Implementation of a Free Maternal and Child Health Programme in a Nigerian State

Abstract

Background: The Government of Enugu State as a policy response to reduce maternal and child mortality and morbidity in the state introduced the Free Maternal and Child Health (MCH) programme for all pregnant mothers and under-5-year-old clients in public health facilities across the state in 2007. Materials and Methods: Forty-three health facilities, 487 clients of the public health facilities, 43 health facility workers, and 8 directors of the State Ministry of Health and the State Hospitals Management Board were randomly selected through a multistage sampling technique involving stratified sampling techniques. Various instruments, namely pretested structured questionnaire, in-depth interview, and document review, were used to elicit data for the appraisal of the programme in terms of concept, policy and plan, implementation, management, and outcome. Data obtained were analyzed and variables tested for significance. Results: Our findings indicate that more than 60% of the clients are aware and utilize the free MCH programme. There was an overall reduction in maternal deaths, and an increase in the number of deliveries in public facilities since inception of the programme in the state. There was also a significant improvement in the MCH service uptake and high clients’ satisfaction. Major setback was inadequate supportive supervision. Conclusion: There is a huge need for increased awareness creation regarding the programme to enhance utilization, especially in the rural areas. Comprehensive baseline data of the health indices of the affected population are paramount to any future comprehensive programme assessment and are hence recommended.