Long road to free maternal and child healthcare law in Kano State
The Kano State Assembly passed the long-awaited Free Maternal and Child Healthcare (FMNCH) Bill into law on May 3, 2023. This made Kano the first state in Nigeria to enact the law. It is therefore not surprising that civil society leaders across the state are in a celebratory mood, just as they have been effusive in their praise for the legislators who voted across party lines to pass the law. The response of Comrade Dr. Ibrahim M. Zikirullahi, Executive Director of the Resource Centre for Human Rights & Civic Education (CHRICED), said it all. The leader of the frontline civic group that vigorously advocated for the passage of the legislation described the bill’s passage as a befitting parting gift from the ninth Assembly to the people of the state. CHRICED,
with support from MSEREOR/KZE, has, since 2014, conducted various activities to address the scourge of maternal and infant deaths in the State. The activities include research, baseline studies, town hall meetings, community enlightenment workshops, media outreach, advocacy meetings, live radio awareness programs, stakeholders’ consultative meetings, legislative retreats, and various forms of grassroots organizing. In the period too there were capacity-building workshops for media and CSOs to support the push for a comprehensive legislative framework in the form of free maternal and child health law.
According to the human rights activist, the gesture of the Kano State House Assembly is highly commendable. Zikirullahi further enthused that the members of the Kano State House of Assembly have demonstrated they are on the side of the people of the State. His words: “Regardless of political differences, the members overwhelmingly supported the Bill’s passage. This law represents a landmark achievement for the health sector, and it will have a tremendous influence on maternal and child healthcare. This is a pivotal moment in our efforts to end maternal and child mortality, which has claimed the lives of thousands of women and children over the years. We are hopeful that the Governor of Kano State, His Excellency Dr. Abdullahi Umar Ganduje, will sign the bill to institutionalize free maternal and infant healthcare.
Similarly, civil society leaders also commend the Speaker of Kano State House of Assembly, Rt. Hon Hamisu Ibrahim Chidari, the Deputy Majority Leader, Hon. Magaji Zarewa, and Hon. Musa Ali Kachako, who sponsored the Bill and ensured its passage. Other stakeholders whose commitment was noted to have tilted the scales towards the passage of the law include the Kano Emirates Council, particularly the Emirate Council Committee on Health led by Dr. Basheer Mohammed. For CHRICED and its civil society allies, the road to the passage of the FMCH Bill has been long and difficult. Noting the role of the people at the grassroots in the process, the group recognized the efforts of the community men, women, religious bodies, persons with disabilities, and activists in Kano State. It equally commended the researchers, resource persons, and facilitators who worked on the project, as well as officials of the Kano State Ministry of Health, Departments, and Agencies. CHRICED also expressed its deep appreciation to its international partner, MISEREOR/KZE of Germany, which provided both technical and financial support in achieving the historic milestone of the FMCH law.
However, the passage of the legislation also offered some opportunity for civic groups to reflect on what the historic moment means for the ultimate target of decisively addressing maternal and child mortality. This particular concern of the advocates becomes even more important as Nigeria’s reputation as one of the worst places for women to give birth continues to garner unfavorable international scrutiny. As of now, Nigeria is nowhere near achieving the Sustainable Development Goal (SDG) target of reducing the global maternal mortality ratio to less than 70 per 100,000 live births. Professor Abdulmumini Bala Ahmed of the Faculty of Law at Bayero University in Kano provided some insight into the role that the law should play. Prof. Ahmed stated at the Kano Statewide Stakeholders Consultative Forum convened by the Resource Centre for Human Rights & Civic Education (CHRICED) immediately after the law was passed that once assented to and faithfully implemented, the FMCH law will save the lives of thousands of women and children.
The university don emphasized that the passage of the law represents a significant step toward promoting the constitutionally guaranteed right to healthcare in Nigeria. “The right to health encompasses not only a right to health care but also a right to the underlying determinants of health,” he argued. According to Professor Ahmed: “Many of these determinants play a key role in ensuring that women are able to access the necessary services and facilities to prevent maternal mortality. It encompasses prenatal care, reproductive and maternal healthcare services (prenatal and postnatal), and child health care services.” Professor Ahmed equally posited that the right to health includes entitlements to a range of health interventions that have an important role to play in reducing maternal mortality. These entitlements he said include emergency obstetric care, a skilled birth attendant, education and information on reproductive health, and primary health care services.
“The State has an obligation to provide these services in order to prevent maternal mortality. To achieve this, the state needs strategies, which would empower women, girls, families, and communities, while prioritizing country ownership, leadership, and supportive legal, regulatory, and financial mechanisms.” Professor Ahmed, therefore, called on all stakeholders to apply human rights framework to ensure that high-quality maternal and newborn healthcare services are available and accessible to all who need them.
Consequently, with the passage of the FMCH law by the Kano State Assembly, Professor Ahmed gave insights about how the law will help achieve the goal of drastically cutting down the high maternal and infant deaths in Nigeria’s most populous State. The first point made in this respect is that the Law provides robust support to enable access to prenatal, maternal, and child health care services in Kano State. His words: “The Law recognizes and promotes women and children’s entitlements to medical and healthcare services in Kano State. Therefore, it will ensure the government’s commitment to developing strategies and plans to fund maternal and child healthcare services in Kano State.
“The Law encompasses and makes provisions for pre-natal care, post-natal care, reproductive care, and child health care services. It guarantees the provisions, supply, and use of all the necessary instruments, conditions and material aids necessary to ensure that mothers and children receive the best medical and health care services in Kano State. This will promote and ensure the availability of free maternal and child healthcare and other matters related thereto in the State. The good people of Kano State will therefore be assured of a qualitative healthcare service that will guarantee timely and appropriate treatment in all cases of maternal and child health challenges.” These many benefits of the law, he noted will be consistent with current professional knowledge and uphold basic reproductive rights, while guaranteeing a clinically effective, and safe experience for the patient. “With this Law in Kano State, it is expected that there will be a substantial reduction in maternal mortality and child health challenges, especially with the promotion and advancement of maternal and child healthcare.”
With the historic passage of the FMCH law, civic actors in Kano State led by CHRICED, have also started brainstorming about how to find the resources to implement the ambitious targets, which the newly enacted law proposes. This is an important issue because the claim of lack of resources was one of the issues, which made the political actors skeptical about the law before now. The law creates a synergy between the state and Local Government Areas on how to generate the quantum of resources required to match the scale of the problem. However, CHRICED alongside fellow CSOs has always insisted that the push for additional resources must be tied to accountability in the use of current resources. On this point, there has been unanimity that the spotlight should be focused on the current resources. The logic is that for future resources to be effectively utilized, the use of current funds must be properly evaluated to identify gaps and areas where better management is required. As such, civic groups have clamored for accountability, transparency, inclusion, and value for money in the utilization of maternal and child healthcare funds.
CHRICED has focused on these objectives during the implementation of the project of Strengthening Maternal and Child Healthcare Through Accountability Interventions in Kano State by galvanizing the grassroots to become active participants in the maternal and child healthcare governance process. The effectiveness of this approach is demonstrated by an increase in the number of ordinary residents who routinely come from remote and hard-to-reach areas of the rural interior to participate in activities such as legislative public hearings and yearly budget presentations.
As things stand, Kano State civil society leaders are optimistic that with the FMCH law in place, more of these accountability and transparency initiatives, which use citizens’ agency to monitor the use of public resources for delivering quality maternal and child healthcare, will become even more relevant. Finally, over eight years of arduous struggle by civil society activists to spur action in terms of lowering maternal and newborn mortality in Nigeria’s most populous state has paid off. The new law would stimulate the civic arena, ensuring citizens are engaged and duty bearers are pressured to significantly reduce maternal and child mortality in Kano State. It is hoped that other states of the federation will follow the Kano House of Assembly’s lead and pass similar legislation in their respective states.