Death of pregnant women and infant is a major challenge to many countries and Oyo state had a reputation as a leading contributor of at least 41 deaths per 1,000 births in the country. But the state government recently launched Tomotiya Initiative to rewrite the narrative. Adeyinka Adeniran writes:
Maternal mortality, the death of a woman during pregnancy, childbirth or in the first 42 days after delivery remain a major challenge to health systems globally. All regions of the world have experienced declines in maternal deaths but fell short of achieving MDG 5.
Due to the changes that are bound to occur during the period of postnatal care (0–6 months after birth) in the lives of mothers and their new-born babies, the World Health Organisation (WHO) has reiterated that the period is a critical phase in the lives of the mothers and new-born babies.
Following the critical nature of this period, the Nigeria Demographic and Health Survey (NDHS 2018) report shows that the continuous provisions of health care services during pregnancy and childbirth including after delivery is important for the survival and the well-being of both the mothers and their infants.
Although there has been incredible progress in the global under-five mortality rate which had reduced from 93 deaths (in 1990) and 76 deaths (in 2000) to 39 deaths per 1,000 live births in 2018, the reduction is uneven across regions and the Low and Middle-Income Countries (LMICs) of the world.
The Oyo State Story
Oyo State, with an estimated population of 8.4 million, has about 1.7 million children under 5 years of age and ranks very high in neonatal mortality, infant and child mortality.
Going by the 2018 National Demographic and Health Survey (NDHS), the rate of a child under the age of one dying alarmingly stands at 41 deaths per 1000 live births. That puts the state as the third-worst in Nigeria after Kano and Jigawa. In all, Oyo State contributes over 30 per cent of the total of all infant mortalities in Nigeria.
Changing the Narrative
Not unaware of the unpalatable and negatives indices, the state government inaugurated a Steering Committee and Technical working group of the Oyo State Expanded Material And Child Healthcare initiative christened “Tomotiya Initiative”.
The event which held at International Conference Centre, UI, Ibadan had in attendance top government functionaries, health stakeholders, development partners and international partners.
Speaking before the inauguration, Governor Seyi Makinde said the staggering statistics on the maternal, infant and neonatal mortality rate is not the only negative indices the government is aware of and determined to turn around.
He reiterated that the state has no business being in the list of worst states in terms of deaths due to deliveries being taken by unskilled birth attendants and unmet needs of family planning.
Tomotiya Initiative
As the name denotes in Yoruba language, the initiative is “of and or for mother and child”. It is one key way through which the government hopes to meet the Sustainable Development Goals (SDG) number three, which targets improving maternal health and ensures that qualitative Maternal and Child Health services are offered at minimal cost.
According to Governor Makinde who was represented by his Deputy, Rauf Olaniyan, before the administration came into office last year, “we had studied statistics on the various sectors in Oyo State which formed a basis for what our focal points would be.
“One of the sectors that we realised we had to focus on was the healthcare sector. We knew there were huge infrastructural deficits in the sector. But something else that caught our attention was the quality and cost of healthcare and their multiplier effect on the vulnerable.
“From the 2018 National Demographic and Health Survey (NDHS), we saw that in Oyo State, the rate of a child under the age of one dying is 41 deaths per 1000 live births. That puts us as the third-worst in Nigeria after Kano and Jigawa. Oyo State contributes over 30 per cent of the total of all infant mortalities in Nigeria.
“Therefore, we have gone to the drawing table and come up with an initiative that will drastically reduce these figures. It is this project that we are here today to inaugurate, the Tomotiya Initiative.”
The Governor said ahead of 2023 when a new NDHS report would be released, a new projected target has been set to change the uncharitable status of the state in terms of infant, neonatal and maternal mortality. This is in addition to the plans to increase the number of births by skilled birth attendants in the state
“Our plan is to ensure qualitative Maternal and Child Health services are offered at a minimal cost. This will enable us to meet the objectives of this initiative. We are aware, that in 2023 when this administration will be winding down, there will be another NDHS report. When that report comes out, we would like to see drastic reductions in these negative indices. Our goal is to reduce maternal mortality by 30 per cent and reduce neonatal mortality by 20 per cent in Oyo State.
“To achieve this, by the grace of God and with the dedication, hard work and commitment of everyone involved in this project, we aim to increase the number of births by skilled birth attendants in the state by 30 per cent while also increasing the health care facility utilization in the state to 60 per cent.
“So, we hope to start piloting some of the programmes under this initiative in the shortest possible time. One of the important things we will be advocating is meeting the WHO recommendation of four or more antenatal care visits during pregnancy. The statistics show that when pregnant women are able to make at least four visits, the major complications that account for nearly 75 per cent of all maternal deaths are prevented”, the Governor added.
In his welcome address, the State Commissioner for health, Dr Bashir Bello said the initiative will ensure the welfare of women before, during and after birth disclosing that the government is also working on an effort to insure pregnant women in the state through a collaborative effort between the government and kind hearted willing donors.
The initiator of Tomotiya, Dr Funmi Salami, who is also the Special Adviser on health to Governor Makinde said the vision of the initiative is to contribute to a healthier and more prosperous society as healthy babies grow into healthy adults who thrive and can contribute to their communities and society.
She said “Tomotiya mission is to initiate a consultative process between all stakeholders to identify priority areas and identify clear strategic directions for Reproductive, Maternal, Newborn and Child Health (RMNCH). With a mechanism for oversight and constant quality review, we will build a sustainable and strong healthcare system.
“Also, to support our partners align their strategic directions and catalyse collective action to achieve easy and readily available access to comprehensive, high-quality reproductive, maternal, newborn and child health care.”
The Game Plan
In a slide presentation at the event, Dr Salami identified inadequate infrastructure and equipment, technical and managerial capacity at all levels, poor utilization of essential services and barriers to access as some of the challenges facing the sector.
She gave a three tier of intervention including, the community, primary healthcare facilities and secondary healthcare facilities to be achieved through a harmonized coordination of the activities of all relevant stakeholders.
Additionally, she said the Tomotiya Initiative would be achieved by identifying gaps and device impact interventions to fix them; quality improvement while also ensuring sustaining intervention from the communities, government, private sector, supported by partners.
Unlike other initiative before it, Dr Salami said the Tomotiya Initiative would be introducing what she described as “novel high impact initiatives” including Ward Health Rangers, comprising two respected members of the community per ward to be responsible for the health of the families in their ward for efforts such as immunization, hanging up mosquito nets, family planning and ensuring routine Antenatal care for the people living in the ward.
She added that the concept would also seek to introduce community health taxis, emergency transport system and designated emergency departments, all in the bid to aid people in need of medical attention to the nearest Primary Health Centre (PHC) in the local government ward.
Other new concepts in the scheme include, insurance adoption programme to sponsor pregnant women and children under five, community midwives initiative, digital health network and electronic medical records to be aided by the government’s plan to renovate and upgrade at least one PHCs per ward in the 351 wards in the state.
International Partners
International partners at the event, including, Dr Marcus Oluwadare (World Health Organisation), Mr Tushar Ranee (United Nations Children Emergency Funds, UNICEF) and Aids Prevention Initiative of Nigeria (APIN) pledged their support to the government and success of the programme.
While the Steering Committee is to have the Special Adviser on health, the Permanent Secretaries, Ministry of Health, Health management Board, Executive Secretaries, Primary Healthcare Board, Health Insurance Agency as members; the Technical Working Committee has Directors, Medical Service, Nursing Services, PR & S, Deputy Director, Public Communicable diseases, select PHC programme managers among others as members.
