Ondo State pays traditional birth attendants to get them off pregnant women

Ondo State is not resting on its oars after successfully launching the Abiye Project, which is why it has determined to get TBAs off the back of pregnant women completely to enhance absolute safe pregnancy delivery, but not by providing no other means of livelihood for the TBAs!
After the rollout of the Abiye program in 2009, the Committee for the Confidential Enquiry on Maternal Death in Ondo State (CEMDOS) conducted a research in 2010 to determine the causes of death of pregnant women in the State. The result of the survey showed that 90% of deaths occurred due to delay from Traditional Birth Attendants (TBAs) and the Mission Home Birth Attendants (MHBAs) in seeking medical care for their clients.This informed the government to seek partnership with the TBAs and MHBAs to refer all pregnant women who come to them to the nearest health facilities immediately.The government offered to provide the sum of N2, 000.00 for each referral done, give them skills on various trades and grant those who acquired new skills microcredit facility of N50, 000.00 each. When the N50, 000.00 is returned, the value of the microcredit will be doubled to N100, 000.00 each.Those who disregard the government partnership and provision and fail to abide by the new directive will be prosecuted.Agbebiye Initiative is a rider on the successful Abiye Project. It was launched on September 4, 2014 in Akure, the capital of Ondo State and was attended by the delegates from Ministries, NGOs, religious and traditional bodies. As people were entering the venue of the launch, the Environmental Health Officers blocked the entrance and mandated everyone to wash their hands at the running water points, rub on hand sanitizers and be screened for Ebola Virus before entry.Health workers manning handwashing section before entering the hallTraditional ruler sets the handwashing exampleAmidst pomp and pageantry with traditional music and cultural dance that heralded the entry of dignitaries and the State Governor, the program was opened with 2 documentaries to tell the story of horror of childbirth due to delays from TBAs and MHBAs and the interventions that have been put in place by the government of Ondo State.The CMD of Mother & Child Hospital Ondo and Chairman of CEMDOS, Dr. Lawal Oyeneyin, anchored the documentaries. Dr. Oyeneyin said talking about these situations will not effectively drive home the point to the people, but watching it happen makes better sense. Data that came up in one of the documentaries showed that 114 maternal deaths out of 4, 500 were traced to the TBAs/MHBAs.Cross section of attendees at the launchDr. Oyeneyin also stated that the Mother & Child Hospital has become a learning centre for Obstetricians beyond the shores of Ondo State and Nigeria (they had students from the UK!).PARTNERSIP THAT WORKSWorld BankDr. Odutolu, a Senior Health Specialist at the World Bank acknowledged that the Agbebiye initiative has included wealth distribution in its intervention (skills acquisition & micro-credit facility), which is in line with the World Bank objectives. He said the World Bank is ready to partner with the State on this. He charged the State Government not to neglect interventions in postnatal care, which is critical to survival of mothers.United Nations Children’s Fund (UNICEF)Dr. Mariam Abdul represented UNICEF. She led the Kebbi and Adamawa delegates on a study tour to Ondo State. She felicitated with Ondo State people and especially the governor for all the achievements they saw in the communities they visited. She stressed on the need for sustainability of all the laudable programs. She said UNICEF is ready to partner with the State to look at policy options for sustainability.Society for Family Health (SFH)Mr. John Oshiole represented SFH. He stated that SFH is partnering with Ondo State Government to increase access to health facilities, improve the quality of services by building capacity of the health workers, as well as working with the people to accept the program, own it and use the facilities. He said Ondo State is a recipient of the Bill and Melinda Gates Foundation grant to improve the capacity of health service providers, improve routine immunization and support the smooth running of health facilities in the State.Kebbi State House of AssemblyThe Chairman, House Committee on Health, Kebbi State House of Assembly; Hon. Jafaru Mohamed, spoke on behalf of the study tour delegates. He said that he marveled at the level of the success of the health systems the government has put in place, and he is going to replicate such in his State to further strengthen the systems they already have.The Governor’s RemarksOndo State governor, Dr. Olusegun Mimiko, said that the investment on Safe Motherhood in Ondo State is intentional; it is a socio-economic intervention to improve the livelihood of women in Ondo State. It is a process of tracking pregnancy from conception to delivery and to eliminate financial barriers to safe delivery of babies.He said further that since the inception of the Abiye program, there has been up to  70% facility utilization. In 2013, a facility based review was conducted for maternal mortality ratio, and was found to be 223/100, 000 live births, but has since reduced to 187/100, 000 live births in 2014.The governor atthe display of some of the products-hats, beads, liquid soap, tie and dye fabrics e .t.c. made by the TBAs/MHBAsGovernor's wife at TBAs/MHBAs fabric displayHow the Agbebiye Initiative was bornThe CEMDOS review of causes of maternal deaths in 2010 revealed that 90% of deaths occurred due to delay from TBAs/MHBAs. This gave birth to the Agbebiye (which can mean safe pregnancy delivery or safe birth attendant) Initiative. The Initiative has been piloted for 6 months in Akure South local government area. Each TBA/MHBAs is registered and attached to a Health Vanguard and the nearest Health facility to the Birth Attendants home to ensure smooth referral process.The Health Vanguards are to ensure the compliance of each TBA. The TBAs/MHBAs have a register of the clients they refer for follow-up. Each referral attracts N2, 000 for the TBA/MHBA. The referral coupons are then counted per TBA/MHBA to be paid at the end of the month.TBA receives payment cheque for her referrals in AugustFrom the pilot in Akure South LGA for the 6 months;·      618 women have been referred. ·      There have been 362 deliveries. ·      No single maternal death.·      4 sets of twins were delivered.·      2 sets of triplets were delivered.·      1 quadruplet was delivered.The Mother and Child Hospitals now have influx of pregnant women from other States in the country. There is about 30% of influx in Akure and 25% influx in Ondo. The governor said that he had approved the employment of additional 200 midwives to be posted to the PHCs across the State to manage the influx.The governor concluded that it was good that he had a vision, but then, it is better that he has people around him running with the vision to make it a reality. He then declared the Agbebiye Initiative open to scale up to other LGAs of the State.Payment for the Referral Coupons67 TBAs/MHBAs were paid for the month of August at the event, while cheques of N50, 000 each were presented to 100 TBAs/MHBAs who have acquired various skills. They were told that if they return the N50, 000.00, then they will get N100, 000.00 next to keep improving their businesses.MHBA receives payment cheque for her referrals in August

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