CHAPTER ONE
1.1 Background of the Study
The health and well-being of a nation's populace, with a particular focus on the welfare of mothers and children, serve as crucial barometers for gauging the overall societal health. Notably, the antenatal phase and early childhood represent pivotal developmental stages, as they lay the groundwork for a child's future health and well-rounded development. Consequently, ensuring the optimal health of expectant mothers during pregnancy and the well-being of children during their formative years constitutes not only a moral imperative but also a cornerstone of social and economic advancement, thereby serving as the fundamental yardstick for measuring the prosperity of a society or nation (Adah et al., 2023).
It is the recognition of this undeniable reality that has elevated maternal and child health care to a paramount position within healthcare initiatives, addressing the unique health requirements of women during pregnancy, labor, and delivery. However, despite its undeniable importance, maternal health care is beset by a host of challenges. Maternal mortality remains a pressing concern in the developing world. In 2017, there was a notable global reduction of approximately 38% in the maternal mortality ratio, representing the number of maternal deaths per 100,000 live births. Notably, 94% of all maternal deaths occurred in low- and middle-income countries, a sobering statistic highlighted by the World Health Organization. Furthermore, it is disheartening to note that around 810 women lost their lives in 2017 due to preventable causes related to pregnancy and childbirth, among whom were young adolescents between the ages of 10-14, a vulnerable group that faces elevated risks of mortality and post-childbirth complications (World Health Organization, 2019).
Reports emanating from the Fragile State Index indicate that countries classified as fragile states, characterized by poor health outcomes, can be further categorized into high alert and very high alert classifications. These fragile states encompass fifteen nations, namely South Sudan, Somalia, Central African Republic, Yemen, Syria, Sudan, the Democratic Republic of the Congo, Chad, Afghanistan, Iraq, Haiti, Guinea, Zimbabwe, Nigeria, and Ethiopia. In 2017, these fifteen countries exhibited maternal mortality ratios ranging from 31 (Syria) to a staggering 1150 (South Sudan). The stark socio-economic disparities contributing to this glaring divide between the affluent and disadvantaged segments of society exacerbate the challenges faced by underserved pregnant women, rendering their access to healthcare facilities even more precarious (Fragile State Index, 2022).
The advancement of a nation hinges on the development of its future generations, particularly newborns and children under the age of five, whose well-being is crucial for the perpetuation of a nation's legacy. However, the persistent challenge of neonatal and under-five mortality, particularly prevalent in sub-Saharan Africa, remains a pressing concern. The majority of fatalities among neonates, which encompasses babies in their first 28 days of life or the initial month after birth, stem from infections and congenital anomalies (World Health Organization, 2022).
Nonetheless, the provision of antenatal care, especially during the early stages of pregnancy, offers a pathway to mitigate or preempt many of these adversities (European Board and College of Obstetrics and Gynaecology (EBCOG) Scientific Committee, 2015). Antenatal care, fundamentally defined as the healthcare services tailored for women during pregnancy and childbirth, spans from the confirmation of conception to the postnatal phase (Adegboyega and Ayodele, 2018). This holistic approach to preventive healthcare empowers women to gain insights from qualified healthcare professionals regarding healthy practices during pregnancy, acquire a deeper understanding of warning signs during pregnancy and childbirth, and receive indispensable social, emotional, and psychological support during this critical juncture in their lives.
Antenatal care also facilitates access to vital interventions, including micronutrient supplementation, hypertension management to avert eclampsia, and immunization against tetanus. In regions where malaria prevails, healthcare personnel can furnish pregnant women with medications and insecticide-treated mosquito nets to combat this debilitating and potentially fatal ailment (UNICEF, 2022). Furthermore, antenatal care serves as a platform for conducting HIV testing and administering medications to thwart the transmission of the virus from mother to child.
The significance of a robust healthcare system, especially in the context of antenatal health, cannot be overemphasized. As elucidated by the World Health Organization in 2020, a healthcare system encompasses all the organizations, individuals, and activities primarily dedicated to promoting, restoring, or maintaining health. This encompasses not only endeavors to influence the determinants of health but also more direct interventions aimed at enhancing health. Therefore, a healthcare system extends beyond the framework of publicly-owned facilities providing individual health services, encompassing the institutions, personnel, and resources engaged in the delivery of healthcare to individuals. These health systems bear a crucial and enduring responsibility for the well-being of individuals throughout their lives, playing an indispensable role in fostering the healthy development of individuals, families, and societies on a global scale, as emphasized by Donev et al. (2013).
The paramount objective of any healthcare system is the enhancement of public health. Nevertheless, this objective comprises a dual dimension, not characterized by singularity. The pursuit of good health encompasses a twofold aspect: the attainment of the highest feasible average health level, which we shall refer to as "goodness," and the reduction of inequalities among different individuals and groups, thus ensuring "fairness." Goodness in this context signifies the healthcare system's capacity to effectively meet the population's expectations, while fairness necessitates the provision of uniformly excellent care to all individuals without any form of discrimination.
WHO has articulated a set of three fundamental objectives that are intended to guide the central pillars of healthcare systems within each nation: the attainment of sound health, responsiveness to the expectations of the populace, and the equitable distribution of financial contributions. The progress toward these goals critically depends on how effectively healthcare systems execute four fundamental functions, namely, service provision, resource generation, financing, and stewardship. A comparative analysis of how these functions are carried out serves as a basis for understanding variations in performance over time and among different countries.
Healthcare systems are bound by certain minimal requirements that must be equitably met, including ensuring access to high-quality services for both acute and chronic health needs, delivering effective health promotion and disease prevention services, and offering an appropriate response to emerging health threats, such as newly emerging infectious diseases, the aging of populations, the increasing burden of non-communicable diseases and injuries, and the health impacts of global environmental changes.
Health systems have played a significant role in improving the health of the global population throughout the 20th century and beyond. In the present day, health systems, regardless of a country's economic status, exert a more substantial and influential influence on people's lives than ever before. Healthcare systems, in some form or another, have existed as long as individuals have endeavored to safeguard their health and combat diseases.
In light of this background, this study endeavors to explore the role of healthcare systems in the context of antenatal and child health.
1.2 Statement of the Problem
In spite of significant strides made in the field of healthcare, maternal and child mortality rates continue to cast a shadow over global health concerns. Notably, Nigeria, as one of the most populous countries in Africa, grapples with the second-highest estimated maternal mortality rate worldwide, coupled with alarmingly high neonatal mortality rates (United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), 2018; World Health Organization, 2015). The World Health Organization (WHO) reported a staggering maternal mortality ratio (MMR) of over 800 maternal deaths per 100,000 live births, along with a neonatal mortality rate of 33 per 1,000 live births in 2019 (World Health Organization, 2020). These figures stand in stark contrast to those of the United Kingdom and the United States, where maternal mortality rates hover around 10 to 18 deaths per 100,000 live births, and neonatal mortality rates remain below 4 deaths per 1,000 live births (United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), 2018; World Health Organization, 2015).
It is imperative to recognize that maternal and newborn health (MNH) outcomes are inextricably linked. Maternal deaths not only result in the tragic loss of maternal lives but also exert a profound influence on the survival and development of newborns (United Nations, 2015). The Sustainable Development Goal (SDG) 3 underscores the global imperative to tackle these issues head-on, with a call for all countries to reduce MMRs to below 70 per 100,000 live births and neonatal mortality to fewer than 12 deaths per 1,000 live births by 2030 (Black et al., 2016).
However, the disheartening reality is that, if the present trends persist, Nigeria is at risk of falling drastically short of these crucial SDG targets, despite substantial efforts and resource allocations (Izugbara et al., 2016). This persistent and disconcerting trend underscores the urgent need for an exhaustive examination of the strategies in place to address this pressing public health challenge. Therefore, this study seeks to delve into the role of the healthcare system in addressing these problems and working towards enhancing antenatal and child health outcomes, thereby contributing to a much-needed shift in the current narrative of maternal and child health in Nigeria.
1.3 Aim of the Study
The primary aim of this study is to assess and understand the role of the healthcare system in antenatal and child health.
1.4 Objectives of the Study
The specific objectives of this study are as follows:
- To examine the healthcare system's services related to antenatal care and child health.
- To analyze the influence of the healthcare system on maternal and child health outcomes.
1.5 Research Questions
This study will address the following research questions:
- What are the key services provided by the healthcare system for antenatal and child health?
- How does the healthcare system impact maternal and child health outcomes?
1.6 Research Hypothesis
H0: The healthcare system's effective provision of antenatal and child health services has no significant impact on maternal and child health outcomes.
H1: The healthcare system's effective provision of antenatal and child health services has a significant impact on maternal and child health outcomes.
1.7 Justification of the Study
The significance of understanding the role of the healthcare system in antenatal and child health cannot be overstated, given the profound impact it has on the health and well-being of both mothers and children. The findings of this study will provide essential insights for policymakers, enabling them to make informed decisions and formulate evidence-based policies that can lead to a substantial improvement in antenatal and child health outcomes.
Additionally, healthcare professionals, including doctors, nurses, midwives, and other healthcare providers, will benefit from a deeper understanding of the healthcare system's role in antenatal and child health. This knowledge can contribute to the refinement of healthcare services and practices, ensuring that pregnant women and children receive the highest quality care available. Ultimately, this will lead to better health outcomes for both mothers and their offspring.
Researchers in the field of public health and maternal and child health will find value in this study as it provides a comprehensive analysis of the healthcare system's involvement in antenatal and child health. It can serve as a foundational resource for further research and studies aimed at delving deeper into specific aspects of maternal and child health. This, in turn, can pave the way for innovations and evidence-based interventions that can address the persisting challenges in this crucial area of healthcare.
1.8 Scope of the Study
This study will focus on the healthcare system's role in antenatal and child health, primarily in Nigeria, to allow for in-depth analysis and meaningful conclusions. The study will cover various aspects, including healthcare infrastructure, policies, services, and their impact on maternal and child health outcomes.
