From Ali Galadima, Bauchi
Despite the concerted effort of government agencies and its partners to address the preventable deaths of women and children in Nigeria as a result of pregnancy complications, Gombe State in Northeastern Nigeria still has a high number of maternal and neonatal mortality rate at 814 per 100,000 live births and 35 per 1,000 live births respectively
A data obtained from National Health Research Ethics Committee, Nigeria (NHREC) and Gombe State Government in June 2019 estimates national maternal mortality ratio (MMR) at 814 per 100,000 live births and neonatal mortality rate (NMF) at 39 percent per 1,000 live births.
However, statistics by the United Nation Children Fund (UNICEF) confirmed that the Northeastern zone has the highest maternal mortality ratio of 15,491 per 100,000 live births compared to 165 per 100,000 live births in the Western zone of the country.
Gombe State has a projected population of 3,022,590 in 2017, but the state hospital-based maternal mortality rate is said to be much higher than the national average of 811 despite a total of 615 health facilities comprising 512 primary health care centers, 22 secondary health facilities and two tertiary institutions.
A statistic available from UNICEF indicates that globally 2.5 million children die in the first month of life in 2018 and approximately 7,000 newborn deaths are recorded every day with about one third dying on the day of birth and close to three quarters dying within the first week of life. The infant mortality rate for Nigeria in 2019 was 60.662 deaths per 1,000 live births, with a 2.38 percent decline from the 2018 survey.
Furthermore, a table chart of infants mortality rate contained in the United Nations projection document from 1950 to 2020 through the year 2100 shows that the current infant mortality rate for Nigeria in 2020 stands at 59.181 deaths per 1,000 live births which is a total of 2.43 percent decline from the initial 2019 projection
However, in Gombe State alone, 576 women die within 42 days of childbirth as a result of health conditions that were aggravated by pregnancy or its mismanagement.
When 247ureports tried to find out some of the root causes of maternal deaths in Gombe State, it was discovered that a lack of skilled health practitioners during delivery in hospitals, especially a lack of obstetric emergency care and poor access to family planning facilities were responsible.
Other causes include harmful cultural practices among households and women of childbearing age and poor health funding by the government. These are serious issues that need to be handled with the utmost attention.
One solution is to provide transportation to expectant mothers to ease their difficulties when they go to health facilities.
Also, there are inadequate infrastructure, social disorganization and low awareness on maternal and newborn health which need to be addressed to avert the death of women and children.
A report by Nigeria Health Watch in October 2019 revealed that Gombe State maternal, newborn and child health services (MNCH) project which was co-founded by the Bill and Melinda Gates Foundation (BMGF) and the Gombe State Government started in 2009.
According to the report, BMGF has invested $50 million in the MNCH project so far and Gombe was the first state to receive support from BMGF in Nigeria in the area of maternal health with the sole aim of reducing maternal and mortality rates, which yielded positive results in 2017.
The key role played by the Society for Family Health (SFH) Nigeria in the design and execution of one of the elements of the project known as village health worker (VHW) initiative has greatly changed the perception and narrative of most communities on maternal health and improve service delivery.
Contributing, the Managing Director, SFH Dr. Omokhudu Idigho explained that “10 years after, a lot of progress has been made in terms of a massive reduction in the number of mothers who are dying during childbirth and also children who are living”.
He further said what excites him most is the way the government has demonstrated ownership of the project through contributing 50 percent payment of 6,000 monthly stipends to the 1,200 village health workers (VHWs) in 2017 and have taken 100% responsibility since 2018.
The scheme started in 2017 as part of the main project that commenced in 2009 after several strategies had been tested to determine best practices.
Other strategies adopted involve working with traditional birth attendants (TBAs) and Federation of Muslims Women Association in Nigeria {FOMWAN) in strictly community-based efforts to address issues related to family health.
However, the intervention made by BMGF and other partner governments is not enough. The federal and state government need to wake up from slumber and intensify awareness campaigns and strengthen improved service delivery in health facilities.
To address the issue of maternal health head-on, the state government needs to employ more skilled health workers that would be evenly distributed across the 615 primary health care facilities across the state, embark on re-training of TBAs and provide ongoing support where necessary.
Therefore, there is a need for both government at all levels and non-governmental organization to imbibe the culture of persuasion methods on women to embrace orthodox medical services and step up behaviour change communication strategy rather than doing things in the old ways.
It is also paramount that all stakeholders including the government implement some health policies that would tackle the root causes of maternal deaths and obstetric fistula. There is also a need to create more awareness especially in rural areas and improve access to girl child education.
Dr. Ibrahim Kabo, Technical Director USAID funded project Integrated Health Program (IHP), suggested that a lot of campaign awareness needed to be done to strengthen health system support for primary health care services, improve access to primary health care (PHC) and increase quality services delivery.
He said the overall goal of Integrated Health Program (IHP) intervention is to contribute to the states reduction in maternal and child morbidity and mortality rate and further increase the capacity of the health system sustainability.
Dr. Kabo also identified journalists as key stakeholders towards achieving USAID/IHP cardinal objectives of reducing maternal health in Gombe State.
He added that the media in Nigeria should promote health-related issues through effective reportage and uncovering health needs of women and children through awakening politicians to what they should do to improve health services in the country.
