PRIMARY HEALTHCARE SERVICE - HOW ONDO BATTLES MATERNAL MORTALITY

Due to the increasing rate of vehicular accidents, incessant bombings, as well as other unforeseen emergencies, claiming lives of Nigerians in thousands, the federal government has revealed the plan to build no fewer than 22 trauma centres across the country, to take care of victims of such emergencies.

But in a recent interview with THISDAY (a Nigerian newspaper), the Ondo State Commissioner for health, Dr. Dayo Adeyanju believes that the federal government's plan to build such trauma centres may not be a final solution. In his view, there is nothing bad about building trauma centres, but some issues must be put into consideration to be able to achieve effective result from such centres.

He gave the example of Ondo State, where the present administration met a deplorable health situation that portrayed the image of the successive administrations in the State in a bad manner. The state was even voted as the worse in terms of maternal health shortly before the inception of the present administration.

The commissioner revealed that as a result, the government decided that it has to turn the tide by overhauling the whole health care delivery programme of the state. This according to him has changed the concept of health care services in the state, in which greater attention is focused on mother , child, accident and emergencies.

In reconstructing the health sector, the government has built a complete medical centre, comprising of three major departments: Mother and Child section, trauma, (accident and emergency), diagnostic centre known as (Gani Fawehinmi Diagnostic Centre) and the information centre in Ondo town.

According to him, at the mother and child section, pregnant women are treated throughout the pregnancy period free of charge, while children also receive free medical treatment until the age of five years.

On accident and emergency, the government had identified the major roads where accidents occur on regular basis, such as, the Akure-Ondo-Ore and Akure-Owo roads, as well as other major urban link roads of the state and had set up the trauma centre where it provided ambulances fitted with medical gadgets capable of providing the necessary first aid medical services for any victim of accident.

The Commissioner said that the third section, which is the information centre has been set up to facilitate information regarding accident from any part of the state into a single hub capable of distributing the information where the centre could mobilize the ambulance to evacuate the victims and immediately start the dispensing of first aid before getting the victims to the nearest hospital for full treatment.

Adeyanju said the governor on assumption of office met ill-motivated workforce, poor infrastructure, poorly managed health sector, with very poor health indices. And as a medical doctor himself and a two-time commissioner for health in Ondo state, it is expected that he would want to revamp the health sector. He then made a promise that he would provide exceptional qualitative health care to the people of the state where they live, work and play.

"When you talk about qualitative healthcare, you look at the indices of healthcare: maternal mortality; under-five mortality; life expectancy. For maternal and under-five mortality, you will understand if anybody's focus or the fulcrum of his health sector drive is based on that, because this category of people constitute the vulnerable group." He said.

He explained that the government realised the fact that there is usually the rural-urban disparity in terms of maternal and under-five mortality. Often times, the disease burden is in the rural areas, but health facilities are usually located in the urban centres. "So when we want to reform our health sector, we started from the primary healthcare," He noted.

We understand that we must go to the rural areas, which was why we launched the Abiye (safe motherhood programme) in order to reverse the totally unacceptable increasing maternal mortality.

He revealed that it was the uncomplimentary remarks by the World Bank that spurred the government into action. "Coincidentally when this administration came on board, the World Bank visited and told us that we have the worst health indices in the whole country; they said our own was the worst in the entire South-West, so Abiye was meant to reverse that trend and to ensure that our women no longer die,"

The Commissioner further stated that the government discovered that the reason why pregnant women die is because the delivery was not being handled by skilled birth attendants. "We actually try to ensure that we get skilled birth attendants to take deliveries and we look at how we can track the women back to our health facilities by making sure that we catch all of them through registration."

Because we have discovered most of the pregnant women patronize traditional birth attendants (TBA), mission homes and some even take deliveries by themselves which is why we have high maternal mortality. So if we are able to get them to come and deliver at the health facilities, we will be saving a lot of lives.

So Abiye is basically to bring back those women to the health facility. So having registered them we refer them to people we call health rangers who will track them and we have equipped these health rangers with tricycles. They also have a customized checklist to help us determine the women that are at risk;

The commissioner said “if a woman is short-statured and has a big baby with small pelvis, there is no way that woman will deliver normally. If there is no checklist, there is no way you would know, the TBA has nothing of such; they will ask her to continue to push until she ruptures her uterus. So for us when we register them, we will be able to know those that are at risk; the woman who have high blood pressure in pregnancy, the woman who has diabetes in pregnancy or those with other medical problems and in view of this, we can do what we call the back plan for them," he explained.

Talking about how much the government has spent to build the medical village, he said, in terms of cost the trauma centre is worth 4 billion naira while the mother and child is between 600 and 700 million naira. The Gani Fawehinmi Diagnostic Centre is also between 600 and 700 million naira.

Our budget provision for health this year is almost 9billion. Even with this we have not achieved the World Health Organisation (WHO's) recommendation of 15 per cent total budget for health which explains why there is a lot of out-of- pocket expenditure for health. If you and I fall sick, we will still have to pay from our pockets because government provision is not adequate to meet up with the requirements.

For us in Ondo state, "under the Abiye (Save motherhood), the treatment is free of charge and we also give mobile phones to pregnant women free of charge because this is the only way they would be connected to their health rangers and they can get connected to the policy makers and even the governor himself when any doctor is misbehaving and since we have established rapport with the health rangers, he can always track them back to the health facilities," he explained.

In one year (2009-2010) of the Abiye programme, "we have succeeded in reducing maternal mortality by 15 per cent. So we believe that by 2015, we would have achieved a 75 per cent reduction thereby achieving MDGs and be the saving grace for the country because Nigeria has been listed as one of the forty countries that will not achieve MDGs."

According to him, " when the State presented the result in Washington DC, the World Bank said for the first time in the history of Nigeria it was getting a result, noting that before now, when they give support, people don't come back with result."

The strides in primary healthcare in Ondo are capable of turning the tide for primary healthcare in Nigeria, if the Federal government work in partnership with States to revamp primary healthcare.