Capital Punishment: Dying Out but Still Killing #deathpenalty


Posted: 28/06/2013 , huffingtonpost
Maryland Death Penalty

It’s a loose comparison, but sometimes I think that people who get executed these days are like those killed right at the end of a war. Another day, another month … and they might survived.

I say this because when you look at the figures for capital punishment around the world, you can see there’s a strong trend toward abolition. It’s happening year by year. Fifty years ago only nine countries in the world had abolished the death penalty; by 1977 it was 16; now 140 countries have abolished judicial killing in law or stopped it in practice.

Even in “pro-death penalty” countries, the number of sentences and executions is generally falling or the scope for imposing executions being reduced. For example, in China the number of crimes which might lead to a lethal injection or death by firing squad has beenreduced from a reported 68 to 55 (still a staggeringly high number). Meanwhile, in the USA – another major user of capital punishment – individual states are peeling away from the majority on the issue, with six states scrapping the death penalty in the past six years – New Jersey and New York state (2007), New Mexico (2009), Illinois (2010), Connecticut (2012) and Maryland just last month.

Anyway, though in the last year or so there have been what Amnesty says is an “alarming” spike in executions in Iraq and a resumptions after considerable gaps in the use of the death penalty in Japan, Gambia, Pakistan and India, the underlying global trend is still clear and apparently fixed: state-sanctioned judicial killing is slowly dying out.

So to me there’s a particular tragedy to the late nature of executions in this context. Last night’s execution of Kimberly McCarthy in Texas was regrettable for many reasons (especially the apparent role of racial prejudice in her trial), but in five – ten, 20? – years’ time there’s a distinct possibility that we won’t have people in Texas being strapped down to a lethal injection gurney and killed by technicians in a disgraceful pseudo-medical “procedure”.

I know of course that of all US states Texas is a “hard case”, one that may not go the way of national and international abolition in the immediate future. It’s just reached the miserable milestone of 500 executions in 31 years, nearly five times higher than any other US state. The Lone Star State indeed. See Amnesty USA’s Brian Evans on Texas’ fatal addiction to the death penalty. However, with support for capital punishment in the USA falling, and controversy over lethal injection drugs and unfair trials growing, I think abolition even in Texas will come ….

But still, the machinery of death clanks on. Just this week, in addition to McCarthy’s execution we’ve had four men hanged in Nigeria (and another facing death by firing squad imminently) and alarming reports that 117 people in Vietnam may face execution soon because of a recent law change (we’re talking – in some cases – about death by lethal injection, using specially-produced drugs to execute prisoners for non-violent drugs offences). There’s an urgent text campaign on Vietnam being run by Amnesty – see here.

So no, if you take an abolitionist view on the death penalty, there’s no cause for complacency. According to Wikipedia, the last person to die (from the British Empire side at least) during World War One was a 25-year-old Canadian man called George Lawrence Price. He was shot by a German sniper in the Belgian town of Ville-sur-Haine at 10.58 on the morning of 11 November 1918. The Armistice came into force at 11am. A needless death then, just like everyone killed by the state in the cold-blooded and thoroughly repugnant business of administering capital punishment.

 ,Press Officer at Amnesty International UK


#India – Africans complain of discrimination in Mumbai

BBC News

Sambo Davis and his wife Sheeba RaniSheeba Rani has been ostracised by many friends and relatives for marrying Nigerian Sambo Davis

Africans staying in and around India‘s commercial capital, Mumbai (Bombay), complain of indiscriminate racism and constant police harassment, reports the BBC’s Zubair Ahmed.

Nigerian Sambo Davis is married to an Indian woman and lives in Mumbai.

All his documents are valid, but he was arrested by the police recently on suspicion of being a drug dealer.

He and 30 other black Africans were detained for hours before they were let off with an apology.

But the following day, Mr Davis said that he was shocked to read in local newspapers that they were “arrested for drug peddling”.

“The police treat us Africans like dogs,” he says.

Mr Davis claims he often faces discrimination when he goes to restaurants or when he tries to rent an apartment in gated middle-class communities.

Continue reading the main story

“Start Quote

Ikeorah Junior

If Africans don’t have papers, then deport them, don’t put them in jail”

Ikeorah JuniorNigerian cafe owner in Mumbai

But he is nevertheless one of the lucky ones. He found a decent flat to rent, thanks to his Indian wife.

But his fellow countrymen, he says, still face discrimination: “When they go to rent flats in a normal building they are told – ‘you are a black man, you are Nigerian, and you are not wanted’. This is racism.”

‘Hide and seek’

There is no official data on how many Africans live in Mumbai, but since India’s economic progress gathered momentum in recent years, many have come to work in and around the city. Unofficial estimates put their numbers at more than 5,000.

Most of them are engaged in exporting garments to Nigeria and other African countries.

Many others are students, enrolled in the region’s prestigious educational institutions.

But there are also hundreds of Africans, mostly Nigerians, who live as illegal immigrants in India. They have either “lost” their passports or their visas have “expired”.

Every day, these people play hide-and-seek with the police – if they are caught, they are sent to jail.

Ikeorah Junior from Lagos runs a cafe for Africans in a crowded market on Mumbai’s Mohammed Ali Road.

“I don’t understand why they [police] have to go from house to house to arrest the people who don’t have their papers. If they don’t have papers, then deport them, don’t put them in jail,” he says.

Ahmed Javed, who is in charge of maintaining law and order in the state of Maharashtra, says it is not that simple: “In most cases they have no passports. So, unless their nationalities are determined, they cannot be deported.”

Dozens of Africans have taken up residence on Mira Road, a dusty, nondescript town just outside Mumbai.

One “illegal immigrant” there asked me for money, claiming he had not eaten for two days.

He looked worried and told me that he had been approached by drug dealers to work for them.

African man in Mumbai streetMany Africans face discrimination when they try to rent apartments

“I have been here for three years – my visa expired a long time ago. I want to go back home. Please help me, brother,” he tells me.

In this neighbourhood, Negro or kaalia (black in Hindi) are the two words indiscriminately used to describe all black people.

“We call them Negro because they are black. They look frightening,” says one woman.

“They don’t find homes to rent in Mumbai, they only stay in Mira Road. Why? Because of the way they behave. They sell drugs and indulge in other illegal activities. They cannot be trusted,” a local man commented, seemingly unaware of the offensive nature of his words.

‘Embarrassed and ashamed’

Against such a backdrop of pronounced prejudice, Sheeba Rani married Sambo Davis four years ago and the couple have two children.

Mrs Davis says her parents are enlightened Christians and they blessed them because they thought the marriage was God’s wish.

But, she says, she has been ostracised by many friends, relatives and society since her marriage.

Mrs Davis is “embarrassed and ashamed” by the behaviour of the Indian people towards black Africans.

Wedding picture of Sheeba Rani and Sambo DavisSheeba Rani’s parents blessed the couple saying the marriage was God’s wish

“When I used to go to a mall or if I walked with him, I always wanted him to hold my hand. But when people saw me with him, they thought I was from a bad family or even a prostitute.”

Earlier, she did not understand why black people were being looked down upon, but now she says she does.

“Because our society is obsessed with white skin. If I had married a white man, I would have gained more friends and society’s approval too.”

Mr Davis believes that the discrimination is solely “because I am a black man”.

“It’s because I am from Africa, I am a Nigerian. I think Indians see us as inferior.”

Yet despite the discrimination they face, nearly all Africans the BBC interviewed said they had a soft spot for their adopted country.

They say the relations between India and Africa are “rock solid”. Many argued that Indians and Africans are brothers.

“We look after Indians in our countries. They have become rich there. All we want here is for Indians to understand we are not drug dealers. We are not violent. We are just like them.”

When corporations abuse human rights

Can a corporation face civil liability in a U.S. court for aiding a foreign government’s acts of torture and murder of innocent villagers? That was the question before the Supreme Court on Oct. 1 when it heard oral arguments in Kiobel vs. Royal Dutch Petroleum.

The plaintiffs, all Nigerian nationals now living in the U.S., claimed that Dutch, British and Nigerian corporations affiliated with Shell (and engaged in oil exploration and production in Nigeria) assisted the Nigerian military in committing human rights abuses between 1992 and 1995 to quash protests over grave environmental damage caused by the oil operations.

The Supreme Court initially heard this case in its last term on the question of corporate civil liability under a U.S. statute that permits an “alien” to bring a civil action for violation of international law in the U.S. federal court. A divided Second Circuit Court of Appeals had ruled that  customary international law does not recognize corporate civil liability and hence corporations are immune under the statute in question, the Alien Tort Statute. That reasoning was subsequently rejected by three other federal courts of appeal.

The Supreme Court asked the parties for supplemental briefing on whether the statute allows courts to hear a case concerning violations of international law “occurring within the territory of a sovereign other than the United States” — that is, whether the law applies extraterritorially.

The statute in question, enacted by the first Congress in 1789, lay dormant for two centuries until the Second Circuit decided a case in 1980 which involved a Paraguayan tortured and killed in Paraguay. The court held that since torture is prohibited under international law, jurisdiction is proper under the statute, and it found the defendant liable for huge damages. Subsequently, in another decision, the Supreme Court left the door open for a federal court to hear a case based on an international norm accepted by the civilized world as “specific, universal, and obligatory.” Torture and extrajudicial execution, as occurred in this case, fit that definition. But the court has not ruled on whether corporations can be sued under that statute.

The Kiobel case has broader implications. Will the Supreme Court with its conservative majority insulate companies from liability for human rights violations committed abroad? The five-member majority led by Chief Justice John Roberts has in the last few years issued a series of opinions favoring corporations, such as the 2010 Citizens United ruling.

What are the court’s options? It could rule that while the Alien Tort Statute applies to persons it does not apply to corporations. However, under American law, plaintiffs have been able to sue corporations for more than 200 years. Why should this principle not apply to claims against corporations under the Alien Tort Statute in the case of severe human rights violations? If corporations have constitutional rights, as Citizens United established, why should they not be held to the same standards as persons?

On the other hand, the court could hold that the statute does not apply to acts committed abroad and thus corporations committing human rights violations abroad are shielded from liability.

The United States must uphold its tradition of protecting international human rights by not allowing a corporation to avoid liability when it has committed heinous human rights crimes abroad.

Ved P. Nanda (, Thompson Marsh Professor of Law and director, International Legal Studies Program, University of Denver Sturm College of Law.

“To those who believe in resistance, who live between hope and impatience and have learned the perils of being unreasonable. To those who understand enough
to be afraid and yet retain their


#Fellowship- Maternal Health #India #mustshare




Maternal mortality is a major threat to women’s lives in developing countries. While maternal health outcomes have improved in some countries over the past few decades, rates of maternal death remain alarmingly high. Every minute, a woman dies in pregnancy or childbirth and over 300 million women in poor countries suffer from maternal morbidity. In many very poor countries the majority of mothers do not receive even the most basic health care, and quality care during childbirth – when both the mother and child are most at risk – is often unavailable.
Program Overview
To reduce maternal mortality and morbidity over the long-term, emerging public health leaders need to be equipped with the skills, commitment, and vision to respond fully to multiple causes and consequences of this threat.
Maternal Health Young Champions are students or young graduates in public health or a related field who are committed to improving maternal mortality and morbidity through either research or innovative field work in their home country.
Maternal Health Young Champions Program, a partnership between the Institute of International Education and Harvard School of Public Health, offers a unique fellowship to 10 young people who are passionate about improving maternal health in their home country. The Young Champions who are selected will be matched with in-country mentors from selected organizations for a nine-month research or field project internship focusing on a particular area of maternal health. The fellowship includes leadership training and participation in the Global Maternal Health Conference 2013 in Arusha, Tanzania.
Eligibility Requirements Applications are currently being accepted from candidates from Ethiopia, India, Mexico, and Nigeria who meet the following minimum criteria:
  • Bachelor’s or equivalent degree
  • 20-35 years of age
  • Clearly articulated plans for continued technical experience, research, or study
  • Demonstrated career commitment to improvement of maternal health, especially in developing countries
  • Interest in academic research or technical service provision in the field (excluding policy advocacy)
  • Articulated work/study project goals
Please circulate this information widely within your institution or networks, particularly to candidates whom you think would be excellent applicants for this program.

For more information on the program or to apply, go to or contact:

John Bodra
Program Officer India
Tel: +91-11-2651-6873                     Email:



A LANDMARK JUDGMENT – Holds That Dismissal Based On #HIV-Positive Status Is Unlawful


October 9, 2012
Lagos, Nigeria
Press Statement
Holds That Dismissal Based On HIV-Positive Status Is Unlawful
The Lagos State High Court handed down a landmark judgment in the first ever Human
Immunodeficiency Virus (HIV) discrimination lawsuit, Georgina Ahamefule V. Imperial Medical
Centre & Dr. Alex Molokwu (Suit No. ID/1627/2000), on Thursday September 27, 2012. The
Honorable Justice Y.O. Idowu held that the termination of Georgina Ahamefule’s employment by
the Imperial Medical Centre on the ground of her HIV-positive status is illegal, unlawful and
actuated by malice and extreme bad faith.
On July 14, 2000, the Social and Economic Rights Action Center (SERAC) filed the lawsuit
challenging the termination of Georgina Ahamefule’s employment as an auxiliary nurse by the
Imperial Medical Centre and its Chief Medical Director, Dr. Alex Molokwu, based on her HIV-
positive status.
Georgina joined the Imperial Medical Centre as an auxiliary nurse in 1989. In 1995, while she was
pregnant, Georgina developed boils on her skin and sought medical attention from her employer Dr.
Alex Molokwu who carried medical examinations and diagnostic tests without disclosing the nature
and outcome of the tests to her. Dr. Molokwu referred Georgina for further testing to one Dr.
Okanny at the University of Lagos Teaching Hospital with a note in a sealed envelope. Dr. Okanny
carried out various tests without disclosing the nature of those tests to Georgina. She was
subsequently informed that she had tested positive to the Human Immuno-deficiency Virus (HIV).
Georgina was never provided any form of counseling before or after the tests were carried out as
required by medical ethics and the law.
Dr. Molokwu promptly terminated Georgina’s employment as an auxiliary nurse at the hospital on
the ground of her HIV-positive status. In the termination letter dated October 23, 1995, Dr.
Molokwu explained that the hospital’s management could not compromise the facility or its patients
by exposing them to risks associated with Georgina’s HIV-positive status. However, Dr. Molokwu
had no hesitation to giving Georgina a letter recommending her for employment in other medical
The emotional and psychological trauma that she suffered as a result of the news of her HIV-positive
status and the loss of her employment contributed to a spontaneous miscarriage of her pregnancy.
Georgina was further victimized, rejected, humiliated and put at great risk when Dr. Molokwu
declined to carry out his own prescribed evacuation of the miscarried pregnancy on the ground of
Georgina’s HIV-positive status. Medical doctors at another hospital eventually carried out the
evacuation procedure.
Unfortunately, the unfairness suffered by Georgina did not stop at the hands of Dr. Molokwu and his
hospital. In 2001, on an application for an accelerated hearing of the matter, the then presiding judge
in the case, Hon. Justice Caroline O. Olufawo of the Lagos State High Court, barred Georgina from
entering the courtroom because of her HIV-positive status. In a shocking display of judicial
ignorance, Justice Olufawo further ruled that satisfactory expert evidence must be presented in court
to convince her that the judge and others would not become infected with the HIV virus as a result of
Georgina’s mere physical presence in the courtroom. SERAC appealed that decision and the Court
of Appeal remitted the matter back to the High Court for trial. Georgina testified in her case without
further restrictions or impediments.
In 2010, SERAC demanded and secured the arrest and prosecution of Dr. Molokwu, and
Shamsudeen Aileru, a law clerk in the law offices of Professor Abraham Adesanya, Senior Advocate
of Nigeria (SAN), counsel to Dr. Molokwu. Pursuant to a Legal Advice issued by the Lagos State
Director of Public Prosecutions, dated September 28, 2010, the defendants were arraigned before the
Lagos State High Court, Ikeja, Lagos in The People of Lagos State V Shamsudeen Aileru & Dr. Alex
Molokwu (ID/50C/2011) for Perjury contrary to Section 118, and Conspiracy to commit a felony
contrary to Section 516, of the criminal code law Cap 17 Volume 2, Laws of Lagos State 2003. On
conviction, the offenses of conspiracy and perjury are punishable with 7 and 14 years imprisonment
This prosecution was triggered by SERAC’s executive director’s petition to the Commissioner of
Police, Lagos State requesting immediate investigation and prosecution of the defendants for
conspiracy to commit perjury and perjury. Professor Adesanya’s law clerk, Mr. Aileru, deposed
falsely to an affidavit on oath that Georgina had died in her hometown. Georgina is alive and well.
The affidavit was filed in support of a motion seeking to dismiss Georgina’s lawsuit against Dr.
Molokwu and his hospital. Relying on information supplied by Molokwu the law clerk deposed to an
affidavit stating falsely that Georgina had died, and urged the court to dismiss the lawsuit being a
personal action. The false declaration was one of many efforts by Dr. Molokwu and his lawyers to
frustrate Georgina’s quest for justice in the matter of the wrongful termination of her employment
and other violations.
The defendants pleaded ‘not guilty’ to the charge and the prosecution opened its case on July 5, 2011
with Mr. Felix Morka, SERAC’s lead counsel in the civil matter, as its first witness. Georgina and
the police investigators also testified on the prosecution’s behalf. The prosecution closed its case on
the December 1, 2011. After dismissing a no case submission made on the Defendants’ behalf by
Professor Adesanya, the court directed the defendants’ to open their case. The case is currently
adjourned to October 31, 2012 for defense.
In an epochal decision, the Hon. Justice Y.O. Idowu of the Lagos High Court held as follows:
· That the purported termination of the Plaintiff’s employment is illegal, unlawful and actuated
by malice and extreme bad faith.
· That the Defendants’ action in subjecting the Plaintiff to HIV testing without her informed
consent constitutes an unlawful battery on her.
· That the Defendants’ action in not affording the Plaintiff pre-test and post-test counseling
services constitute an unlawful negligence of a professional duty to the plaintiff.
· That the Defendants’ action in denying the Plaintiff medical care on grounds of her HIV-
positive status constitutes a flagrant violation of the right to health guaranteed under article
16 of the African Charter on Human and Peoples’ Rights (Ratification and Enforcement)
Act CAP 10 Laws of the Federation of Nigeria and article 12 of the International Covenant
on Economic, Social and Cultural Rights (ratified by Nigeria in 1993).
· An order for 5 Million Naira (Five Million Naira) general damages for the wrongful
termination of the Plaintiff’s employment.
· An order for 2 Million Naira (Two Million Naira) being compensation for unlawful conduct
of HIV testing without the Plaintiff’s informed consent and for the Defendants’ negligence.
This decision represents a major victory for Georgina and for all those living with the HIV virus in
the country, and a major triumph of justice over illegality and unfairness. It is the first-ever judicial
pronouncement on the unlawfulness of HIV-based discrimination. The decision is also significant in
holding that conducting HIV testing without the individual’s informed consent is tantamount to
unlawful battery. Further, it is equally definitive on the point that conducting HIV test on an
individual without pre-test and post-test counseling constitutes unlawful negligence. The case also
establishes the principle that denial of medical care on grounds of HIV-positive status constitutes a
flagrant violation of the right to health. The monetary damages of 7 Million Naira awarded against
Dr. Molokwu and the Imperial Medical Centre sends a strong signal that this kind of unjustifiable
and unlawful discrimination against people living with HIV will no longer be tolerated. We salute
the courage and wisdom of Her Lordship, Hon. Justice Y.O. Idowu.



Maternal Deaths Halved in 20 Years, but Faster Progress Needed

Eritrean women

Eritrean women (Photo credit: Wikipedia)

UN News
The report “Trends in maternal mortality: 1990 to 2010”, shows that from 1990 to 2010, the annual number of maternal deaths dropped from more than 543,000 to 287,000 – a decline of 47 per cent. While substantial progress has been achieved in almost all regions, many countries particularly in sub-Saharan Africa will fail to reach the Millennium Development Goal (MDG) target of reducing maternal death by 75 per cent from 1990 to 2015.

Every two minutes, a woman dies of pregnancy-related complications, the four most common causes being: severe bleeding after childbirth, infections, high blood pressure during pregnancy, and unsafe abortion. Ninety-nine per cent of maternal deaths occur in developing countries; most could have been prevented with proven interventions.

“We know exactly what to do to prevent maternal deaths: improve access to voluntary family planning, invest in health workers with midwifery skills, and ensure access to emergency obstetric care when complications arise. These interventions have proven to save lives and accelerate progress towards meeting the Millennium Development Goal 5,” said Dr. Osotimehin.

Disparity exists within and across countries and regions. One third of all maternal deaths occur in just two countries – in 2010, almost 20 per cent of deaths (56,000) were in India and 14 per cent (40,000) were in Nigeria. Of the 40 countries with the world’s highest rates of maternal death, 36 are in sub-Saharan Africa.

Similarly, Eastern Asia, which made the greatest progress in preventing maternal deaths, has a contraceptive prevalence rate of 84 per cent as opposed to only 22 per cent in sub-Saharan Africa, a region that has the highest rates of maternal death.

The Midwives Service Scheme in Nigeria

  • Seye Abimbola1*, Ugo Okoli1, Olalekan Olubajo1,Mohammed J. Abdullahi1, Muhammad A. Pate2,3

1 National Primary Health Care Development Agency, Abuja, Nigeria2Federal Ministry of Health, Abuja, Nigeria, 3 Duke Global Health Institute, Durham, North Carolina, United States of America

Citation: Abimbola S, Okoli U, Olubajo O, Abdullahi MJ, Pate MA (2012) The Midwives Service Scheme in Nigeria. PLoS Med 9(5): e1001211. doi:10.1371/journal.pmed.1001211

Published: May 1, 2012

Abbreviations: ANC, antenatal care; LGA, local government area; MMR, maternal mortality ratio; MNCH, maternal, newborn and child health; MSS, Midwives Service Scheme; NC, north central; NE, northeast; NMR, neonatal mortality ratio; NW, northwest; PHC, primary health care; SE, southeast; SS, south south; SW, southwest; WDC, Ward Development Committee

* E-mail:

Summary Points

  • Maternal, newborn, and child health indices in Nigeria vary widely across geopolitical zones and between urban and rural areas, mostly due to variations in the availability of skilled attendance at birth.
  • To improve these indices, the Midwives Service Scheme (MSS) in Nigeria engaged newly graduated, unemployed, and retired midwives to work temporarily in rural areas.
  • The midwives are posted for 1 year to selected primary care facilities linked through a cluster model in which four such facilities with the capacity to provide basic essential obstetric care are clustered around a secondary care facility with the capacity to provide comprehensive emergency obstetric care.
  • The outcome of the MSS 1 year on has been an uneven improvement in maternal, newborn, and child health indices in the six geopolitical zones of Nigeria.
  • Major challenges include retention, availability and training of midwives, and varying levels of commitment from state and local governments across the country, and despite the availability of skilled birth attendants at MSS facilities, women still deliver at home in some parts of the country.


Nigeria, with more than 140 million people, including 31 million women of childbearing age and 28 million children under the age of five, is by far the most populous African country. However, the maternal mortality ratio (MMR) in Nigeria is 545/100,000 live births, as only one in three births in Nigeria is attended by skilled personnel, less than 20% of children are fully immunised at age one, and 36% of pregnant women do not receive antenatal care (ANC) [1]. Thus, strengthening these services is an urgent imperative.

Midwives Service Scheme: The Rationale

The slow rate of progress in Nigeria makes the Millennium Development Goals (MDGs) targets unachievable using current strategies alone [2]. Health indices in Nigeria vary widely across geopolitical zones (See Box 1) and socioeconomic groups [3]. The northeast (NE) zone has the highest MMR: 1,549/100,000 live births compared to 165/100,000 live births in the southwest (SW). There are also urban and rural variations with MMR of 351/100,000 live births in urban areas compared to 828/100,000 in rural areas. The under-5 mortality rate of 171/1,000 live births also varies between the lowest (219/1,000 live births) and highest (87/1,000 live births) wealth quintiles. This pattern is replicated in other indices of childhood mortality. Maternal, neonatal, and child mortality rates in Nigeria are highest in the NE and northwest (NW) zones and lowest in the southeast (SE) and SW [1]. However, although the rates are lower in the SE and SW, indices in these regions still fall short of global development targets.

Box 1. The Political Organisation of Nigeria

Nigeria is divided into 36 states and one Federal Capital Territory (FCT), which are further sub-divided into 774 local government areas (LGAs). There are six geopolitical zones in Nigeria: north central (six states and the FCT), northeast (six states), northwest (seven states), southeast (five states), south south (six states), and southwest (six states).

These variations in health indices are influenced by the presence of tertiary hospitals, social amenities, and a population that can afford to pay for health services that in turn attract highly skilled health workers [4]. Therefore, in much of rural Nigeria, beyond issues of access, there are inadequate human resources for providing 24-hour health services in primary health care (PHC) facilities [5]. Nigeria faces a crisis in human resources for health (HRH) in the form of health worker shortages, requiring an immediate and significant increase in the number of health workers [6], or in the meantime a strategic redistribution of health workers to grossly underserved rural areas (See Box 2).

Box 2. The Political Economy of Health Care in Nigeria

Health services in Nigeria mirror political organisation. The federal government is responsible for tertiary care, state governments for secondary care, and the local governments (LGs) run primary care. Health financing is tied to the flow of funds from the federation account, which are shared between levels of government according to an allocation formula that keeps about half of funds at the federal level, the 36 states share a quarter, and the other quarter is distributed to the LGs. These resources are not sectorally earmarked and the states and LGs are not constitutionally required to provide budget and expenditure reports to the federal government. This results in poor coordination and integration between levels of care, giving rise to a weak and disorganised health system with widely varying patterns of outcomes. The MSS is an unprecedented emergency stop gap collaborative effort among the three tiers of government to improve maternal and child health indices in rural Nigeria.

Efforts to better reach underserved communities have been on task shifting to community health workers (CHWs) [7]. While task shifting has offered a cost-effective expansion of the overall HRH pool, skilled attendance at birth is essential to reducing the burden of maternal mortality [8]. The shortage of skilled birth attendants in rural Nigeria impacts negatively on utilisation of services by women in these areas [5]. Launched in December 2009 , the Midwives Service Scheme (MSS) was set up to address the HRH needs in rural primary care, based on the evidence that when the number of midwives increases, utilisation of services increases, women’s satisfaction with care improves, and maternal and newborn mortality decrease [8],[9]. To do this, three categories of midwives were recruited as part of the MSS: the newly graduated, the unemployed, and the retired. They are posted for 1 year (renewable subject to satisfactory performance) to selected PHCs in rural communities.

Midwives Service Scheme: The Structure

The facilities selected for the MSS were linked in an effective two-way referral system through a cluster model in which four PHC facilities with the capacity to provide basic essential obstetric care were clustered around a general hospital with the capacity to provide comprehensive emergency obstetric care. There were 815 participating health facilities: 652 PHC facilities and 163 general hospitals. Each PHC facility has four midwives to ensure 24-hour provision of skilled birth attendance at all times, as well as other maternal and child health services.

MSS Geographical Distribution

The number of facilities in each of the six geopolitical zones was selected on the basis of maternal mortality burden. Nigeria was divided into three zones (Figure 1) according to MMR: very high MMR (NE and NW), high MMR (north central [NC] and south south [SS]), and moderate MMR (SE and SW). NE and NW have six clusters per state, SS and NC have four clusters per state, and SW and SE have three clusters per state. The project currently serves an estimated aggregate of 15 million people in Nigeria.

thumbnailFigure 1. The states of Nigeria and their MMR categories.

Red (northeast and northwest), very high MMR; yellow (north central and south south), high MMR; green (southeast and southwest), moderately high MMR.


Selection of MSS Facilities

Participating PHC facilities and general hospitals were selected based on rigorous criteria. Selected PHC facilities are in hard-to-reach areas or among underserved populations with a population of 10,000 to 30,000 people. The PHC facilities have potable water supply and offer 24-hour basic health services with minimum equipment including blood pressure apparatus, weighing scale, and basic laboratory diagnostic facilities for malaria and anaemia. Selected general hospitals provide basic services including ANC, child delivery, postnatal care, and family planning; comprehensive emergency obstetrics care and prevention of mother-to-child transmission of HIV (PMTCT) services; administration of antibiotics and intravenous fluids; and treatment of pre-eclampsia. The general hospitals have at least 12 maternity bed spaces, a functioning operating room, blood bank, and stand-by alternative power supply.

Midwives Service Scheme: The Process


The midwives under the scheme are selected with adherence to the International Confederation of Midwives (ICM) global standards for midwifery education [10]. The minimum entry level of students for midwifery education is completion of secondary education, and the minimum duration of A-Level-entry midwifery education is 3 years and 18 months for post-nursing midwifery education. The maximum age limit for recruitment is 60 years. Following an initial nationwide recruitment exercise, 2,488 (instead of the expected 2,608) successful midwives were deployed to 652 designated PHCs in the 36 states and Federal Capital Territory (FCT) on the scheme—45% of them are unemployed midwives recruited to the scheme, 44% are basic midwives during their mandatory pre-registration community service year, and 11% of them are retired midwives.

Continuing Medical Education (CME)

To enhance the quality of their services, midwives are trained quarterly in life saving skills (LSS) and integrated management of childhood illness (IMCI). The competency-based training sessions are conducted at schools of midwifery in each state. The trainings run for 6 consecutive days and the class size varies from 24 to 32 people. The training programme involves interactive theoretical and illustrative lectures with skills demonstration and practical sessions. There are initial practical sessions on dummies, then on consenting patients in the wards towards the end of the course. Participants partake in a course review and tests to assess the effectiveness of the training.

There are no defined entry criteria for the CME, as recruitment into MSS is an ongoing process to cope with the challenge of attrition. Thus, all recruited midwives are eligible for participation in both training programmes.

Political, Financial, and Community Commitment

Given the high level of fragmentation in the governance of the Nigerian health system (see Box 2), a crucial initiative of the MSS programme was for state and local governments to sign a memorandum of understanding with the federal government agency responsible for PHC in Nigeria, the National Primary Health Care Development Agency (NPHCDA), which is also the implementing agency for MSS. The state governments are expected to match with N20,000, the N30,000 monthly remuneration paid to the midwives by the federal government through NPHCDA.

In addition to the monthly stipend, the federal government provided basic health insurance coverage for all the midwives, provided midwifery kits for each of the participating PHC facilities and each midwife, and supplied a personal health record booklet, basic maternal and child health equipment, drugs, registers, and monitoring tools. The federal government funds the CME and provides technical support to the states and local government areas (LGAs) on the implementation, supervision, monitoring, and evaluation of MSS.

The state governments support the use of general hospitals as referral facilities for the MSS by upgrading the hospitals to provide comprehensive emergency obstetric and newborn care, including basic equipment and supplies such as drugs and other consumables, ambulance services, steady electricity and potable water supply, stationery, and security for health workers and equipment. The state governments also monitor and supervise the programme within their jurisdiction and coordinate the provision by LGAs of free decent accommodation in the host communities and at least N10,000 supplementary allowances for the midwives.

For each PHC facility, a ward development committee (WDC) made up of influential people in the community is established to enhance community participation and ownership and to promote demand for services. The WDCs meet monthly to discuss health and other developmental issues in the community under the supportive supervision of the LGAs. During the monthly WDC meetings, the midwives address any concerns of the community and brief the community on their work within the month, including their challenges. The WDCs in turn provide support to the midwives by ensuring their security and accommodation. While they do not routinely provide direct financial support for women seeking care, the WDCs support the transportation of pregnant women and neonates in cases of emergency. In addition to their clinical duties, the midwives serve as change agents in the target communities by working with WDCs to mobilise the people for health action and promoting women and child health care and home visits. Training for these roles is part of the basic midwifery training, and the midwives are involved in the creation of the WDCs.

Midwives Service Scheme: The Outcome

Monitoring and Evaluation Platform

MSS implementation was preceded by establishing key baseline maternal, newborn, and child health (MNCH) indicators to define goals and provide a clear framework for future evaluation. There was a nationwide survey conducted at all the facilities (primary and secondary) and communities where the intervention was located. Table 1 shows the seven core indicators of progress in the MSS, nationwide data from the Nigeria Demographic and Health Survey (NDHS) 2008, baseline data from the MSS primary care facilities, and the gains that the scheme hopes to achieve by 2015. Even though facility-based data are expected to reflect better indices, the baseline survey shows that MSS target areas are worse off compared to the national average (data from Nigerian Demographic and Health Survey 2008) even though the national data is population based.

thumbnailTable 1. MSS core indicators and projected outcome, with data comparing 2008 NDHS with MSS facility baseline data.


Impact of the MSS

Figures 25 show MNCH indicators for the six zones comparing data from mid to the end of 2009 and mid to the end of 2010. The gains of MSS have not been even across geopolitical zones, although it shows an overall improvement in the MNCH indices.

thumbnailFigure 2. MSS facility-based maternal mortality ratios comparing July–December 2009 with July–December 2010.

NE, northeast; NW, northwest; NC, north central; SS, south south; SE, southeast; SW, southwest; MSS, Midwives Service Scheme.


thumbnailFigure 3. MSS facility-based neonatal mortality ratio comparing July–December 2009 with July–December 2010.

NE, northeast; NW, northwest; NC, north central; SS, south south; SE, southeast; SW, southwest; MSS, Midwives Service Scheme.


thumbnailFigure 4. MSS facility-based maternal health indicators comparing July–December 2009 with July–December 2010.

ANC, antenatal care; TT, tetanus toxoid; FP, family planning.


thumbnailFigure 5. MSS facility-based maternal health indicators percentage increase from July–December 2009 to July–December 2010.

ANC, antenatal care; TT, tetanus toxoid; FP, family planning.


The facility-based MMR in the same period in 2010 was 572 compared to 789 per 100,000 live births for the same period in 2009. However, facilities in the NE and SE did not show a decrease in MMR when compared to 2009. The facility-based neonatal mortality ratio (NMR) in the same period in 2010 was 9.3 per 1,000 compared to 10.97 per 1,000 live births for the same period in 2009. Facilities in the NE, NW, and SW did not show a decrease in NMR when compared to 2009. The maternal health indicators show a general overall improvement over baseline: family planning visits, pregnant women with new ANC visits and those with at least four ANC visits, facility-based deliveries, and the number of women receiving two or more doses of tetanus vaccine.

The lack of improvement in MMR and/or NMR in specific zones may be due to an increase in the proportion of high risk deliveries in the MSS PHC facilities. As shown in Figure 4, the majority of the women who attend facilities ANC still deliver at home. The additional deliveries in MSS facilities are likely to be among women with high risk pregnancy who present too late for life saving interventions in pregnancy or the neonatal period. We hope that the continued presence of skilled birth attendants in the communities will ensure positive behaviour change, especially in seeking early and routine interventions from the PHC facilities.

These data provide useful information on the progress of MSS 1 year from establishment. There have been overall improvements in the provision of MNCH services in rural areas that usually lack skilled birth attendants such as midwives. The data also provide a powerful tool for advocacy to support the scheme particularly in the NE zone where the gains have been limited.

Midwives Service Scheme: The Challenges Top

  • The project is currently funded from the debt relief granted to the Nigerian government by the Paris Club. The greatest threat to MSS is the uncertainty about continued funding beyond the 3-yearcommitment from the grant. However, the National Health Bill passed in 2011 promises to further provide secure funds for the administration of PHC in Nigeria [11]. The state governments are encouraged to be fully involved in MSS programmes, as the plan is for them to gradually take over the scheme in their respective states.
  • Implementation of the memorandum of understanding signed with state and local governments is a persisting problem. This mainly involves provision of accommodation for the MSS midwives and irregular or delayed salary payment by state and local governments. Regular monitoring of the PHC facilities and midwives by field agents from the NPHCDA serves to coerce the state and local governments into fulfilling their roles.
  • Availability of qualified midwives poses a challenge to the success of the scheme particularly in the areas of most need: the NE and NW. Ongoing recruitment and deployment of midwives to these areas are strategies employed to overcome this problem.
  • Retention of midwives in the scheme is one of the major challenges. Most of the newly graduated midwives (44% of MSS midwives) are young, single, or newly married; a particularly mobile cohort who tend to return to their home zones (usually southern zones) after the completion of their 1-year mandatory pre-registration participation in the MSS. However, another set of newly graduated midwives replace the ones who leave at the end of the 1-year mandatory pre-registration programme.
  • Inadequate social amenities, language barriers between the midwives and the local community, and working in hard-to-reach rural areas are some of the factors responsible for attrition. Strategies and incentives used to overcome this include attractive pay package and provision of ambulances, accommodations, and health insurance coverage for the midwives. Some hard-to-reach areas in the northern zones (NC, NE, and NW) were further provided with an additional 1,000 CHWs. Two CHWs were deployed to each facility and they provide support and complement the work of the midwives. They are also encouraged to spend time within the community to identify women and children who need care and refer appropriately. There is a long-term plan to identify and train locals to become midwives who will then work within their own communities. There are also ongoing discussions around providing supervised home delivery as part of the MSS in order to better reach women, especially in northern Nigeria, who present for ANC, but choose to deliver at home for sociocultural reasons.
  • Current training of the midwives focuses mainly on LSS and IMCI. However, there is a need to also train them on other various critical aspects of health care such as PMTCT, family planning, and information and communications technology (ICT) skills. There is also a need for capacity building of the PHC team beyond just midwives.


The MSS strategy of the Nigerian government recognises that strategically redistributing and improving the skill set of existing cadres of health workers is achievable on a large scale. The initiative potentially serves as a model for other developing countries within and outside sub-Saharan Africa who may need to redistribute their health workforce to reduce the inequities that exist among geographical zones and between urban and rural areas.

Author Contributions

Wrote the first draft of the manuscript: SA UO. Contributed to the writing of the manuscript: SA UO OO MJA MAP. ICMJE criteria for authorship read and met: SA UO OO MJA MAP. Agree with manuscript results and conclusions: SA UO OO MJA MAP.

References Top

  1. National Population Commission (NPC) (2009) ICF Macro. Nigeria demographic and health survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.
  2. Overseas Development Institute (2010) Millennium Development Goals (MDG) report card: measuring progress across countries. Available: Accessed 22 March 2012.
  3. Harrison KA (1997) Maternal mortality in Nigeria: the real issues. Afr J Reprod Health 1(1): 7–13.FIND THIS ARTICLE ONLINE
  4. WHO (2006) Working together for health: the World Health Report 2006. Available: Accessed 22 March 2012.
  5. Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, et al. (2006) Going to scale with professional skilled care. Lancet 368(9544): 1377–1386. FIND THIS ARTICLE ONLINE
  6. WHO/UNAIDS/PEPFAR (2008) Task shifting: global recommendations and guidelines. Geneva: WHO. Available: Accessed 22 March 2012.
  7. Samb B, Celletti F, Holloway J, Van Damme W, De Cock KM, et al. (2007) Rapid expansion of the health workforce in response to the HIV epidemic. N Engl J Med 357(24): 2510–2514. FIND THIS ARTICLE ONLINE
  8. Campbell OM, Graham WJ (2006) Strategies for reducing maternal mortality: getting on with what works. Lancet 368(9543): 1284–1299. FIND THIS ARTICLE ONLINE
  9. Betran AP, Wojdyla D, Posner SF, Gulmezoglu AM (2005) National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity. BMC Public Health 5: 131. FIND THIS ARTICLE ONLINE
  10. International Confederation of Midwives (ICM) (2010) Global standards for midwifery education. Available: Accessed 22 March 2012.
  11. Federal Government of Nigeria (2011) National health bill 2011. Available: Accessed 22 March 2012.

Corporate Abuse Abroad, a Path to Justice Here

By LINCOLN CAPLAN, Published: March 3, 2012 , NYTIMES

Should foreigners be allowed to use American courts to sue foreign corporations for human rights atrocities committed abroad?

 Charles Wiwa in Chicago last month. He is one of the Nigerians trying to sue three companies in American courts, charging them with human rights violations in Nigeria.

The Supreme Court heard arguments last week on this question in a case brought by Nigerian citizens against the Royal Dutch Petroleum Company and other firms, charging gross violations of human rights in Nigeria. Four conservative justices expressed skepticism about the federal courts having the reach to deal with such disputes.

But an arcane 1789 law, called the Alien Tort Statute, permits just such lawsuits to be heard in federal courts if brought against individual defendants. The same should hold true for corporations accused of such offenses abroad, provided they have contact with this country, say, by selling products here.

In a world where multinational corporations are primary actors, the need for a way to hold them accountable for extreme abuses is more urgent than ever. When corporations do business in America, they have to operate under American law. Providing a forum for victims seeking justice against corporate bad actors is appropriate to America’s history and role in the international community.

The aim of the statute — which allows suits for “any civil action by an alien for a tort only, committed in violation of the law of nations or a treaty of the United States” — was to help enhance this role. The law was passed as part of the new nation’s efforts to show the world respect for the law of nations by opening its courts to foreign claimants. The statute lay dormant for 170 years, but the principle is just as important today.

It was not until 1980 that the law was unearthed and employed in a watershed case that led to a $10.4 million judgment against a former official of Paraguay (who was visiting the United States) for the torture and murder of a young man in Paraguay. Since then, federal courts have heard over a hundred cases brought by foreign nationals against foreign individuals, and since 1997, against corporations as well.

Human rights lawyers realized that suing only individuals was often inadequate because multinational firms were among those violating international law. Offenses growing out of companies’ operations (for example, the brutal use of forced labor) contributed to their profits, so it made sense to seek damages from them for ill-gotten gains.

It was not until 2004 that the Supreme Court took up a case applying this law. In a 6-to-3 ruling, it confirmed that the law allows foreigners to sue for violations of a limited category of universally accepted rights. It also held that those rights and violations should reflect the law when a case is brought.

In 1789, the violations concerned piracy, mistreatment of ambassadors and violations of safe passage. Today, federal courts have found that such violations include torture, genocide, slavery and other crimes against humanity.

The statute does not explicitly say who can be sued. But even in 1789, corporations could be sued for damages for their actions and those of their employees. Under American law, corporations are granted rights like the ability to shield their investors from liability, and in exchange, they are legally accountable for wrongdoing.

Four federal appeals courts have ruled since 2005 that corporations can be held liable under the Alien Tort Statute. Only the Second Circuit Court of Appeals, in Kiobel v. Royal Dutch Petroleum, the case now before the Supreme Court, has rejected that concept on grounds that international tribunals have not held corporations liable for human rights violations.

The Nigerian plaintiffs are seeking monetary damages for a brutal campaign in the mid-1990s by three oil companies and the military dictatorship in Nigeria to silence protesters against environmental damage caused by oil operations. Scores were allegedly killed. Many others, including the plaintiffs, said they were captured and beaten. The conduct alleged includes torture, crimes against humanity and executions.

Royal Dutch Petroleum argues that the Supreme Court must look to the law of nations on the question of corporate liability and that no such provision exists in international law. It also contends that finding liability could create international tension.

That stance is wrong on law and policy. International law defines the violations, but enforcement is up to each nation’s domestic law, and under American law, corporations have been subject to suits for centuries. Worries about international repercussions are also overblown. As the Supreme Court decided in 2004, the statute applies only to the most abhorrent conduct, and federal courts have carefully rejected suits for infringing on American foreign policy-making as well as for evidentiary reasons.

There is no good justification for a categorical rule against corporate liability. As the economist Joseph Stiglitz said in an amicus brief, these lawsuits can be an efficient way to enforce human rights in countries where court systems and other means of policing violations are ineffective. Potential civil liability gives corporations an incentive to improve their conduct. If a multinational company commits an offense like torture, the fact that it is a corporation and not an individual is immaterial in the pursuit of justic


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