Written by Sade Oguntola
A beautiful piece, this is a must read!!....
IT was a room filled with women and their common denominator was that without appropriate and timely treatment, they were candidates for death because of reasons ranging from excessive bleeding after childbirth and high blood pressure to big babies.
The room, which had about three beds, contained women from different socioeconomic status and age ranges. The women, from Ondo and neighbouring states, were at the Mother and Child Hospital, Akure, Ondo State.
From the corridors running through the wards and treatment centres, were children and women. “This is a busy hospital where we take deliveries of between 27 and 30 babies every day,” stated Mrs Victoria Owolabi, a staff nurse at the hospital, which provides free integrated maternal and childcare service to as many women and children that care to knock on its door.
Ironically, the hospital, instituted by Ondo State government as part of its mandate to offer qualitative and critical interventions towards reducing deaths in mothers and children, is a little over two years.
Mrs Jumoke Ibitoye, a civil servant with her second baby, came from Ekiti State to deliver her baby at the hospital. “This is my second baby. I decided to come to this health facility because it is very good. I had a Caesarian operation on Tuesday because my baby weighed 4.1 kilogrammes, but now I have started to walk around and would be discharged by tomorrow.”
Jokingly, Mrs Ibitoye stated, “I am okay. I have started to walk around and currently waiting for my third meal of the day.”
Mrs Toyin Ojo, a 38-year-old woman with her fourth baby boy, seated and breastfeeding her baby in the ward, recounted her journey to the hospital. She stated that she was brought in by her husband from the state’s General Hospital. “I have paid nothing since I was rushed in by my husband. They treated me promptly, in fact I have really enjoyed favour from God,” Mrs Ojo stated in an emotion-laden voice.
What is more, Mrs Rebecca Aribisala stated that the rumour that nurses and doctors in Mother and Child Hospitals usually expected gratification could not stop her from seeking medical assistance at the hospital.
The hospital serves as a referral centre for pregnant women that community health workers, under the health ranges scheme, pick out to be at a higher risk of dying from complications in pregnancy.
Mrs Aribisala, who declared that a huge medical bill would have been incurred if she had had her baby at another government or a private hospital as she had developed pregnancy induced hypertension.
Like Mrs Ganiya Afolayan, a-20 year old new mother, who was referred from a maternity centre in Igbaraoke to the Mother and Child Hospital, Akure, over 40,000 patients, including 21,000 children, are living witnesses of what interventions like the Abiye safe motherhood programme, which commenced with the administration of Governor Olusegun Mimiko of Ondo State, could do to improve Nigeria’s health indices.
Abiye is the Yoruba translation of safe motherhood. But in the context of Ondo State, it is more. It was borne out of the determination to ensure that when abiye is said to mothers on the way to the labour room, they actually come back alive with their babies.
Governor Olusegun Mimiko (middle), his wife, Kemi, and Commissioner for Health, Dr Dayo Adeyanju, carrying some of the babies delivered at the Mother and Child Hospital.
Globally, more than 1,500 women lose their lives every day from pregnancy to childbirth-related complications.
The four major killers of these women are severe bleeding, infections, hypertensive disorders (such as preeclampsia) and obstructed labour.
Prior to the inception of Dr Olusegun Mimiko as the governor, Ondo State had the worst health indices in South-West of Nigeria with its material mortality rate far above the national average of 545 per 100,000 live births.
“This unacceptable figure of women and children that were dying unnecessarily and the promise of providing exceptional qualitative health care led to the home grown Abiye programme,” said Dr Dayo Adeyanju, Ondo State Health Commissioner.
This was piloted in Ifedire Local Government Area and with amazing results. Dr Adeyanju stated: “Out of the 3,817 pregnant women registered since the commencement of the project, 1,035 babies have been delivered safely. Also, there was an addition of 2,600 new registrations to the initial 1217 pregnant women previously registered and we had recorded only one death. The woman, who only came to deliver under the programme, succumbed to disseminated tuberculosis.”
According to the health commissioner, “we have recovered from a mortality rate that was far above the national figure of 545 per 100,000 live births and by extrapolation to 100 in 100,000 live births.”
Conversely, “Before the Abiye programme, out of 240 deliveries, 160 were delivered by traditional birth attendants. Now post-Abiye, we have had over 5,000 antenatal registrations and have delivered over 2000 of them and only 40 were carried out by traditional birth attendants.”
How did the programme succeed in restoring confidence to women and making them patronise government hospitals to access skilled deliveries? According to Dr Adeyanju, through the use of mobile phones and motorcycles, the health rangers, a group of community health extension workers who were assigned to the programme in each community establishes interact well with pregnant women.
“We track the women through the health rangers to ensure that they come back to the health facilities and by this ensure that their deliveries are done by skilled birth attendants. Childbirth is a critical moment in pregnancy.
What is the role of health rangers in ensuring safe delivery?
Dr Adeyanju stated, “there are 25 pregnant women assigned to an health ranger. Even if they check on a pregnant woman a day, the health ranger would be able to go round before the end of the month. Their work includes emphasizing on good nutrition in pregnancy; use of insecticide treated nets; immunization, focused antenatal care and family planning.”
The health rangers also help the women to develop a birth plan as well as do what is referred to as complication readiness plan. Women who are at increased risk of complications of pregnancy include those with short stature, small pelvis and big babies.
Basically, women in labour use their phones to call for assistance at the health centre where midwives could easily attend to them. When the case is beyond that of a midwife, such a pregnant woman is then referred to the comprehensive health centre, where they are attended to by the doctor.
What is more, ensuring that pregnant women receive appropriate backing by their relatives to seek skilled birth deliveries has been further made easier, especially with the 2011 legislation that stipulated a penalty for cases of deaths of women that were not reported to the government.
The legislation on confidential enquiry into maternal deaths while making it mandatory that all deaths in women should be reported, is not for any punitive purpose. Nonetheless the failure of patient’s relatives to report attracts a N100,000 fine or a jail term of six months.
“The implications of the legislation, is that when they know that there would be enquiry into the cause of the death, then they will not take a pregnant woman into the place of a traditional birth attendant and allow such a woman die,” stated Dr Adeyanju.
Conversely, the legislation again is now making traditional birth attendants to bring pregnant women that they know they cannot handle to the health facilities because they do not want any enquiry linking them to the death of any pregnant woman.
Meanwhile, as the Abiye programme is being scaled up to cater for at least 10,000 pregnant women in the other 17 local government areas in the state, Dr Adeyanju stated that now health rangers had been provided with mobile ambulance tricycles to further address the areas of delay to safe motherhood.
Already the registration of pregnant women has commenced as part of the scaling up of the Abiye programme.
According to the health commissioner, based on the last statistics, 30, 000 women would be pregnant at every point in time and that is why our target is to look at an average of 10,000.
Dr Adeyanju stated that the opportunity that the phone gives the women to healthcare providers, their co-pregnant women and even the policy makers, inclusive of the commissioners, wife of the governor as well as Ondo state governor had been a great incentive, bringing both the educated and uneducated to want to register and partake of the free health comprehensive care to reduce the hitherto high maternal and child death ratios in the state to possibly zero.
He added, “Even after delivery, the women, with the help of these prepaid user groups and with unlimited access to phones can still call for advice if their children fall sick. If it is a critical case, the health ranger will be there to pick up such a child in the tricycle ambulance. Many of the health rangers are women and driving the tricycle ambulance would further enhance their work.”
The 100 tricycle ambulances can easily move from the remote parts of the community to health facilities where a four wheel-ambulance can pick such a patient up for transfer to the appropriate hospital to access health care.
With the scaling up of the Abiye programme, he stated that Ondo State, by 2015, would attain all the Millennium Development Goals (MDGs) of reducing deaths in mothers and children below five years of age.
“We succeeded in reducing maternal mortality by 15 per cent in 2010 and by extrapolation would have attained 75 per cent reduction by 2015.”
In addition the Mother and Child Hospital, a referral centre, designed to handle emergencies, has been filling the vacuum of the absence of referral centre for “at risk” patients in the state.
The hospital, currently being replicated in Owo, and meant to treat referred pregnant women and children below five years free, irrespective of the severity of their health problem, social status and residency, has been witnessing an influx of patients.
The pioneer Chief Medical Director, Mother and Child Hospital, Oke-Aro Akure, Dr Lawal Olawale Oyeneyin, stated that the 100-bed hospital, which has being in operation for over two years was indeed addressing the gap in tertiary healthcare services.
“We serve as a model that apart from giving that quality care, we must be able to attract people back to the public health service. To a large extent, the public has been disenchanted with public health services. And you can see for yourself the crowd coming in here.
“In terms of our impact, we registered and treated almost 40,000 patients, including over 21,000 children and almost 19,000 women in a spate of two years. Also, we have safely delivered almost 10,000 babies, out of which almost 1,700 were by Caesarian operation, all 100 per cent free of charge.
“We discovered that at least 20 per cent of the clients that come in here, actually reside outside Ondo State, including Ekiti, Kogi, Osun and Edo states,” Dr Oyeneyin said. “They are attracted to this facility, not only because we offer 100 per cent free services, regardless of where they come from, but because they are sure of quality care.”
Dr Oyeneyin, who remarked that the mother and child hospital was able to cater for more mothers and children because it instituted clinical guidelines and protocols for treating common life threatening ailments, invested in its personnel, adopted task shifting and task sharing concepts as well as a unique drug procurement system that prevented out-of stock drug syndrome.
He stated, “Our unique drug procurement system has practically eradicated the out-of-stock drug syndrome of essential drugs that are pertinent to saving lives in particular of mothers and children. In fact, this had attracted lots of encomiums in this facility.”
Dr Oyeneyin, who remarked the accumulative effects of the scaled up Abiye programme and the completion of another Mother and Child Hospital at Owo town would be tremendous, stated that indeed, all that was being experienced and done to ensure pregnancy was no more a death sentence but “is a service to humanity.”
Obviously, Abiye and its constituent-the Mother and Child Hospital have distinctly proved to be a dire need of our society if we must drastically reduce death rates in mothers and children as well as save the nation from the resultant anguish and losses.
The overall effect of all these will culminate in longevity and a quantum leap in the socio-economic life of the people bearing in mind that women remain the driving force of any economy.
http://tribune.com.ng/index.php/features/37639-towards-reducing-maternal-deaths-in-ondo-state
