By Kayode Joseph Abiye was first brought to global reckoning in August 2011 during a courtesy call on Governor Mimiko in Akure, the state capital, by a World Bank team, led by Dr Dinesh Nair , a senior health specialist. Nair had said the state had attained a leadership position in maternal and child health not only in Nigeria , as it had become a benchmark and a reference point in Africa . Indeed, as indicated by the World Bank prior to the Mimiko administration, Ondo had the worst maternal and child health indices in the South-West geopolitical zone. The 2008 Nigeria Demographic and Health Survey indeed returned the damning verdict that less than 50 per cent of pregnant women in Ondo State were delivered by skilled providers, a big anomaly, given, as it pointed out, that "the single most important strategy to reducing maternal and newborn deaths from obstetric complications is to ensure that every pregnant woman is attended to by a skilled birth attendant at delivery…" Launched in October 2009 in Ifedore Local Government Area of the state, the pilot Abiye programme was aimed at bringing qualitative and effective health care to women and children where they live, work and play, and developing sustainable equity-based health care services that will provide universal access to the people. The revised goals are to reduce maternal and child mortality by at least 50% and increase facility utilisation by at least 60%, by the end of 2012. The delays which predisposed to maternal and child deaths were identified, including primary phase of delay in seeking care when complications arise; secondary phase of delay in reaching care when decisions are taken to seek care; tertiary phase of delay in accessing care on arrival at a facility, and quaternary phase of delay in referring care from where it is initiated to where it can be continued or completed. Strategies were consequently drawn up to tackle these delays head on. While the primary phase of delay was tackled by tracking pregnant women, using the health ranger assigned to them, with monitoring done with motorbike or tricycle using customised checklist and mobile phone, the secondary phase was tackled by providing motorbikes, tricycles or four wheel drive ambulance and boats, as appropriate means of transportation whenever complication or emergency situations arose. The tertiary phase of delay in accessing care was addressed by ensuring that basic or comprehensive health facilities were provided in each of the wards in the18 local government areas in the state, with a General or Specialist hospital also provided, well equipped and manned by trained personnel. The last phase was tackled by ensuring that all the health personnel understood the effective referral network from basic to comprehensive and then to specialist hospital or mother and child hospital, the apex maternal and child health care centre. Abiye has recorded landmark achievements in seven key areas. These include: managing and discharging routine post-vaginal delivery patients within 24 hours and post-caesarean section patients within 48 hours without compromising on quality of care, thereby reducing cost of care and work load per patient, and increasing patient turnover by more than 100 per cent, simultaneously; developing a confidential enquiry format of reporting and recording maternal and child deaths with emphasis on avoidable factors, missed opportunities and levels of substandard care; developing an easily reproducible scoring system of tracking maternal morbidities and near-miss mortalities to expand our maternal health data base; developing a unique and cost-effective digitalized drug procurement system that has practically eradicated out-of-stock syndrome, the bane of many free health schemes across the country; having in its possession state-of-the-art training mannequins including electronic force monitoring birthing and airway management simulators for life-like practical demonstrations and applications on emergency care; collaborating with the London School of Hygiene and Tropical Medicine to conduct a multi-centre double blind randomized clinical trial on management of postpartum haemorrhage using tranexamic acid (an anti-fibrinolytic agent); and, finally, developing a revolutionary health education video CD in vernacular (subtitled in English), emphasising birth preparedness and complication readiness. Addressing a side attraction session at the United Nations General Assembly in New York on the world renowned Abiye programme in October 2013 , the Ondo State governor, Dr Olusegun Mimiko , hinged the success of the globally renowned Abiye (safe delivery/motherhood) programme on the adoption of three key principles adopted in its execution: "Tracking of the pregnant women from conception to delivery; opening the health care sector for universal and free access and allocation of resources in the most efficient and equitable manner." The Confidential Enquiry into Maternal Death, an initiative to track death of pregnant women, he said, explained the fast reducing mortality figures in the state. The governor said: "We vowed that pregnancy will no longer be a death sentence in our state and we embarked on a comprehensive process of intervention that has yielded noticeable results in a short period of time. From a novel process of tracking pregnant women through ICT tools, to providing care and access at all stages of pregnancy to delivery and five weeks after, we have provided care at no cost to the woman or her family at the point of care. Several lives have been saved in the process." Dr Mimiko addressed broadly the same themes he had addressed six months earlier in the USA , where health experts hailed the Abiye programme as a template for Africa . The verdict of the team of experts from around the globe, including the World Bank and representatives of the United States government , who spoke at the Centre for Strategic and International Studies (CSIS), Washington DC , during a presentation by Dr Mimiko: for Nigeria to attain the Millennium Development Goals in health and reverse the prevalent high mortality rate among mothers and children, it must adopt the Abiye programme with immediate dispatch. Speakers at the event, including Jennifer Cooke , CSIS Director, Africa Programme; Dinesh Nair , Senior Health Specialist at the World Bank and Mohammad Murtala Mai , Senior Technical Advisor, Pathfinder International and others lamented the lip service paid to health care delivery by successive administrations in Nigeria as well as the low level performance of some of the nation's health programmes such as the National Health Insurance Scheme (NHIS), meaning that Nigeria today remains one of the most dangerous countries in the world for a woman to give birth. Indeed, in inviting Dr Mimiko to deliver a lecture, the Centre for Strategic and International Studies observed pointedly: " Abiye model is a work in progress, and the initiative's leadership is cognizant of the challenges associated with scale-up and sustainability over time. But the programme does provide a positive preliminary model of how data collection, technology and innovation, efficient use of resources and mechanisms of accountability – backed by sustained political will – can come together in a comprehensive strategy.'' The accolades here in Nigeria have been no less resonant. Former Vice-Chancellor of the University of Port Harcourt , Emeritus Professor Kelsey Harrison , showered accolades on Dr Mimiko for his administration's success in the reduction of child and maternal mortality in Ondo state. Harrison likened Mimiko to the sage, Chief Obafemi Awolowo . An Emeritus Professor of Obstetrics and Gynaecology, Harrison was guest lecturer at the 7th Annual Olikoye Ransome-Kuti Lecture held at the Lagos University Teaching Hospital , in July last year. His verdict: Abiye has made tremendous impact in the lives of pregnant women in Ondo State. His words: "Under the leadership of Governor Mimiko , a functional health care system for maternal and child health has been set up and, from all accounts, it works. The people for whom the set-up is established trust it, with the result that its coverage increasing rapidly. Quality records are kept, they are easy to retrieve, so that with time the date obtained when analysed, will provide much correct information not only for health planning but also socio-economic and political advancement". In his lecture titled "Preventing Maternal Deaths in Nigeria : Looking Back and Looking Forward", Harrison traced the high maternal mortality rate in the country to social, economic and political failure on the part of all stakeholders and called for the orientation of the entire population on maternal health. In September last year, former Minister of Health, Prof. ABC Nwosu, predicted that Abiye would soon become a phenomenon in Africa . Nwosu spoke during a visit to the Mother and Child Hospital , Akure, with the Special Adviser to the President on Inter-Party Affairs, Senator Ben Obi . Nwosu's testimony: "With the indigenous and practical approach of Dr. Olusegun Mimiko's government to the maternal and infant mortality reduction, it is unarguable that the safe Motherhood health care programme is fast becoming the new phenomenon in the black world. The maternal and child care system in Nigeria is a shame of the nation. The way to come out of it was my target if I had stayed longer as the Minister of Health. No doubt, this project could only have been done by government of ingenuity and commitment. It is not out of place to say that this Safe Motherhood programme should become a continental affair. The adoption of this programme which is the first in Africa will fast track our achieving the Millennium Development Goals (MDGs). "Whoever is saving lives is saving the world, he is also saving humanity. I am fascinated and held spell bound that while other hospitals are charging hundreds of thousands of naira for Caesarean section, there is a governor who is doing it free of charge." On his part, Obi said the programme would make Africa a safe haven for pregnant women who were before now vulnerable to avoidable cheap deaths. The Chief Medical Director of the hospital, Oyeneyin, stated that the hospital within its two years of existence, had attended to 52,000 women and children, taken 13,000 deliveries, carried out 2,100 Caesarean Section, said it recorded zero maternal death out of 600 deliveries in August 2013 alone. •Joseph writes in from Akure.
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