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The Federal Government, through the National Primary Health Care Development Agency (NPHCDA), established the Midwives Service Scheme to facilitate an increase in the coverage of skilled birth attendants and reduce maternal, newborn and child mortality. But findings revealed that women in rural communities in Ogun state still suffer inadequate access to midwives during childbirth, leading to pain and anguish for pregnant women. SODIQ OJUROUNGBE visited some health centres in the state to tell their stories.
In July 2019, Tayo Adeoti was in pain. She was about to give birth but the trado-medical doctors in the Ode-Omi area of Ogun waterside in Ogun State, could not help her to be delivered of the baby. The maternity centre in the community was in a bad state. So, she had to be rushed to a general hospital at Ibiade, a three-hour journey from Ode-Omi.
To be transported to Ibiade, she had to travel through waterways. She spent about two hours on a canoe, she got down at Makun, unfortunately, Adeoti had given up the ghost before she could get to the hospital.
Adeoti’s husband, Bashir, attributed his wife’s death to the non-availability of a well-equipped health care centre and experienced midwife in Ode-Omi, a border community in Ogun State.
“My wife and child would still be alive if the government had provided us with good health facilities and medical practitioners. We lack access to good healthcare and we need to travel over water to bigger towns to get better healthcare,”, Bashir said.
Making the torturous journey to Ibiade to give birth is commonplace. Habeeb Logere, a boat helmsman in Ode-Omi, said that not less than 29 pregnant women have been transported from Ode-Omi to Ibiade for medical attention in the last two years.
Logere explained that pregnant women were those who mostly have complications during labour.
The boat driver however said while some have died during the journey, few were lucky to be alive.
In his words, “We always take them through canoe to Ibiade general hospital which is about three hours from the community.
“Many people have lost their lives before getting to the hospital.
“But now, we used to rush them to Lagos State because the road is now better than before.”
Maternal mortality is not limited to Ode-Omi. Many other rural communities in Ogun State lack medical practitioners, including midwives, and good health care facilities.
Many families have resorted to trado-medical centres, where quality healthcare is nil. The alternative is to patronise health care centres in big towns where service delivery is better.
Findings by this reporter showed that while men could cope better, pregnant women and nursing mothers narrate how they suffer the pains of travelling miles through waterways, dusty and bad roads to access basic health care.
Those who cannot face the troubles, patronise traditional birth attendants, herbalists or nearby healthcare centres that lack basic amenities and staff.
Investigation has shown that there is still a high maternal and child mortality rate in rural communities in the state.
Despite the federal government allocating not less than two billion naira to the Midwives Service Scheme in Nigeria, available data shows that the country is not in any way improving on maternal mortality rate (MMR) as more pregnant women and nursing mothers face huge difficulty with accessing basic healthcare, especially in the rural areas.
According to the World Health Organisation, approximately 830 women die every day from preventable causes related to pregnancy and childbirth. More worrisome is the fact that 99% of all maternal deaths occur in developing countries.
Statista report that Nigeria In 2017 recorded 917 deaths of mothers per 100,000 live births.
A report by the United Nations Children Fund (UNICEF) claimed Nigeria is the highest contributor to under-5 deaths in the world.
According to the World Bank, MMR in Nigeria is still as high as 821 per 100,000 live births.
In March 2018, at the 18th general membership meeting on reproductive health supplies coalition (RHSC) in Brussels, Belgium, experts disclosed that while global maternal mortality dropped by about 43 percent since 1990, Nigeria still ranked highest among sub-Saharan African nations with high maternal deaths.
Efforts by govt. in reducing maternal, newborn and child mortality
Nigeria has a very poor record regarding maternal and child health. Over the years, the government has introduced several initiatives and programmes to reduce infant and maternal mortalities. Despite these efforts, maternal and child healthcare services remain poor.
The Nigerian Midwives Service Scheme (MSS) was created in December 2009 to help lower maternal and infant mortality rates in rural, underserved areas. The scheme was expected to address the shortage of skilled obstetric care providers and poor access to basic emergency obstetric care through the recruitment and deployment of newly qualified, unemployed or retired midwives, and equipping clinics to provide basic emergency obstetric care.
The programme’s goal was to double the number of deliveries attended to by skilled birth attendants and lower maternal and infant mortality in target areas by 60 percent by December 2015.
Phase 1 of the MSS, which took place in 652 primary care clinics across Nigeria’s 36 states, was expected to serve more than 10 million people. The scheme was administered by the National Primary Health Care Development Agency and was funded by a special MDG-DRG (Debt Relief Gains) Account.
The MSS is a public sector initiative and a collaborative effort between the three tiers of government in Nigeria. A memorandum of understanding between the federal, state and local governments sets out clearly defined shared roles and responsibilities, which are supported by the strategic partners of the MSS.
Budget documents showed that from 2016 to 2020, over three billion naira was allocated for the Midwives Service Scheme.
In 2020, the Ogun state government said it had earmarked 20 per cent of its revised 2020 budget to the health sector as part of measures to sustain the fight against COVID-19 pandemic.
The governor, Dapo Abiodun also said his administration will build one primary health care centre in each of the 236 wards of the state using local manpower.
Midwives missing in hospitals despite billions spent on MSS
Findings by this reporter, however, showed that despite the billions invested in MSS, there were no midwives in all the primary health centres visited across Ogun state.
Rural communities like Ode-Omi, Orile-Itesi, Igbokofi, Idigbo, Iga, Agbele Ibore, Orisada, Akerun, among other places visited in Ogun State do not have access to the service of midwives. Residents in the rural areas still rely heavily on the facilities in urban centres to survive especially during childbirth.
Primary health centres in the rural communities are being operated by Community Health Extension Workers, (CHEW), consisting of volunteer workers such as auxiliary nurses, attendants, and cleaners, among others.
Some of the health extension workers said no midwives were deployed to any of the clinics visited. They were not even aware that MSS existed.
A health worker, Mrs. Tolu Yusuf, said only a few pregnant women come to the primary health centre in Ode-Omi as many of them have resorted to traditional birth attendants.
According to her, the success rate of child delivery in the health centre is very low because clinics mostly receive patients when traditional birth attendants could not deliver babies safely.
Dilapidated health care centres causing agonies
Although it was over a year ago that Sherifat Ogunlana lost her child to a serious illness, she still feels the pain. She lost her child at age 4 after he had a convulsion.
She explained that her child was rushed to the only primary health centre in the Akerun General hospital in Yewa North area of Ogun state, but there was no paediatrician to treat her child which eventually led to his death.
Sherifat claimed to have given birth to late Olawale in 2016 at a trado-medical centre. She noted that Olawale from birth had been experiencing convulsions, but became worse when he was four.
She explained that she went to a lot of traditionalists to seek a solution to her child’s ailment. According to her, the primary health centre in the community would have been the first point of call if only it was working perfectly.
“Olawale is my only child. My husband and I were married for three years before I was able to give birth to him,” Ogunlana said.
“We accepted fate and took him as our only child. He was my joy and happiness, but death took him away all of a sudden.
“We were ready to spend any amount on him, but no good health facility or health workers here. To access a good facility, you need to go to the town which is about a three-hour journey on a bad road.”
Lola Olaosebikan lost her child during labour. Olaosebikan gave birth to a dead baby at a non-functional health centre in Owode Balogun also in Yewa North area of Ogun state.
He insisted that the auxiliary nurse that attended to her was responsible for the complication that occurred during her labour.
She explained that she was not having any complications, but lost her child because of an “inexperienced” nurse that attended to her.
According to her, the auxiliary nurse in the health centre does not really know much about childbirth. “But, we had no choice but to patronise the hospital because there is no other health clinic here.
“I am not the first that will be losing a child because of the in-experience of the nurse here and I am sure I will not be the last,” Olaosebikan said.
Abandoned, dilapidated health care facilities
Some healthcare centres visited in Ogun State lack delivery kits and health officials.
The health centre in Igbokofi in Yewa Local Government of the state, serves about ten other villages,including, Idigbo, Iga, Agbele, Ibore, Orisada, among others, was locked as of
The paint on the building that housed the health centre was already peeling off, Its windows were broken, iron beds were rusty, and its benches were termite-infested. Some equipment were apparently condemned.
Seun Oguntade, one of the residents who showed this reporter around the village, said the health centre was built about 10 years ago.
He said the villagers and those from other neighbouring villages used to enjoy the service of a doctor and two nurses. But years later, the doctor stopped coming and then the two nurses followed suit.
He, however, explained that the residents have resorted to looking for alternatives.
At the Akerun General Hospital, despite having little equipment, the residents of the community prefer going to a trado-medical centre to give birth than going to the health centre.
It was gathered that the Akerun general hospital was to serve about 12 villages, including Isagba, Ilukan, Agbode, Mosan, Abe Obi, Ijege etc.
The residents said they could not put their lives in the hands of those they described as “inexperienced” health workers. The dilapidated building was also an eyesore.
The only official present at the clinic, an auxiliary nurse identified as Mrs Ajayi,said no baby has been delivered at the hospital since she resumed there in 2021.
“Pregnant women don’t come here. We have tried to educate them, but it seems like they trust the traditional way more than us.”
The only official on duty at Ode-Omi health centre was Madam Yunus, an auxiliary nurse. The hospital is expected to serve about 30 villages which include, Okun, Igbosere, Elefon, Abaolori, Losumeta, Iroadukora, Adurokora, Eva, Iseku, Ijegbe, Abaolori, Okun elefon etc.
Madam Yunus said midwives were not available in the hospital and pregnant women or sick people don’t come to the centre.
The community leader of Ode-Omi, Evangelist Yesir Otudeko, said people stop going to the health centres due to non-availability of health workers.
The village head noted that the community trusted the traditional healers. “In the beginning when they just built this centre, our people were ready to visit the clinic, but there was no doctor. The only doctor we have always comes when he is available because he serves a lot of communities in Ogun waterside LG,” Otudeko said.
“Since we could not get the attention of doctors, our people lost complete interest in the medical way, they prefer the traditional means which has never failed us.”
Why midwives not available in rural communities
The MSS was expected to recruit and deploy newly qualified, unemployed, and retired midwives so as to provide basic emergency obstetric care.
However, many midwives prefer employment at specialist or teaching hospitals because of better conditions of service and remuneration.
Some listed lack of accessible roads and insecurity as reasons for not taking up jobs in rural areas.
“How do you expect us to go to the rural communities when the government will just pay us peanuts, a midwife Laolu Awosika, said. Going to rural areas comes with a lot of risks and nobody is ready to take such risk for the government that is not responsible.” he said.
Another midwife, Tolani Roland, alleged that MSS is another means of diverting funds by government officials.
Rolando noted that opportunities around the scheme are not available to midwives.
“We just keep getting information about the scheme, many of my colleagues that have interest in the scheme did not have access to the opportunity,” Roland said.
“MSS is just another method to syphon funds from the government. Go to many of our health care centres, you will discover that there are no midwives there, then you begin to ask who exactly are those the government claimed to have recruited? If someone like me or my friends did not benefit from it, I still wonder who they have recruited and where those people they claimed to have recruited are.”
200 nurses, midwives to service 448 functional health centres in Ogun
Not less than 200 nurses and midwives are reportedly available at the 448 functional primary health centres in the state.
The chairperson of National Association of Nigeria Nurses and Midwives in Ogun State, Roseline Solarin, said that there is a shortage of nurses at government-owned hospitals across the state.
Solarin also lamented that the state is not employing nurses and midwives to replace those that retired.
“The last time that the Ogun State government employed midwives into those communities was in 2011,” Solarin said.
“You know, from 2011 to 2022, a lot of people will have retired. Some will get employment somewhere else.
“So, as I am talking to you right now, the total number of nurses and midwives we have at the local government level is less than 200. In all the 20 LG that we have in Ogun State.
“And then, we have about 448 health facilities but definitely, those one cannot cover all”, she submitted.
Speaking on the non-availability of midwives at the hospitals visited, the NANMM Chairperson explained that the Midwives Service Scheme stopped working in the state since 2015
She said MSS was running “until 2015 when the state government cannot meet up with the expectations from their side; because the federal government signed an MoU that there would be a percentage to be paid by the federal; State will contribute their own and the local government. Local Government will produce accommodation and every other facility for the centre.
“From 2015, the Ogun State government has not been able to pay the midwives so all of them decided to go back. Because nobody will continue to work without money.”
Solarin insisted that primary health care centres are suffering because there is a shortage of manpower in the state.
She noted, “The primary healthcare centres are suffering because there is a shortage of manpower. If you don’t put the proper people there, they cannot do the work of the midwives.
“The truth of the matter is, our people are suffering. Where they are supposed to see healthcare centres but the centres were not there, what will they do?
“And generally in the country today, we are having shortage of manpower all over. A lot of people are leaving the country for greener pastures by travelling out of Nigeria.
“So, shortage of manpower is everywhere but still, we have schools in Ogun State today, including the colleges of nurses, universities that are training nurses. There are more than eight.”
On June 25th, 2022, this reporter tried to reach out to the Ogun state commissioner for health, Dr. Tomi Coker on the phone, but she did not pick up calls or respond to text messages sent to her.
On July 7, 2022, this reporter once again reached out to the health commissioner via phone calls, text and Whatsapp messages. She however refused to pick up the call, while she read the Whatsapp messages, but never replied.
In another attempt, this reporter reached out to the commissioner for information in the state, Waheed Odusile via phone calls and WhatsApp messages, but he did not pick up or respond to text.
Another attempt to reach out to the health commissioner on 13th July 2022 was not successful as calls and messages were not replied.
This story was supported by the Africa Data Hub Community Journalism Fellowship.
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