USAID-IHP: Providing support to mitigate maternal, perinatal, child deaths in Bauchi

Ishola Michael writes on maternal, perinatal, and child deaths in Bauchi State and how interventions like the USAID-funded Integrated Health Programme (USAID-IHP) could help bring succour to vulnerable residents of the state.

Currently, the only reliable data on maternal deaths in Bauchi State is that of the 2018 National Demographic and Health Survey (NDHS). However, projections from current surveys on the maternal health status of women in the state point to an insignificant change in the indices, a development that leaves much to be desired, at least, in the quest to mitigate the maternal mortality rate in the state.

According to the Multiple Indicator Cluster Survey (MICS) 2021, delivery assisted by any skilled attendant in Bauchi State is only 17.4 percent. Delivery after at least four visits to an ante-natal clinic (ANC) is 43.3 percent, while delivery after one visit to an ANC is 42.5 percent.

The MICS 2021 also indicated that postnatal healthcare checks for mothers are at 40.4 percent, while women protected against tetanus are at 57.8 percent. The survey also revealed that women aged 15-49 who received appropriate care in Bauchi State received less than in the North-East subregion and national rates.

Also, the survey indicated that early childhood death rates are higher in Bauchi State compared to the rates for the North-East and the national rate of children dying before the age of 5.

As contained in the MICS 2021, under-five mortality per 1000 live births is 153, which is above the national average of 102, and the entire North-East sub-region which stands at 114. Also, the child mortality rate in Bauchi State stands at 70 per 1000 live births, just as the infant mortality rate is 89. Post-neonatal and neonatal mortality rates in Bauchi State are 43 and 45 per 1000 live births, respectively. (MICS 2023).

From the above statistics, perinatal and early childhood death rates are higher in Bauchi State compared to the rates for the North East and the national rate of children dying. Most of these deaths, according to health experts are not reported as pregnancy or birth-related deaths at the community or even health facility levels.

Bauchi State Government, health experts, elites, and other concerned citizens have, at several forums, expressed worries over the persistent health indices, especially maternal and child deaths, and the accompanying pains, anguish, and despair that usually come with such losses.

Thus, when the Federal Government of Nigeria, through the Federal Ministry of Health, adopted a World Health Organization (WHO) concept known as Maternal, Perinatal, and Child Death Surveillance and Response (MPCDSR), state governments and other key stakeholders in the health sector saw it as an innovative approach to reduce, to the barest minimum, maternal and child deaths in Nigeria.

The primary goal of MPCDSR is to eliminate preventable maternal, perinatal, and child mortality by obtaining and using information on each maternal, perinatal, and child death in order to guide public health actions and monitor their impacts.

Bauchi State Government is aware of the challenges in its health sector, so when the MPCDSR concept was advocated for, the government did not waste time in keying into it. This it did, with a view to further raising the bar in reversing the worrisome trends in its healthcare delivery systems, especially as it relates to women’s and children’s healthcare.

The Bauchi State Ministry of Health, the State Primary Healthcare Development Agency, and other agencies, with support from development partners, are implementing the MPCDSR initiative aimed at reducing preventable maternal and perinatal deaths across all levels of healthcare delivery in the state.

Recall that the scope of MPDSR in Nigeria was expanded in 2022 to include child deaths with the development of a new 2022 revised MPCDSR guideline and tools.

With the technical support of the Gates Foundation-funded intervention known as the Evidence 4 Action Mamaye (E4A) Project, a State Steering Committee on MPCDSR was formed with the mandate of providing the state government with intermittent forensic information and recommendations on how to reduce maternal, newborn, and child deaths in line with the conceptual approach of MPCDSR.

The composition of the steering committee was drawn from all health-related state MDAs, professional bodies, and an evidence-driven Bauchi-based CSO known as the Bauchi State Accountability Mechanism for MNCH (BaSAM).

The E4A Mamaye Project has done its best in providing technical support to the steering committee, as the members were always on the ground to facilitate and support review meetings of the steering committee, just as Rotary International too had supported the State MPCDSR steering committee through a capacity building program and the cascading of such training to the LG personnel.

All these were carried out with a view to inculcating the culture of maternal and child death audits at both the health care facility and community level. As it is with every pilot initiative, people saddled with the responsibility of making it viable always need a push and proactive leadership to excel and even mentor others to follow the same path.

It was, however, glaring that after the exit of the E4A Mamaye Project, the Bauchi State MPCDSR Steering Committee had also gone to sleep, thus negating the purpose of keying into the MPCDSR concept as a tool deployed to reduce preventable maternal and child deaths in Bauchi State.

The good news, however, is that only recently, an intervention has come through what is known as the USAID-IHP, a well-funded project of intervention in the health sector that has come to the rescue of the state and is doing everything possible to resuscitate and strengthen MPCDSR in the state.

When the USAID-funded Integrated Health Program (USAID IHP) intervention debuted in Bauchi State, it came with an innovative approach to supporting the state to reverse the disturbing trends associated with maternal and child deaths, which is aimed at improving MNCH services.

The USAID-IHP intervention is strongly providing system strengthening through capacity building of healthcare service providers across the state, particularly at the primary level, where the bulk of the people who need care are living.

So, when USAID-IHP Task Order 3 observed how the State MPCDSR Steering Committee was becoming quite ineffective, it quickly swung into action by organizing a three-day intensive capacity training, attracting the entire membership of the Committee, representatives of WHO, UNICEF, the Pediatrician Association of Nigeria (PAN), Nigeria Medical Association (NMA), PLAN International, Journalists for Public Health and Development Initiative (J4PD), and Breakthrough Action Nigeria (BAN), amongst other participants.

At the capacity training meeting, the State MPCDSR Steering Committee took the lead in facilitating the sessions, with the team from USAID-IHP TO3, led by its Technical Director, Dr Ibrahim Kabo, and Human Resource Advisor, Dr. Robinson Yusuf, providing much-needed technical support during the training.

One interesting aspect of the training was the presence of the Bauchi State Commissioner of Health, Dr Sabiu Abdu Gwalabe, and the Permanent Secretary of the Ministry, Aliyu Babayo Gamawa all through the three days of training because, by default, every Commissioner of Health automatically becomes the chairman of the Steering Committee.

During the training meeting, the commissioner chaired and moderated all the sessions.

One of the key outcomes of the training was the adoption of the recommendation on the need to bring tertiary health institutions like the Abubakar Tafawa Balewa University Teaching Hospital and Federal Medical Center Azare, into the membership of the state MPCDSR steering committee.

Another key outcome of the training was the formation of three sub-committees that will support the steering committee in fast-tracking the implementation of the MPCDSR concept in some of the selected health facilities across the state. This will eventually cover all the health facilities, including private ones, in all 323 wards of Bauchi State.

The co-opting of two members of Journalists for Public Health and Development Initiative (J4PD), a media-based CSO, into the advocacy sub-committee, was seen by many stakeholders as a master stroke that would give visibility to the activities of the newly re-jigged state MPCDSR steering committee and further create more awareness through evidence-based advocacy, using all channels of communication for a wider reach.

There were other recommendations at the end of the capacity training that focused on improving the capacity of the old and new entrants of the state MPCDSR steering committee, and participants and USAID IHP all agreed that it was the right step in the right direction.

With the resuscitation of the State MPCDSR steering committee, chaired by Dr Gwalabe and the practical demonstration of its members’ ability to carry out their responsibilities, all that is left is for the Bauchi state government to provide the financial support and enabling environment for the implementation of the initiative, which is geared towards providing information and recommendations on measures to adopt in mitigating maternal and child deaths, thus reversing the ugly trends in maternal, newborn, and child health in Bauchi State.

The workshop’s conclusion included a summary of the workshop’s key issues and recommendations. These included the development of action points and challenges, tracking of developed actions, reviewing all maternal deaths, the majority of perinatal deaths, and notifying deaths.

The major issue identified is the shortage of health human resources (HRH) with Specialist Hospital, Bauchi (SHB) as a case in point, suggesting, therefore, a finalized process of training at SHB as well as refresher training for all General Hospitals (GHs) MPCDSR, along with training for tertiary HFs committees.

The stakeholders also called for the revisiting /activation of the MoU between SMOH and tertiary HFs in the state, as well as the recruitment and retention of optimal HRH by the Commissioner of Health.

The stakeholders also lamented that the governance structure of the MPCDSR SC is too state-centred, recommending therefore that Vice Chairman II of the Steering Committee must be a paediatrician from ATBUTH (to be rotated across tertiary health facilities (HFs) in the state.

Another challenge is the communication gaps in the implementation of the guidelines with ATBUTH as a case in point Considering the fact that correspondences from the State Ministry of Health to tertiary Health Facilities on MPCDSR is not active, calling on the Secretary to do something urgent by the second week of May 2023.

The stakeholders further lamented that training/capacity building on MPCDSR is not extended to tertiary health facilities in the state recommended therefore that there should be a Scheduled training/inauguration of Committee members in all Tertiary Health Facilities in the State

On access to emergency drugs for MPCDSR, the stakeholders stressed that there should be engagement of relevant MDAs towards Leveraging BHCPF in order to Strengthen 2 Health Facilities Drugs Revolving Fund in the State.

The stakeholders further lamented the low level of awareness of MPCDSR implementation among HCWs, while the LDHF approach should be utilized to build capacity within the health facilities.

They also lamented that wrongly captured Maternal death elements on the registers recommending that there should be continuous engagements with the M&E officers during bi-monthly LGA data review meetings

Also, there is the challenge of inadequate follow-up of recommendations made to address issues/challenges from MSS

Strengthening of the MPCDSR steering committee to conduct continuous advocacy on issues raised, just as it was observed that there is weak coordination between the Ministry of Health and agencies in leveraging resources to strengthen coordination between and among all the MDAs.

As the next steps to the successful implementation of MPCDSR in the state, there should be a sharing of action points/list of members of sub-committees by the secretary within the next week.

Also, sub-committee inaugural meetings should be called by the chairpersons of the sub-committees within the first week of June 2023, while the State Steering Committee Second Quarter meeting should be called by the chairman by the end of June 2023, and the committee should create WhatsApp platforms for all members.

 

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