By Stephanie Ududuwa, Sparkling FM
Available data shows that Cross River State records 820 deaths every 100,000 live births and this number may be lower if declarations from the Government about equipping the health facilities to deal with medical emergencies arising from childbirth are fulfilled.
Interventions from Non-Governmental Organizations (NGOs) like Pathfinder through Saving Mother Giving Life Initiative also contributed to this decline.
One may wonder what could lead to the death of a mother and child during, while or after giving birth.
Lack of access to good health facilities, poorly trained manpower and under equipped wards are at the front seat of causes leading to high maternal deaths.
How We Got Here
Mrs. Esther Ekpeyong is the Facility Head of Primary Health Center Ikot Ishie, she shared a sad experience of how a patient went into postpartum hemorrhage undetected because epileptic power supply.
“There was an issue when we delivered a mother and there was no light. It was a safe delivery no doubt but the mother collapsed as she was trying to breastfeed the baby.
“The mother was bleeding and we did not know, since all these candles, rechargeable lamps, and phones we used cannot cover everywhere, she slumped.”
They were able to save the woman because they sprinted out, in search for neighbors to help convey her to the University of Calabar Teaching Hospital where she was transfused because they don’t have ambulance.
This scenario explains why Nigeria accounts for 20% of the global maternal deaths, mostly due to poor maternal healthcare systems, poverty, ignorance and bad decision making.
When Pathfinder’s Saving Mothers Giving Life Initiative was launched in Nigeria in 2015, it was to replicate the success recorded in Uganda and Zambia. Both countries saw a 44% and 41% decrease in maternal mortality respectively. This initiative aimed at reducing maternal mortality by 25% and neonatal mortality by 35%.
The initiative which was supported by We Care Solar, installed solar panels to light selected sections in health facilities across the State. The solar lamps illuminates the delivery rooms, postnatal wards and waiting area.
The solar system comprises a suitcase from which the lamps and panels are controlled.
The panels charge the suitcase and the lamps. Two of these lamps are located in the delivery area, while the postnatal and waiting area have one lamp each.
The installation of these solar lamps required a team of solar technicians, electricians, facility heads and the cooperation of the host community.
In Cross River State, The Saving Mothers Giving Life Initiative was captured in all 18 Local Government Areas in the three Senatorial Districts of the State.
In the Northern Senatorial District 19 primary healthcare centers benefited from this initiative, in the State Central District 24 primary healthcare facilities were part of the initiative, and 13 PHCS were captured in the Southern District. However some health facilities in the Northern and Central District were omitted because of communal clashes and closeness to secondary health facilities.
The State Commissioner for Health, Dr. Betta Edu says a large number of primary healthcare centers worked using archaic means of lighting such as candles and lanterns to deliver babies, which reduced the efficiency and effectiveness of the health workers.
“At the time where Pathfinder was coming in, we had a lot of challenges around maternal and child health. Mothers were giving birth in unsafe environments with unskilled workers and led to the death of many mothers and their new born babies,” she said.
She went further to State that, the project had a 360 approach; providing a conducive environment for mothers to give birth.
The initiative involved key stakeholders in the health sector in Cross River State; it involved the State Ministry of Health, the Cross River State Primary Health Care Development Agency and the State Government.
The key objectives of this initiative includes; increasing timely utilization of institutional delivery services. Ensure women and their newborns receive key health services and improve the quality of maternity care and institutional delivery services, including emergency obstetric and newborn care.
Data from Pathfinder International reveals that 59% of women in Cross River State have home births, while 34% of these women patronize public health facilities whiles 6% visit private facilities.
There’s a low patronage of health facilities by pregnant women because they lack credibility. They often question whether a facility without a stable power supply can provide optimum health care delivery system, thus resulting in the high rate of home births, which would in turn increase the number of Maternal deaths.
A Bright Start To A Worthy Course
Sally Atem is the Coordinator of the Saving Mothers Giving Life Initiative at the Cross River State Primary Health Care Development Agency. She revealed that successful installation stemmed from support of host communities during the installation of the solar suitcases.
They were so excited to have that initiative in the facility, some of the communities even volunteered to put protectors round the solar suitcase to avoid theft.
A Cause Not Without Challenges
Atem highlighted some of the challenges faced during the installation of the solar suitcases;
The facilities that were colored red were not accessible because of intertribal crisis. Then another challenge that slowed down the installation, was the national strike; all the health care workers were at home .
She also described how differences in scheduled activities affected the training of health care providers. We had a clash of activities during campaigns, the health workers were not there to be trained, because we needed to train them, she said.
Dr. Betta identifies challenges that are threatening the usage of the solar suitcases.
We had challenges around the usage and maintenance of some of these solar panels, the health workers, some of them were not conversant with this solar system and the way they work. Actually, when we have trained somebody and the person is posted out, it becomes very difficult for the entire facility.
She added that the strength of the panels are unable to carry the entire facility well depending on the size of the facility, most of them it was just restricted to the labor room, the waiting area, post natal ward.
The health facilities that were omitted from the project are still operating using archaic systems of health care delivery, which has a ripple effect in the effectiveness and patronage of these facilities.
Ekpeyong, explains how a low maintenance following the installation of the solar suit case has affected the facility.
When they were trying to install the solar, we had some opening in the ceiling and the clinic is now leaking.
The facility head at Nyanghasa Mercy Otu, also narrates challenges associated with the solar panels. saying, during the rainy season, if we have constant rain we may not be able to recharge it.
Also, a mother who was delivered at the Ikot Ishie Health center, Happiness Oguni, disclosed that despite the professionalism of the health workers, electricity is still a major problem.
“There was no light the day I delivered my child, they were using a torchlight. One of the nurses was pointing another midwife to the work, which I know is not healthy.
“I saw the panels that were mounted on the roof of the delivery ward, I asked some questions they said they had a battery issue that was not functioning well.” She said.
Oguni further disclosed that despite the installation of the solar lamps in the facility, these lamps were not functional on the day she delivered.
This highlights how the issue of continuity and maintenance of these solar panels has become more of a pressing issue.
A Question Of Continuity
Years after the installation of solar panels, the question of continuity still lingers, and the provision of constant power supply in health facilities in the State by the State Government has still not been attained.
We’ve not been able to get more solar panels from We Care Solar, and for many reasons. First, the due process of the State will not allow you to procure from external bodies without having them locally registered in the due process office in Nigeria. There are a lot of modalities which are problematic says the State Commissioner of Health.
Edu added that although funds for maternal health were included in the 2020 budget of the State, the State was unable to actualize this, due to the covid pandemic, which necessitated most of the State funds to be directed towards addressing the covid pandemic.
She however disclosed that; this year it has also been included again, and she is hopeful that they can opt for locally made solar panels that would help facilities and help people address maternal and child health issues.
Despite the large success that was recorded by the Saving Mothers Giving Life Initiative, Nigeria still battles with the delivery of proper health care in health facilities.
To completely eradicate maternal mortality, the local communities are the first point of focus, in this case, the primary health centres where adequate maternal care should be rendered to an average woman that is unable to afford high end secondary and tertiary health facilities.
This story was produced with grant from Maternal Figures given to Sparkling 92.3 FM Calabar.