Pregnant woman in Lagos facing a life-threatening complication, only to find the nearest emergency care is over 50 minutes away—could strategic tweaks to health insurance save her life? A groundbreaking new study reveals how optimizing facility placements could slash travel times and boost maternal survival rates in Nigeria’s bustling megacity.
Emergency obstetric care Nigeria, geographical accessibility health insurance, Lagos State Health Scheme, UHC 2030 Nigeria, maternal health disparities—these trending terms underscore the urgency as researchers from Frontiers in Health Services analyze comprehensive emergency obstetric care (CEmOC) within the Lagos State Health Insurance Scheme (Ìlera Èkó). Published on October 16, 2024, the study assesses how well insured residents can reach life-saving services like caesarean sections and blood transfusions, crucial for reducing maternal deaths.
Led by shared first authors Aduragbemi Banke-Thomas from the London School of Hygiene and Tropical Medicine and Tobiloba Olubodun from the University of Greenwich, the research team—including experts from Nigeria and the U.S.—geocoded 166 functional public and private CEmOC facilities on the scheme’s panel as of December 2022. They used Google Maps’ directions API to calculate peak-hour driving times from population grids of women of childbearing age (WoCBA, 15-49 years), sourced from WorldPop data.
Key findings show a state-level median travel time (MTT) of 25 minutes to the nearest public CEmOC facility, dropping to 17 minutes when including private ones. At the local government area (LGA) level, MTT to public facilities varied from 9 minutes in Lagos Island to a staggering 51 minutes in Ojo, with a median of 18 minutes. Adding private facilities improved this to 5-36 minutes (median 13 minutes), with the biggest gains in Ojo (down to 13 minutes). However, in six LGAs—Alimosho, Eti-Osa, Ojo, Ikorodu, Badagry, and Ibeju-Lekki—no public CEmOC was reachable within 30 minutes, a critical threshold for emergencies. Even with private additions, Ibeju-Lekki remained unreachable, highlighting suburban and slum disparities.
The study verified 796 CEmOC-capable facilities statewide (26 public, 770 private), but only 23 public (88%) and 108 private (14%) were insured. Facility-to-population ratios per 1,000 WoCBA ranged from 1 in Mushin to 28 in Alimosho, with urban centers like Ikeja and Agege boasting more options. Researchers noted private facilities cluster in densely populated areas, leaving peripherals underserved.
Expert opinions in the paper emphasize strategic onboarding. Banke-Thomas and team recommend prioritizing private CEmOC in high-MTT LGAs like suburbs (Ibeju-Lekki, Badagry) and slums (Mushin, Ojo) to reduce times below 10 minutes, linked to better outcomes. They warn against over-relying on privates, urging public facility development in unattractive areas. Oladapo Ogunyemi, affiliated with Lagos State Ministry of Health, highlights the scheme’s role in minimizing catastrophic costs, but stresses geographical equity for UHC.
Public reactions are emerging online. Frontiers’ official X account announced the study on October 17, 2024, garnering views and sparking discussions on maternal health reforms. Users praised the innovative use of tech like Google Maps for policy insights, with one commenter noting, “This could revolutionize insurance planning in Africa.” Broader sentiment on platforms echoes calls for similar analyses in other states, amid Nigeria’s low 3% insurance coverage.
For U.S. readers, this resonates in global health contexts, influencing aid from organizations like USAID that support Nigeria’s NHIA for UHC by 2030. Economically, better access could cut Nigeria’s maternal mortality (over 800 per 100,000 births), boosting workforce productivity and diaspora remittances exceeding $20 billion annually. Lifestyle-wise, it aids Nigerian-Americans advocating for family back home, while politically, it aligns with U.S. foreign policy on women’s rights and SDG 3. Technologically, the study’s API-driven approach inspires U.S. health equity tools, like mapping rural obstetric deserts amid hospital closures.
The Ìlera Èkó scheme, launched in 2020, covers premiums from ₦8,500 ($8.5) individually to ₦40,000 ($40) for families, funded partly by state revenue. With over 600,000 enrollees by 2022, it mandates private HMOs, but the study urges data-driven expansions to slums and suburbs for true equity.
As Nigeria strives for UHC, this research provides a blueprint: Link verified facilities with realistic travel data to ensure no woman is left behind in emergencies.
In reflecting on the findings, strategic private-public mixes could halve maternal risks, paving the way for healthier generations by 2030.
By Sam Michael
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