Ondo State, three years ago had the highest maternal mortality rates in the southwest region of Nigeria. At the time, the landscape of the country was littered with mothers bleeding to their death and countless burials of little children. Olusegun Mimiko was elected and his government made the reduction of maternal mortality and child mortality its main goal.
As someone whose professional life is dedicated to the very same goal, I took notice of the Mimiko government’s activities and achievements. Nigeria currently has 10% of all maternal deaths in the entire world and only 2% of the world’s population is Nigerian. The high maternal mortality and child mortality rate in Nigeria are caused by three delays in seeking the simple procedures that saves the lives of countless women in the world. The first is the delay to recognize danger signs in the mother. If danger signs are recognized early, she must get to the health facility on time, transportation constraints usually stops her as Nigeria has virtually no emergency infrastructure. If she is able to recognize danger signs, and access transportation on time and gets to the health center, her ability to pay for services causes the third delay. Even when services are free there are many peripheral costs associated with the inefficient service delivery at government health centers. These were the major factors that led to that terrifying 10% of the world’s burden of maternal mortality in Nigeria.
The Abiye program was created to ameliorate Ondo State’s share of the burden. The different component of the pilot project was designed to solve all the delays with proven workable solutions. The first step was a baseline survey to better understand which delay leads to Ondo state’s high burden of maternal mortality. An interesting finding of the baseline survey shows that only 16% of those mothers who got antenatal services actually came back to deliver at the health center. That is, the majority of mothers in Ondo State were dying because of the first two delays; the delay in seeking health and the delay of getting to the health centers.
The Abiye Pilot in Ifedore Local Government Area was soon launched. The pilot had tree main interventions. It aimed to provide all pregnant mothers with prepaid mobile phone so they can connect with the new health rangers (doctors) for better recognition of danger signs to ameliorate the first delay. This was made possible by a public-private partnership between the Ondo State and a telecom company called Globacom. The second action was to hire fifty new doctors trained as health rangers responsible for twenty-four pregnant mothers. The health ranger closely monitors the mother from the day she registers for antenatal care up till the day she delivers. She is monitored, given general advice, and encouraged to deliver at the health center. The program also led to the building of a major health center, the Apex Mother and Child Hospital. Health services were made free for all pregnant mothers and under-5s across Ondo State. Finally, an ambulance that provides emergency transportation from the household to the health facility free of charge, which decreases the second delay of getting to the health center on time, and removes the transportation challenges.
The positive results of the Abiye Pilot Project were numerous. A 90% reduction in maternal mortality is especially note worthy. The result of the pilot meets and surpasses the state Millennium Development Goals of reducing maternal mortality by 75%. Also, many thousand new users of the program were registered and finally more than two thousand healthy Ondo State citizens were ushered into the world free from harm. All these were possible by increasing the utilization of a newly efficient health services. This is simply remarkable.
The model of this project is even more innovative in public health policy in Nigeria. Generally, most governments simply implement massively expensive program without first testing and attempting to find out what the issues are. The Abiye idea was different in that a baseline was conducted and a pilot was implemented before scaling to all the other seventeen LGAs in the state. Abiye Plus introduces some changes based on the lessons learned during the Abiye Pilot Project. The changes are highlighted below.
Thirty-two new midwives were hired to augment the health workforce. A new model of service delivery was designed with two comprehensive health centers for complicated cases and four basic health centers in each ward that handles normal delivery. The four basic health centers are equipped with tricycle ambulances that move patients from rural areas to the comprehensive health center in case of emergencies. The community is encouraged to get involved in the program by monitoring and evaluating the health rangers’ performance. Although the cost of the Abiye Plus is extensive, the results are projected to be even bigger.
As a citizen of Ondo State, I am simply proud of this project. It is wonderful to be able to write, for once, about an indigenous program created to save the lives of Nigerian mothers, and more importantly, a massively successful one.
Post cross posted on: healtheffect.wordpress.com