Fighting maternal mortality, health sector challenges through LEAPS

Nigeria is reportedly one of the worst places to give birth. Nigeria’s Maternal Mortality Rate, otherwise called MMR, according to statistics from the World Bank remains as high as 821 per 100,000 live births.In 2015 alone, while 303,000 women reportedly died globally due to complications of pregnancy and child births, over 58,000 of them are Nigerians, making the country one of the highest contributor to maternal mortality in Central and Western Africa and accounts for 14 per cent of the global maternal mortality rate.

The high level of maternal mortality rate is only one of the many indicators of an unhealthy health sector in the country.  Just recently, the World Health Organisation ranked Nigeria 187th out of 191 countries in healthcare delivery. In 2015, infant mortality rate for Nigeria was 69.49 deaths per thousand live births. With growing gap in the capacity of health practitioners, policy, infrastructure and investment, there are unending cases of life threatening diseases like respiratory infections, HIV/AIDS, diarrhea, road injuries, protein-energy malnutrition, cancer, meningitis, stroke and tuberculosis. The sicknesses currently account for high percentage of under five mortality, childhood mortality and maternal mortality.

Painfully, while one Nigerian woman dies every 13 minutes, the situation is reportedly alarming in the Northern region, where UNICEF and GirlsNotBrides showed that 17 per cent of girls are married before the age of 15; 15, 44 per cent are married before the age of 18, while the development was forecast to hit 68 per cent.This is coming at a time when the non-profit organisations disclosed that pregnancy-related complications are the leading cause of death among young women aged 15-19 years in Nigeria.

Considering the challenges afflicting the sector, especially in the, a public-private partnership solution was developed in October 20I5 by the Healthcare Leadership Academy (HLA), with the goal of building the leadership, management, and quality improvement capabilities of healthcare professionals of all cadres and across disciplines. Called the Leadership Enhancement and Accountability for the Public Sector (LEAPS), the programme factored that the health system is complex and dynamic and as such requires stewardship from individuals who are equipped with the skills, tools, and capacity required to effectively execute their functions. Besides, since factors such as the need to increase healthcare access for individuals and communities, as well as a sub-optimal supply of high quality, affordable healthcare services are critical to healthcare delivery, series of interventions by LEAPs initiative is beginning to address critical health challenges, particularly maternal and infant mortality. Targeting policymakers who are committed to driving positive health system reforms does this.

While stakeholders discussed ways to address the gap in the Nigerian health sector at the 2019 graduation ceremony of the programme, the organisation showed the true picture of the healthcare challenge in selected states in the North and how the problems are being addressed.

Some of the projects carried out across the states, were the need to reduce maternal mortality due to malaria in pregnancy through the use of a sort of immunization called SP in Niger State, increasing modern contraceptive prevalence rate, reducing poor antenatal care and increasing skilled birth delivery in Nasarawa, as well as the need to increase Penta3 immunization coverage and ensuring commodities available across primary healthcare centres in Kaduna.

Medical experts, including Founder, HLA, Dr. Kelechi Ohiri, Country Director, Nigeria, Bill and Melinda Gates Foundation, Dr. Paulin Basinga, Chief Medical Director of Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Director of Primary Healthcare in Nasarawa State, Hamza Iwara, Director at Niger State Ministry of Health, Joseph Barde and others, who decried the collapse of the nation’s health sector said tackling the challenges by boosting the capacity of people, who are in charge of policy and administration could address root causes of the challenges.

Speaking on the challenges in the sector, Ohiri bemoaned that though it was unacceptable for people to die for preventable diseases, the situation in Nigeria is getting worse. He thinks nobody should die when some diseases are still preventable.“One of the reasons all these continue to persist is due to the way the system is managed. It is humans that deliver care and manage the system,” he said.
 
Noting that care delivery process has the clinical and managerial and leadership aspect, Ohiri said there was need to effectively implement policies and manage to ensure the health sector run appropriately.  “For instance, in the case of treating malaria, treating the disease is clinical while the managerial is from ensuring the application of drugs prescribed for the patients, ensuring that the facilities are well kept so that people cannot come and get infected, ensuring that records are properly kept and information system are managed.

“What we focus on is not in training doctors and physicians, it is making sure that we train and build the capacity of people to effectively implement policies and manage so that at the end of the day everything that needs to be provided for health care to be accessible is there,” Ohiri said.

He insisted that the country needs to manage the system to care for people that are suffering from the sicknesses, stressing that training health sector managers and policy formulators would help to organise a system where issues that bothered people are properly cared for.

Addressing some of the lead causes of maternal death in Kaduna for instance, the group discovered that poor availability of the 10+ WHO Life Saving Commodities across primary healthcare centres in Kaduna was adding to death rate among pregnant women. Through combined efforts from the experts, the situation has been mitigated from 34 per cent it was last year to 85 per cent through intense awareness, engagement of third party logistic, supervision, monitoring and evaluation.

While there were equally only 35 per cent pentavalent vaccine coverage in communities in Kaduna, the initiative deployed solar direct drive refrigerators in primary healthcare centres, conducted listing and reconciliation of under one year by ward heads to tracking of defaulters and thereby increase the immunization to 83 per cent in attempt to reduce infant mortality rate.

Meanwhile, Nasarawa ranked lowest in terms of skilled birth delivery with practically no skilled birth in some communities in the state. Campaign by the team of experts under the scheme, which focused on stakeholders’ engagement, social mobilization, training, procurement and distribution of hospital equipment have increased hospital delivery in some communities across the state.

An attempt to improve on antenatal, which was overseen by Dr. Hassan showed that while Nasarawa State has 775 public PHC facilities with the provision of Antenatal Care (ANC) Services, pregnant women who complete four antenatal care visits remained at 50 per cent.

“This is not surprising as statistics from MICS and Nigeria Demographic and Health Survey (NDHS) showed inadequate knowledge on ANC benefits by the community, 90 per cent of women with more than a secondary education received ANC from a skilled ANC provider, as compared with 36 per cent of mothers with no education.“In addition, the reports revealed gaps in the skills of health workers required to provide quality ANC services, only 59.8 per cent of pregnant women received information of symptoms of complication as part of routine antenatal care visits in 2017,” Hassan said.

With the intention of increasing the percentage of pregnant women completing four antenatal visits at PHCs from 50 per cent to 55 per cent, the project showed that about 85 per cent of target health workers of 1,510 were trained through the programme, 40 per cent of 147 communities held sensitisation meetings for pregnant women and women of child bearing age, while ANC equipment and commodities were procured and distributed to 100 per cent of health facilities as a result of proper planning while at the training.

Barde led the Niger group disclosed that modern contraceptive prevalence (mCPR) rate had remained below 11 per cent but through quarterly provision of family planning commodities and consumables to 197 of 322 health facilities across nine local government areas of Niger State; increase private facilities reporting in District Health Information System  (DHIS) platform from 3.06 to 27 .6 per cent, and training of 60 religious leaders on family planning message.

According to him, integration of private facilities will help increase data coverage, consistent supply of commodities and consumables to provide free services and encourage turnout of clients.The group initiated the reduction  of maternal mortality due to malaria in pregnancy through the use of sulfadoxine-pyrimethamine (SP) and identified that uptake by pregnant women for the prevention of malaria in the state was generally low, especially  Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp2). The programme, therefore increased the percentage of pregnant women receiving IPTp2 for the prevention of malaria.