Lagos MCCs… 15 years of taming maternal, child mortality amid limitations

The construction of the MCC was one of the outcomes of the Lagos State Maternal and Child Mortality Reduction Programme (LSMCMRP), which aims to map out strategies for the reduction of the high maternal and child mortality rates in the state in line with Sustainable Development Goals (MDGs) Four, Five and Six.

The LSMCMRP was launched at a time when the country had one of the highest maternal mortality rates in the world. Even though the state’s figure for 2008 was better than the national average of 650/100,000 live births (NDHS 2008), the government insisted that it was unacceptably high.

Speaking on the construction of the MCCs, then governor of the state, Babatunde Fashola, whose administration conceived the idea, noted that the project, designed as 100-bed facilities, would be located in strategic areas of the state to reduce the travel time of residents who want to access them.

Through the MCCs, the state government provides comprehensive care for pregnant and nursing mothers, and also their babies. Every pregnant woman who registers in any of the MCCs goes through stages of care in the hands of various professionals employed in the facilities.

A former Lagos State Commissioner for Health, Dr. Jide Idris, gave further insight into the project.

He said: “During Governor Babajide Fashola’s time, we looked at the maternal mortality statistics for the state and other related statistics like infant mortality rates. As a government, we felt we needed a programme to properly deal with all the indices.”

Idris said the administration was able to design proper and robust strategies, adding that the building of the MCCs was one of the strategies under infrastructure development.

“We did other things like building capacity, resources and enlightening the people on antenatal and others. In the area of financing, we tried to link the provision of maternal and child services to the health insurance scheme, aside from purchasing a lot of equipment. And the MCC was actually to address the issue of maternal, neonatal, and child mortality because they are related,” he added.

Idris stated that under infrastructure, the administration initially worked at the primary healthcare level, improving some PHC facilities in the process, but later decided to upgrade infrastructure at the secondary care level.

He said that it was then that the idea of building the MCCs came up, especially in hospitals with no complete scope of secondary care facilities where maternal and child care services were provided.

He disclosed that one of the positives from the project was that the state was able to conduct a survey and an assessment of the maternal mortality situation for the state, which had not been done before then.

“In terms of advocacy and enlightenment, it was a massive thing as we went around all local councils, using key government officials, notable persons in the society, and community people to engage the community. We also produced maternal booklets and information for mothers to learn and know about pregnancy. We developed a health booklet on milestones and child development. In terms of building capacity, there was so much training we did for staff on life-saving skills and emergencies,” he added.

Sharing her experience, a mother, Chidimma Onyekwe, said that she registered at the Amuwo Odofin MCC when her pregnancy was five months old. She recalled that she routinely had a date at the hospital during which her baby’s growth progress was monitored even as she was cared for and educated on how to provide the right environment and nutrients for the baby’s growth.

She said that she visited the hospital monthly till the pregnancy was seven months. Thereafter, she was asked to visit every three weeks, followed by every two weeks, and then weekly in the ninth month.

According to her, during each visit, her blood pressure and sugar level were checked aside from other care she received.

She added that nurses at the MCC educated pregnant women on how to keep healthy during the period of their pregnancies and the importance of reporting at the hospital once they noticed any signs of sickness.

Onyekwe said pregnant women were also educated on how to breastfeed and the importance of breastfeeding as well, adding that newborns were given free vaccines at birth and periodically until they are five years old.

The Guardian learnt that each of the centres has many clinics for mothers, babies, and children. These include a neonatal unit for premature babies, labour ward with a delivery room, an emergency clinic, and a theatre for carrying out Caesarean sections for complicated deliveries.

It was observed that the MCCs were designed as four-storey edifices with ramps at the main entrance into the floors and the fire/service stairway at the other end.

In addition, two waiting sheds/holding areas to accommodate the clients and their guests flank the building. To complement the services being rendered, the gas station, public toilets, the power room, the engineering section, and the water tank stands were constructed close to the main building.

Mrs. Tayo Oredola told The Guardian that she delivered her two babies at the Isolo MCC. According to her, the service at the facility was by far better compared to what was obtainable in other state-owned government hospitals.

However, she noted that the facility lacked enough medical and non-medical staff.

“One of the challenges observed is that the facility had a shortage of staff. Last year when I had my baby there, I overheard the nurses saying most of the young doctors refused to stay. And in a ward of 25 people, just one or two nurses attended to patients within a 24-hour interval, which was stressful. It was the same with the doctors; the doctor-to-patient ratio was not encouraging.

“The few times patients complained were when the doctors got exhausted due to the workload. The same doctors attended to patients in the wards, emergency unit, theatre, and outpatient units. It amounted to a longer waiting time for patients,” she said.

She also disclosed that some patients were discharged earlier than they were supposed to just to allow for new intakes because of inadequate bed space.

Oredola, nonetheless, insisted that she still prefers the health facility despite the challenges.

“It is the reason I always prepare my mind to spend the whole day when I need to go to the hospital. The personnel are very okay, welcoming, caring, and open to my own experience. There is room for improvement, however, in terms of facility and staff,” she added.

Another mother, Gloria Nwafor, gave birth to two of her children at the Amuwo Odofin MCC in 2019 and 2021 respectively. Nwafor observed that in 2019, the number of nurses on duty that attended to patients was higher compared to the number she saw in 2021 when she returned to the hospital to deliver her second child.

“For instance, when I gave birth to my baby in 2021, while still at the hospital, a senior matron lamented how the state government refused to employ more hands resulting in the available personnel being overworked,” she said.

According to Nwafor, the senior matron said that many of the nurses resigned to travel abroad, noting that the state government did not replace those who left despite the large number of mothers that use the facility.

“At the ward, a lot of mothers that needed attention were not urgently attended to because just one matron or nurse attended to a large number of mothers with their newborns.

“However, the services are acceptable, because I was adequately taken care of and had no regrets using the hospital. In terms of cost, it is still considerable, but more expensive than a general hospital.

“I also learnt that the number of cleaners has reduced. In such an environment, there must be cleaners doing their jobs round the clock so that there would be no spread of infections, especially among children,” Nwafor added.

Years after the MCC project started, available statistics have indicated a reduction in the incidence of maternal deaths, which often occur as a result of delivery by unskilled birth attendants, haemorrhage, infection, obstructed labour, and malaria, among others. When the project started, the Maternal Mortality Ratio (MMR) was 650/100,000 live births. As of 2020, it was 555 per 100,000 live births.

A staff of one of the MCCs, who spoke under anonymity, noted that services like pediatric surgeries, ear, nose, and throat cases were referred there, which shouldn’t be the case.

The source also revealed that there was no intensive care unit in the facility she works at even though it is one of the flagship MCCs.

According to her, the medical lab unit in the facility does not conduct tuberculosis tests because there was no safety cabinet. She also disclosed that aside from doctors and nurses, there were no changing rooms for other medical staff.

Efforts to get the Ministry of Health to provide some insights into the success stories of the MCCs were not successful.

It is however hoped that the challenges highlighted by patients that had visited the facilities would be addressed so that the overall objectives of establishing them would be achieved maximally.

This story was produced with the support of Nigeria Health watch through the Solutions Journalism Network, a non-profit organisation dedicated to rigorous and compelling reporting.