Many stakeholders working to improve maternal health have observed and argued that some women in Nigeria prefer delivery at traditional birth homes to hospitals, yet the TBAs are not skilled or trained to deliver women during complications.

It is understandable that many experts would see this  argument as mere assumptions and baseless but will not deny the fact that 61 percent of women attend antenatal care from a skilled provider and 38 percent are delivered by a skilled provider, while about 34 percent do not attend antenatal  care (NDHS 2013).   

In a recent investigation on barriers women face in accessing health care in Nigeria, the NOTAGAIN Editorial team found that some experts have already begun asking a critical question about why women fail to return to health care facilities or a skilled provider to deliver their babies after attending antenatal care.

One of such expert is Dr. Kole Shettima, the Director, MacArthur Foundation's  Africa Office and Chair, Annual Population Lecture Series. According to him, there might be some barriers preventing women from accessing health care which have not been properly looked into. He therefore highlighted 3 areas which need urgent attention in order to ensure women have an unrestricted access to health care.

Attitude of Health workers:

Attitude of health workers is one of the several factors women complained about as challenges in accessing health care in Nigeria. According to the NDHS 2013, about 16.5 percent of women said attitude of health workers was reason why they did not access care. Attitudes of health workers could mean treatment meted out to patients, opening and closing hours, and so on. It is a fact that pregnancy doesn’t give notice and emergency could occur at any time of the day - whether it is 2am or 2pm. Thus, it becomes imperative for hospitals to be functional throughout the day.

Quality of Service

According to Dr. Kole, some Nigerians travel outside the country to seek medical attention. Nigerians have been reported attending care in Niger, Chad, Cameroon, India, South Africa, America and others. Thus, it essential to  know why they do that, what kind of services they offer, and what should be done to enable them to stay in Nigeria.

He said, "maybe there are certain things that they do there in terms of convenience of services, attitude of the health workers, even the security guard or the person who on/off the generator in clinics and hospital."

Accountability:

The heath system is expected to be accountable to its citizens and make it possible for them to work. According to Dr. Kole, there is a need for enquiry into the death of every single woman whose death  relates to pregnancy and childbirth.

He said, " if a woman dies, what we should have is what we call confidential inquiry just to know why the woman died. Maybe if we can find out why she died, it would help us prevent the other woman from dying. Maybe she died because she came and the person who was supposed to be at the reception has closed and gone and they are trying to look for someone who is going to write simple thing like admission of the person or the nurse who is supposed to be there to provide the service did not report on time" he said

 "So there are all kinds of little things that could contribute to the death of the person but if you can have a system that is not punitive. What you don't want to do is to punish the person. What you want to have is a system of a confidential inquiry in which you would say if a woman dies, we need a report. Why did she die? Once she came to the hospital, what are the things that we did? and what are the things we didn’t do? Maybe that will help us in order to prevent the system from failing in the future" he added.

 Furthermore, Dr. Shettima believes that a lot of these that needed adjustment in the system may not necessarily require big money but  will help the health system itself.