Reducing maternal, child deaths in Nigeria
Worried by the high child and maternal mortality in the country, a Professor of Obstetrics and Gynaecology and Consultant Obstetrician and Gynaecological Surgeon at the College of Medical Sciences, University of Jos, Plateau State, Innocent Ujah, has made recommendations on how to navigate and sweep landmines for safe motherhood in Nigeria.
Ujah, a former Director General (DG) of the Nigerian Institute of Medical Research (NIMR) Yaba, Lagos, in his inaugural lecture titled “Navigating Landmines: The Travails of Motherhood in Nigeria,” delivered Tuesday, October 22, 2019, at the Multipurpose Hall University of Jos, made the following recommendations: compulsory and free formal education for the girl child; awareness creation on the prevention of maternal morbidity and mortality; equipping health institutions with adequate manpower and medical supplies; re-introduction of community midwives; expansion and strengthening of National Blood Transfusion Service (NBTS).
Other recommendations include: manpower development must be intensified; morning review meetings in all the Departments of Obstetrics and Gynaecology in the country be made a policy and compulsory; improvement in road and power infrastructure; compulsory National Health Insurance Scheme (NHIS); full implementation of National Health Act 2014; establishment of National Bank for Health; prevention of industrial crises; strengthening family planning policy and implementation; and periodic evaluation of maternal deaths.
Ujah concluded: “Deaths in pregnancy and childbirth should not be seen in isolation as a chronic maternal socio-medical disease process but an outcome of the complex chain of causation leading to the final stop in a long maternal death road.
“Maternal death is influenced by the mothers’ age, the interval between births, total number of lifetime pregnancies, socio-cultural, economic and institutional circumstances, all of which is correctly termed the three-delays contributing to deaths in pregnancy and childbirth.
“The underlying causes of maternal deaths must be identified and effective strategies developed to overcome them with adequate evaluation and monitoring mechanisms.”
On compulsory and free formal education for the girl child, Ujah explained: “It has been established that if all girls are educated up to secondary school level, over 80 per cent of maternal deaths in Nigeria and indeed other developing countries will be prevented. Education is a powerful weapon for improved socio-economic development. The federal government should, therefore, make education compulsory for all but free for the girl child up to secondary school level.”
On awareness creation on the prevention of maternal morbidity and mortality, the surgeon said deliberate, aggressive, focused and sustained awareness programmes must be designed through the various agencies of government and organizations such as National Orientation Agency (NOA), National Women Commission, the National Council for Women Society (NCWS), Society of Gynaecology and Obstetrics of Nigeria (SOGON), the Nigeria Medical Association (NMA), National Association of Nigerian Nurses and midwives to educate women and their husbands on the singular values of antenatal care and institutional deliveries because over 95 per cent of maternal deaths are prevented through supervised pregnancy and Institutional delivery.
On equipping health institutions with adequate manpower and medical supplies, he said all levels of health care: primary, secondary and tertiary must be improved and appropriately equipped with human resource and up-to-date medical equipment for quality healthcare service to women and children and the Basic Health care provision Fund (BHCPF) must deployed to the Primary Healthcare Centres (PHCs). Ujah said the fund should be transparently utilised for the care of women and children in order that motherhood will be safe as a way of navigating the landmines in human reproduction.
On the re-introduction of community midwives, Ujah said the training of community midwives which was abolished by the Nursing and Midwifery Council of Nigeria should be brought back to replace the Traditional Birth Attendants (TBAs) who clearly do not the requisite knowledge and skills to provide clinical obstetric care and the complications arising therefrom. This, he said, will help to reduce the distortion in the distribution of midwives in the country towards improving maternal and childcare.
On the expansion and strengthening of National Blood Transfusion Service, the obstetrician and gynaecologist said haemorrhage (severe bleeding) is a leading cause of maternal deaths in Nigeria and most developing countries and that the current national blood transfusion service established in the six geopolitical zones should be further expanded and strengthened to respond to the needs of the people which will reduce the avoidable deaths from obstetric (ante, intra and postpartum) heamorrhage.
On intensifying manpower development, Ujah said a deliberate policy must be put in place to train and retrain all levels of health care providers for skill development, technical and logistic support with the purpose of improving health care delivery for safe motherhood. In addition, he said, the task-sharing policy of the federal government that allows Community Health Extension Workers (CHEWs) who have acquired some skills in the art of midwifery to supervise antenatal care and conduct deliveries must be constantly evaluated and reviewed to ensure the quality of care.
On making morning review meetings in all the Departments of Obstetrics and Gynaecology in the country a policy and compulsory, the medical doctor said the morning review meetings, a practice established in the Department of Obstetrics and Gynaecology of the University in 1996, which is an adaptation of good practice from the Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospital (OAUTH), should be made a policy for all Departments of Obstetrics and Gynaecology in the country to adopt/adapt where such practice currently does not yet exist.
Ujah said the regular review mechanism has greatly enhanced the quality of clinical care in Obstetrics and Gynaecology and improved undergraduate and postgraduate medical education and research in the department with impressive outcomes.
On improvement in road and power infrastructure, he said improvement in infrastructural development programme such as Directorate of foods, roads and rural Infrastructure (DIFRRI) for the construction of good roads to link communities for ease of transportation system; expansion of Rural Electrification Programme as well as provision of water and observance of environmental sanitation will greatly enhance maternal and child healthcare in Nigeria
On compulsory NHIS, Ujah said the Scheme must be repositioned and made compulsory to all Nigerians for the improvement of the health of pregnant women and children. This, he said, will enhance financial access, which will help to reduce avoidable deaths in pregnancy and childhood. The surgeon said the establishment of the State Health Insurance Scheme by the various State Governments as it is being currently done must be made fully functional and responsive to the needs of the people
The former NIMR DG said the full implementation of the National Health Act (2014), including the release and prudent utilisation of BHCPF must be enforced. This will greatly enhance affordable service delivery, including maternal and child health.
Ujah said advocates the establishment of National Bank for Health (NBH), like those of Banks of Industries and Agriculture. He said this would support access to fund at a single-digit interest rate, which will further boost affordable quality healthcare particularly maternal and child healthcare. In addition, he said, such policy will curb medical tourism and improve quality health through the procurement of state-of-the-art equipment.
On prevention of industrial crises, Ujah said stable work environment devoid of industrial disputes would further help to build the confidence of the patients in accessing the health facilities. He said this could readily be achieved through high-level advocacy, consultations, negotiations and dialogue.
On strengthening family planning policy and implementation, the surgeon said no woman will die of maternal death if she is not pregnant and therefore, in order to prevent pregnancy and its complications, it is advocated that family planning made an effective strategy for the prevention of maternal mortality not only in Nigeria but also in all countries where maternal deaths are still very high.
On periodic evaluation of maternal deaths, Ujah said the national policy of maternal and perinatal death surveillance and response (MPDSR) must be meticulously implemented at all levels of the health care system. He said this would provide the necessary data and information to government and policymakers on the magnitude and trend of maternal morbidity and mortality for effective planning, adequate and appropriate resource allocation.