Imperatives of engaging nurses, midwives in war against maternal, child mortality

IT is no secret that women die from complicated pregnancies and childbirth. The number keeps increasing daily. Statistics shows that nearly 800 women die every day from complications of pregnancy and childbirth and every hour nearly 20 women die in Africa from pregnancy-related causes.

According to (NDHS 2013), Nigeria, which represents only two per cent of the world’s population, has a maternal mortality ratio of 576 per 100,000 live births, accounting for over 14 per cent of the world’s maternal deaths.
Across the zones in Nigeria, maternal mortality in the North West and North East is six and nine times than the rate of 165/100, 000 live births recorded in the South West Zone. The main causes of maternal mortality in Nigeria are: Haemorrhage (23%), Infections (17%), Unsafe Abortion (11%), Eclampsia (11%), Malaria (11%), Anaemia (11%) and others (including HIV/AIDS) contribute about (5%) of maternal death. It is also estimated that for every maternal death, at least 30 women suffer short to long-term disability such as Vesico-Vaginal fistula (VVF).

Maternal health is an important issue that determines global and national wellbeing. This is because every individual, family and community, at some point, intimately involved in pregnancy and the success of childbirth.
In a bid to reduce the prevalence of maternal and child mortality, the United Nations Population Funds (UNFPA) in partnership with National Primary Health Care Development Agency (NPHCDA) has made available the procurement and distribution of Maternal Health Life-saving commodities and the training and retraining of nurses and midwives for the provision of quality maternal health services at the States and local government areas.

Evidence has shown that midwives who are educated and regulated to international standards can provide 87 per cent of the essential care needed by women and their newborn.

Data also shows that 75% of deaths can be averted if women had access to commodities and interventions to preventing or treating pregnancies and birth related complications, in particular haemorrhage, infection, unsafe abortion, eclampsia and obstructed labour.
Most of the women who die from these causes do so because they had no access to Skilled Care including Emergency Obstetrics Care and quality maternal mortality lifesaving commodities like the; Oxytocin, Magnesium sulphate, Misoprostol among others.
According to the UNFPA, life-saving commodities like the Magnesium sulphate is used in the prevention and management of Pre-eclampsia/Eclampsia, while Oxytocin and Misoprostol is used in the prevention and management of postpartum Haemorrhage.

In his statement, Executive Director, UNFPA, Dr. Babatunde Osotimehin, said that the government of Nigeria needs useful policies and enhanced accountability for effective delivery especially for women and children.
He said: “Nigerian Government has continued to work in collaboration with partners to support maternal and child health at all levels to achieve its goals and to advance efforts to achieve MDGs 4, 5 and 6. But if we are to really deliver for women and girls, we need effective policies, innovative financial mechanisms, enhanced accountability, aligned and transparent budgets, and systems and programmes.

“We also need dedicated people who will work towards clear and measurable targets to improve maternal health, and our efforts must be coordinated for maximum efficiency.”
He said that in supporting the government of Nigeria for the procurement of commodities, $2.5million has been pledged yearly from 2013-2017, noting that this year and beyond, all midwives will be supported globally as they strive for a healthy future for present and generations to come.

“We are making a pledge of US$2.5 million yearly for 2013 – 2017 to support procurement of additional MNCH commodities in addition to a pledge of US$3.4 million yearly for procurement of contraceptives bringing it to a total of almost $6 million yearly.”
He noted that in Nigeria, UNFPA has “provided support to 14 midwifery schools in terms of equipping skills laboratories and training on anatomical models, and has provided capacity building, technical support and training equipment for Long Acting Contraceptives (LARC) to all the 98 schools of Midwifery.

“We will continue to make a case for greater investments in midwifery to increase the number of midwives and enhance the quality and reach of their services.”
Osotimehin said that UNFPA Nigeria would continue to advocate for effective production, deployment and retention strategies in midwifery.

He said: “As we approach the deadline to achieve the Millennium Development Goals (MDGs), we are proud of the progress made for Goal 5, to improve maternal health. Maternal deaths have dropped by nearly 50 per cent, down from an estimated 523,000 in 1990 to some 289,000 at latest count.

“We must do more. We must start with training and providing more midwives.

“Today, we call for greater investments to increase the number of midwives and enhance the quality and reach of their services. Strong political commitment and investment in midwives is needed to save millions of lives every year.”
He further said: “UNFPA will continue to support midwifery and sexual and reproductive health and reproductive rights for all women. We fund more than 250 midwifery schools with books, training equipment and trained faculty, and helped train over 15,000 midwives globally.

“We support midwifery in more than 70 countries worldwide, and in 2014 helped launch Bachelor’s degree programmes in midwifery in Afghanistan, Burkina Faso, Somalia and Zambia.

“This year, as we prepare for the post-2015 international development agenda, the future we want is one where midwives play their full role in ensuring safe deliveries, promoting healthy birth spacing, and protecting the health and rights of women and girls,” he stressed.

Meanwhile in Abuja, the National Association of Nigeria Nurses and Midwives (NANNM), offered free medical services to Internally Displaced Persons (IDPs) in Abuja as part of the activities to commemorate this year’s International Day of the Midwives.
Speaking at the event in IDPs’ camp in Durumi, Vice President of the association, Margret Akinsola, said the choice to visit displaced persons was based on the fact that IDPs in the Federal Capital Territory lacked what it takes to live a worthy life.

Akinsola however, highlighted some the challenges facing midwifery in the country, which include; inadequate midwives in health centres, poor remuneration, housing, transportation and employment opportunity to skilled midwives.
She said: “They are not well fed; and even lack access to basic healthcare services. We decided to come here to give them succour in area of health. The purpose of this is for them to feel the impact of the midwives.”

According to her, “Nigeria is meeting the target needs of midwives needed in the nation by 97% in the area of maternal and child health but unfortunately where are these midwives? They are not employed.”
The vice president decried the huge migration of skilled midwives from rural area to the urban areas, noting that the migration was due to lack of basic amenities and medical equipment in rural health centres.

“In a situation where a midwife does not find what to work with, she would be discouraged to work.” She said

She appealed to government to not only build structures but also equip them.

She acknowledged the fact that dearth of midwives was among the main causes of maternal and child mortality, but appealed to midwives to see the work as a humanitarian service and stay wherever they were.
In her speech, the representative of Wellbeing Foundation Africa, Felicity Ukoko, said, accessibility varies significantly across sub-Saharan Africa, including Nigeria, with rural communities bearing the brunt of the disparity of access.
Ukoko, noted that only 40% of Nigerian women gave birth with a skilled birth attendant present, adding that investing in fully equipped health facilities would enable skilled midwives to offer full range of services and save lives of the thousands of women and babies who die each year from preventable causes related to pregnancy and child birth.

She said: “More midwives mean more lives would be saved.”
At displaced persons’ camp, hundreds of nurses and midwives offered the IDPs free antenatal, postnatal and family planning services after which drugs and food items were presented to them.

Men and women including their children, who trooped out en masse to benefit from the service expressed appreciation to the organisers.
In her responds, Aisha Muhammad from Gwoza, Borno State, who spoke on behalf of the IDPs in Durumi, thanked the midwives for bringing the medical services to them.

Meanwhile, nurses and midwives have been warned to strictly follow the new Midwives Prescription Regime which demands that all midwives must follow strictly the prescription given by the medical doctor for pregnant women in order to reduce the incidences of women dying from childbirth and pregnancy related complications.

Registrar, Nursing and Midwifery Council of Nigeria (NMWC), Chika Azuike, gave the warning while receiving Training Arm Models for the 98 Midwifery Schools in Nigeria.
The UNFPA donated the Training Arm Models, which are part of the vital training equipment as initiated by the International Confederation of Midwives.

The training arm model are meant to provide the midwives with a practical element in their training, provide the midwives with precisely the kind of skills-based training for them to function effectively as midwives anywhere in the world.
She said: “We have come out with the Midwives Prescribing Regime which have now been incorporated in the Act that set up the Nursing and Midwifery Council of Nigeria.

“What we do as midwives is to strictly implement the prescription of the medical doctor as regards whatever symptom they have seen in any pregnant woman.

“Closely to this is to tell the midwives that they can overcome pregnant women having complications by not to prescribing drugs but following the doctor’s instruction.

“Drug prescription, especially in the tertiary institutions such Teaching and Specialist hospitals are the exclusive reserve of the medical doctors. So, the midwives are to comply with the instruction of the doctors,” she noted.
She stressed that her council is trying through the midwifery schools to change the reaction of midwives to patients and those under labour.

“We are trying to change the attitude of the midwives towards patient reaction during labour.”
Speaking while donating the Models, the UNFPA Representative in Nigeria, Ratidzai Ndhlovu, expressed grief that 111 women die every day during childbirth and from pregnancy related complications.

She explained that there is scientific evidence that 30 per cent of maternal deaths can be prevented by increasing access to, and uptake of contraceptives.

“To achieve universal access to sexual, reproductive, maternal and new born care, midwifery services must respond to 12.8 million pregnancies per annum by 2030, 59% of these in rural settings.

“ The health system implications include how best to configure and equitably deploy the Sexual and Reproductive Maternal and Newborn Health (SRMNH) workforce to cover at least 837.4 million antenatal visits, 163.8 million births and 655.4 million post-partum/postnatal visits between 2012 and 2030.

“Midwives are in the best position to provide these critical services for mothers and their babies by virtue of their training.” She said.
She, however, urged all stakeholders from the both federal, states and local governments, development partners, the private sector to help invest in midwifery to make the changes that would transform into positive inputs to Nigeria’s economic development by saving the lives of the 111 women who die every day from child and pregnancy related complications.
The wife of the Senate President, Toyin Saraki, said that the impact of the training models would go far beyond the 98 midwifery schools that they will be sent to.

According to her, the impact of the training models will reach approximately 111 Nigeria women who die every day from preventable causes related to childbirth and pregnancy.
Her words: “This equipment will be used by thousands of midwives across the country in 98 midwifery schools. This equipment will allow thousands of midwives to leave their schools and enter the workforce with the right skills and the right experience to treat more women, in the right way.

“They will leave their schools and enter the communities with practical skills that can save thousands of lives and ensure many women can receive quality care, respectful maternity care and expert advice on family planning, birth spacing and more.”
The National President, National Association of Nigeria Nurses and Midwives (NANNM), Abdrafiu Alani Adeniji, said that Nigerians should stop housing the greatest burden of new born deaths in Africa but to overturn the negative health indices and chart the path towards a better health outcomes that is both care and cost effective.

She addressed some of the challenges, noting that nurses must “ clearly articulate and demonstrate the value and cost effectiveness of nursing and nursing outcomes to consumers, other health providers and policy makers at all levels through engaging in research and developing innovative models of care delivery that will contribute evidence of nursing effectiveness to planning, management and policy development.

“Nursing services must be directly managed by nurses because the nurse is accountable for the scope and standards of nursing practice and nurse leaders should lead advocacy for the development of national healthcare systems that provide a range of publicly funded essential and universally accessible and equitable health services to the population and vulnerable groups.”
She stressed the need to join forces with other health sectors to fully utilize their potential and promote health care system that is low cost, high impact patient, family centered and evidence based.

Her words: “As nurses, we are not oblivious of the role we play in consolidating gains made and expanding frontiers in more challenged areas. This is the time for us to renew our commitment to providing care with resilience and versatility as well as become fully involved in health care policy development and decision making to reflect our force for change.

“ It is a well known fact that for the smooth running of healthcare system that is focused on optimum level of quality care, government must play its own role effectively. We demand full implementation of the Yayale Ahmed Committee recommendation on the human resource for health in Nigeria.”

She urged the joint health sector unions to suspend its nationwide strike and ensure full health care services resumes in all health institutions across the nation as a mark of respect for President Buhari.

She said that the union should be guaranteed that all demands will be met and for government to expedite actions at resolving the outstanding demands of the unions, which includes; implantation of the new circular on promotion of our members from CONHESS 14 to 15 as directors which places premium on the need to sanction defaulting hospital managements ; enabling circular authorizing consultancy cadre for health professionals that have fulfilled the laid down criteria for consultancy status, as spelt out in the federal ministry of Health circular on consultancy and specialist allowances. Ref: SMH.491/S.2/VOL.II.221 of 29th march, 1976, and in compliance with the judgment of the National Industrial Court of Nigeria;and payment of arrears of specialist allowances to qualified hospital based health professionals with effect from January 1, 2010 and immediate and full payment of arrears of the skipping of CONHESS 10 which remains outstanding since the year 2010, in line with court judgment, among others.”

Alani urged government to halt all unwholesome developments to prevent unnecessary industrial crisis in the health sector.