Following the feedback from our story on the work of Pro Health International, we realised that very little is known by many Nigerians on what is going on in various parts of the health sector in Nigeria. We will be visiting many of these projects and programmes in the next few months to bring these stories to you and enable you to develop an informed opinion on what is happening and where the deficits are. Two members of our team, Anja Choon and Ada Ezeokoli, visited a SURE-P MCH run primary health centre in Byazhin, Abuja. This is their story …
We recently visited a SURE-P MCH run primary health centre in Byazhin, Abuja. Our guide for the visit was Victoria Akinrolabu, affectionately called Mama SURE-P by her staff and the clients of the health centre. Victoria herself is a nurse and midwife, retired but still active, and one of a cadre of retired midwives brought back to active service to support maternal and child health in Nigeria.
It is no longer a secret that Nigeria has some of the worst maternal mortality rates in the world. The most recent figures in the DHS survey in 2013 puts it at 576 deaths per 100,000 births.
The Subsidy Reinvestment and Empowerment Programme (SURE-P) was instituted in 2012 to lessen the impact of the petrol subsidy removal in Nigeria. A subsection of SURE-P is the Maternal and Child Health project (SURE-P MCH), which works towards reducing the maternal and child mortality rates in Nigeria (Millennium Development Goals 4 and 5). In order to achieve that objective, the project supports a selection of 1000 Primary Health Care Centres in all 36 states as well as the FCT Abuja, providing free antenatal care, skilled birth attendance, postnatal care, immunization and family planning counselling. SURE-P MCH is scheduled to run till 2015, concentrating particularly on rural and underserved communities.
One of the important responsibilities SURE-P MCH has taken on is to build the capacity of existing health workers at the primary health care level. One way the program does this is by training midwives and Community Health Extension Workers (CHEWs). All CHEWs are taught how to handle “normal” deliveries when necessary, so for instance, when a CHEW meets an expectant mother at home and the baby’s head is already visible, the CHEW will be able to handle the delivery. Afterwards, she will take mother and child to the health centre. In addition, CHEWs train the village health workers (VHWs), passing on the key knowledge. Since not all of the latter can read, a pictorial guide is used for their training, which is accompanied by instruction in four languages: English, Hausa, Igbo and Yoruba.
The primary health centre in Byazhin is one of the 1000 supported by the SURE-P MCH across Nigeria. At Byazhin, the officer in charge, Gloria, tells us about all the changes to the clinic since the support of the SURE-P MCH started. Gloria has been working at the centre for six years, the last two years for SURE-P MCH. The changes include the addition of a second building to the health centre, adjacent living accommodation for the midwives so that they can be easily reached at all times, a borehole and solar panels. The health centre now has new furniture, delivery equipment and other medical instruments needed for the clinic to serve its clients better. In addition to improved infrastructure, the clinic also employs a larger staff complement: six midwives, three CHEWs, six permanent health workers, three voluntary health workers, cleaners, security and recorders.
This in turn has led to an increase in the number of pregnant women and mothers with children who attend the centre, for instance, the number of births supervised has increased from 10 to 70 per month. Gloria explained that because of the increase in clients using the clinic, even the larger staff complement is no longer enough to cope with demand. The clinic would benefit particularly with a doctor as they currently have to transfer every case that requires a doctor to the general hospital.
We met two women, Mama Kadija and Mama Iya. They had both brought their children to be immunised on the day of our visit. One had her sleeping baby strapped to the back. She told us that the little girl was two and a half months old and called Kadija. Mama Kadija herself is 24 and has another child, a five-year old boy. Mama iya’s daughter, Iya is a bit older, already four months; and she sat smiling on her mom’s lap during our interview. Mama Iya, who is 28 years old, tells us that she has four more children. Both Mama Kadija and Mama Iya were happy with the changes they had seen in the care the clinic provided for their children.
Both mothers have had deliveries at the General Hospital as well as the Primary Health Centre under SURE-P MCH. They agreed that they prefer the health centre since the staff are “very nice” and give them “gifts”. With “gifts” they referred to the Mama Kit, which contains items used during the delivery and others for the newborn, and the conditional cash transfer (CCT) system, which rewards mothers for using maternal and child health services.
Mama Kadija’s husband brought her to the health centre for antenatals while she was pregnant. Now she comes on her own to have the progress of her baby checked and to get all her required immunisations. She also takes her son to the health centre when he is sick. Her husband also comes for treatment to the centre since; apart from maternal and child services, the centre also provides general health services. Any drugs they hand out during such visits are free of charge to the clients.In addition, SURE-P MCH offers counselling on family planning, which Mama Iya and Mama Kadija found very useful.
The health centre does not have in-patients, although some patients stay overnight. We are told that the first 2 hours after delivery are a critical period during which a woman can easily die from excessive bleeding, and therefore midwives have to keep a close eye on them. If a woman still requires medical attention after 24 hours, the health centre refers her to the General Hospital.
Since the centre does not have an ambulance, transferring a client is especially challenging at night when it is harder to find a taxi. If a mother, however, is doing well, she is discharged and will be visited by a staff from the health centre every day for one week and at intervals after that. Gloria tells us that these visits are a bit challenging and would be easier if the centre had access to a bike.
As we are about to leave, Victoria introduces us to a staff member of the National Population Commission, who is in the process of issuing birth certificates. Every baby born at the health centre is registered, and the mother receives a certificate.
The SURE-P MCH programme has no doubt transformed the Byazhin Primary Health Centre. In addition to SURE-P MCH, the MDG office as well as NPHCDA’s MSS scheme are all involved in supporting PHCs across the country. The SURE-P MCH programme is a time limited programme, which, if not extended, will come to an end in 2015. Its biggest achievement may be that it has shown that it is possible to transform PHCs to deliver better health services for Nigerians. To sustain this however will require State and Local Governments, with whom the responsibility for Primary Health Care actually reside to step up and provide the leadership required to transform primary health care in a sustainable way for Nigerians. At least now, the people of Byazhin know how a primary health centre should work. It is unlikely that they will settle for less in the future.
For more photos from our trip to the SURE-P MCH Health Center in Byazhin, visit our Flickr page.