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SPEECH OF MR. GOVERNOR, DR. OLUSEGUN MIMIKO AT THE 9th INTERNATIONAL CONGRESS AND 49TH ANNUAL GENERAL MEETING OF THE SOCIETY OF GYNAECOLOGY & OBSTETRICS OF NIGERIA IN SHERATON HOTEL, ABUJA
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It is once again a tremendous pleasure to be present among you, my fellow SOGON members. This is especially so on this occasion of the 9th International Congress and 49th Annual General Meeting of our dear Association which coincides most auspiciously with our 50th anniversary celebration.
It seems like yesterday that I had the humbling privilege of being conferred with a Honourary Membership of the Society of Gynaecology and Obstetrics of Nigeria at a similar Meeting four years ago in Ibadan, the Oyo State capital. At that time the Ondo State health sector was just two years into reaping the fruits of the maternal and child health reforms instituted via the Abiye (safe motherhood) programme. It is with a sense of pride and utmost fulfilment that I hereby announce that our dear State now stands out as perhaps the only State in Nigeria to have attained the Millennium Development Goals 4 and 5 with the empirical evidence to prove same.
At the inception of our administration in February, 2009, we met a poorly funded, inadequately equipped health infrastructure manned by an ill-motivated, demoralized and under-staffed professional work force. To worsen matters, the 2008 Nigeria Demographic Health Survey (NDHS) put Ondo State as having the worst maternal and child health indices in the southwest. In addition, Ondo at that time, had the unenviable reputation of being the only southwestern State and one of the few nationwide without a State-run teaching hospital for both under- and post-graduate training.
Ondo state has now reduced its Maternal Mortality Ratio from a baseline of 545 per 100,000 births (referencing the household survey by the NDHS in 2008) to a verifiable 170 (referencing the verbal autopsies by the Confidential Enquiry into Maternal Deaths in Ondo Statein May 2015), a reduction of over 70%. Concurrently, a facility-based 5-year audit of Maternal Mortality Ratio at the Mother and Child Hospital Akure (arguably the busiest and most affordable maternity centre in Nigeria with over 30,000 births) showed a reduction from 708 per 100,000 births in 2010 to 208 in 2014, another fall of over 70%. We have gotten to the point where over 90% of pregnant women residing in the Stateare being tracked at every point in time (i.e. names, addresses, place of deliveries, outcomes, etc) and we have the data to back it up.
Despite these significant achievements our administration is often criticized for not showcasing ourselves much more than we are doing at present. I will therefore like to use this unique opportunity to share with you some of the principles that have guided our policieswith a recommendation for replication in other states and at the national level:
Our commitment to track every pregnant woman in the State from conception, to delivery and reach out to them wherever they live, work or play, laid the foundation for the Abiye (safe motherhood) programme. It was in this line that we painstakingly set up modalities to register our pregnant women, monitor their antenatal care and record the outcomes of their deliveries including the unfavourable ones, thereby amassing enough data to institute strategies to improve care. I am pleased to discover that SOGON in conjunction with the Federal Government and other developmental partners are now working towards instituting a nationwide maternal and perinatal death surveillance response (MPDSR) system, similar to our Confidential Enquiry into Maternal Deaths in Ondo State (CEMDOS).
It is my wish that this forum will be an opportunity to represent our 3rd consecutive report to our amiable Association President.
(2) We chose to remove all impediments preventing pregnant women from inter-phasing with healthcare professionals. This principle led to the establishment of the Abiye maternity centres and of course, the Mother &Child Hospitals in Akure and Ondo. We discovered that financial impediments were a major factor militating against unfettered access to qualitative healthcare services, so we provided the latter free of charge (i.e. free consultations, admissions, drugs, laboratory tests, surgeries and blood transfusions!). As at today, there is hardly any household in Ondo State that has not benefitted either directly or indirectly from these services in the last 6 years. It is clear that any populace will gravitate towards affordable and qualitative health care facilities manned by well-motivated professionals.
(3) We recognized allocation of State resources towards maternal and child health care as an investment rather than just an expenditure. These investments were however premised on specific needs assessment and performance- based principles. The latter has since been adopted by The World Bank and performance-based financing (PBF) is now recommended for the sustenance of the provision of qualitative healthcare services in the developing world.
On another note, the challenges with ensuring skilled birth attendance in all deliveries were being hampered by the ubiquitous traditional birth attendants and faith-based healers. In fact, the first CEMDOS report identified over 90% of unfortunate maternal deaths as being linked to mismanagement or delayed referrals from such unskilled hands.
In the first quarter of last year, we launched an innovative and pragmatic collaboration with traditional birth attendants and faith-based healers incentivizing their referrals of pregnant women for delivery in public health facilities while gradually phasing them out which we termed ‘Agbebiye Initiative”. To the best of our knowledge this is the first successful and sustainable statewide intervention to address the menace of unskilled attendance at deliveries and has already attracted the attention of developmental partners. In one year of this Initiative, almost 6,000 pregnant women have been referred from various traditional birth and faith-based healing homes to various health facilities across the state. The resultant deliveries included 11 twins, 7 triplets and one quadruplet.
As regards child health, through our “Orirewa” programme, Ondo has on the two consecutive occasions been accorded the State with the best immunization coverage nationwide, courtesy, the prestigious Bill and Melinda Gates National Leadership Award in Eradication of Polio in 2013 and 2014, respectively. We are poised to repeat this monumental feat this year as well.
Our human capital development in the last 6 years is unmatched and may well be our greatest area of impact. It is to our credit that from just 7(including 2 obstetrician/gynaecologists) in 2009, we now have 75 Specialist Consultants (including 16 obstetrician/gynaecologists) an increase of almost 1000% . Along with the employment, is a robust remuneration package put in place despite the limited financial resources of the State. This massive intake of healthcare professionals extends to other cadre like nurse-midwives, pharmacists, medical laboratory scientists, etc. We will also continue to invest in the professional workforce because we know how critical their roles are in complementing our efforts.
Time will not allow me to go into details of our other milestone achievements including establishment of the world class Medical village comprising the Trauma and Surgical Centre (as part of an Emergency Medical System) to cater for various surgical specialties and victims of road traffic crashes. To date, the Centre has conducted almost 2,000 procedures, including some that hitherto would have warranted patients going abroad e.g. pacemaker insertions, hip replacements, neurosurgeries etc. In addition, a fully equipped Kidney Care Centre established just last year is operational in the same axis and has till date, treated over 800 patients and conducted over 2,000 dialysis sessions. Of note is that the second Mother and Child Hospital in Ondohas been formerly accredited for post graduate training in Obstetrics & Gynaecology in less than 3 years from inception.
I cannot round up without mentioning the establishment of the first University of Medical Sciences in Nigeria. Located within the same Medical village complex in Ondo, it is our expectations that when combined with the adjoining tertiary facilities, the institution will be a ready source of manpower not only for doctors but for other cadre as well. Make no mistake we are poised to be a Centre of Excellence in health service delivery, training and research. It is heartening to note that our pioneer Vice Chancellor is no other than Prof Friday Okonofua, a respected member of SOGON.
In conclusion, ladies and gentlemen,I stand before you with a conviction that the areas of convergence of interest with SOGON will be explored to the fullest in line with a joint mandate to make universal access to affordable and qualitative healthcare services our ultimate goal in reducing maternal deaths in Nigeria.
May The Almighty God, continue to strengthen such future collaborations as we strive to better the lot of the teeming masses.
God bless and thank you.
