The mere mention of maternal mortality rate (MMR) in Nigeria most often elicits embarrassing statistics and comments. It has been so for decades. With a maternal death rate of over 800 per 100,000 deliveries, Nigeria has continued to remain among the four countries with worse maternal health indices; the others being India, Pakistan and Bangladesh. Recent findings even rated Nigeria as second to India in world’s worse maternal related death. In the main, the implication of this is that Nigeria is still very backward in her human capital development, suggesting, of course, that the country’s healthcare structures are ill-equipped to save lives from preventable deaths of women, such as those from pregnancy and child births.
Unfortunately but expectedly, experts and analysts still rate the entire country poorly without taking into cognizance efforts of some state governments that have deliberately put structures in place to tackle maternal mortality headlong. In Delta State for instance, the fight to frontally combat high maternal mortality started in November, 2007 when the Dr Emmanuel Uduaghan-led administration launched the free maternal programme in Ughelli. The programme recognizes the inhibitory factor of poverty to accessibility of healthcare and thus provides free antenatal, laboratory, pharmacy and surgical services right from conception to six weeks after delivery, inclusive of caesarean section. This is in addition to the engagement of additional staff, provision of blood for the needy and construction of Integrated Mother and Child Care Centres. The idea is in consonance with the Millennium Development Goal No. 5 that is targeted at reducing deaths resulting from pregnancy and child birth to 75 per 100,000 live births by 2015.
According to a survey carried out by the UNFPA in 2005 the maternal death rate in Delta State was put at 456 per 100,000 live births. Another done three years later (2008) by the National Demographic and Health Survey showed that the maternal death rate was 545 per 100,000 live births. It has been four (4) years since the free maternal programme started and statistics gathered from hospitals across the state showed that there has been a steady improvement in the fight against maternal mortality.
In the first year of the programme covering November 2007 to October 2008, a total of 54,193 women benefited in the antenatal bookings with 143,273 routine antenatal visits recorded. A breakdown of the figure indicated that 1,871 women benefited from the free caesarean section while the MMR for the period reduced in the state from 545 to 395 per 100,000 deliveries.
Similarly, in the second year of the programme that covered November 2008 to October 2009, a total of 44,488 women benefited from antenatal bookings with 170,972 routine antenatal visits recorded. One of the significant achievements for the period is not just that 2,520 women received free caesarean section but that the MMR reduced further from 395 in the previous year to 301 per 100,000 deliveries.
The third year of the programme covering November 2009 to October 2010 recorded 42,571 beneficiaries in the antenatal bookings while 141,489 routine visits received attention, out of which 2,310 women got free caesarean section. The MMR for the period also recorded significant decline from 301 to 276 per 100,000 deliveries.
The period from November 2010 to October 2011, representing the fourth year of the programme showed that 52,636 women benefited from the antenatal bookings while 175,723 visits made by the women were given due attention. Out of those registered, 2,836 benefited from deliveries through caesarean section. The fourth year equally recorded significant decrease in the MMR from 276 to 221 per 100,000 deliveries.
It is obvious that the MMR in Delta State has progressively reduced over the years, owing to the timely interventionist package encapsulated in the free maternal programme. However, the state hospitals’ authorities are of the view that the strides made could have been more if poorly managed cases had been brought to government hospitals on time, particularly those of eclampsia; a condition of persistent but increasing high blood pressure that sometimes accompanies pregnancy, especially the first.
As at 2011, the MMR in the State has reduced to 221 per 100,000 deliveries while 193,888 women have benefited from the free maternal programme which also includes 631,457 routine antenatal visits and 9,537 free caesarean section. However significant this feat may be, what is more paramount to the state commissioner for health, Dr Joseph Otumara, is to further reduce the maternal death figure to 150 by 2013 and eventually to 75 by 2015. A major impediment to achieving these targets, according to the Honourable Commissioner, is the patronage of quacks by expectant mothers saying this allows for mismanagement, unnecessary and prolonged retention of very ill patients and possibly death. ‘There is no reason why any woman should go to unrecognized birth attendants when the state is giving them free and qualitative services’, the commissioner queried, adding: ‘we have put in place the structures and we are well able to reduce maternal mortality rate to two digits by 2015.’
With the structures and achievements on ground so far in enhancing maternal health, there is no doubt that Delta State is very much on course to meeting the maternal health targets of the Millennium Development Goal (MDGs). The snag, if any, is that the State does not blow its own trumpet despite being the foremost in the country in terms of having a comprehensive maternal health package that is not only free and qualitative but also accessible to Deltans and natives of other states. This is evident in the 65 hospitals that the State manages and spread across the 25 LGAs, out of which six have been upgraded to a central status, acting as referral centres to the general hospitals. In addition there is the Specialist/Teaching Hospital with state-of-the-art facilities such as Magnetic Resonance Imaging (MRI), CT Scan, Fluoroscopy Machine, ECG, Ultrasound, automatic ventilators and complete patient monitors. The teaching hospital, with trained and experienced workforce, is grouped among the few best in Africa. It is noteworthy that the state also boasts of 446 functional primary healthcare centres (PHCs) which far exceeds the national and WHO recommended number of 225, considering the State’s land mass and the one PHC for every five kilometre radius target.
A conducive health structure and package of this magnitude is certainly the envy of all. This is why it is no longer news that even indigenes of neighbouring states and elsewhere cross borders on daily basis to benefit from the state’s big-hearted disposition towards healthcare delivery. Sometime in the recent past, there was a case of a woman of Taraba extraction who relocated temporarily to Delta State because of the need to have her baby delivered free through caesarean section. Cases of this nature are commonplace but for the State Government, any sacrifice to reduce the maternal mortality rate in the State will not be too much to bear. On how the State Government hopes to tackle non-Deltans infiltrating the scheme, Dr Otumara said, ‘We do not see the need to start screening beneficiaries of the scheme to eliminate non-Deltans because such measure would end up creating bottlenecks that would defeat the very essence of the programme to drastically cut down maternal mortality rate in the state.’
The effort of the Delta State Government in reducing maternal deaths may be viewed by some as small but it nevertheless contributes significantly to reducing the MMR in the country especially as people from other states are also beneficiaries of the free maternal programme. This feat has not gone unnoticed; which is why officials of the World Bank who were on a sectoral assessment tour to the State recently rated the health sector as the overall best in performance index. A testimonial of this stature can only get better for a state government with so much paragon of rare political goodwill to perfect the lots in the health sector.
–Mr. Oyowe is the Head, Public Relations, Delta State Ministry of Health, Asaba.