EU/UNICEF Reducing High Maternal And Infant Mortality Through HTR programme in Bauchi
By Huseyn Abubakar Mbar (NAN).Huseyn
Iya Abdullahi, is a mother of eight, and hailed from Jabbal Settlement in Bindir Ward of Katagum Local Government Area of Bauchi State. At 35, Iya’s one desire is to have more children in keeping with the tradition of her people.The Islamic tenent on inheritance provided that a larger share of inherited wealth goes to the woman with the highest number of children.This is even more compelling if the woman has more Male offsprings.
But Iya’s dream for more children ended too soon and in a tragedy. Expectedly, she was in a high spirit before she went into a prolonged labour.Iya bled profusely and died after she was delivered of her baby prematurely. The baby also died shortly after due to the absence of a health facilities in the settlement about 10km away from Azare Federal Medical Center (FMC), the Katgum Counci’s headquarters.
Iya is not the only victim of the seemingly high mortality rate in Bauchi State. Addaworo Muhammed, also 35, of the same settlement, had aborted eight children due to lack of modern health facilities that would have avert such ugly trend. Available statistics show that over 1.5 per cent of pregnant women die from pregnancy-related complications in the area.This translates to about 1,559 women in every 100,000 births, the figure showed.
World Health Organisation data corroborated the simily ugly data. WHO said that the maternal mortality rate in the state is far above the national average of 800 per 100,000 births. It said that the figure rippled the 300 deaths per 100,000 births in the entire South-West states. Besides, WHO said, was not significantly better among the under-five- year-old. WHO reports, said that the under five Mortality rate in the state stands at 596 per 100,000 birth clearly indicates that the state parades one of the highest maternal mortality rates in the world.
But what exactly is responsible for the high maternal and infant Mortality rates in Bauchi State? Available records showed that the state government had accorded health sector priority in its budgetary allocation annually in the last 12 years. Former gov. Muhammed Abubakar of the state had between 2015 and 2019 evolved a five-point health agenda to salvage the sector but was thwarted by lack of release of the budgetary allocation to the sector. Some stakeholders have adduced reasons for the ugly situation.
The EU/UNICEF Team Leader in charge of Hard To Reach (HTR) Project in Katagum Local Government Council, Mrs Adebisi Ibinola, corroborated the statistics revealed by The Nigeria Democratic and Health Survey (NDHS), 2018 that the rate of maternal rate of the state was 596 deaths per 100,000 births and said maternal Mortality rate in the state called for concern when compared with the national average.
Of the 63 per cent of women who received antenatal care from health professionals in the state, she said, only about 17 per cent had their babies with help from trained professionals.
Ibinola, who is also a retired Nurse and Midwife, believed that the high teenage pregnancy and unsafe abortion rates in the state had also compounded the ugly trend. She blamed the state’s high maternal Mortality rate on the low socio-economic status of women. This, she argued, had denied women access to modern reproductive health services due to the high cost of health services.
Another reason, she said was distance to health facilities “bad roads and poor attitude of health providers to pregnant women are also contributing factors,” Ibinola said.
Other factors, she said, included socio-cultural barriers that prohibit women from accessing reproductive health information and services. The factor that a woman must first seek permission from her husband before leaving home for the hospital contributes to the problem.
Ibinola said even under emergency situations, a woman must not leave home for the hospital without the permission of her spouse.
However, Hajiya Amina Abdu, a retired Nurse and Midwife, who is the Team Leader of HTR in Misau Council of Bauchi State, also corroborated Ibinola saying that the neglect of the health sector by the past administration was the major factor. She also attributed the negative trend to the activities of untrained birth attendants.
Abdu cited othe factors to include harmful traditional practices, poverty, ignorance and malnutrition among women of reproductive age. According to her, some women die due to excessive bleeding caused by pregnancy-related complications. She said that the death of qualified reproductive health experts and the absence of modern health facilities were part of the problem.
The health sector, Abdu said, was starved of funds during the past years.
In a determined efforts to improve healthcare delivery services particularly on maternal and child health, UNICEF-Nigeria received funding to the tune of €54m Euros from the European Union (EU) in 2017 to support Bauchi State implement health care services under the project titled, “Strengthening Primary Health Care and Community Resilience for Improved Maternal, New-born, Child Health & Nutrition (MNCHN),” in three Northern States of Nigeria.
The €54 million-euro multi-sectoral health and nutrition project being implemented across the three states of Adamawa, Bauchi and Kebbi by EU/UNICEF, is aimed at supporting the benefiting States to strengthen Primary Health Care (PHC) and Community Resilience for Improved Maternal, New-born, Child Health and Nutrition (MNCHN) in the three States.
The goal according to the Communication Officer of UNICEF, Bauchi Field Office, Sam Kaalu is to significantly contribute to the reduction of maternal, new-born and child mortality and morbidity in the three states towards the achievement of Sustainable Development Goal (SDG) with overall objective of improving the nutrition and health status of women and children through a sustainable primary health care delivery system and improved community resilience.
In Bauchi state, accordiing to Kaalu, several interventions are being carried out to meet the objective, with many achievements recorded including, Supply of standard equipment to all 323 main PPrimary Health Care Centers (PHCCs), in the state (PHC/ward), Health workers trained to improve their capacities in delivering quality of care services in the PHCs, including Modified Life Saving Skills (MLSS), Quality of Care, Prevention of Mother-to-Child Transmission (PMTCT), Integrated Management of Common Childhood illnesses (IMCI), Integrated PHC services, Health Management Information Systems
Also achieved is, Free commodities supplied to the main PHCs to ensure free treatment for all under 5-year-old children; free Ante-natal Care (ANC), hospital deliveries and post-natal care (PNC), including screening of every pregnant woman for HIV; and providing the ones confirmed positive with Antiretroviral drugs to prevent mother-to-child transmission.
The intervention also recorded Engagement of volunteer health workers (Nurses/midwives, Community Health Extension Workers, CHEWs; Junior Community Health Extension Workers, JCHEWs) and record officers to visit hard-to-reach (HTR) communities that find it difficult to access standard health care services in the PHCs in nine Local Government Councils of Alkaleri, Bauchi, Toro, Ningi, Ganjuwa, Misau, Katagum, Zaki and Gamawa.
Several integrated services including ANC, PNC, management of labour and deliveries of pregnant women, immunization, nutritional screening, screening and treatment of common childhood illnesses (Malaria, Pneumonia, and Diarrhoea diseases), and treatment of common ailments, are provided at the community level. The nine teams in these LGs have attended to over 90,900 under 5 children and over 8,500 pregnant women who all benefitted from one or more of the integrated services being provided.
Also, a total of 1,200 Volunteer Community Oriented Resource Persons (CORPs) were trained on Integrated Community Case Management (ICCM) of common childhood illnesses (Malaria, Pneumonia, and Diarrhoea disease) with guidelines and protocols to follow to continually deliver treatment of these illnesses in their various HTR communities
According to him, all These volunteers who cover 1,200 settlements, are from the settlements they cover and reside in these settlements. They are kitted with tools and commodities necessary for easy diagnosis and treatment of children aged two months to under-5 years (59 months). They were also trained to refer conditions with danger signs that are beyond what they were assigned to treat. Health workers from the main PHC in each ward where the CORPs operate were also trained and empowered to supervise the CORPs monthly.
It is also a strategy to bridge the gap of easy access to PHCs by those HTR communities. All treatment is free. So far, the CORPs have seen and attended to over 93,000 under 5-year children and treated over 68,000 for malaria, diarrhoea, and pneumonia in those HTR settlements.
Furthermore, Community-based Management of Acute Malnutrition (CMAM) according to him, was one of the interventions of UNICEF in the state before the coming of EU-UNICEF MNCHN project. However, the project scaled up the intervention, previously in only three LGAs (Kirfi, Katagum and Dambam), with additional six LGAs (Bauchi, Darazo, Gamawa, Itas Gadau, Tafawa Balewa, and Warji) to nine LGAs. This has led to screening, admission, and successful treatment of 91.4% of over 24,000 severely malnourished children in the six EU/UNICEF funded CMAM sites. EU/UNICEF also provides micronutrient powder (MNP) to six and 23 months old children in the state, especially through the CMAM sites to prevent malnutrition; and has since commencement in the second quarter of 2018, reached 84,482 children aged six and 23 months with MNP covering 168% of the project target.
The project also engaged the services of Clinical Mentors (Doctors and Midwives from General Hospitals, and the LGA MCH Coordinator) in all LGAs to visit all main PHCs in each LGA to continually mentor the health workers to ensure quality of care just as 212 Motorcycles have been supplied to selected main PHCs to help the health workers carry out outreach integrated services to distant settlements.
Also, Renovation of selected PHCs (108) to improve infrastructure is ongoing, with 32 already completed just as Conditional Cash Transfer (CCT), a Social Protection Program (SPP) in three LGAs (Bauchi, Katagum and Misau) where a pregnant woman is enrolled into ANC and given transport fare of N1,000 in each of her recommended four ANC visits; N4,000 when she delivers in the health facilities and child receives first immunization vaccines, and N1,000 in each of the next four immunization schedules for the child.
These amount to a total of N12,000 for one woman from pregnancy stage, through delivery, to fully immunized stage of the infant. This strategy is designed to bridge the gap of financial barriers hindering pregnant women in remote communities from attending ANC; delivering in the hospital or fully immunizing their children against preventable diseases. Over 3,500 women have benefitted from the scheme in the three supported PHCs.
The project has also supported the state through National Population Commission (NPopC) and State Primary Health Care Development Agency (SPHCDA) to conduct Birth Registration (BR) of children through mass campaigns and through routine Birth Registration at the PHC levels; and so far, over 1,420,000 under 5-year children have been registered and received Birth Registration certificates.
He concluded that these, amongst several other interventions, are the strategies employed by UNICEF to meet the objectives of the European Union (EU) funded MNCHN project.
The HTR projects in Katagum and Misau Local Government Councils according to findings is that of success story. Alhaji Suleiman Hassan, the Village HTR Mobilizer who is also the Head of Jabbal Village, described the activities of EU/UNICEF to his people as a “miracle.”
Ibrahim Musa of Garin Mallam Barka, corroborated his Jabbal counterpart, saying ” the ailments that my people were known for before the coming of this project is gone.
“Though in the beginning, we were sceptical and thought it was another gimmick towards another means of birth control and rejected all the medications.
“With persuasion and enlightenment campaigns from the council headquarters and the team managers we accepted it and today it has become a blessing to us,” he said.
Ibinola, disclosed that the team had treated 12,259 pregnant women and children below five years of age in 16 settlements in Bidir, Madara and Magunshi Wards all in the hinterland between October 2018 and December 2019.
She said that the clients were treated of cases of malaria, pneumonia, diarrhoea and pregnancy related problems, while clients with serious problems were referred to Kuskuri health facility and Federal Medical Centre (FMC), Azare.
The team leader said that the programme had impacted positively on the health status of pregnant women and children during the period.
She, however, appealed to the state government to assist the team with motorcycles or Four-wheeled driven vehicles to enable them perform better.
One of the volunteers, Malam Adamu Umar, who led NAN correspondent to the affected areas, said that at the beginning the communities were so sceptical and unwilling to accept the programme.
Umar said that the communities made a reverse when they discovered that the few ones that had earlier accepted the services were living better than those who refused to accept it.
He identified lack of transportation to access the settlements and called on the government and philathrophists to assist the team with motorcycles to enable the team excel in its work.
The community heads of Jabbal and Garin Malam Barka, Messrs Suleiman Hassan and Ibrahim Musa, commended EU and UNICEF for the gesture, which according to them, had improved the health status of their women and children.
“Before the coming of EU/UNICEF, we convey our pregnant women and sick ones on donkey, Ox-Drawn Trucks or motorcycles to nearby health facilities which is about 15km and 20km ,” said Hassan.
“Our pregnant women who have hitherto had no knowledge of antenatal, post natal care and child diseases were being taken care of by the team.
“Though the team visit us once in a month, the services rendered to this group are tremendous and wonderful,” Musa said.
The leaders who are also the Village Mobilisers of the programme, called on the state government to provide them with roads, health facilities as they lack such amenities as motorcycles remain the only means of transportation in the area.
They also called on the state government to sustain and scale up the programme to enable them benefit more from it.
Some of the beneficiaries who spoke to NAN in separate interviews also commended EU/UNICEF for the gesture.
Hajiya Fatima Mohammed, 40; Malama Adama Suleiman, 30; Mr Adama Sani, 25; and Madam Hajara Yakubu, 35; said that they have never attended antenatal care except with the introduction of the programme.
They said that it has helped in promoting mother and child health care, thereby, reducing maternal and infant mortality in the area.
They also called on EU/UNICEF to sustain and scale up the programme and in instance it had to end the programme, they urged the state government to sustain it.
The Team Leader of the programme in the Misau council, Hajiya Amina Abdu, said that between April 26, 2019, and Oct. 22, 2019, the team treated 11,937 patients in 16 settlements of Sarma, Dunkurmi and Kafin Sule wards of the council.
Abdu, who is a retired Nurse and Midwife, disclosed that the team had also treated 10,289 patients between May 2019 and November 2019 in another 16 settlements under Ajali, Sirka and Beti wards of the council.
She called on the state government and other non-governmental organisations to sustain the programme after the EU/UNICEF might have pulled out of the areas due to its importance.
The team leader said that the beneficiaries were under-5 years children, who may be suffering from minor diseases and antenatal care to pregnant women.
She said that cases considered beyond their capacity were either referred to Dankwi Kasuwa Primary Healthcare Centre or Misau General Hospital, a five-hour journey, to access the facilities.
Mr Abdullahi Musa, a volunteer, said that when the team started, most of the parents were sceptical and preferred alternative medicine to the conventional ones, but the situation had changed for the better.
Some of the beneficiaries interviewed expressed delight towards the EU-UNICEF project and called for its sustenance.
Some communities in the council’s areas say they use donkeys and ox-drawn trucks to transport pregnant women and sick people to hospitals due to lack of motorable roads.
The communities disclosed this when a News Agency of Nigeria (NAN) correspondent visited Babuwuri and Ngummachame settlements, which are tagged“Hard-To-Reach (HTR)” in terms of healthcare by the EU/UNICEF.
The Heads of the settlements, Malam Magaji Abdu and Alhaji Ahmadu Garba, disclosed that the only means of transporting pregnant women and sick ones to health facilities were donkeys and ox-drawn trucks.
“This is due to the hard to reach nature of our settlements coupled with the lack of road networks and distance from health facilities.
“If a woman developed obstructed labour or any delivery complications as well as sick ones who cannot be conveyed on motorcycles, the last option is to use either donkeys or ox-drawn trucks.
“This is done over a distance of 20km or 15km depending on the location of the settlements and health facilities,” Abdu said.
The community leader, however, thanked God that in 2018, the EU/UNICEF introduced a health programme whereby a medical team came to their settlements once a month to conduct antenatal on pregnant mothers and children below five years.
On his part, Garba said: “They visit our settlements once in a month and render various medical services including antenatal, nutritional, minor ailments, immunisation and others.
“Fortunately for us, both the services and drugs are given to us free of charge and it has reduced both maternal and child mortality rates.”
The community heads, who are also the village mobilisers for the programme, stressed that in spite of EU/UNICEF assistance, they still used donkeys and ox-drawn trucks to convey patients during emergencies.
They called on the state government to provide them with roads, health facilities and schools, as well as to sustain the EU/UNICEF outreach programme in their areas.
They said that their children and pregnant women were given antenatal care and treatment from minor ailments.
This, perhaps, informed the decision by Gov. Bala Mohammed of the state to declare state of emergency in the health sector immediately he assumed office. Mohammed said that the health facilities he inherited from his predecessors were unfit for to provide medical services to the people. According to him, the facilities also poised great danger to the lives of patients due to their “pathetic state.” He, therefore, allocated a lion share of the 2020 budget to the health sector. (NAN)