By co-opting Traditional Birth Attendants (TBAs)/Agbebi and optimizing their services with the Abiye programme spread across the 18 Local Government Areas (LGAs) and two dedicated Mother and Child Hospitals, the Ondo State Government has been able to reduce Maternal Mortality Ratio (MMR) by 84.9 per cent that is from 745 per 1000,000 live births in 2009 to 112 per 100,000 live births in 2016.
The concept is tagged Agbebiye. Abiye is Yoruba literary translation of safe motherhood while Agbebi means local birth attendants or TBAs.
The Ondo State Government initiated Agbebiye, a partnership with TBAs, Faith Based Organisations (FBOs) and Mission Home Birth Attendants (MHBAs), aimed at ensuring safe pregnancy for all mothers in the state.
This means that the State surpassed the Millennium Development Goals (MDG) agenda 5, which is on maternal health. The MDGs was adopted in 1990 by Nigeria and all member bodies of the United nations, which sets two targets – one, to “reduce by three quarters, between 1990 and 2015, the maternal mortality ratio”, and two, to “achieve, by 2015, universal access to reproductive health.”
MMR is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.
MMR in Nigeria was last measured at 820 in 2014, according to the World Bank.
Ondo State Commissioner for Health, Dr. Dayo Adeyanju, told journalists: “We still have the only pioneer Mother and Child Hospital in Akure, but today, what is new and what is more is that Abiye has been scaled up across the entire 18 Local Government Areas (LGA) of Ondo state, and the Mother and Child Hospital has been replicated in Ondo; making two Mother and Child Hospitals. The beauty of this is that, with all of that, when we had the three year impact assessment, we were only able to succeed in reducing maternal mortality from 745 per 100,000 life birth to 317 as average. This is empirically based from all the survey we conducted using the sisterhood method, the one conducted by institute of public health, even the KEMDOS report which is confidential enquiry into maternal deaths in Ondo state.
“As well as facility base, they were just hovering around between 317 and 320 something per 100,000 live births meaning that we were able to do about 50 per cent reduction in three years, so again, this does not inform the update. We now realised that most of the 317 deaths per 100,000 occur in TBAs as well as mission home attendance, which was what informed the partnership between the Abiye programme and TBAs/mission attendance. You know those people are called in our local parlance, Agbebi. So the combination of Agbebi and Abiye was what lead to the formation of Agbebiye, and Agbebiye means we had to form a partnership between the Abiye and the TBAs.
“We started by asking them not to take deliveries again, giving them the mandate to just refer all their pregnant women from their own coffer or the one they have registered; and when they do that, we then give them a coupon and register those pregnant women. So by the time the pregnant women delivers, you then redeem that coupon with N2,000.
“And that redemption of N 2,000 makes it a win-win situation, meaning that they are having some financial gains and we are saving lives.
“So that collaboration further dragged our maternal mortality to where we piloted to now, about 172 per 100,000-life birth. In fact as we speak now, it may have gone further because this was as at last year, 172 per 100,000 life births.
“In fact at the pilot LGA, which was Akure south, in six months we increase facilities in tradition by 20.4 per cent and that has impact on the maternal mortality ratio, so that was what informed the scaling up of the Agbebiye programme across the entire LGA, which has referred over 6,718 pregnant women, in the last one year of the programme.
“So we are yet to conduct a survey now, but with some facility based records and some measure of statistics, we were able to realize that it is hovering around 112, per 100,000 life birth.
But even based on 172, when you look was we are coming from in 1999, which is 745 per 100,000 live births, that is far above 75 per cent which is the MDG mandate.”
Adeyanju further explained: “Agbebiye in Yoruba means ‘Safe Birth Attendant’ it can also mean ‘Safe Pregnancy Delivery’. The project addresses the need to have skilled birth attendant at every delivery of pregnant women as it strives to ensure Universal Health Coverage (UHC) for comprehensive sexual, reproductive, maternal and newborn health care. It is a win-win performance based financing approach that bridges the gap between the traditional birth attendants and Mission Home birth attendants. With the programme, more demand is created for facility utilization and institutional delivery especially at the primary health facilities which with Abiye increased by over 70 per cent.”
According to the World Health Organization – Human Reproduction Programme, “The ultimate goal of the Post-2015 maternal health plan is to end all preventable maternal mortality, the strategy to achieve this goal is grounded in a holistic, human rights-based approach to sexual, reproductive, maternal and new-born health and rests on the foundation of implementation effectiveness which is context-specific, systems-oriented and people-centric.”
Adeyanju added: “When we came in February 2009 the MMR was 745 per 100,000 live births but today it is about 112 per 100,000. So that is why we sound bold and say empirically, we have been able to go beyond MDG. So we have succeed in making sure our delivery by skilled attendants, which was around 39 or 37 per cent or there about when we came in, has increased to 89.9 per cent; meaning that pregnancy is safe and no longer a death sentence in Ondo state.”
The medical doctor said Abiye and Agbebiye are community driven. Adeyanju added: “You see, Agbebiye, after we register them to TBA, and then ask them not to deliver, but refer, we then give them training on vocations like cake making, bead making, tie and dye.
“Because you cannot evict someone from their business and not provide an alternative, they were certificated and on that note we gave them soft loans of N100,000 per person to start that business. Not only did we say, they should start, we patronize them. When you go to our facilities, you will see the Agbebiye soap, detergent.
“… So we patronize them as well to sustain and keep the business going, so those TBAs and mission home attendants who are enjoying this programme as Agbebiye or Abiye. The people we called vanguard, ensuring and making sure they do not revert back, so they are the people who we call the Abiye vanguards. There are about 417 of them in the entire state, and we have over 5,000 TBAs in the whole state, so you would imagine the kind of havoc they were wrecking.”]
Adeyanju faults Lagos State on the training of TBAs. He said: “You cannot train them; you cannot build something on nothing. They have mere elementary biology, how do you teach them to take delivery? You cannot train them.
Some other states like Kano are training TBAs. They will wreck more havoc, it is human nature to go beyond limits.”
Good enough, all these achievements did not go unnoticed. Not long ago, Ondo State won the Bill and Melinda Gate Leadership Award twice for its exceptional performance in the area of immunization. This attracted several millions of naira to the state, which the Governor further invested in the health sector in order to make healthcare delivery accessible to all the people of the state. Apart from this, Dr. Olusegun Mimiko ‘s achievement in the health sector has made the state earn a global recognition. It has also become a benchmark for the entire Continent of Africa.
Apart from the Gates’ awards, the revitalization of the state’s health sector also fetched the Governor a number of other awards which included; Award of Excellence in Healthcare delivery by Pharmaceutical Society of Nigeria (PSN), Award of Excellence by Gynecologists and Obstetrics of Nigeria on maternal Health, Award of Excellence in Health by the speaker of the Nigeria youth parliament, Award of most kidney Friendly by Oxford, Award of Excellence in Public Health by the Institute of Public Health OAU, Gold medal of Excellence in public Health Award in recognition of contribution to Primary Health care (PHC) by the Institute of Public Health OAU, among others.
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