Above you see MamaYe Country Director, Dr. Tunde Segun (L) and Ondo State Commissioner for Health, Dr. Dayo Adenyaju (R), during the closeout of MamaYe in Ondo State. Photo credits to Morooph Babaranti.
In 2014, when MamaYe proposed to Abiye in Ondo State, the question was what kind of newborn would this union produce, as the State was already doing well in stemming the rate of maternal and newborn mortality with its Abiye Initiative?
But, MamaYe had a vision. What has become very clear to us is that, reducing the rate of maternal and newborn mortality goes beyond medical interventions and governance. There has to be people's participation, government accountability and evidence based planning. This is what informed our theory of change whereby, using evidence for advocacy to demand accountability results in efficient use of resources to achieve quality of care that leads to saving the lives of pregnant women and newborns.
So, when we started out in Ondo State, we went around and identified exceptional individuals who had contributed to saving the lives of pregnant women and newborns. These individuals were not expecting to be identified or commended in any way; they were just playing their part as people who care. We call them MamaYe champions, heroes and heroines.
Read about our champions, heroes and heroines and their contributions in Ondo State here.
Afterwards, we introduced these individuals to be part of a State-Led Accountability Mechanism (SLAM). They became part of a process of using evidence to advocate for improved maternal and newborn health policies.
In Ondo State, the SLAM was christened Ondo State Accountability for Maternal and Newborn Health (ODAMM). It was made up of CSOs, government representatives from the ministry of health, State Primary Health Care Development Board and Hospitals Management Board, Professional Bodies and the media.
The SLAM consisted of sub-committees on evidence (data) generation, advocacy and knowledge management, and media and communication. These committees produced evidence materials and advocacy briefs that were communicated to the government to influence decisions on MNH interventions. Our champions, heroes and heroines belonged in the advocacy and knowledge management sub-committee.
This happened through a series of trainings. Dr. Francis Akanbiemu, Director, Planning, Research and Statistics, Ondo State Hospital Management Board and Chairman of ODAMM’s Evidence sub-committee, said in a chat that the trainings brought improvement to the State’s MNH data quality and integrity. He said that they’ve now dismembered bureaucracies that once hindered access to data, and that data collection was now done in a way that gave the true position of MNH in the State.He said,
It was not as if we did not have the information before, but MamaYe has come to ignite that fire that is making us to actively collect the data and see how to use it for intervention.
The evidence sub-committee used data generated from Ondo State DHIS2 2013/2014 and NDHS 2008/2013 to develop scorecards, which helped the State to realise grey areas in certain indicators of maternal and newborn health.
For instance, a maternal, newborn and child health scorecard prepared using hospital data from January to December 2015 showed that in health facilities in the 18 local governments in the State, only 2 local governments had a manageable percentage (56%) of pregnant women who registered for antenatal care.
And we know that it is best for a pregnant woman to attend antenatal care at least 4 times during her pregnancy. Attendance of antenatal care helps in early detection of complications that may affect the health and survival of a pregnant woman or her newborn.
With this information, the government could take steps toward increasing the number of pregnant women registering for, and attending antenatal care in all the local governments.
Dr. Adeniyi Aderoba is a consultant gynecologist and obstetrician at Mother and Child Hospital in Akure. He is also the Chairman of ODAMM. He said in an interaction that the government concentrated efforts on combating severe bleeding, which was the major cause of death of pregnant women in the State, and was able to reduce it.
But the focus on severe bleeding shifted to severe sepsis after it was discovered through a January to March 2016 maternal death review data that severe sepsis was the next biggest culprit causing maternal death.
Because of this evidence, the stakeholders had to turn their attention to combating sepsis.
A scorecard may expose a very poor area of performance, which may look embarrassing to the coordinators of the health system. But, scorecards are not meant to shame anyone, rather, they are meant to show where a lot of effort is needed to make improvements. This is why the State's ministry of health requested MamaYe to conduct a capacity building training on the design of scorecards for…(mention who the participants were). This formed part of the legacies that MamaYe left in the State.
In addition, MamaYe championed the institutionalisation of maternal death review (MDR) in the State. MDR is a process of finding out why a pregnant woman died in a health facility, and using the findings to identify avoidable and remediable factors in order to prevent future deaths. After all, it has been established that most of maternal deaths are preventable.
Most health facilities in the State have set up their MDR committees that would help in improving maternal health through data collection for decision making.As MamaYe exits Ondo State, out of numerous others, certain things stand out in the achievements of the SLAM:
- Development of MNH advocacy tools (policy briefs, fact sheets, memos).
- Using evidence to demand improved MNH service delivery.
- The media use of evidence to pick communities in collaboration with OSPHCB and sensitise them on their key roles, the benefits of their participation and involvement in MNH issues.
MamaYe was able to systematically unite policy makers, CSOs, the media and the community using the theory of change. This added a huge value to the successful Abiye project of the State.