Safety of pregnant women and children under the age of five has become a major concern of the Bayelsa State Government. In today’s Bayelsa, women need not worry about pregnancies. Men need not bother about the cost of impregnating their wives especially the ante-natal and neonatal cares.
Following the new policy introduced by the state Governor, Mr. Seriake Dickson, once a woman residing in Bayelsa is pregnant irrespective of his state of origin, the government steps in to take over the antenatal burden from her and her family.
Besides, the government pays the woman a monthly stipend of N7000 for a period of 10 months. Every cost about the pregnancy and the health of the woman is borne by the state government. The government is also making deliberate efforts through many programmes to safeguard the health of children under the age of five.
Bayelsa’s demographic survey problem
The government is jolted by the high maternal mortality rate in the state. Despite previous efforts by Dickson to reduce the death rate, Bayelsa is still ranked among the riskiest states to give births.
Commissioner for Health Prof. Ebitimitula Etebu recently said 1,870 expectant mothers die in the state in every 100,000 births. He described it as a sad state of affairs insisting that it bellied investments on improved health facilities dotting different parts of the state. He said despite the provisions of health infrastructures, pregnant women in the state still preferred other alternative local means of giving birth.
The professor also blamed the sorry state of expectant mothers in the state on unwholesome practices of most Traditional Birth Attendants (TBAs). Though he cited the World Health Organisation (WHO) statistics, indicating that over 100 women die every day in the country for causes related to child birth, he said Bayelsa case was not better than the national statistics.
In a paper titled, Management of Bleeding During Pregnancy, Labour, delivered recently during the launching of a safe motherhood campaign in Bayelsa, a notable gynecologist, Dr. Andrew, Igbafe listed major causes of complications in pregnancy as excessive bleeding during pregnancy and after child birth, prolonged labour, unsafe abortion, harmful religious and traditional practices.
Igbafe called for zero tolerance for maternal and infant death in the state; girl-child education; enlightenment campaigns to every nooks and crannies of the state; support from traditional rulers, elders, chiefs, medical practitioners and TBA’s among others to stem the tide of infant and maternal mortality.
In January this year when the Society of Gynecology and Obstetrics of Nigeria (SOGON) visited Dickson, the governor did not mince words on his government’s concerns about expectant mothers’ safety in Bayelsa.
He told the group led by its National President, Prof. Oluwarotimi Akinola, that the issue of infant and maternal healthcare was critical in the state. But he gave his assurances that the government would reduce the infant and maternal mortality rate in Bayelsa.
He said: “I want the Bayelsa rate to be the lowest in the federation, which is why we are building the best of health care facilities. I have instructed the Commissioner for Health to devise a special scheme within the confines of the Health Insurance System that will incentivise our pregnant and nursing mothers to register and be captured.
‘’I want a situation where every woman who gets pregnant is captured within the first three months for us to know where she lives, what becomes of her pregnancy and we will support her to deliver safely and monitor the health of both mother and child”.
The Incentives
The government through the Ministry of Health designed the first Maternal and Infant Mortality Summit. The event attracted all stakeholders within and outside the state. During the summit, the government launched Safe Motherhood in Bayelsa. The campaign for deliberate and coordinated programmes to force down the figure was inaugurated by former President Olusegun Obasanjo.
Dickson read out the state policy. The governor said his government would give N3000 monthly allowance to each pregnant woman in the state. But there is a caveat. For a pregnant woman to benefit, she must first tell the government about her pregnancy by reporting to any of the nearest government-controlled clinics.
Her pregnancy will be documented and automatically she and her unborn baby will become the “property” of the state. Immediately, she will be qualified to receive the allowance. In addition, the government will freely nurture the beneficiary and her pregnancy till the birth of the child.
The policy is to encourage pregnant women to use health facilities provided by the government. It is to discourage them from visiting TBAs which have high mortality risk. Dickson immediately released N100million to the Ministry of Health for the payment of the special allowances.
To make health facilities accessible to pregnant women across the state, Dickson directed the ministry of health and his team to build health centers in each of the 105 wards in the state. He gave the ministry a cheque of N1.2bn to commence the project.
He said his government would not do it alone. He, therefore, called on community leaders, women, opinion leaders and other stakeholders to be part of the process of ensuring that no death of pregnant woman is recorded in Bayelsa.
He said: “Every pregnant woman living in Bayelsa is entitled to N3, 000, until delivery and it will be accessed upon registration for anti-natal programme at the nearest medical facility for safe delivery.
“This is to ensure that, the health team gives me information on the number of pregnant women in the state. I want a report on their delivery; that’s how serious we take this issue of infant and maternal mortality.
“In the event of any thing going wrong, I will give directive for a special coronary inquest, check the integrity and conduct of medical personnel involved or the traditional birth attendant responsible, so that I will know the consequences that will follow.”
Dickson’s action attracted plaudits from Obasanjo. He observed that the governor built adequate healthcare facilities in the state adding that with the existing health infrastructure no pregnant woman should die during pregnancy and after delivery.
He said: “What gladdened my heart most is what Bayelsa State is doing, because the state according to the governor will meet the standard of Ondo State and surpass it in the shortest time possible. Bayelsa has taken the solution to where the problem is.
“Already, there are hospitals in all the local government areas and the governor has told me that we are going beyond local government to individual community so that no pregnant woman will have to travel beyond allowable distance to get ante natal care which is very necessary for safe delivery.
“There will be training of people who will address and deal with those who are pregnant. I want to assure you that whatever you do here that can be copied by any other state, l will be your advocate. Advocacy and raising awareness is one thing that we have to do.
“If we have the facility that is of world standard for medical checks and treatments, why should our children and pregnant women be dying? I am a witness that you are changing the face of Bayelsa on daily basis?”
Dickson’s wife also applauded her husband for the special interest his administrations continually give women in the state. She said with the initiative, it was obvious her husband was committed to ensuring that pregnant women give birth safely.
“With the huge investment by the government in the health sector, the infant and Maternal death rate in the state would be drastically reduced”, she said calling in women to take advantage of the initiative.
Cash incentive increases from N3000 to N7000
To underscore its seriousness, the government through the ministry of information inaugurated a committee with a mandate to take the messages to all nooks and crannies of the state.
The sensitisation committee headed by Chris Odi, a Director in the ministry, was asked to break communication barriers and ensure all women living in hard-to-reach areas such as fishing ports and creeks get actionable information on the programme.
Inaugurating the sensitisation committee, the Commissioner for information, Daniel Iworiso-Markson, said Dickson was determined to drastically reduce the mortality figure.
He said: “Some days ago, the governor launched the safe motherhood initiative which is one very important programme. We are losing a number of our pregnant women due to cultural practices because they don’t go to hospital and there, they are not well informed of what to do.
“We are taking the message to every nooks and cranny of our state. We will reach every single community because most fatalities happen there.
“No woman should die during childbirth. We are deploying all our means to sensitise our people. We are going from door to door to get the message to those that matter. As long as you are pregnant, married or not, you are covered.”
Pregnant women further received another cheering news from Etebu. The health commissioner said the ministry was adding N4,000 to the N3,000 earlier approved for pregnant women to make it N7,000 in about 10-month period of pregnancy.
“At the level of the ministry we are going further. Because about 70 percent of our people go to primary health centres, they will no longer wait for people to come to them.
“We will go from house to house. Get records and ensure that these women attend our facilities. The governor has said he is giving N3,000 to these pregnant women but we are adding some incentives.
“For coming to the health centres we are insentivising them with N2,000 and at the antenatal, we are giving out another N2,000 and this is to ensure that they are motivated. The traditional birth attendants will also be motivated to ensure that they take these women to where they can get the right care.
“We are giving them money to ensure they do this. The community governance structure will also be brought in. Traditional rulers, community groups etc will be involved. This is a continuius measure. All communities must be reached. We are taking this seriously,” he said.
Other multifaceted programmes to reduce death
Years before the launching of the safe motherhood campaign, Dickson has ensued active participation of the state in various programmes to safeguard the health of pregnant women and children. As part of Governor Dickson’s Safe Delivery Project, Bayelsa enrolled in the Saving One Million Lives (SOML) programme.
SOML, a Federal Ministry of Health initiative was launched in 2012 in response to poor health outcomes in the country particularly women and children. It was repackaged and rebranded in 2015 to Saving One Million Lives Performance for Results (SOML PforR) following a $500m International Development Association (IDA) credit from the World Bank.
Periodically, the State Steering Committee headed by Etebu meets to compare notes and review the performance of the state in its execution of SOML. In a recent meeting held in Yenagoa comprising all health workers in the project, the committee evaluated the programme’s reach and its challenges. Etebu also inaugurated Local Government Desk Officers and charged them to drive the implementation of the scheme in local government areas.
Etebu explained that the rebranded SOML focuses on six important pillars of Maternal, Newborn and Child Health (MNCH) such as improving maternal, newborn and child health; improving routine immunization coverage and achieving polio eradication and elimination of mother-to-child transmission of HIV among others.
Etebu said states are the greatest beneficiaries of the programmes receiving 82 per cent of the $500m with an initial grant of $1.5m to each state and funding for subsequent years based on disbursement linked indicators. He said Bayelsa under the leadership of Dickson put measures in place to ensure maximum and strict utilization of funds focusing on results and outcomes.
The professor said his ministry set up implementation workplan that addressed all bottlenecks to ensure efficient healthcare service delivery in the six thematic areas of the programme.
He said the ministry further introduced initiatives for quick wins to create a direct and massive impact on the people of the state especially mothers and children. He said the Dickson’s Eye Care Project and the Dickson’s Award for the Best Performing Primary Healthcare Centre per Ward strategy were all rolled out under the state’s SOML.
The Programme Manager, Dr. Okoye Ebikapaye, said the grants from SOML were judiciously utilized in Bayelsa. He said In immunization, the committee ensured that vaccines and other materials were distributed to the health facilities. He, however, lamented lack of awareness and poor-health-seeking habit of pregnant women in the state as part of the challenges facing the programme.
“To ensure that pregnant women deliver in health facilities, we provided cash incentives to the women. To help in the delivery services, we provided the governor Dickson’s Safe Delivery Kits where all that is required at the point of delivery is given to pregnant women.
“We provided 2000 of the kits across the state. We want to improve. We have identified 500 women qualified for the cash grants and disbursement will be made soonest. The public awareness is not enough. We want it to be optimal.
“People are not utilizing the opportunities available. There is poor-health-seeks g habit of our pregnant women. They prefer our TBAs to the health facilities. So even after registering in health facilities, they end up delivering in TBAs”, he said.
Already, he said 11,000 persons accessed the Tele-health aspect of the programme adding that 2000 persons were attended to by skilled birth attendants. Ebikapaye noted that the immunization aspect of the programme increased from 43 per cent to 53 percent.
According to him HIV/AIDS thematic area had about 6000 pregnant women, who were counseled and tested and a few of them found positive were connected to where they would get anti-retro viral drugs.
Furthermore, the state participates actively in Maternal, Newborn and Child Health Week (MNCH). A fresh week took off recently. Etebu said it was the implementation of the first round of the 2018 edition of MNCH.
“It is a weeklong event organised to deliver integrated high-impact low cost result oriented and effective preventive and curative healthcare services”, he said adding that the programme would further increase maternal and child health indices.
He explained that the indices were expected to increase in the areas of vitamin A supplementation in children, deworming of children, nutritional assessment of children, iron/folic supplementation for pregnant women, routine immunisation, birth registration, intermittent treatment of malaria in pregnant women, HIV counseling and testing and counseling on key household practices such as hand washing.
He said the busy week would compel medical workers to improve access to high quality medical services to reduce high mortality rate and improve maternal health. He noted that a finding from the recent Nigerian Demographic and Health Survey indicates high neonatal, under five and maternal mortality.
Etebu said: “In consonance with the foregoing, is the fact that the MMCH is implemented in two rounds. Indices from Bayelsa state from the recent multi indicator cluster survey and national immunisation cluster survey is undesirable”.