Professor Atiene Solomon Sagay - University of Jos Institutional ...

In developed countries, the advent of modern obstetric care in the late 1930s gradually moved
the process of childbirth from home to institutional settings, with post-partum follow-up and
care by a skilled health-care provider. In most developing countries including Nigeria, the
majority of women deliver at home without skilled health-care providers. The Nigerian
Demographic and Health Survey 2008 reported that in the North-central zone of Nigeria,
65% of pregnant women receive antenatal care while only 41% deliver in health facility
(NDHS 2010). In Plateau State, Nigeria in 2004, a total of 71,655 women attended at least
one antenatal visit but only 22,640 delivered in health facilities, indicating that over twothirds
of women who attend antenatal care still deliver at home. Little wonder that we
reported a maternal mortality ratio of 740 maternal deaths / 100,000 births (Ujah et.al 2005).
The challenges to be met are not new technologies or new knowledge about effective
interventions, because we mostly know what needs to be done to save the lives of mothers
and newborns. The real challenges are how to deliver services and scale up interventions,
particularly to those who are vulnerable, hard to reach, marginalized and excluded. Effective
health interventions exist for mothers and babies such as post-abortal care, emergency
obstetrics care, immunization, nutrition counselling and reproductive health services.
However, none will work if political will is absent where it matters most: at national, state
and local government levels.
A key constraint limiting progress is the gap between what is needed and what exists in terms
of skills and geographical availability of human resources at local, state and national levels.
The Midwifery service scheme which is being implemented by the federal government
through the national primary health care development agency (NPHCDA) is a commendable
step. The table below highlights the nursing personnel gaps in PHCs in all 17 local
government areas of Plateau State (Table 1).
Other challenges are how to address deteriorating infrastructures; how to maintain stocks of
drugs, supplies and equipment in the face of increased demand; lack of transport; ineffective
referral to and inadequate availability of 24-hour quality services – particularly emergency
obstetric care services – and weak management systems. We need to challenge our policymakers
and unit heads to refocus on the development of viable organizational strategies for
monitoring and evaluation that ensure a continuum of care and account for every birth and
death.
South Africa is one of the few developing countries with a national confidential inquiry into
maternal deaths. 164 health facilities obtain audit data for stillbirths and neonatal deaths, and
a new audit network does so for child deaths. Three separate reports have been published,
providing valuable information about avoidable causes of death for mothers, babies, and
children. The leaders of these three reports have united to prioritise actions to save the lives
of South Africa's mothers, babies, and children (Bradshaw et al 2008).
Nigeria should establish a national confidential inquiry into maternal deaths and mandatorily
obtain audit data for stillbirth, neonatal and child deaths. Although Edo and Ondo States have
already promulgated the enabling laws, I advocate a national buy in and leadership at the
national level.
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