Beyond New Facilities: Helping Politicians Understand Universal Health Coverage

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By: Dr. Oluwadamilola O. Olagoun, Project Manager, White Ribbon Alliance for Safe Motherhood

This post is part of the Woman-Centered Universal Health Coverage Series, hosted by the Maternal Health Task Force and USAID|TRAction, which discusses the importance of utilizing a woman-centered agenda to operationalize universal health coverage. To contribute a post, contact Katie Millar.

Nigeria girl mother woman maternal mortality infant mortality stillbirth home birth
Hadiza, lost her baby and nearly her own life when she gave birth at her parents’ home, instead of a hospital, despite displaying clear danger signs. Photo: Lindsay Mgbor / DFID

As we left the facility, my colleague and I shared a glance and giggled. I couldn’t help but express my mind. “You know if this was to be [the] only facility within my jurisdiction, [even though] the health workers are very friendly, I might still consider a home birth,” I said.

“And I will be glad to assist” my colleague replied.

How can I, a health worker advocating for respectful maternity care (RMC) and facility delivery, talk like this you may ask? By visiting some facilities, you would come to a conclusion that homes are many times cleaner and better equipped than some health facilities.

The facility we just left was relatively tidy, but I can’t say clean. Everything was in place, but you can see that maintaining a proper hygienic environment is a big challenge. We worked through the antenatal, postnatal and labour wards and there was no sink in sight. Not a single one. You could see signs of inadequate cleaning and frequent usage of materials. There was no sight of antiseptic or a delivery set and for many, a kerosene stove is the alternative to sterilizers. Bed sheets, cotton wool and antiseptic, if available, are all provided by clients.

A “disrespectful environment” is something I often address when I talk about a lack of RMC.

Universal health coverage does not mean adding new buildings but equipping the existing ones with the minimum standard needed for basic maternal & child health service delivery.

Many times, Nigerian politicians think they are doing a lot by building additional health facilities and further equipping tertiary health institutions as a response to advocacy. But this never solves the problem of universal health coverage, primary health care or RMC. With new facilities, the few existing health workers will be further divided and assigned to the additional facilities with basic amenities still lacking in other health facilities, especially in primary health care. Workers are further stretched and resources are further depleted. With resources given to building new facilities instead of properly equipping existing ones, women still don’t receive the highest attainable level of care and this still equates to disrespect and abuse.

We need to educate our policy makers and politicians of these facts:

  1. Universal health coverage means equipping already existing health facilities with the minimum basic requirement before proceeding to build new ones.
  2. A primary care health facility with the minimum standard contributes a lot to the delivery of RMC and boosts the confidence of a health worker in giving it.
  3. It is more advantageous to concentrate effort on one health center and bring it to standard, rather than to build many with no standard.

Working on a campaign and project addressing disrespect and abuse in Nigeria has been very intriguing because a rights-based approach to addressing health issues is still relatively new. However, focusing on behavior and attitude change with little emphasis on infrastructure might eventually make very little difference.

I strongly believe that communities will better appreciate a single health facility managed by the few available skilled birth attendants and with the minimum basic requirements than five new ones with insufficient staff and equipment.

< Hadiza, from Yanduna community, Nigeria>©<2011>< Lindsay Mgbor / DFID> used under a Creative Commons Attribution license:<>