Ondo: Extending the frontier of safe motherhood through “Abiye Plus”

Written by Yinka Oladoyinbo, Akure
The pilot phase of the safe motherhood programme of the Ondo State government in Ifedore Local Government Area of the state known as “Abiye” recently marked two years and the government has subsequently expanded the programme to other 17 councils. Yinka Oladoyinbo, in this reports, looks at the projects and the challenges ahead.

TO the family of Mr and Mrs Johnson Adeleye in Ero town, Ifedore Local Government Area of Ondo State, one of the dreams of their life was to come together as husband and wife and give birth to children that will live after them. However, this dream has been difficult for them to achieve because four years after their marriage, the wife has not been able to have a safe delivery. During the first three years of their wedlock, Folake, the wife had two still births.

If the case of the Adeleyes is pathetic, that of Mr Rotimi Ekundayo may be more touching as he was married to his wife, Adekemi, and they had to wait for five years before the wife could conceive. After confirming the pregnancy and because of their financial status they decided to register the woman with a traditional birth attendant in one of the towns in the local government.

When it was time for the woman to be delivered after carrying the pregnancy for eight months, she went into labour and she was rushed to the traditional birth attendant home. After many hours of labour, she lost strength and she could no longer push for the baby to come out, but because she had lost a lot of blood, she died when the people decided to rush her to a nearby hospital.

However, since the woman could not be buried with the baby, it was later discovered that she was carrying a set of twins, one boy, one girl and this further exacerbated the agony of the husband as he lost the wife and the babies.

These were typical situations in the state which made it to be ranked by the World Bank as the state with the highest number of maternal and infant mortality in the southwest region of Nigeria.

With this picture in mind and faced with unfavourable statistics as far as death of pregnant women and children under the age of five was concerned in the state, government in December 2009 inaugurated a safe motherhood programme tagged “Abiye” with Ifedore Local Government Area as pilot for the project.

The programme was aimed at providing opportunities for pregnant women to have access to unrestricted and uninterrupted medical care from the first day they are confirmed pregnant up till the day of delivery. To facilitate smooth implementation of the programme, the state government after conducting the base line study entered into partnership with one of the leading mobile telecommunication service providers, Globacom and set up a Caller User Group (CUG), which was toll free for the pregnant women and health workers that take care of them.

Each of the pregnant women was provided with a phone that enables her communicate with health worker assigned to her and she was able to update her ranger with information about her condition, this affords the health workers the opportunity of ascertaining the condition of the pregnant women at every point in time. The use of the telephone also created personal rapport among the health workers and the pregnant women, thereby making health facilities utilisation to be at the best maximum.

Speaking on the concept of Abiye, the Commissioner for Health in the state, Dr. Dayo Adeyanju, said, “Abiye basically talks about addressing the issue of maternal mortality and under-five, it is so sad that Nigeria still accounts for more than 10 per cent of the global record of maternal mortality despite being only two per cent of the world population. The statistics is not different in Ondo State as attested to by the World Bank which states that Ondo State has poor health indices in terms of maternal and under-five mortality.

“To a responsible government, a caring heart government and governor, it chose to brainstorm and bring about a home grown strategy that will address the reasons why women die in pregnancy which are basically the four delays and they are delay in seeking health care, delay in reaching health care, delay in receiving healthcare, so we put together the concept of Abiye which has to do with addressing each of those delays with the component of Abiye

“But before then, we conducted the sensitisation, we piloted it in Ifedore Local Government Area where we felt it was easier for us because there were other projects going on there and we feel they could complement one another, and what we did was that we sensitised the entire people of Ifedore and conducted a baseline so that we know where we are starting from and we can know how far we have impacted after a period of time.

“The most exciting thing about the baseline is that only 16 per cent of those that will come and register and have their ante natal clinic will eventually come back to deliver in the hospital and this gave us a clue that 84 per cent will have gone elsewhere and it is an indication of why we have high maternal mortality because they go elsewhere where we cannot ascertain the skill of those who are taking such delivery, so what we then needed to do is to start addressing the delay in seeking health care, making sure that we bring them back to the hospital because we felt it is trough addressing that delay that we can address the utilisation of health facilities which is the third goal of Abiye, increasing hospital utilisation so that we can reduce maternal mortality because at the health facilities we can ascertain who will take the delivery.

“So after registering the pregnant women during the baseline, we assign them to health rangers and they establish rapport, put them on toll free Caller User Group (CUG) prepaid by government and they were in close contact with the health rangers and they can do what they called a birth plan for them, they can also call them when they are close to their delivery or when they have contraption, they can call them to come to the hospital and if there are those they identified to be at risk, then the ambulance will go and pick them they can do Caesarean section for them, the baby and the mother can be alive.”

Two years after, government has a success story to tell about Abiye as there had been a significant increase in hospital utilisation and a near zero maternal mortality rate. The commissioner said in the first two years of the pilot in Ifedore, over 5,000 pregnant women registered under Abiye with over 2, 000 babies successfully delivered under the programme.

The success of the pilot of the programme has however made government to attempt to replicate it across the state under the name “Abiye Plus” in order to ensure that pregnant women across the state can have a story to tell about the revolution going on in the health sector of the state.

Adeyanju stated that expansion of the programme would however come with certain modifications to reflect some of the lapses noted in the pilot scheme. The commissioner explained that adjustment would have to be made in terms of distribution of health facilities in each of the remaining 17 local government areas of the state.

The commissioner said, “That is the beauty of a pilot, a pilot will enable you to have some lessons learnt which will enable you improve on what you are going to do next. During the pilot in Ifedore, we had health facilities in all the wards and we had personnel challenges, 10 wards, 10 basic health centres, four comprehensive health centres and one general hospital. The midwives that we had on ground were not enough to go round. So now we will not do that.

“We have mapped out the facilities, ensured equity in their distribution, we now have to scale down to four basic health centres and two comprehensive health centres, which is where surgical operation can take place and each of these will be in one ward, then complement the remaining four wards with tricycle ambulances, so the tricycle ambulance can move them from the hinterland to the basic health centre or the comprehensive health center or the comprehensive health centre can send its four wheel ambulance to move them that will now address the delay in seeking or reaching health care and in receiving healthcare and in referral.”

He also stated that efforts were going on to solve the personnel problems faced by the pilot programme as the Nigerian Midwifery Council had approved that government retain all its products from the school of midwifery for them to partake in the Abiye programme. He said the state had 32 last year and this year again it would add another 32, so that there would be no shortage of manpower.

The investment of the state is in this aspect of the health sector is expected to bring about further improvement in the maternal and infant mortality rate and this may eventually lead to an increase in reproduction in the state. According to Adeyanju the expansion of Abiye to other local government areas of the state is expected to gulp about N2 billion, while annual child birth is put at 30, 000.

To the state government, these efforts are expected to stop the operations of unskilled birth attendants in the state as people are expected to take maximum advantage of the facilities being put in place by government.

Adeyanju said, “With the kind of facilities we are putting in place, with the kind of approach of Abiye, it behoves on the pregnant women to take an informed decision, we should first put our structure, our facilities on ground and see how we will mobilise the pregnant women to come there because at the ward level we have the community health committee that are helping us in mobilisation and monitoring the rangers to ensure that they do their work and ensuring that the local government play their own part, so they are helping us mobilise. We will go to the three senatorial districts to mobilise them because the baseline is commencing immediately”.

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