State of midwives service scheme in Kano

The Midwives Service Scheme (MSS) introduced by the federal government to reduce the rate of maternal mortality in the country was implemented in 2009 under the National Primary Health Care Development Agency (NPHCDA).
The MSS is a public sector initiative and a collaborative effort between the three tiers of government. An Agreement was reached through the signing of a memorandum of understanding between the federal, state and local government’s defined shared roles and responsibilities.
The aim is to facilitate an increase in the coverage of skilled birth attendants to reduce maternal, newborn and child mortality.
The program took off in Kano with six clusters formed and in each cluster there are four facilities under it. In 2010, another three clusters were formed to further reach the rural women. In each facility four midwives and two community health extension workers are deployed.
When SURE-P came up, it further increased the number of clusters by forming eight additional clusters. When it started, the deployed midwives were doing it with zeal but with time their morale was weakened due to nonpayment of their allowances by the federal government and other challenges.
Investigations by the Daily Trust Health Desk has revealed that the midwives deployed to the health facilities in the selected local government areas are finding it difficult to access their allowances from the federal government.
 In some places, they are faced with insecurity.
 “Some of us are yet to receive our outstanding allowance from the federal government,” said an anonymous midwife.
The zonal technical officer and focal person of the Midwives Service Scheme (MSS) in the zonal office of the National Primary Health Care Development Agency (NPHCDA) Mariya Nasir said when the scheme was moving smoothly, the rate of maternal mortality was reduced by 75 percent.
She said nonpayment of their allowance by the federal government has brought a setback.
She said:  “The MOU signed at the inception of the programme was that both the federal, state and local government would contribute their share in keeping the midwives. While the state and local government were doing their best, the federal government was unable to fulfill its part. So this lack of payment of their allowance by the federal government cause a set back on the scale up of the intervention.”
She revealed that the scheme has also faced  the challenge of retention. Some of the midwives abandoned the job because of the insurgency problem in the zone. She however added that the MDG has pledged to pay the outstanding allowances of the midwives.
Daily Trust Health Desk also gathered that because of the nonpayment of the midwives allowance by the federal government through the MDG, the success of the scheme slowed down and as they were coping with the nonpayment of their allowance, the insecurity problem came and compounded the matter and made them withdrew their service in the state.
To avoid losing the midwives, the Kano State government in November last year decided to absorb them so that they could continue with their work.
When contacted, Kano State MSS coordinator said he would not talk because very soon the state governor would lead the discussion on the scheme. He would therefore not pre-empt the state governor.
However, Daily Trust Health Desk gathered that Kano is not ready to lose the midwives because they are not enough in number. The state does not have adequate number of indigenous midwives that was why the state government decided to absorb them and continue to pay them their allowances.
It was further gathered that deployment of the midwives to the rural areas has helped in reducing maternal mortality in the state. It has made it possible for the rural women to access ante natal and child delivery at a nearby health facility. Apart from bringing the service to their door step, it has also made it easier to refer them to a higher facility in case of a complication.
A research conducted by a Kano based health organization, Community Health and Research Initiative (CHR) revealed that if these midwives are given good accommodation either within the facility or very close to it to ensure easy access to the health facility when called upon to attend to a pregnant woman, maternal mortality would be reduced drastically.
It said where the midwives were not assured of their safety and their allowances not paid on time, it would be difficult for them to continue to live in the rural areas to give the services required.