Bringing Mother And Baby Home Alive

4 ways to reduce maternal and child mortality in Nigeria

More babies die in Nigeria, than almost anywhere else on the planet.

According to the WHO, the number of babies that die has increased over the past few years due to two main reasons. Firstly, the persisting low numbers of births occurring in health facilities and secondly, the low number of births attended by trained healthcare service providers.

UNICEF says one in 34 babies born in Nigeria die before their first birthday.

The WHO also points out that, the under five mortality ratio in Nigeria is 201 per 1000 live births meaning that one in five Nigerian children never reach the age of 5. Infant deaths, which account for half of child mortality have increased from what they were in 1990. With a 13% immunization rate for children between 12–23 months, Nigeria is the African country with the lowest vaccination rate. Substantial presence of Acute Respiratory Infections and diarrhea also contribute to the elevated mortality rates for children.

In my book, Fixing Healthcare in Nigeria, I call this Nigeria’s child death epidemic.

To help paint a clearer picture of the gloomy state of things, imagine a Boeing 777: one plane carries approximately 350 passengers. Now, imagine a single Boeing 777, filled with 350 children crashing. There would be an international outcry, a full investigation, and a vow to make safety a national priority.

To equate this to our national health crisis, you would need 3000 Boeing 777 plane crashes — yearly. 10 crashes per day

The following are four keys steps we can take in Nigeria to reduce the number of maternal and child deaths in the country:

1. Improve diagnostics

Twice as many people die in low and middle-income countries from poor quality healthcare than from lack of access to care
-IFC

Research quoted by both the IFC and the Lancet reveal that quality of healthcare is one of the major challenges in developing countries and that it is an even bigger challenge than access.

If hospitals in developing countries like Nigeria are able the obtain the correct equipment and if this equipment can be correctly maintained, a key problem affecting service quality will be solved.

2. Centralise Tertiary Care

Study after study in Britain and overseas has accepted that hospitals with bigger caseloads have better results. The Safe and Sustainable review team point to reviews of paediatric heart surgery in Sweden, Canada, Australia, the Netherlands and Germany.

One of the best examples of centralisation is provided by the stroke service in London. Eight “super” units currently provide treatment which previously was done by 30 hospitals. This radical reform in stroke care will save about 400 lives a year.

This article from the Archives of Disease in Childhood supports this by stating the various benefits of treatment in central specialist hospitals which include concentration of expertise, more appropriate consultant on call commitment, development of support services, and junior doctor training. The paper argues that there is a critical mass ( a minimum number of patients that a surgeon needs to operate on) required for clinical effectiveness.

Surprisingly, this doesn’t just apply to the surgeons operating on children. The paper also states that ‘there is clear evidence in anaesthesia that anaesthetists doing small numbers of neonatal procedures had significantly worse results. The same seems to be true in the fields of oncology, radiology, pathology, and intensive care’

3. Task-shifting

Given Nigeria’s current training models and health delivery practices, it would take that country 300 years to train the same number of doctors per capita as currently exists in developed countries

-WEF

According to the WHO, at least 57 countries have a crisis shortage of health workers. 36 of those countries are in Africa.

The WHO goes on to recommend that task shifting is one way the public health community and national governments can address this issue head-on.

Task shifting is the name given to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers.

By reorganizing the workforce in this way, task shifting presents a viable solution for improving health care coverage by making more efficient use of the human resources already available and by quickly increasing capacity while training and retention programmes are expanded. In Nigeria, pharmacists, biomedical scientists, nurses, physiotherapists and respiratory therapists in Nigeria all could potentially have their roles expanded to fill the gaps left by limited numbers of doctors.

4. Invest in Primary Care

90% of people’s health needs across their lifetime can be provided by primary healthcare from maternity care and disease prevention through vaccination, to management of chronic conditions and palliative care.

-Lancet

Currently, only 20% of Nigeria’s primary healthcare facilities are functional. Thus, children with mild illnesses that are preventable lack access to the medical care services they need

Spending on health care in markets with a larger percentage of primary care physicians (PCPs) is lower at any point in time than is true in other markets

-Chernew at al

Bearing this in mind, a deliberate approach at redirecting existing polices and current healthcare management models to focus and emphasize on a more decentralized-but funded and supported-primary healthcare system along with developing public health infrastructure would be a great step in the right direction.More efforts must be channeled to ensuring primary care is made available at grass root levels

Coca-cola in partnership with the Federal Ministry of health, SDGs and Medshare has launched the Safe Birth Initiative; let’s bring mum and baby home alive.

Their activities are categorized as;

1. Procurement: Purchase of new equipment safe for use for mother and child in 15 selected hospitals.

2. Training: Train biomedical engineers to ensure adequate functionality of the equipment.

3. Reactivation: Old and abandoned equipment are reactivated by the trained biomedical engineers rather than disposing them

4. Advocacy: Value oriented campaign to get different stakeholders committed to the cause.

This shows this is a great example of how the private sector can partner with governments in Nigeria and across Africa to help enhance our healthcare system.

Conclusion

Bringing more mothers and babies home alive will involve collaboration between a host of different organisations and stakeholders from the government, non-profit sector and the private sector.

This article outlines some of the challenges we face and the solutions that we can implement to help make this goal a reality.