Maternal health is one of the big health issues facing Nigeria today. A woman’s chance of dying due to complications around pregnancy and birth in Nigeria is 1/15, compared to 1/5000 in developed nations. It is estimated more than 53,000 women and 250,000 newborns die each year due to preventable causes.
The NPHCDA was charged with establishing a programme in response to the high number of maternal and child mortalities at birth. As a result the Midwives Service Scheme (MSS) was launched by the NPHCDA in 2009. Its focus is on ensuring there is skilled attendance at birth to reduce maternal, infant and child mortality.
The programme has five key components:
1. Institutionalising community participation
We are recognising the role of the community in the success of the scheme, and involving local Ward Development Committees across all 652 primary health care (PHC) facilities.
2. Deploying skilled birth attendants in rural communities
More than 2,600 trained midwives have been deployed at PHC facilities to support more mothers and babies across Nigeria.
3. PHC support with basic equipment and supplies
The PHC is supplying basic equipment and supplies needed by midwives. These include BP apparatus, stethoscopes, scales, midwifery kits, essential drugs and consumables as well as service guidelines.
4. Capacity building and training of midwives to improve the quality of care
On top of their traditional midwife training, all midwives have been trained in Life Saving Skills (LSS) and Integrated Management of Child Illness (IMCI). This ensures they have the skills needed to save lives.
5. ICT communications support
The programme is connecting midwives to other health workers and support services through a new communication system. In addition to voice and data transmission, midwives can use internet and video conferencing that can work with mobile technology.
The programme is being delivered using a ‘cluster’ or ‘spoke and hub’ model. Four PHC facilities have the capacity to perform basic obstetric care. These are clustered around a general hospital to which the PHC can send patients for emergency care. The scheme currently has 163 clusters comprising 652 PHC facilities around 16 general hospitals.
To ensure the programme’s success a Memorandum of Understanding has been signed between Federal and State Governments. It has the support of strategic partners including WHO, UNICEF, UNFPA, PRRINN-MCH, Pathfinder International, ACCESS/JEPHIGO and PPFN. The programme is also part of Nigeria’s commitment to the United Nations Millennium Development Goal (MDG) 5, which sets out to improve maternal health and reduce the maternal mortality rate by three quarters by2015.
To ensure the programme achieves its objective of reducing maternal, infant and child mortality, the MSS has outlined a set of targets to be achieved by 2015. They are:
- To ensure all midwives recruited under MSS are trained in LSS and IMCI
- To increase the proportion of primary health care facilities offering a 24hr, qualified midwife-managed service by 80%
- To increase the proportion of pregnant women receiving antenatal care from 60% to 80%
- To increase the proportion of primary health care facilities providing essential/emergency obstetric care (BEOC) by 60%
- To increase the proportion of deliveries attended to by Skilled Birth Attendants form 36.3% to 72.6%
- To increase contraception (Family Planning) uptake from 13% to 50%
- To reduce maternal, newborn and child mortality by 60%
While there is still much work to be done to meet both the targets of MDG 5 and 2015 programme goals, there has been good progress to date.
- More than 2,600 midwives have been deployed to over 650 rural health centres across Nigeria
- 650,000 Mama kits for safe delivery have been distributed
- 2,300 midwives have been trained in life-saving skills
- 650 rural centres now have communication links to the national operations hub
- 160 medical officers are now trained in emergency obstetrics
The MSS programme is driven by the NPHCDA goal of improving access to basic healthcare services, and the United Nations Millennium Development Goal 5: improving maternal health.