Closing the Obstetrics Gap
Paul Obi and Kasim Sumaina write on the steps by Rotary International and other stakeholders to improve obstetrics in Nigeria
The quality of care given to mothers and new born has over the years become a source of concern. It is in that light that stakeholders believed that improved obstetric services remains the key to unlocking the challenges confronting care associated with newborn babies and mothers in the nation's healthcare system.
Thus, in its quest to ensure improved quality obstetric care and to integrate quality assurance model into health systems, Rotary Clubs from Germany, Austria and Nigeria between 2008 and 2010 substantially improved the quality of obstetric care in 10 hospitals in the states of Kaduna and Kano with a comprehensive approach including quality assurance in obstetrics ( OQA).
This intervention, according to observers has scaled up healthcare service delivery in many fronts. The programme brought together Rotarians from Nigeria, Austria and Germany with the Rotarian Action Group for Population and Development (RFPD) to work with state governments in Kano, Kaduna, FCT-Abuja and Enugu since 2008 to establish a system of quality assurance in obstetric ( OQA).
The project which is a pragmatic involvement of key health facility personnel to track maternal and fetal mortality within the facility, determine causative factors (especially structured & functional) and addressing them, especially through capacity building and structures improvements. This effort has gone ahead to reduce maternal and fetal mortality in the hospitals involved.
From November until April 2015, this innovative pilot project was successfully scaled up to 20 hospitals: 10 hospitals of Ondo State and FCT Abuja in addition to the 10 hospitals in the states of Kaduna and Kano. This initiative compiled, analysed and studied data on maternal and feta/ newborn deaths in these hospitals, identified the contributory gaps in quality of care and responded by building staff capacity and equipment provision to reduce the deaths. Improvements made are reviewed in an ongoing benchmarking process and monitored through regular visits to the hospitals. With community dialogues conducted in the villages in the neighbourhood of the hospitals, facility-based deliveries increased. Over the years, tens of thousands of mothers and newborns have already benefited from this improvement in healthcare.
The project jointly sponsored by Rotary International in Conjunction with Ministries of Health (MoHs) of Kaduna, Kano, Ondo and FCT-Abuja at the Final Prenatal Review Meeting of the 1st Rotary MCH Scaling up Project for Commissioners of Health of the MoHs for Doctors and Midwives is expected to streamline various healthcare interventions related to obstetric services and general care for new born. The Ministries of Health in the participating states have committed themselves to integrate this quality assurance model into their state health systems. The integration process will began with an autonomous continuation of OQA in the project hospitals and its expansion to all state hospitals and health centres in the states. The MoHs will provide their public hospitals with additionally required medical equipment. Rotary will- in the transition period -supply necessary training for health personnel and provide consultancy to the statistical offices of the MoHs.
Chief Executive Officer, Rotarian Action Group for Population and Development (RFPD), Prof. Robert Zinser, in his address said, the objective of the proposed project are to sustainably reduce maternal and newborn mortality, improved the quality of (obstetric) care and strengthen the health systems in the five states of Nigeria. “This shall be achieved through the inclusion of a system of quality assurance in obstetrics (OQA) into the states’ health policies and its implementation in health facilities’ obstetric departments. The OQA system has already been successfully introduced in 25 selected hospitals within the Rotary Maternal and Child Health (MCH) scaling up projects. The QOA systems proved to bring forth documented reductions in maternal and perinatal morbidity and mortality and to be scalable. Therefore, the QOA system shall be integrated into Nigeria Maternal and Perinatal Death Surveillance (MPDS) program as an effective response mechanism for improving the quality of (obstetric) care, and then be introduced in additional health centres in the five states of Kano, Kaduna, FCT-Abuja Ondo and Enugu. The ultimate goal is the integration of the MPDS/QOA system into the national system and a nationwide implementation.”
Speaking further, he said: “In order to extend the application of the MDSR program and improve its outputs, it shall