By KAYODE AKINMADE
For the second time, Abiye, Ondo State interventionist programme on safe motherhood, is taking Governor Olusegun Mimiko to the world stage. This time, the outing is at the Centre for Strategic and International Studies (CSIS), Africa Programme in Washington DC, United States.
The first time Mimiko mounted the world stage, it was at the invitation of the World Bank, which had so much to cheer about Abiye to the point of recommending it as a model to redress Africa’s frightening child and maternal mortality rate. At that time, World Bank Vice President for Africa Oby Ezekwisili, praised the programme as “a role model and a benchmark for the African continent in tackling infant and maternal mortality rate.”
The latest Mimiko outing is significant, to the extent that CSIS, just like the World Bank, is one of the world’s pre-eminent international policy institutions focused on transactional challenges on development and economic integration. Global health challenges, no doubt a development matter, fall within the purview of CSIS. Indeed CSIS officials were in Nigeria in August 2012 to have first-hand information on how close the country is to achieving the Millennium Development Goal (MDG) on child and maternal mortality, ahead of the 2015 target date.
The visit was apparently predicated on the fact that, in achieving the MDG target of reducing global maternal mortality by 75 per cent, progress in Nigeria could prove pivotal. In 2010, an estimated 40, 000 Nigerian women died in childbirth. The country accounts for an estimated 14 per cent of maternal deaths worldwide. Nigeria remains one of the 10 most dangerous countries in the world to give birth. It is estimated that 630 of every 100,000 live births result in a maternal death.
The statistics presented a bleak outlook. The visiting CSIS officials conducted a series of interviews with government officials, implementing agencies and health professionals to better understand the country’s national strategy on maternal health and the obstacles that are slowing progress. Amid the Nigerian grim outlook on maternal deaths, the CSIS team found something promising in Ondo State. They found Abiye, a safe motherhood initiative, which has won early praise from maternal and public health experts in Nigeria and beyond. The team notes in their report:”
The programme is seen by many as a promising home-grown effort to build a comprehensive, sustainable, and evidence-driven approach that ensures that women have reliable access to quality maternal health services.” They add: “The Ondo approach is not dramatically new; rather it is an example of how broad principles of maternal health on which there has been widespread agreement for several decades can be tailored to localised circumstances and implemented in a concerted, organised way.”
The CSIS team believes the Abiye programme is work in progress, saying the Ondo State leadership is cognizant of the challenges associated with scale – up and sustainability over time. “But the programme does provide a positive preliminary model of how data collection, technology and innovation, efficient use of resources, and mechanisms of accountability, backed by sustained political will, can come together in a comprehensive strategy that, in its first two years, is yielding significant results,” they point out.
The CSIS invitation to Mimiko to share his experience on the giant strides Abiye is making on a continent that presents the worst child and material mortality scenario is a follow-up to the world body’s officials August 2012 visit to Nigeria. In its letter of invitation to the Ondo governor, the CSIS observes: “Nigeria today remains one of the 10 most dangerous countries in the world for a woman to give birth, accounting for an estimated 14 per cent of maternal deaths worldwide each year. But despite these bleak national statistics, there are signs of growing opportunity.
In recent years, the Federal Government has devoted greater policy attention and resources to maternal health than previously and a handful of state governments are beginning to tackle the challenge in a strategic and comprehensive way.” The CSIS then singles out Ondo State for standing out of the pack in tackling child and maternal mortality. It says:” In Ondo State, the Abiye (Safe Motherhood) programme is winning praise as one such promising model, creating incentives for expectant mothers to seek care and for health providers to deliver quality service.” Mimiko, according to the letter, will describe the programme’s achievements to date and challenges ahead, while Dinesh Nair, World Bank senior health specialist for Nigeria, will describe the bank’s ‘results-based financing’ pilot programme. Murtala Mai, former country director for Nigeria, for Pathfinder International, the letter says, will speak on the broader maternal health trends in Nigeria.
The Abiye programme has come a long way since 2009 when the initiative was conceived by Governor Mimiko. Alarmed by the 2008 Demographic and Health Survey (DHS) findings, which showed Ondo State as the worst performer on maternal health in the South-West region, the governor made bringing down the state’s maternal mortality rate a priority. The programme was launched in 2010 as a comprehensive strategy to address four critical delays that contribute to maternal morbidity: the delay in deciding to seek care (because of lack of education about care, mistrust of the health system, family constraints); the delay in reaching care (because of distance, infrastructure, communication); the delay in receiving appropriate care on arrival (because of inadequate manpower, supplies, drugs, health infrastructure), and the delay in referral when complications beyond local facility capacities arise.
An initial pilot scheme was launched in Ifedore Local Government Area and expansion to Ondo State’s additional 17 LGAs is underway. A flagship Mother and Child Hospital in Akure was completed in 2010, a second in Ondo town in 2012, and a third under construction in Owo. The programme operates at no cost absolutely to beneficiaries. To address the delay in seeking care, the model relies heavily on mobile telephony and a subset of community health extension workers, dubbed Health Rangers.
When a woman first registers for antenatal care, in addition to receiving a routine examination and blood tests, she is assigned to a Health Ranger for the duration of the pregnancy and receives a starter pack that includes an anti-malarial bed net and a pre-paid mobile phone linking her to her Health Ranger, the local health facility, emergency transport and state health authorities. The Health Rangers are trained to identify signs of high-risk pregnancy, map out a birth plan and a “complications preparedness” plan and offer basic information on nutrition, family planning, child immunisations and the use of insecticide treated mosquito nets to prevent malaria in the mother and eventually the new born.
The results in 30 months since Abiye’s inception have, according to experts, been impressive. Records show that prior to the pilot programme, Ifedore health facilities managed 100 deliveries annually. Officials say in Abiye’s first year, more than 2,000 women delivered in health facilities and, in the second year more than 6,000. The officials add that before the safe motherhood pragramme, 13 per cent of women who registered for antenatal in Ifedore eventually delivered in a health facility, in the programme’s second year, the proportion was over 60 per cent.
The Akure Mother and Child Hospital, in its first 30 months, registered 50,000 women, managed 12, 500 deliveries and performed 2,000 caesarian sections. Mimiko’s invitation to the world stage, the second time, on account of the achievements of Abiye, is a recognition of excellence, and an acknowledgement that Nigeria and, indeed Africa, could achieve the 2015 target date on the MDG on maternal mortality if the various governments heed the World Bank’s admonition to adopt the Abiye model to address the mother and child challenge. • Akinmade is the Commissioner for Information and Strategy in Ondo State