Need for Multi-faceted Approach in Achieving Zero Maternal Mortality

At the recently held Nigeria Heath Watch’s conference in Abuja themed ‘Evidence for Change – Learnings and Recommendations for Quality Maternal Care’, stakeholders harped on the need for a multifaceted approach toward achieving a world of zero maternal mortality. Sunday Ehigiator reports

Ending preventable maternal mortality (EPMM) remains an unfinished agenda and one of the world’s most critical challenges. Maternal health, well-being and survival remain central goal and investment priority in the framework of the Sustainable Development Goals (SDGs).

According to the World Health Organisation (WHO), EPMM targets and strategies are grounded in a human rights approach to maternal and newborn health and focus on eliminating significant inequities that lead to disparities in access, quality as well as outcomes of care within and between countries.

The SDGs build on the gains of the Millennium Development Goals (MDGs) with a target for the reduction of maternal mortality ratio to less than 70 per 100,000 live births and the reduction of newborn mortality to less than 12 per 1,000 live births by 2030.

The Ending Preventable Maternal Mortality (EPMM) programme’s target of a reduction of the Maternal Mortality Rate (MMR) by all countries to at least two-thirds of their 2010 baseline levels is reliant upon the provision of available, accessible, acceptable, quality service in an enabling environment that respects human rights principles.

Similarly, the WHO posited that attention to maternal mortality must be accompanied by improvements along the continuum of care, including commitments to sexual and reproductive health, family planning, and newborn and child survival.

With the high burden of maternal and perinatal mortality (including in health facilities) at 576 per 100 000 live births and 77 per 1 000 live births in 2013, and women experiencing life-threatening complications with short-term or long-term impacts on quality of life, according to the National Demographics and Health Survey (NDHS), it becomes extremely important that more effective approach is explored towards reducing the scourge.

Against this backdrop, stakeholders at the conference recommended multiple approaches, including, digital technology, building the capacity of health facilities through the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD–4–QED) programme, and empowering and equipping health providers to deliver better quality maternal care.

Other recommendations include expansion of access to better quality maternal care, supporting women’s pregnancy journey through better quality of care, proper funding of primary healthcare centres across the country, and effective policies around maternal medicines in Nigeria.

Earlier while delivering her welcome address, the Managing Director, Nigeria Health Watch, Vivianne Ihekweazu said it was possible to achieve a world where no woman dies while giving birth.

According to her, for the past 18 months, Nigeria Health Watch has been working on a maternal health advocacy and communications programme to spotlight the importance of quality of care in maternal health in Nigeria through MSD for Mothers funded projects.

“So over the period, we have interacted with all of you to spotlight insights and evidence from MSD for Mothers collaborators programmes, all to spotlight interventions that will enable Nigeria to achieve the SDG target of a global Maternal Maternal Ratio of fewer than 70 maternal deaths per 100,000 live births by 2030.”

On the approach to spotlighting quality of care for women’s maternal health, Ihekweazu said the focus was on six thematic areas which include, understanding quality of care gaps, quality assurance, private sector capacity, affordability, digital support/technology, and evidence for change.

She said the objective of this Evidence for Change is to “amplify MSD for Mothers-supported collaborators, as evidenced through the outcomes and impact of the initiatives and innovations in improving maternal health outcomes in Nigeria; and highlight the importance of adopting a quality-of-care approach to delivering maternal health care in Nigeria through the strategic approaches of MSD for Mothers-supported projects in Nigeria.”

Also speaking, a representative of WHO, Dr Bosede Ezekwe, in a paper titled, ‘How the World Health Organisation is improving the capacities of health facilities through the MPD-4-QED Programme’ said the Nigerian Maternal and Perinatal Database for Quality, Equity and Dignity (MPD4QED) seeks to address the high burden of maternal and perinatal mortality (including in health facilities) at 576 per 100 000 live births and 77 per 1 000 live births in 2013, according to the National Demographic Health Survey (NDHS).

Ezekwe, whose paper was presented by the Director of Policy & Advocacy, Nigeria Health Watch, Ify Babatunde-Yusuf, said in addition, many women experience life-threatening complications with short-term or long-term impacts on quality of life.

She said among the quality standards expected to be available in every health facility, is that every mother and newborn has a complete, accurate, and standardised medical record during labour, childbirth and the early postnatal period.

Ezekwe said it is also expected that every health facility has a mechanism for data collection, analysis and feedback as part of its activities for monitoring and improving performance around the time of childbirth.

On human resource challenge, Ezekwe said “the motivation for data collections requires new strategies and innovations, as stipends will no longer be provided under FMoH.

“There has been waning motivation for data collection following stoppage of stipends as well as attrition (reposting/relocation of trained data collectors and hospital coordinators). Training required for new staff coming on board,” she said.

Associate Manager, Women’s Wellness, moc Healthcare, Chiagoziem Abiakam, in a paper titled, ‘Empowering Women Through Digital Technology: Providing holistic support through virtual coaching and digital nudges’ harped on ways in which the organisation is solving maternal mortality with the digitalized process.

She said mDoc optimises the end-to-end self-care experience for people with regular and chronic health needs by harnessing quality improvement methodologies, behavioural science, data and technology.

“mDoc is a digital health company, which leverages a high-tech high-touch approach to optimize the end-to-end care for people living with chronic conditions in Nigeria. They harness behavioural science, quality improvement methodologies, data and technology to provide an integrated care solution for people with chronic and regular health needs.

“We oﬀer a four-pillar, high tech, high touch approach to integrated self-care- Virtual coaches and digital nudges through CompleteHealthTM; In-person community-based NudgeHubsTM and community ambassadors; Tele-education of providers and patients MQNTM

“We help you ﬁnd quality healthcare services you need on NaviHealth.ai, our geo-coded directory. Patient review can be a powerful tool. They increase visibility and conﬁdence in existing and potential individuals to utilise the facility.

“The NaviHealth.ai patient feedback system is based on the dimensions of quality (safety, timeliness, eﬀectiveness, equity, eﬃciency, and patient-centred care) as established by the National Academy of Medicine.”

She said they are using a women-centred QoC model to reduce the risk of indirect MMM linked to PE/E.

On capacity building (clinical/Quality Improvement, QI, Abraham said the project is conducting onsite skills-based training; tele-ECHO virtual sessions to re-enforce provider learning/knowledge; supportive supervision and mentoring; and access to job aids and guidelines.

To ensure QI, she said the firm identifies quality gaps, sets improvement aims, develops QoC measures; establishes and supports QI teams to test changes (PDSA) and monitors trends in measures to track progress toward aims. Strengthen the Non-Communicable Diseases (NCD) Health Management Information System (HMIS) and use it for decision-making.

Quote