Nigeria Health Watch with support from MSD for Mothers organized a stakeholders meeting in Abuja on Evidence for Change: Learning and Recommendations for Quality Maternal Care.
The different stakeholders discussed experiences and made recommendations on achieving quality maternal health care.
In an experience-sharing session, Zara Zarma, a Village Health Worker with Girl Child Concerns (GCC), shared her experiences in providing health education, support and referral services for women in her community.
Zarma, who appreciated GCC for training her through MSD for mothers on maternal care, said it had not been easy moving from house to house sensitizing pregnant women to always seek medical attention during pregnancy.
She said “now that I have been trained, I see the need for pregnant women to seek help from the hospitals because they do not have to die at childbirth. .
“People do not really see the need as they prefer to do it the local way, which may lead to the women losing their lives.
“I move from house to house to talk to women to access health facilities for their medical attention to save their lives and the lives of their babies.”
Iyadunni Olubode, Nigeria Director, MSD for Mothers, in her opening remark at the meeting, said no woman should die in childbirth.
“We believe the voice of Nigerian women is pivotal.”
She emphasised that understanding maternal health challenges is important in finding solutions to them.
Olubode maintained that more women must be reached across the country to address their challenges together.
“When we understand the challenges, we review them together and then know what works,’’ she said.
Also, Mrs Vivianne Ihekweazu, the Managing Director, Nigeria Health Watch, thanked collaborators and MSD for Mothers for the work and support and requested for a call to action on maternal quality healthcare.
She said “Nigeria Health Watch has been working on maternal health advocacy and communications programme in the past 18 months to spotlight the importance of quality care in maternal health in Nigeria through MSD for Mothers funded projects.
“So over the period, we have interacted with stakeholders to spotlight insights and evidence from MSD for Mothers collaborators programmes.
“The aim is to spotlight interventions that will enable Nigeria to achieve the SDG target of a global Maternal Ratio of fewer than 70 maternal deaths per 100,000 live births by 2030.’’
She said with the approach to spotlight quality of care for women’s maternal health, the focus is on six thematic areas for the purpose of the project.
“The thematic areas are Understanding Quality of Care Gaps, Quality Assurance, Private Sector Capacity Affordability, Digital Support/Technology and Evidence for Change.’’
Ihekweazu said the objective of the evidence for change meeting was to amplify MSD for Mothers-supported collaborators, as evidenced through the outcomes and impact of the initiatives and innovations in improving maternal health outcomes in Nigeria.
Another objective according to her is to highlight the importance of adopting quality-of-care approach in delivering maternal healthcare in Nigeria through strategic approaches of MSD for Mothers-supported projects in Nigeria.
She said “we hope to achieve more as we share some of the key learnings and some of the innovative solutions from our various programmes.
“Understanding current challenges and gaps in delivering quality health care in Nigeria, helped by the fact that some of our key stakeholders are in the room with us.
“Ultimately, at the end we hope to be able to synthesise the findings and propose a roadmap for policy implementation for better maternal health care in Nigeria.”
On his part, Dr Usman Tijjani, the Executive Secretary, Private Health Institutions Management Agency (PHIMA), said there was need to emphasise girl child education “and intensify family planning as population will always affect resources and services.
“The government has to come in by improving the private sectors as the burden is too much on the government.
“Government should channel resources on primary services such as health, education, food and security.”
One of the panelists at the meeting, Dr Bolanle Fajemirokun, Director of Partnerships, LifeBank, spoke on keeping blood safe in handling maternal health issues, stressing that it had to be transported in cold chain packages.
She maintained that the quality of blood was essential in maternal care as one of the challenges was the lack of critical supply.
“Another challenge is the lack of structural infrastructure as drones can be used when the patient’s condition is critical.
“When patient’s condition is not critical, we use bikes, tricycles, donkeys among others.”
Fajemirokun maintained that to avoid lack of blood, a pool must be kept full as data evidence was also important.
Another panelist, Dr Uchenna Igbokwe, the Principal, Solina Group, advised that innovations should be designed to address postnatal issues.
He added that what works needed to be scaled up as affordability was also necessary.
Dr Ademola Serrano, the Innovation Manager. PharmAccess, another panelist, said sustainable funding was necessary for clinical care in enhancing maternal care.
Serrano said PharmAccess assisted other partners with a self-care platform to enable women to have proper healthcare.
“We also supported the process of training the people on how to use the self-care platform itself.
“The platform was used as methodology tool to ensure that all delivering service components within the facilities as little as cleaning and washing their bed sheets and caring for wastes were part of the quality rules.’’
He said with other partners, the group identified and trained quality improvement facilitators and set quality improvement tips within each of the facilities and their responsibilities to ensure the facility maintained quality.
A panelist, Dr Mairo Mandara, Founder and Board Chair, Girl Child Concerns, said the system was overburdened because of the crisis in Borno as many health care workers fled but the poor people did not have anywhere to go.
She said they were faced with a lot of challenges particularly in health and education.
Mandara said there were people in the local government quarters, women, men and children but there were no care workers.
“I was opportuned to be among the team that formulated the village health care worker curriculum during the MDG programme, I knew the power and content of village health workers.
“Issues of maternal care can be prevented as no woman or newborn should die and with support from MSD for Mothers, we went to the local government areas and from there, we picked up Zarma four years ago.
“We got young women in those villages and the criterion is being able to have primary six literacy and with the help of traditional rulers and support from their parents, we took them to Maiduguri to the School of Health Sciences and Technology.
“We trained them for three months as village health workers on understanding pregnancy, signs of pregnancy, among others.
“With support from MSD, we trained these women on maternal health, child health and nutrition.
“We also trained 240 village health workers across three local governments and they were improving in their skills to the extent that World Health Organisation (WHO) acknowledged our work as there was an increase in immunisation.”
She added that Girl Child Concerns also trained many women as village health workers when government was returning people back to their homes from the IDP camps.
“Recently, in the last one year, when government was closing IDP camps and returning people to their villages and for every returned village we took a number of women trained them as village health workers and we had a total of 465 couples. So we are supported to do a total of 240 and 60 supervisors which is 300.’’
She maintained that with the work of village health workers, Borno had been doing well even more than some states without crisis.
Mandara maintained that in knowing what women wanted, more research and discussions were needed to address the issues.
Another panelist, Dr Chibugo Okoli, the Deputy Country Director, Jhpiego, thanked MSD for Mothers for funding and addressing quality maternal care in Nigeria.
Okoli said about 649 women were studied in two local governments in Lagos State — Alimosho and Ikorodu, and in the Federal Capital Territory — Bwari and Abuja Municipal Councils.
She explained that between the 649 women, they carried out a point of care test for them as part of the study by looking at their blood pressure, diabetes, anemia among others.
Okoli said most women did not know they had high blood pressure, diabetes, anemia among others, even though the measurements showed that at the point of care something has to be done about it.
“We have worked with the State Ministries, the FCT, Lagos State Ministry of Health through Eko Creation Workshop, where we also invited women to contribute to using the findings; we got to set up an implementation platform called the Women Centre Quality of Care module.
“This is with four components of concentration called patient education, early detection through screening for these diseases and also management for these diseases and making referral.
“We work across General Hospitals, Private Hospitals, Mission Hospitals and Primary Health Care Centres.
“So for us, we focus on quality, which means doing whatever we are implementing for every woman all the time and at the right time and we use the WHO framework on quality of care for maternal health.”
She added that they are always documented as evidence and many women now accessed health facilities during pregnancy.
“As of now, in mid-2022, we have over 80 per cent of women coming to the facilities for their blood pressure, checking for diabetes, among others.
Also, another panelist, Paulina Akanet, State Programme Manager, Saving Mothers Giving Life 2.0 (SMGL2.0) at Pathfinder International, said awareness was needed for women to know that SMGL2.0 services were existing so that they could take advantage of it.
She said the first activity identified earlier in May 2021 was to leverage the facilities and so they got the caregivers at the 25 Pathfinder facilities onboard.
These women, according to her, are directly from their facilities with the activities for three months.
“So, we were able to bring onboard 300 women, which gave us a threshold and a learning process for us to know exactly how these women interacted with chat boards, the messages, and the Q-rated messages on the chat boards.
“We were able to know the challenges they have in accessing the content on the chat boards and so by late August 2021, we launched the digital campaign on Facebook and on Google and we were able to reach about 1.3 million women.
“About 127,000 of them interacted with the AskNivi campaign and we were able to successfully onboard over 1,000 women between the months of August 2021 and December 2021.
“With pathfinder SMGL 2.0, we identified three objectives and the first was to ensure that we encourage women involved in ASKNIVI on WhatsApp, especially on their first trimester.
“The second objective that we identified was to make sure that these women visit and complete the recommended WHO visits required throughout their pregnancy journey of 37 or 42 weeks of pregnancy journey.
“The third objective we identified was to make sure that these women deliver at a high quality supported facility.”
She said the challenge for digital health solution in Nigeria was generic, as the first was Internet Penetration, even though on paper it was recorded that they had over 51 internets per broadband penetration in Nigeria.
According to her, with the Pathfinder SMGL 2.0 in support, we realized that some of these women actually reside in the remote areas in the 25 local governments and that is one of the challenges we have.
She said insecurity also became a factor for accessing the new era and facility; where these women were not able to complete their regular SMGL 2.0 visits because of insecurity.
She added that the internet facility was turned down for a period of three months and that became an issue.
“Another challenge we identified was language barrier: due to the area where these women are located, some of them are not that literate to actually comprehend the content in English language.
“Some of these challenges are infrastructure challenges and some are socio–economic challenges.
“So because of the language barrier, and in a bid to solve it, we transmitted all the content into Hausa language which was completed two months ago.
In her presentation, Dr Bosede Ezekwe, World Health Organization (WHO) Nigeria, said the organization was improving the capacities of health facilities through the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) programme.
Ezekwe was represented by Ify BaBabatunde-Yusuf, the Director of Policy and Advocacy, Nigeria Health Watch.
She said among the quality standards expected to be available in every health facility was that every mother and newborn had a complete, accurate, and standardized medical record during labor, childbirth and the early postnatal period.
According to Ezekwe, It is also expected that every health facility has a mechanism for data collection, analysis and feedback as part of activities for monitoring and improving performance around the time of childbirth.
On the gaps the WHO’s MPD-4-QED programme sought to address, she said that high quality data was required to identify areas for quality of care improvement.
Ezekwe added that high quality data was also needed on the innovative steps taken so far in addressing these identifiable gaps.
According to Ezekwe, one of the process indicators in the QED project includes the development of facility-based routine data collection systems for maternal and perinatal mortality and near-misses necessary for quality improvement.
On global targets, she said the Sustainable Development Goals (SDG) is built on the gains of the Millennium Development Goals (MDGs) with a target for reduction of maternal mortality ratio to less than 70 per 100,000 live births and the reduction of newborn mortality to less than 12 per 1,000 live births by 2030.
“The Ending Preventable Maternal Mortality (EPMM) programme’s target of a reduction of Maternal Mortality Ratio (MMR) by all countries to at least two-thirds of their 2010 baseline levels is reliant upon the provision of available, accessible, acceptable, quality service in an enabling environment that respects human rights principles.
“The World Health Organisation (WHO) Quality, Equity and Dignity (“QED”) project to improve Quality of Communication (QoC) for mothers and newborns in health facilities is one strategy to achieve the SDG targets.
“Nigeria is one of nine first wave countries implementing Quality of Communication (QoC) which aims to halve hospital-based maternal and newborn deaths in five years.’