One of the challenges being faced by the health sector in Nigeria is the high rate of maternal and infant mortality. IJEOMA POPOOLA writes that, the roles of midwives are critical to the solution on the issue.
The significant reduction of child mortality and the boosting of maternal health by as much as 75 per cent, are some key objectives of the Millennium Developments Goals, MDGs, conceived by the UN in 2000.
Nigeria, like many other nations of the world embraced the MDGs with zeal, since it sought to address some fundamental problems in the nation’s life. However, the degree of success so far attained in the implementation of the programme, remains a matter for debate, especially as it approaches a wind down in 2015.
Nonetheless, analysts believe that efforts need to be maximised locally, so as to reap bountifully from aspects of the initiative, which is central to the health of the citizen.
At various fora, the United Nations Fund for Population Activities, UNFPA, had prompted health authorities in Nigeria to prioritise the recruitment and retention of midwives, as a strategy to achieving the goal of improved child and maternal health.
Such promptings were predicated on the belief that shortage of midwives was a major challenge to efficient Maternal, Newborn and Child Healthcare, MNCH, delivery in Nigeria.
Only recently, when the International Day of Midwives was marked at the Sheraton Hotel, Lagos, UNFPA’s programme adviser (Reproductive Health and Rights Unit), Dr Salma Anas-Kolo, commended Nigeria’s Midwives Service Scheme, MSS, which was flagged off in October 2009 by the then First Lady, Mrs Turai Yar A’Adua.
He pleaded with the federal government to strive to improve MNCH’s delivery. The MSS is a collaborative programme involving all three tiers of government, which is aimed at ensuring effective maternal and child healthcare delivery.
Under the scheme, the government engages retired midwives and others on contract basis, to complement the services those still in the public service. The overall aim is to make available more midwives, in order to reduce maternal and child deaths associated with non-accessibility to skilled birth attendants.
Anas-Kolo assured that the UNFPA, along with 20 of its partners, will scale up their joint investment in midwives programme in the country this year.
Mr Tonte Ibraye, National Co-coordinator of the White Ribbon Alliance for Safe Motherhood, a non-governmental organisation, underscored the necessity for the nation to show good commitment to the health objectives of the MDGs.
According to Ibraye, the federal government should develop and implement national MNCH plans to strengthen health workforce and improve routine data collection on it.“These plans should set goals for education and training, legislation and regulation, recruitment and retention of midwives and other health workers,’’ he said.
He called for the removal of all forms of barriers to healthcare delivery for women and children, including hospital fees.
On her part, Mrs Margaret Akinsola, Deputy President, Nurses and Midwives Association of Nigeria, described maternal and child health in Nigeria as “tragic”, while urging that employment of midwives at the grassroots should be intensified.
Akinsola described the MSS as a major intervention in MNCH delivery but noted that there were still some gaps to be filled.
Many health analysts variously canvassed the view that a midwife, at least, should be accessible to 175 pregnant women and that such midwives should be well trained, equipped and adequately remunerated to ensure efficiency.
Sharing his perspective on maternal and child health, Dr Ada Erinne, a WHO official for Child and Adolescent Health, said that there was inequity in the distribution of midwives in many countries of the world, especially developing countries.
Erinne assured that WHO would continue to provide technical support for midwives’ capacity building in Nigeria, as part of its commitment to promoting sustainable healthcare.
Dr Olayinka Oladimeji, the south-west Zonal Coordinator, National Primary Healthcare Development Agency (NPHCDA), hailed the MSS, noting that it had ensured a significant reduction in maternal, child mortality and morbidity.
Oladimeji disclosed that an estimated 4,000 midwives had been recruited since 2009, to serve in 1,000 primary healthcare centres and 250 general hospitals nationwide under the MSS.
He expatiated that under the MSS, four primary health centres were attached to a general hospital, which served as a referral facility for maternal and child health cases.
Oladimeji bemoaned that the North-East and North-West geopolitical zones of country were worst hit by maternal and child mortality but that measures were being taken to redress the situation.
He, however, tasked state and local governments to ensure that they fulfilled the terms of the Memorandum of Understanding on MSS, which they had signed.
Oladimeji said that as part of efforts to expand the scheme’s scope, the federal government would train 10,000 community workers outside the MSS, to cope with emerging challenges.
He described as very worrisome, the finding from a nationwide survey of 652 health facilities, that skilled birth attendants were acutely lacking, resulting in deliveries being carried out by community health workers.
A journalist, Mr Umunna Isiulo, expressed worry at the survey report, insisting that the use of community health workers as birth attendants was unacceptable.
“Only midwives and doctors are legally qualified to attend to births. Let us not create more harm by involving non-midwives,’’ he urged.
Dr Garba Safiyanu, an official with the Partnership for Transforming Health System (Phase Two), also bemoaned the inadequacy of midwives in the country.
He described the situation in Jigawa as particularly pathetic as it had now assumed a “crisis” proportion. He asked the Federal Government to do something urgent about the situation.
He said that outside the MSS, only 21 trained midwives and 70 doctors were working in public hospitals in Jigawa State.
“When I was in the medical school about 20 years ago, the country was said to be having a bad maternal and child mortality indices. Why should we still be having the same record 20 years after,’’ he asked rhetorically.
Dr Femi Olugbile, the Permanent Secretary, Lagos State Ministry of Health, also expressed worries that in spite of interventions, the situation of maternal and child health in the country was not cherry.
He said that the most recent national assessment conducted by the National Demographic Health Survey put maternal mortality rate at 545 per 100,000 live births in the country. This, he said, was unacceptable; hence all stakeholders must poll resources to redress the trend through adequate preventive measures and care, as well as availability of trained and well equipped midwives.
Many analysts agree with such viewpoint, which could significantly raise the health circumstances of the people for the better. (NAN)
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