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Wednesday, June 30, 2010

Primary health care delivery in Bayelsa: A monitors perspective

Nigeria holds the record of having the second infant/maternal mortality rates in the world. About one million Nigerian kids die each year from ailments that could be prevented by the adoption of basic hygiene practices and the administration of inexpensive medicine. Others include proper dietary habits, iodization of salt and the use of insecticide treated nets.
Grim as the introductory scenario may appear, current statistics on the matter also does not give hope for respite as it indicates that the death rate has climbed even higher. Attempts by the governments in Nigeria , International health organization and other well-meaning bodies to halt the onslaught could be liken to a drop of water in the ocean.
Many have pondered, what is the reason for this scenario? Why has the huge resources sunk into the health sector coupled with support from major health organizations in the world failed to failed to bring about a turn around of the situation? And what then is the responsibility of the individual in respect to this dire reality.
Perplexing as these questions may seem, the answers stare at us in the face. African countries with smaller resources have able to reduce infant/maternal mortality to the barest minimum. As it was done those countries all hands must be on deck in Nigeria , including the very rural vulnerables.
Once again, May 27th celebrated as the international day of the child provides a platform for deliberation by all stakeholders on issues which concern children in Nigeria as well as to provide answers to the quandary of maternal and infant fatalities. In the same vein, the week-long Integrated Maternal, Newborn and Child Health (IMNCH) intervention by the federal government and UNICEF coinciding with Children's Day celebration is again another opportunity to reinvigorate health care delivery in rural environs.
In Bayelsa state, the exercise offers a team of journalists who monitored it, an insight as to what may be major challenges that face a country that may very well not meet the Millennium Development Goals (MDG).
Nigeria has one of the finest care delivery system. On paper, brilliant health policies coupled with the best medical minds that should be the envy of Africa but this has not been translated into quality health care for her populace. A critical appraisal of this paradox would simply reveal that the problem had been brought about by a systemic collapse of the health sector. For instance in Bayelsa, media monitors of the IMNCH were greeted by the sight of derelict buildings that were used primary health care facilities. At a small community in Sagbama Local Government Area in Bayelsa, a local health worker who could hardly stomach his angst wonders why government would nothing to improve on the physical structure of the health facility that was built in 1922. This situation, he complains, inconvenience his duties alongside others working with him as they are been pressured to work in an environment limited in space, lacking in security and support staff.
“I have used my money to paint and renovate this place, the place is bushy I often use funds from my pocket to engage labourers”, he angrily told monitors at his one-room health facility.
The light of the primary care-giver's dilemma, it appears that there is little that can be done at the moment as he reveals that he has complained to his head of the department who may likely passes his complaint to another up the bureaucratic ladder. As one health worker told the team, “It is what we have that we will give”.
This also drags in the issue of non-availability of drugs at primary health care centres. Despite claims by government that health is top on its priority, a visit to rural health centres would negate the assertion. The issue of 'No Drugs' has been the cause of distrust between local care-givers and rural dwellers who upon gaining information of free treatment at their local clinics are often disappointed by its non-availability.
Governments must stop paying lip-service to the health sector even as it must stop using health programmes as a platform for gaining public support during elections. It should rather brainstorm on schemes that would bring about prompt payment for health workers, an issue that has been a major source of grumbling in the sector. For instance in some of the centres visited during the IMNCH week a good percentage of the workforce were either deliberately absent because of unpaid salaries or had excuse themselves from their duty post in order to collect a one month wage after three months.
Apart from addressing this issue, government should see it as its primary duty to provide incentives for health personnel in the course of carrying out their assignments. Also ancillary, government must deliberately embark on policies that would invigorate the economy of rural dwellers as malnutrition and vulnerability to diseases can not be divorced from poverty. The above also brings to fore the recent budget by the Bayelsa state government where the state's ministry of finance was given a far higher allocation than the ministry of health, commerce and industry.
Importantly, government must also address the issue of non- availability of drugs in primary and tertiary health institutions if it wants to be taken seriously. Companies and other corporate interests must not see the health sector as the responsibility of government alone but rather should collaborate with it, in sincerity and deep commitment. Prosperous members of the society should extend their charity beyond family and churches to assisting in health care delivery.
While it has been essential to pinpoint gaps in the system, it is also noteworthy to commend the First lady of Bayelsa state Mrs. Alayingi Sylva for her tremendous job in providing succor to Bayelsa kids through her many health care programmes. Her partnership with a visiting UNICEF team recently in Yenagoa should be pursued with vigor to produce positive results.
It would be out of courtesy not to mention the wife of Sagbama LGA Chairman, Mrs. Peremobowei Peretus and other primary health care-givers both in Sagbama and Akenfa-Epie, Yenagoa whose support, enthusiasm and dedication led to the success of the IMNCH in their direct constituencies.

By Theo Agidee
http://www.thephctelegraph.com/stories/June,%202010/0906feat_01.html

Wednesday, June 23, 2010

Reducing maternal death with simple methods


AMIHIN is a Nigeria based international development agency set up in 2000 to address the unacceptably high levels of maternal and newborn mortality and morbidity in poor communities in West Africa.
We work to disseminate information on best healthcare practices to improve maternal and newborn health in poor communities; to provide financial and physical support to mothers and newborn in poor communities. Our particular focus is on pregnancy and the first 1 year of life.
Our vision is an equitable world where all women and their newborns enjoy optimal wellbeing; where child bearing ceases to hold monumental risks of death and where newborns and infants have a better chance of survival.
Our strategic aims and objective includes:
• Increasing awareness of the poor state of maternal and child health in West Africa, particularly Nigeria and to influence governmental policy affecting maternal and child health in Nigeria.
• Raise funds towards providing health solutions in the area of maternal and child health and assisting our partners in providing affordable, accessible and quality health care services to women and newborns.
• Providing information in the form of a blog and magazine on child care and mother care especially during pregnancy and nursing
• To act as a liaison between sponsors and their target audience and to partner with bodies and organisations involved in the provision of maternal and child health services in West Africa.
• Provide assistance in rural areas towards improving maternal and child healthcare – assistance as detailed below.
Hundreds of thousands of women die each year due to complications related to pregnancy and childbirth. Some of the most important first steps to making a difference include:
• Social networking sites and blogs: Awareness on blogs and popular sites like facebook and tweeter can help in raising awareness to these cause and rally people around it more.

• Campaigns and rallies: Regular campaigns and rallies should be held in rural areas in raising awareness and support for the prevention of infant and child mortality; which is the most pertinent issue at stake in Africa and Nigeria. But it has to go beyond internet, radio and television. It has to go to the rural areas where most of these women do not access to these facilities and are not even literate (an issue we mostly overlook).
• Provision of free nutritional and healthcare information to mothers; on some basic hygienic practices that can mean life and death. Knowledge is power and these mostly elude them. An interpretator who speaks their dialect can be arranged to interpret the words that elude them. Some times it is better the interpreter is used that is from there locality, it allows them to be more free and they are able to open up better and ask questions that will really benefit them. This has been discovered to make them more relaxed and able to ask questions.

• Subsidized healthcare services: The health system in some countries, especially African countries are not good enough. For example, the health system in Nigeria is dysfunctional for many reasons. In the federal system there are three levels of government, and each level is responsible for a particular level of healthcare. But there is no law stating what each level of government should do. There is a policy, but no law. Government officials simply tell you they're doing the best they can. Local government receives the least funding from the national budget, so there's also the question of whether it has the money to make a difference. In terms of health there are no fundamental rights; there is a chapter in the constitution that demands there be adequate medical and health facilities for all, but this is a social objective and does not impose a legal obligation. There is also an absence of transparency about what money there is. You hear officials from government agencies and legislative bodies saying that they have put funds into the health sector, but nothing gets done and no one seems to ask questions. If and when resources are allocated, they are not necessarily accounted for. Women do go to the clinics and health centres; they are unable to meet the high demands of these hospitals. (Let us not forget that most of them live on less than a dollar a day). A most disturbing issue is the compulsory blood donation in some hospitals. If a woman comes as a patient she is asked to bring her partner to donate blood. So a lot is wrong with the health sector in my country. So when we talk about subsidising healthcare facilities, the effect can only be seen when they are done to particular hospitals and clinics where the effects are seen. It is more than just donating money to this cause. We must ensure we see our efforts pay off to the end user it is intended for. That is only when we can make significant impacts to seeing a reduction in the death of mothers and children.

• Provision of innovative cost effective solutions such as the emergency motorbike service. These is a project being worked on and which I believe can go a long way in ensuring pregnant mothers are able to receive medical attention as soon as possible by transporting them in safety to the nearest maternity centre or hospital. . Most pregnant women in rural areas are located in farm lands that are inaccessible by road. Imagine a scenario where a pregnant mother-to-be develops complications in the middle of the night in such a location that is inaccessible to vehicles. The only means of transportation that can get her to the nearest hospital or maternity center in relative comfort and safety is the emergency motor bike that has been modified and designed for such a task.

• Provision of clothing, food and medical care for underprivileged mothers & children in rural areas of Nigeria. Most women and mothers live under a dollar a day and most of them; pregnant mother-to-be, nursing mothers and their children are under nourished and are inadequately clothed. They are not privileged to medical care. Most of them don’t go to the hospital except to give birth or when they are terribly sick and even when they do go, it is usually too late. This is because they can ill afford the exorbitant amount of treating one’s self in the hospital. An average Nigerian can barely afford to go for check ups. Not to talk of those in the rural areas.

• The safe-delivery kit is a simple approach to reducing maternal death in women. It helps women and newborns avoid life-threatening infections. These can also be distributed to all pregnant women in the rurqal areas.
A safe delivery kit would contain:
1. a small bar of soap for washing hands,
2. a plastic sheet to serve as the delivery surface,
3. clean string for tying the umbilical cord,
4. a new razor blade for cutting the cord and
5. Pictorial instructions that illustrate the sequence of delivery events and hand-washing.
The kit can be customized to fit various cultures and norms across Africa.
Training of local mid-wives and traditional birth attendants: Most women in the rural areas have been found to trust these local and traditional attendants more than the hospital. This is because they are cheaper and more caring. Most of these women do not like the way they are atte3nded to at the hospitals and need these women who will be there with them through out the period of their child birth. Tey are women who have been delivering there children and are known and reputed to give safe births (and they actually do). It has been discovered to be safer, cost effective and much better to actually re-train these women in childbirth and their training ensures they are in touch with the hospitals and so ensure these women have safe deliveries in the hospitals. These traditional birth attendants are thus trained in the act of attending to pregnant women because they are the ones that will be available when it is most needed and when these women develop complications, they are the nearest people they will call on.

Email: amihn2000@gmail.com

Tuesday, June 22, 2010


the big picture


Monday, June 21, 2010

Saving Nigeria’s Many Orphans


President Goodluck Jonathan recently disclosed that 7.3 million out of the 17.5 million children in Nigeria were orphans. The President also lamented the increasing number of children orphaned by HIV/AIDS. He tasked all tiers of government to provide adequate health care services for Nigerian orphans, and also urged parents to adopt adequate nutrition and good breast-feeding practices for their babies.



Over seven million orphans in a country of 140 million people is a large number. The President must be commended for acknowledging the existence of this great challenge in Nigeria. But as far back as 2004 the United Nations Children Fund (UNICEF) reported that there were 43 million orphans in Sub-Sahara Africa and that 7 million of those orphans were Nigerians. Reports from other sources, which agree with this, however, lament the pitiable plight of the Nigerian orphans.
The worrisome situation is shown by the increasing number of children orphanages, number of children roaming about in the streets, children exposed to child labour, and child trafficking in the last few years in Nigeria.



The clear message in President Jonathan’s message is that in formulating policies at the various levels of governance, the pitiable situation of orphans must be great concern. In these hard socio-economic times when most parents find it extremely difficult to meet their obligations to their children, orphans must indeed be living in difficult conditions. But inspite of being the most vulnerable in the society whose pitiable and helpless conditions are easily exploited by some mindless people, orphaned children, like other children, are the hope of tomorrow. Some of the world’s great people were indeed orphans. 



Therefore we have an obligation to ensure that the future of orphans is secured by tackling those factors inhibiting their proper upbringing and social welfare. Government, individuals, non-governmental and voluntary organizations should fund the children orphanages in the country. Adoption laws and policies should be made less stringent to encourage public-spirited individuals to adopt orphans.



Besides, since many Nigerian children had been orphaned by AIDS, government must strengthen its fight against the scourge. Additionally, there must be deliberate efforts to cater for children orphaned by AIDS.
The scourge apart, maternal mortality in Nigeria is still scandalously very high. The major cause of high maternal mortality in Nigeria is the deplorable primary health care relating to child-birth. Therefore by simply improving the health care system in Nigeria, government would indirectly be preserving the lives of many mothers as well as reducing the number of orphans in Nigeria.



Certainly, the protection of the world’s most vulnerable like the Nigerian orphans would require more than words on paper: it requires political will to put words into practice. It is distressing that many policies articulated on paper by successive Nigerian governments are never implemented. For example, at the National Conference on orphans and vulnerable children held in 2004 government agreed to develop a national action plan focusing on policy development, economic capacity of caregivers, education and capacity building for the Nigerian orphans. But unfortunately till date, that national action plan is yet to be implemented.



We therefore urge President Goodluck Jonathan to walk the talk to tackle the problems afflicting the Nigerian orphans and vulnerable children. At a time when the world is experiencing greater humanitarian welfare services, Nigeria must be seen to be providing succour for her numerous orphans.
The popular perception of our common humanity essentially calls for caring of the helpless and uprooted in the society. Our first responsibility to our children-whether they are sick, disabled, or orphaned children-is to ensure that they have a bright future by removing all the obstacles against their development and welfare.

http://askedward.co.uk/news/?p=8222&cpage=1#comment-569

Friday, June 4, 2010

Many Maternal, Infant Deaths Preventable Using Low-Tech Methods

Nigeria ranks amongst the country with the highest mortality rate in the world. It is no surprise we are the second largest in the whole world. That’s like a plane load of women crashing daily.
The unfortunate thing is that maternal death has touched every Nigerian in one way or the other. It could be as close as one’s wife, mother, aunty or cousin. It could be your employee’s relation, members in the same community, or place of worship. It could be said that chances are if you’re a Nigerian, you’re four people away from someone that died of child birth at one time or the other.

In 2000, at the Millennium Summit held in New York, World Leaders pledged to child mortality and improve maternal health among other goals (Millennium Development Goals) to ensure human development by the year 2015.Since the millennium declaration, Nigeria and many other countries are not on track to attaining the targets for reducing child mortality and improving maternal health.

There are effective interventions to significantly reduce child mortality and improve maternal mortality. The problem is that they are not delivered to the populations in need at high enough coverage (e.g., 80% immunization coverage.

. Efforts have largely fragmented and have not taken into good account the interdependency of the different stages of life. For instance, what we fail to give to a mother today in terms of healthcare, could affect the baby yet to be born and may have intergenerational effect that accrue to affect the child in school and his/her ability to attain the fulle4st potentials for development.

The situation calls for a new approach to doing business in health to improve the health of mothers, newborns and older children. Thus, the development of Advocacy for Maternal and Infant Health in Nigeria – AMIHIN; whose primary aim is in bringing awareness and support to reduce Maternal and Infant deaths by promoting the best interests of children and their mothers and seeking to influence government policy through advocacy.

A lot of issues are militating against the rapid reduction of maternal death in Nigeria. But we can start with the most simple and basic rules like:

1. Awareness: with awareness comes knowledge to the pregnant woman; what they know can be what may save their life. Where the people are aware of the need/urgency in ensuring a pregnant mother gets to the hospital early for proper medical attention.

2. Advocacy and intervention: Which is what we, and all others are doing but the government and stakeholders still need to take the end of the stick by intervening through availability of the basic infrastructures, man power and funds (with proper disbursement) to the basic and most important joints that is necessary for the smooth running of the program. Then we can move on to the others.

3. Training/re-training more midwives: more people should be encouraged to train as midwives in different communities; these people are ones that are usually on hand to determine the survival of the mother and child.

Most communities have their midwives/birth attendant who has been helping women during delivery and the people are comfortable with them. It has been discovered it is much better to re-train these midwives in the proper, safer and more proven methods of birth delivery; and what to do at the first signs of complications setting in.

Training and re-training midwifes in communities is a cheaper, safer and more cost effective way of ensuring pregnant mothers get adequate care and attention when most needed.
Under the new plan, the Bank will help with high maternal death and fertility rate to improve their reproductive health systems by ensuring that women have access to modern contraceptives and the ability to plan their families.

The organization will also focus on identifying gaps in the availability of health workers skilled in midwifery as well as doctors with obstetric skills.
This is because the absence of a skilled attendant at birth has been one of the top contributors of maternal deaths.

The University of North Carolina, School of Medicine conducted a study that shows that by training local birth attendants in a method promoted by the World Health Organization, the number of still births was reduced by about 30 percent.

Every woman should have access to care in a health facility where there is (are) personnel that are skilled and can provide the care she needs and the baby needs.
The interventions can be as simple as keeping the newborn warm. Or by making sure pregnant women have enough nourishing food to eat.

That will reduce the number of underweight babies that are born.
The important part is that these treatments and interventions need to be provided as a continuum. Starting from before the woman becomes pregnant, during the delivery, during the birth and continuing until the child is five years and older. (To be Contd....)