How Lagos combats maternal, child deaths

MamaYe Nigeria is proud to feature Wole Oyebade of the Guardian Newspaper. Wole is an avid MNCH writer and has again brought great insight into MNCH issues in Lagos in his interview with the Lagos State health commissioner.
As written by Wole Oyebade, first published in Guardian Newspaper on June 27, 2013 via http://ow.ly/mtd8V "Maternal and child mortality ratio in Lagos fair better than the national percentage but the state government is not resting on its oars. Commissioner for Health in the state, Dr. Jide Idris in a chat with reporters, explains strategy currently deployed in the statewide Maternal and Child Mortality Reduction (MCMR) programme to reach zero maternal and infant deaths in Lagos. WOLE OYEBADE was there. ExcerptsSINCE the MCMR programme was launched last October, how far has it gone with the strategy of reaching zero mortality?It is worthwhile to mention that we have various strategies that we are adopting in the programme. For instance, training of health workers and public enlightenment with respect to issues of addressing the major causes of maternal and child mortality – using the platform of what we call the three delays: delay in deciding to seek appropriate medical help for an obstetric emergency; delay in reaching an appropriate obstetric facility; and delay in receiving adequate care when a facility is reached.After these strategies were itemized, we started with the launch last year. Part of the strategies is to also go down to senatorial district levels to continue the sensitisation. And after that, we we’ll go to each of the Local Government Areas (LGAs). What we are doing now is sensitisation at the senatorial district levels. We’ve been to Lagos West I, Lagos East and Lagos West II. The next sensitisation will be at Lagos Central district.Having the LGAs to host the sensitisation programme is a way of getting them to take ownership of this programme because, the thematic areas has core aspects like community involvement and community mobilisation. That is the only way the programme can be very effective because you need to get across to various people especially the masses who live at the grassroots.We’ve started at the state level, looking at our data and we have formulated programmes and strategies. The essence is to disseminate it.  Having started this, we need to get feedback from the communities. Second, the essence of the feedback is to be sure that we are getting across to them.  What are the challenges they are facing at the community level? Are our strategies working? Do they know what they are supposed to do? That is the essence of the sensitisation programme.What are the main issues addressed during the sensitisation programmes?During each one, we address specific theme. We let them know that, first and in term of infrastructure, what kind of facility do they have within that locality especially the Primary Health Centre (PHC)? Where they are located? What are the hours of operations/ what are the services they provide? It is when they know that they are inclined to use the facility. Some of the people don’t know, which is why they go to nearest General Hospital to compound the problem.Second, some of the materials that we have produced – like the maternal and child booklets – we want to use the opportunity to teach the people how to use those booklets and what they are meant for. We let them know that these booklets are free and every pregnant woman in Lagos must have a copy of the maternal booklet and every child less than five years must have the child booklet too. Both contain specific information.In respect to mothers, their booklet has information on the number of pregnancies, history of the pregnancy and also contains some education materials to let them know what to do during pregnancy, what to and not to eat, danger signs of pregnancy, family planning and so on. For the child too, they have database that can trace health issues of the child right from birth up to age five; checking development milestones; weight and heights among other things that are expected of a child.These booklets have been distributed to all facilities in the state and we are also trying to get the private facilities involved. The most important thing is capturing as many pregnant women and children so we can look after them – whether they go to private or public care, it is irrelevant as long as they are accessing the right care.These are the things we want to tell the people and of course, to get them to take ownership in the sense that we’ll talk to opinion leaders in the community so they can mobilise their people. They know the people better than we do. The essence is to create demand because a lot of our people don’t know that these facilities and services exist. That is the essence of these Town Hall meetings.And we are getting responses. Some are coming up with questions on challenges that they face when they go to some of these facilities and we are providing answers. For people who may not have access to us at the programmes but have questions, we have created help lines. They can call: 08074574108; 08074574109 and 08074574110. These lines are manned and any one can call them for help.Some of their questions would bother on blood donationYes. Some are asking questions on why they have to donate blood for pregnant women and we’d tell them why. The truth is that the government cannot produce blood. Again, in pregnancy complications, a major cause of high maternal mortality is bleeding and if blood is not available to replace what is lost, then there is going to complication. It can have negative consequences on the mother and the child. So, there must be blood available especially for those pregnancies that are high risk.We cannot have blood that everyone can use and can only do our best within limited resources, so we expect the people to also do their bit. They must understand that. What we need is enlightenment and sensitisation on this, especially to break cultural and religious barriers. Government with the best of intents cannot meet all needs.What are the findings since the programme began?Let me say that assessment of mortality is not something we can do in one sitting. It is something you have to look at data and survey over a period of time. I can’t tell you now that maternal mortality has gone down because we started last year. But the chances are – based on other indicators that we are seeing – we may be able to tell by the time we do another baseline study.We are seeing more people use the facilities, more people attending outpatient services for children, more cases are treated surgically, especially for those that need Cesarean Section (CS). We are seeing increases in that and we still expect more.October 18th of every year is the Maternal and Child Mortality Reduction Programme day. That day, we will give report on how far we have gone on these activities and give data. From utilization of the facilities, we expect that utilization would have increased and with that, we expect these statistics to get better – the number of people who use ANC clinics, number of people that deliver in PHCs. We expect to see a downward trend in maternal mortality. At least, if you address the causes of mortality, then we are in a better position to expect a reduction over a period of time.What is the role of Traditional Birth Attendants (TBAs) and Faith Based Organisations (FBOs) in this programme?TBAs have a role to play and for a simple reason. These are the people that are culturally accepted by our people and the people visit them. We cannot just do away with them. However, you also do know that a lot of these deaths are recorded from their end because of their practices.Our focus in that area is to see how we can change their behaviour. That is why we have organised training sessions where these people are brought in batches; we attach them to secondary care facilities to undergo some trainings to basically ensure that the people they see are treated in as good quality manner as possible. And after the training, they are given some of these delivery kits to use. It is a way of changing behaviour. Quite a number of them have been trained and it is a continuous exercise.Second, some of them also rotate through the college of health technology where they undergo some of the training. It is the same facility that trains Community Health Extension Workers (CHEWs) and community health workers that work at the PHC facilities. It is part of increasing their capabilities and helping them to do things in proper way.As we are getting more PHCs in place, the people are having better options either to go to the TBAs or use the modern facility. Of course, when they go to the facility where services are provided the best way, then the tendency is high that they would go back. That is the three-prong approach in that area: building capacity, change behaviour and give alternatives.FBO are also needed. In fact, we are discussing with the Ministry of Home Affairs and Culture because there are lots of things that we have noticed. A lot of these cases are badly treated by the FB clinics and we need to address that. We need to organise sensitization meeting with their leaders and draw their attention to them. All these clinics must be captured under our monitor. It is no longer permissible for any FBO to just open a clinic anyhow. There must be order so that people will learn to do things properly.Why are we having more CS done in the state?It is because we have more facilities with the capability to do them. More staff have been trained unlike before where they don’t have places to go to. Some of those cases that we are seeing now are people that might have died because they don’t have access. These are parts of the statistics that we are looking at. We are still tracking. We’ll collate and analyse and look for reasons why we are seeing certain trends.Addressing delays at the care facilitiesIt is a problem but we are looking at a new approach of booking appointments rather than everyone coming to the facility at the same time. We are working out modalities on that, so that you’ll schedule appointment for a particular time of the day."

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