Gynaecologists fault criteria for free CS as FG kicks off pilot phase

Maternal health experts have expressed concerns about the criteria set by the National Health Insurance Authority (NHIA) for pregnant women to access the free Caesarean Section (CS) program announced by the Federal Government in November 2024.

They argue that the stringent requirements, particularly in rural areas, may exclude many women in need of the service.

Gynaecologists noted that the reliance on National Identification Numbers (NIN) for eligibility poses a significant challenge, as many women in rural communities lack access to NIN registration.

Data shows that only 110 million out of 223 million Nigerians have obtained their NIN. Experts also emphasized that hospitals lack sufficient human resources to meet the program’s demand for third-party administrators to verify claims, further complicating access.

The NHIA Director-General, Dr. Kelechi Ohiri, defended the criteria, explaining that accurate identification through NIN and third-party verification was necessary to ensure fairness and efficiency. He revealed that 2,819 women benefited from the program’s pilot phase, with over ₦87 million disbursed to cover procedures. The initiative has now expanded to 104 facilities nationwide, with 69 tertiary institutions eligible and 12 already signing agreements with the NHIA.

The program was introduced to address Nigeria’s high maternal mortality rate, driven by severe bleeding, infection, obstructed labor, and anemia. The World Health Organization reported Nigeria’s maternal mortality rate as 1,047 deaths per 100,000 live births in 2020. Despite the initiative’s aim to reduce maternal deaths, experts fear the criteria will exclude the most vulnerable women.

Professor Christopher Aimakhu, the second Vice President of the Society of Gynaecology and Obstetrics of Nigeria, highlighted the need for the government to recruit more trained medical personnel, improve service quality, and prevent mismanagement of funds. He also expressed concern that the program could encourage larger family sizes, exacerbating maternal health risks.

Dr. Joseph Akinde, a Consultant Gynaecologist, criticized the NIN requirement, stating that it excludes many rural women who lack the documentation. He warned that the program’s reliance on third-party administrators would hinder implementation and called for alternative, inclusive criteria. Akinde argued that the government must ensure that all Nigerians, especially those in rural areas, have access to NIN before using it as a prerequisite for critical health services.

The experts called on the Federal Government and NHIA to simplify eligibility criteria and address structural barriers, including the shortage of medical professionals, to ensure the program achieves its goal of reducing maternal mortality. Without these changes, they fear the initiative may fail to reach the women who need it most.