining the initial momentum has always been the bane of many laudable programs. Usually, very little attention is paid to measuring outcomes objectively or articulating the means of sustainability of initial successes. When questions eventually arise about the success of policies or programs over a period or when outcomes data do not appear to match the perceived initial outcomes or long term expectations, there is hue and cry about how much resources have been expended to facilitate better outcomes and often, blame is passed onto others while much needed self reflection is often ignored.
In the case being discussed, public health officials are lamenting the apparent persistently poor basic indicators of childhood mortality in Nigeria. There have been no questions asked about why the observed outcomes differed from the expectations and how both can become confluent. Majority of programs run on the elusive hope and misapplied faith vehicles in the public arena. This ought not to be. We never prepare properly, usually implement shoddily, regularly fail to assess the effectiveness of interventions objectively, and usually congratulate ourselves prematurely about how hard we have worked. We express hope about how programs will transform lives and society and apply faith that such transformation will be self-sustaining. When such hope and faith are subjected to the stress and scrutiny of reality, they tend to fall very short or fail woefully. The major platforms on which policies and programs can yield meaningful dividends on intended goals are those based on proper planning, disciplined implementation, careful outcomes evaluation, and result oriented re-planning.
Proper planning is only achievable in the presence of reliable data. The basic building blocks of effective data management include collection, collation, storage, and analysis. Nigeria has not fared very well in this department, which accounts for our inability to engage in target oriented planning. The National Bureau of Statistics captured the problem of data management very well on its website in the introduction to the health and human services sector (http://www.nigerianstat.gov.ng/descr.php?recordID=9):
“After years of neglect, the health sector has increasingly become a major concern to the Nigerian Government. Improved fertility, better health and the resultant increased life expectancy on the one hand, and population control on the other, are being pursued as mutually compatible programmes in Nigeria today as in most other developing countries. In this direction, Government must rely on adequate health statistics for planning and monitoring its relevant programmes. Data are also needed to estimate health statistical indicators which are required for making geographical (inter-regional and international) comparisons of the health situation in Nigeria. Health statistics are also required for research purposes. Most of the advances made in medicine could not have been possible without health statistics, especially those generated on longitudinal basis. Before the attainment of independence, the items of data on health were collected by the departments of health of the then Regional Governments. Data were obtained from the few general hospitals, infectious diseases hospitals and public health units. Initially, emphasis was on keeping records of reported cases of, and deaths from, communicable diseases such as small pox, cholera, malaria, tuberculosis, leprosy and yaws. Records of immunisation were also kept. Administrative records of health resources, manpower and vital statistics were among the earliest items of data kept by the regional departments of health. Over the years, there has been a noticeable change in the range of items of data in respect of which records are kept in the health sector, especially on the statistics of primary health care delivery. The Federal Ministry of Health coordinates data collation activities in this sector. With the launching of the National Integrated Survey of Households (NISH) programme in 1981, the National Bureau of Statistics devoted more attention to data collection on some health-related aspects by devoting some modules of the NISH to health, nutritional and demographic matters. In spite of all these modest efforts, most of which were supported by international agencies, Nigeria’s health statistics are in a very bad shape. They are generally uncoordinated, incomplete, unreliable and untimely. This situation has prompted recent efforts of Government and the UNDP to improve on the management of health statistics in the country.”
Attempts to retrieve Nigeria’s own collected and published data from the website (obviously supposed to be public information) yielded no fruit. The data available on the website of the Federal Ministry of Health on children’s mortality rely predominantly on WHO World Statistics (http://host1.maasinfotech.com/healthministry/healthprofile.php). The lack of any meaningful data from our own public institutions charged with data management implies that there is no substantive evidence with which to refute any international data believed to be erroneous. Empirical evidence or anecdotal reports are insufficient to debunk indicators published by international organizations, which we have depended on for several years and still depend on for our healthcare and other indices of national development. Hence, the cries of foul by our highly placed public officials sound very hollow. The question they should set themselves to answer ought to be how to build a reliable health database, which will accurately show the number of births, deaths and causes in the country. Identifying the major causes of mortality for different groups – maternal, infant, under-5, teenage, young adults, overall - will set the stage for planning to mitigate or eliminate them.
To be continued.
'Kunle Oyekanmi. |