With an estimated population of about 9.8 million people, Kaduna state ranks as the third most populous state in Nigeria. Kaduna has a high fertility rate, on average women of reproductive age between 15-45 years are likely to have 5 children. Modern contraceptive prevalence rate is still very low in Kaduna at 13.7%.
Evidence in Kaduna shows that 4 out of every 5 women give birth at home without skilled birth attendants (NDHS 2018). This situation is contributing to the high maternal death in the state. Women and girls who get access to skill birth attendance and at a health facility are more likely to survive.
Kaduna State Maternal Mortality Ratio is 452.6 deaths per 100,000 live births and neonatal mortality rate is 63 deaths per 1,000 live births. Globally the target is to reduce Maternal Mortality Ratio to 70 deaths per 100,000 live births and neonatal mortality to 12 deaths per 1000 live births by 2030. Nigeria has committed to the Sustainable Development Goals (SDGs); therefore, the work is cut out for leaders in Kaduna to deliver on this commitment and SDG 3-Health and Wellbeing for All.
The World Health Organization (WHO) recommends a system to audit each death of a mother and baby with an aim to improve quality of care and prevent future mortalities. This is the Maternal Perinatal Death Surveillance & Response (MPDSR) system has been adopted by many countries including Nigeria and subsequently Kaduna State.
Community-MPDSR & Working in Partnerships in Kaduna
To effectively address these challenges facing the state, Evidence for Action (E4A)-MamaYe and State Primary Health care Board (SPHCB) , in collaboration with Population and Reproductive Health Initiative (PRHI) piloted a community-MPDSR (c-MPDSR) model in two communities of Soba Local Government Authority (LGA) in Kaduna.
This c-MPDSR pilot model produced a study which has shown that communities can identify and discuss causes of maternal and perinatal deaths and come up with actions that save lives and improve the health of women and newborns.
Therefore, the need to scale up the c-MPDSR model across other LGAs and communities in Kaduna requires partnerships and collaboration between communities, civil society, and state actors. Working in partnership creates a better chance of enhancing services that meet people's needs and improves health outcomes.
So far, E4A-MamaYe has facilitated series of partner coordination meetings. These meetings have resulted in the development of a scale-up plan for c-MPDSR, targeting 5 additional LGAs in Kaduna with high maternal mortality.
In addition, implementation of MPDSR activities in the state is challenging as there is no dedicated funding in the state budget. Stakeholders through the Kaduna State Led Accountability Mechanism (KADMAM) has been engaging the state government in evidence based advocacy to ensure a dedicated budget is established KADMAM will present an advocacy brief for the establishment of a c-MPDSR budget line during the state Annual Operational Plan (AOP) in preparation for the 2024 Kaduna state budget.
Monica Blagescu and John Young in their paper titled 'Partnerships and Accountability: Current thinking and approaches among agencies supporting Civil Society Organizations' stated that genuine partnerships are not an end in themselves – they are practiced and promoted to strengthen the capacity of the partners and ensure that the results of the partnership will be both relevant to target groups and sustainable in the long term.
E4A-MamaYe’s approach to partnership with KADMAM involves providing demand driven technical assistance. In the past years, E4A has built the capacity of advocates within KADMAM on effective gender transformative advocacy, made tools available for other organizations to use on implementing c-MPDSR and supporting KADMAM with a seed grant to build its organization and attract other funders to support their advocacy efforts.
In recent years, however, there has been a shift towards a more collaborative, mutually beneficial type of partnership. In this new partnership model parties join their resources to achieve common benefits.
A great example is in 2022 when E4A-MamaYe collaborated with the LAFIYA project, Save the children and Partnership to Engage, Reform and Learn (PERL) to support KADMAM disseminate health budget performance and BHCPF score cards including presentation of advocacy asks during the open Kaduna quarterly interactive forum with health sector actors in the state. A result from this collaboration was the sustenance of 15% health budget allocation to health from 14.7% in the year 2022 to 15.9% in the year 2023.
E4A strategy is to harness more of these partnerships and provide stakeholder coordination efforts in Kaduna State. This we believe will accelerate and sustain efforts to improve health outcomes of women, girls, and babies in the State.