According to studies, there are about 800,000 women affected by Vesicovaginal Fistula in Nigeria. This is about 40 per cent of the total world’s estimate of 2,000,000 VVF patients. The endemic states are Sokoto, Kebbi, Borno, Kano, Katsina, and Plateau all in Northern Nigeria as well as pockets of cases in Ebonyi and Akwa Ibom states in the South. This is an aspect of the right to health especially, maternal health that has been neglected by different tiers of government and the Nigerian society.
The VVF is caused by the challenges of child birth especially for child brides whose reproductive organs have not fully developed and matured to position them to give birth. According to Wikipedia, “It is often caused by childbirth (in which case, it is known as an obstetric fistula), when a prolonged labour presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may necrotise (die), leaving a hole. Vaginal fistulas can also result from particularly violent cases of rape, especially those involving multiple rapists and or introduction of foreign objects”. Again, it has been stated by experts that “Most of the affected girls are known to lose their children and even their lives during childbirth and many lose bladder control and constantly leaks urine which leaves them with no option than to wear bags or bucket. The stench from the urine makes them unapproachable even to family members including their husbands who often abandon them sometimes in search of replacement with another child bride. And so, the circle continues”.
Our 1999 constitution protects the rights to life and human dignity. A typical VVF patient in Nigeria loses her human dignity; also risks losing her life while her right to health is grossly violated. She cannot in any sense of the word be said to be enjoying the best attainable state of physical and mental health. For, what is the worth of a human life lived in stigmatising conditions, under inhuman and degrading conditions where the basic respect for personhood is taken away? The Nigerian state is under the obligation to respect, protect and fulfil the right to life, human dignity and the right to health. The basic state obligation to respect for the right to life is not just the respect of the fact of mere human existence. But it includes the promotion and protection of a dignified existence and an existential condition that elevates a human being beyond vegetation. This raises a state obligation to intervene on behalf of the most vulnerable and the poorest of the poor to facilitate the realisation of rights, in the event, victims are unable through self help to do it themselves.
Again, looking at the circumstances that lead to the majority of the VVF cases, it demonstrates a state failure to protect girls and young women from harmful traditional and other practices injurious to health. A good number of the marriages are unions of matured men and girls who have not attained the age of marriage and are in no position to give informed consent to a marriage or its consummation. The state obligation to protect the rights of the girl-child and young women includes preventing third parties from violating their basic rights and taking undue advantage of them under whatever guise. Thus, failure of the state obligation to protect the rights to life and human dignity often leads to the replication of the VVF victims. But can the state afford to look away and do nothing about the plight of these patients?
The budget serves as a major instrument to promote human rights and fulfil state obligations. If a failure to respect and protect rights has occurred, the state should waste no time in remediation of the violated rights especially, if budgetary resources can provide a remedy. The maxim of ubi jus ibi remedium is not only applicable in law courts but provides a basis for a claim of rights under varied circumstances. As such, the treatment and remediation of VVF should attract utmost priority in health funding. The cost of repair surgery is estimated at N39,000 and additional N50,000 for rehabilitation bringing the total to N89,000. Rounding up the cost to approximately N100,000, it will cost the Federal Government the sum of N80bn only for the corrective surgeries and rehabilitation. If the states and local governments join in funding the operations, the burden will be easier to bear among the three tiers of government. This is not beyond the resources of Nigeria and can be provided over a two to three-year budgeting period. This would also be complemented by effective maternal services for pregnant women and enforcing laws and policies against child marriage so that new cases would be minimised. Campaigns against practices that lead to the VVF will also be intensified.
But what does the current public funding scenario look like? The capital budget provisions in the vote of the Federal Ministry of Health for four years speak for themselves. The sums of N658.097m, N850.503m, N250.593m and N221.676m respectively were provided for The VVF in the years 2012, 2013, 2014 and 2015. Evidently, the Federal Government has not prioritised the VVF intervention and the sums provided are paltry. Information about the utilisation of these funds is not publicly available but in the usual Nigerian budgeting practice, appropriated sums are not fully released. The releases when they come are not fully cash backed and the cash backed sums are not fully utilised. Thus, in accordance with the MDA utilisation average, not more than 60 per cent of this sum would have been utilised. Considering that the Federal Government is planning its medium term spending in key sectors including health, it is proposed that the N80bn needed to remediate the VVF can be sequenced over the years – 2017, 2018 and 2019 at N30bn each for the first two years and N20bn in the last year.
According to the Chief Medical Director of the National Obstetric Fistula Centre in Katsina, Dr Aliyu Muhammad El-Ladan, who spoke early in 2016, the centre treats at least 400 VVF patients every year but could only rehabilitate one hundred. The VVF institutions need resources for the repair of the patients, their rehabilitation through provision of skill training and teaching on the VVF. Most the existing interventions are from donors and the Federal Government provides very little for the VVF remediation. It is therefore imperative that Nigeria takes steps to fill the funding gap after analysing what the donors and private sector are bringing to the table. It is a shame that Nigeria leads in many negative indicators relating to maternal and child health. We need to show the world that we care for our women and take the lives of the vulnerable more seriously.
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