The Midwives Service Scheme – an emerging success story


Yesterday was Mothering Sunday (8th May) in some countries among Christian communities (would it not be great if a common date was agreed across all countries)… we thought we should bring you the story of a scheme that is bringing hope to our mothers across Nigeria; the Midwives Service Scheme (MSS), managed by the National Primary Health care Development Agency.

Maternal mortality has continued to be one of our most serious challenges in Nigeria. Despite several efforts (policies, initiatives and instruments etc…) we have not been able to make much progress with this most basic indicator of health and development. In the North East zone the maternal mortality ratio according to the most recent Demographic and Health Survey is as high as 1,500/100,000 live births; meaning literally that just over one in a hundred mothers lose their lives during childbiirth. An extremely distressing statistic…..

To respond to this, the Midwives Service Scheme was established in 2009. It recruited midwives from across the country, some unemployed, others previously retired but still able. The aim at the onset was to provide an emergency stop gap to the human resource shortage of skilled attendance at the level of Primary Health Care in Nigeria by mobilizing and deploying these midwives to health facilities in rural communities. It will not solve all the problems but it is a a start!

The scheme uses a cluster model or hub and spoke arrangement in which 4 Primary Health Centre (PHC) facilities are clustered around a General Hospital. A total of 1,250 health facilities in the 36 states / FCT,  were selected based on agreed eligibility criteria comprising of 1,000 PHC facilities and 250 designated referral General Hospitals making 250 clusters. Each midwife is trained in skilled birth techniques, and is equipped with a ‘mama kit’—a series of tools such as a stethoscope, razor blade, essential medicines, weighing scales, blood pressure indicator and mobile registration system. The midwives also perform child immunizations for facility-based births and family planning services. The major objectives of the scheme are…

  • To increase the proportion of pregnant women receiving antenatal care from 38% to 80% by  December 2015
  • To reduce Maternal, Newborn and Child Mortality by 60% in the MSS target area by 2015.

When I visited the project consultant Dr Ugo Okoli, one cannot help but be inspired by the work they were doing. She spoke with passion about the midwives they had recruited to the scheme who were working across the country, often far from home. She referred to how they were appreciated by the communities they were serving. Dr Okoli also spoke about the programme at the 2nd Nigeria: Partnership for Health Conference in London, last year.

Another innovative approach to the project is its use of mobile phones to collect and send data from the Primary Health Care facilities to a central location for analysis. Entries are collated on the phone and transmitted via 3-page SMS units to the central remote server for processing. Reports are presented in charts  for analysis. This data is then monitored centrally and the managers of the scheme are able to respond to the data in real time.

Other partners in the health sector are now falling over themselves to support this programme, and rightly so! The Federal ministry of Women Affairs launched an ambulance scheme and this has been affiliated to the centers involved in the MSS scheme, while WHO and UNICEF are supporting the capacity building of midwives. PATHFINDER international has provided anti-shock garments for the 37 Midwifery schools in the country.

The scheme is already making a significant difference to the lives of our mothers. The major challenge the programme faces is making an impact in the North East zone. But with energy and drive the programme has shown, maybe we can turn this around.

So the question on all your minds will probably be if we can bring this system to work, why is the rest of the primary health care sector in the rest of the country in such a state. Why is data collection from the health sector such a challenge. These are valid questions for which the NPHCDA will do well to provide the lessons learnt. They promise that they will be documenting progress over the next few months, and hopefully we can build on this as an example that we can deliver an innovative programme when we focus on it.

Watch a video of the scheme HERE.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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