The project “Improvement of Maternal Health - Prevention and Treatment of Obstetric Fistula" in Northern Nigeria was initiated by the Rotarian Action Group for Population Growth & Sustainable Development (RFPD), supported by 200 Rotary, Rotaract and Inner Wheel Clubs mainly from Germany and Austria and implemented by Nigerian Rotarians. The core project amounted to 1.2 Mio. US$ and was co-financed by the German Section and Austrian Section of RFPD, by the THE ROTARY FOUNDATION, the German Ministry for Economic Cooperation and Development (BMZ), the AVENTIS FOUNDATION and International Association for Maternal and Neonatal Health (IAMANEH). In addition to this, it enjoyed significant support from Rotary Satellite Projects and contributions from various stakeholder groups with cash and in kind donations amounting to 1.8 Mio US$. It is a comprehensive approach to reduce maternal and child mortality (MDGs 4 and 5). The duration of the pilot project was from 2005-2010. In March 2010 the state governments of Kano and Kaduna took over the project and committed themselves to maintain it enhancing its positive results. This year we will start a scaling up of the pilot project which will run until 2013.
Our comprehensive approach
In an innovative multifaceted evidenced based approach to reduce maternal and child mortality we improved the quality of care in the rural areas of Kano and Kaduna State and introduced quality assurance in obstetrics in ten selected hospitals. By improving the quality of structure (e.g. providing necessary equipment to the hospitals) and the quality of process (e.g. training of health staff) we managed to significantly reduce the maternal mortality in those hospitals (quality of outcome).
In order to include the surrounding communities of the hospitals into the process of improving the quality of care, awareness and advocacy campaigns formed the basis of our approach. We informed the target group about causes and prevention of maternal and fetal mortality and obstetric fistula using radio, television, print media, dramas on the streets (public plays), ‘town criers’ and community dialogues. At this, we closely collaborated with the traditional/religious leaders in the project area which facilitated complete access to the communities. In collaboration with the Public Media Center (PMC) radio drama serials were produced and broadcasted through a local radio station. In ‘Community Dialogues’ held in the surrounding villages of the selected hospitals, the Chief Midwife of the project informed women of childbearing age, Traditional Birth Attendants (TBAs) as well as husbands and parents about nutrition in pregnancy, the necessity of attending antenatal care, the importance of immunization including polio, family planning/child spacing and sending young primiparae to the hospital for delivery. A substantial part of the reduction of maternal mortality within this project was possible with this type of community based intervention.
A comprehensive approach of this scale cannot be done alone. Therefore, we kept all stakeholders well informed and got valuable support from many of them, e.g. supply of solar power for hospitals lacking energy and the provision of antiretroviral drugs for Preventing Mother-to-Child Transmission (PMTCT) of HIV, to name but a few. Where more help was needed Rotary clubs assisted and supplemented the core project with supporting projects (satellite projects) e.g. ensuring reliable water supply to the hospitals and rehabilitation of VVF patients through vocational training and microcredits.
Our comprehensive approach consisted of three major parts:
- Awareness and advocacy campaigns to inform the communities, integrating traditional/religious leaders and governments.
- Introduction of quality assurance in obstetrics improving the quality of structure, process and outcome by regular data collection, analysis and benchmarking process.
- Treatment and prevention of obstetric fistula including rehabilitation through vocational training and microcredits.
The results – a successful model to reduce maternal and newborn mortality
- Introduction and anchoring of quality assurance in ten selected hospitals achieving a reduction of maternal mortality in these hospitals by more than 50%.
- Establishment of two specialized fistula wards (one per state) including rehabilitation facilities and provision of needed hospital equipment.
- 1,500 fistula patients were successfully treated (500 more than planned) and rehabilitated; many of them also got vocational training and microcredits to built up their own small businesses.
- Seven doctors were trained as fistula surgeons and 15 ward nurses were trained in fistula care.
- 43 doctors, 344 nurses and midwives, 200 CHEWS and 197 TBAs were trained on how to improve obstetric services in the ten selected hospitals.
- Hospitals lacking theses facilities were provided with water and solar energy (satellite project).
- 24,000 mosquito nets were provided to the selected hospitals and surrounding communities (satellite project).
- 3,000 IUDs were distributed to the selected hospitals (donation from Bayer Schering).
- TBAs were equipped with delivery kits and anti-shock garments (satellite project).
- Hospitals were provided with drugs for Preventing Mother-to-Child Transmission (PMTCT) of HIV (donation from Boehringer Ingelheim).
The scaling up (start 2012)
Stakeholders and state governments of Kano and Kaduna State found that this project provides a model for reducing maternal and fetal mortality that needs to be replicated in other hospitals. The governments of the states within the project area have been continuing the project since the end of its duration in March 2010. They committed themselves to maintain the created structures and enhance the positive results of the project. We continue with the monitoring and are currently planning a scaling up (expected start: 2012).
The aims of this scaling up are a further reduction of maternal and fetal mortality in the ten selected hospitals and surrounding communities in Kano and Kaduna State and to prove the replicability of the model in the rural areas of the Federal Capital Territory (FCT) Abuja as well as in Ondo State. Apart from the audit process within the quality assurance in the selected hospitals there will also be a documentation and examination of maternal and child deaths in the communities in order to identify their causes and eliminate them.