How to ensure quality maternal care in Nigeria

Daily, women die while giving life in Nigeria. Experts say there is a need to change the narrative by using innovative approaches to increase access to better quality maternal care toward ensuring a reduction in maternal deaths in the country.

According to the 2018 Nigeria Demographic and Health Survey (2018 NDHS), the country’s maternal mortality ratio (MMR) is 512 deaths per 100,000 live births.

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The World Health Organisation (WHO) also estimates that the risk of a woman in Nigeria dying during pregnancy, childbirth, postpartum or post-abortion, is 1-in-22 compared to 1 in 4,900 in developed countries.

Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

The major reasons for maternal deaths in Nigeria include post-partum haemorrhage (bleeding after child birth), unsafe abortions, pre-eclampsia, eclampsia,  obstructed labour and other complications from delivery and infections following childbirth, among others.

Other factors associated with maternal mortality include low health-seeking behaviour, poor emergency obstetric services, harmful traditional practices, high out-of-pocket expenditure on health care and poor transportation.

The country’s poor maternal mortality indices, therefore, underscore the need for solutions to address the challenges.

Stakeholders in maternal health recently met at a forum tagged ‘Evidence for Change” where they shared lessons learnt and approaches they adopted to ensure better quality maternal care in the country.

The stakeholders made up of MSD for Mothers collaborators also outlined their challenges, and made some recommendations. The meeting was organized by MSD for Mothers, in collaboration with the Nigeria Health Watch.

Nigerian Director MSD for Mothers Iyadunni Olubode said the organisation believes in the possibility of a world where no woman will die giving life.

She said, “We believe that pregnant women in Nigeria can have access to high-quality care that gives the best maternal health outcomes.

“We believe that healthcare workers can be exposed to the tools that deliver this high-quality care. We believe that the voice of the Nigerian woman is pivotal in shaping the solutions targeted at her.”

She said the belief is supported by investment and in collaboration with implementers, adding that implementers do this by seeking to understand the challenges from the perspective of all stakeholders especially from the women.

“And one way to understand why women are dying is to strengthen the surveillance mechanism. Engaging women and technology also offers us a lot of channels to reach more women across the country,” she said.

The managing director of Nigeria Health Watch,  Mrs. Vivianne Ihekweazu, said her organisation has for the past 18 months, been working on a maternal health advocacy and communications programme to spotlight the importance of quality of care in maternal health in Nigeria through MSD for Mothers funded projects.

“So over the period, we have interacted with all of you to spotlight insights and evidence from MSD for Mothers collaborators programmes, all with the aim of spotlighting interventions that will enable Nigeria to achieve the Sustainable Development Goals (SDGs) target of a global Maternal Ratio of fewer than 70 maternal deaths per 100,000 live births by 2030,” she said.

Ihekweazu, said the approach to spotlight quality of care for women’s maternal health focused on six thematic areas for the purpose of the project.

They are: understanding quality of care gaps, quality assurance, private sector capacity, affordability and digital support/technology evidence for change.

Dr. Bosede Ezekwe of WHO, in a paper titled, ‘How the World Health Organization is improving the capacities of health facilities through the MPD-4-QED Programme’, said among the quality standards expected to be available in every health facility is that every mother and newborn has a complete, accurate and standardized medical record during labour, childbirth and the early postnatal period.

Represented by the Director of Policy and Advocacy, Nigeria Health Watch, Ify Babatunde-Yusuf, she said it is also expected that every health facility has a mechanism for data collection, analysis and feedback as part of its activities for monitoring and improving performance around the time of childbirth.

On the innovative steps taken so far in addressing the identifiable gaps, she said 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-miss necessary for quality improvement.

The Associate Manager, Women’s Wellness, mDoc Healthcare, Chiagoziem Abiakam, said

the goal of providing virtual care to women of reproductive age under RICOM3 project is to reduce Maternal Mortality and Morbidity (MMM) from indirect causes by applying a QoC model to improve prevention, early detection and management of indirect causes of MMM associated with pre-eclampsia/eclampsia (PE/E) along the continuum of public and private Maternal Health (MH)/Reproductive Health (RH) care services for women of reproductive age (WRA).

Dr Uchenna Igbokwe of Solina Centre for International Development and Research (SCIDaR) said tackling heavy bleeding using a human-centred approach, would go a long way in changing the narrative on Nigeria’s poor maternal health indices.

Dr Usman Tijjani, Executive Secretary, Private Health Institution Management Agency (PHIMA), called on the federal government to increase funding for health to ensure quality services.

He said family planning and girl child education will help women make decisions about their health and lives.

Dr Mairo Mandara, founder and board chair, Girl Child Concern (GCC) Nigeria, said with the support of MSD for Mothers, young women living in rural areas in Borno State that lacked adequate healthcare providers were trained to enable them to provide basic healthcare services and refer women and children to healthcare facilities.

Sharing her experience, Zara Zarma said she was one of the health workers trained by GCC Nigeria in her village, adding that the knowledge helped her in her work with pregnant women.

Dr Chibugo Okoli, Deputy Country Director, Jhpiego said ensuring quality of care means the same quality of care should be given to every woman that steps into the facility all the time.