Hope for motherhood as Oyo unveils Tomotiya health plan

Over the years, Nigeria has grappled with high rates of infant and neonatal mortality. In fact, Nigeria’s newborn mortality is among the highest in the world. An estimated 10 percent of all newborn deaths in the world is recorded in Nigeria. The 2018 Nigeria Demographic and Health Survey (NDHS) findings reveal that infant mortality is 67 deaths per 1,000 live births, under-five mortality stands at 132 deaths per 1,000 live births while neonatal mortality stands at 39 deaths per 1,000 live births in 2018.The NDHS 2018 revealed that Nigeria was only able to reduce neonatal deaths by three percent in 28 years.

According to World Health Organisation (WHO) in 2018, majority of all neonatal deaths which account for 75 percent occur in the first week of life and about 1 million newborns die within the first 24 hours of life. Experts have identified prematurity, intrapartum complication, birth asphyxia, infections as the common reported causes of infant, neonatal and maternal deaths. Also, while spacing births at least 36 months apart is recommended, the NDHS report shows that the median birth interval in Nigeria is 30.9 months. This also contributes to neonatal mortality rates as infants born less than two years after a previous birth have high under-five mortality rates.

Poor antenatal care also increases rates of neonatal mortality, neonatal tetanus, malaria, and maternal anaemia. The high mortality rates in Nigeria is not unconnected with issues affecting the nation’s health sector that includes lack of access to quality delivery services, people not having money for adequate health treatment, long distance to health facility and ineffective transportation system, lack of trained health care providers attending to births with an estimated only six in ten mothers receiving antenatal care from a trained medical professionals.

The neonatal and maternal mortality rate in Oyo state is among the highest in the country. Out of the state’s estimated population of 8.4 million, 1.7 million are children under five years of age. In terms of child health, Oyo is characterized by high neonatal morality and low levels of immunization. According to NDHS 2018 report, the state records 30 deaths per 1,000 live births. A UNICEF’s situation analysis of 2016 ranked Oyo state third after Kano and Jigawa in terms of numbers of neonatal deaths and contributes more than a third of all babies dying in Nigeria before their first year of age. The state recorded a child mortality rate of 24 deaths per 1,000 live deaths and an infant mortality rate of 41 deaths per 1,000 live births. The state also recorded an unmet need for family planning of 30.6 percent.

The situation in the state is worsened with a myriad of issues that include alarming number of births attended to by unskilled birth attendants, shortage of health care staff, lack of equipment in health care facilities, limited funds for health care financing, shortage of drug supply, limited funds for health care financing, shortage of drug supply, limited capacity building of health care workers, poor infrastructure of healthcare facilities and lack of integration of healthcare services across the different levels of healthcare in the state. Over the years, the health sector has suffered from poor funding. It is rare to find states in Nigeria allocate 10 percent of their budget to the health sector. While the state witnessed a slight improvement as compared to the past, only about five percent of the 2020 budget was allocated to the health sector.

Worried by the ugly trend of high maternal mortality and neonatal mortality, the Oyo state government last Wednesday launched an expanded maternal and child health care initiative known as Tomotiya. Tomotiya is simply a Yoruba translation for Mother and Child. The initiative set off with a goal to reduce maternal mortality by 30 percent and neonatal mortality in the state by 20 percent by 2023. While targeting having healthy babies and a health society, by extension, the initiative hopes to close gaps and eliminate barriers to maternal and child health care and continue routine Routine, Maternal, Neonatal and Child Health (RMNCH) programmes. The presence of partners like UNICEF, WHO, Rotary, Society for Family Health, Nigerian Urban Reproductive Health Initiative (NURHI), APIN Public Health Initiatives and others at the event held at the University of Ibadan, pointed to desire by the state to catalyse collective actions towards building a sustainable and strong healthcare system in the state.

Other objectives of the initiative are to increase the number of births by skilled birth attendants in the state by 30 percent, increase health care facility utilization to 60 percent, improve advocacy at the community level for health promotion, set up newborn corners in one primary health centre per ward, develop innovative mobility options to accessing health care and train health care providers on emergency obstetric care and essential newborn care. Prior inaugurating the steering committee of the initiative, Governor Seyi Makinde, represented by his deputy, Mr Rauf Olaniyan, added that the state will be advocating adherence to WHO recommendation of four or more antenatal care visits during pregnancy. He noted that the major complications that account for nearly 75 percent of all maternal deaths are prevented when pregnant women make at least four antenatal visits. He added that the state’s aim was to increase health care facility utilization in the state to 60 percent while offering qualitative maternal health care at minimum cost.

According to Special Adviser to the Oyo state governor on Health, Dr Funmi Salami, the targets by the next two years are to have a significant increase in number of skilled birth attendants to provide essential care during childbirth from the onset of labour up to 24 hours and are able to recognise complications early and appropriately manage them. Other targets are to have wider immunization coverage to reduce vaccine-preventable deaths among children, to set up an efficient two-way referral system between the state’s facilities and to mandate prompt referral to primary heath care centres in cases of complications.

In collaboration with partners like the UNICEF and WHO, there will be RMNCH interventions on integrated management of pregnancy and childbirth, health systems strengthening programmes, integrated management of childhood illnesses, interventions on family planning, HIV, nutrition, child health. Also, the existing Oyo State Health Insurance Scheme (OYSHIA) is to be adopted with organisations and donor agencies to be encouraged to insure some pregnant women and children. Furthermore, the Tomotiya plan encompasses having community health taxis, community first responders and community midwives as well as taking medical records electronically in primary and secondary health care facilities.

In his remarks at the launch, state Commissioner for Health, Dr Bashir Bello decried that some families still engaged in traditional treatment and other practices which endangered the lives of children leading to their death before five years. When a child dies, he bemoaned that families consoled parents with statements that the child was not meant to live or died so as avoid seeing evil in life. To reduce neonatal deaths, Bello pointed out that the initiative will also include appropriate sensitization of pregnant women on taking care of themselves before, during and after birth. In their various remarks, representatives of the partners expressed commitment to the initiative with Rotary International particularly hinting of a plan to distribute contraceptives across the country. The partners stressed that the robustness of healthcare depended on collaboration of all and sundry.

Meanwhile, states and the country at large are known to launch beautiful initiatives with little or no implementation. Poor allocation of resources by federal, state and local government to maternal, neonatal and child health is also a problem. In addition, several Primary Health Care (PHC) centres do not have medical doctor leaving unskilled birth attendants to take deliveries. The health facilities in Nigeria, therefore, need to be equipped and skilled health providers including doctors, nurses and midwives available at all time. Experts hold that ending preventable newborn deaths can be achieved by improving access to skilled health professionals during pregnancy and the time of birth as well as other lifesaving interventions like immunization against illnesses, breastfeeding, increased access to clean water and good sanitation. High mortality rates also stem from women’s difficulty to access healthcare as they face problems of inadequate money for treatment and transportation as well as far distance to good health facility.

For Oyo state, the countdown to two years time with the set deliverables of the Tomotiya initiative in Oyo state has started. No doubt the task of Tomotiya steering committee with membership to include the Special Adviser on Health; Permanent Secretary, Ministry of Health; Permanent Secretary, Hospital Management Board; Executive Secretary, Primary Health Care Board; Executive Secretary, Health Insurance Agency is well cut out. By 2023, it waits to be seen whether there will have been a significant increase in skilled birth attendants to provide essential care during and after childbirth, whether maternal mortality will have reduced by 30 percent, if neonatal mortality will have gone down by 20 percent, whether newborn corners will have been set up in each select PHCs across the 351 wards in the state, whether facilities in health centres will have been substantially strengthened to appropriately recognise and manage complications from childbirth, if there exists an efficient two-way referral system between state facilities, whether there is wider immunization coverage and integrated management of childhood illnesses.

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