AN ADDRESS BY THE HONOURABLE COMMISSIONER FOR HEALTH, DR. J.S. OTUMARA, ON THE FIFTH YEAR ANNIVERSARY OF THE FREE MATERNAL HEALTHCARE PROGRAMME IN DELTA STATE

Distinguished ladies and gentlemen of the fourth estate, it is with all pleasure and gratitude to God that I address you on this memorable day which happens to be the fifth year anniversary of the free maternal healthcare programme.

INTRODUCTION
As part of its’ resolve in the global campaign to reduce maternal death, the Delta state government launched the free maternal healthcare programme at Central Hospital, Ughelli on the 26th of November, 2007 under the chairperson of Professor Adenike Grange, the then Minister of Health. This was in line with the human capital development of Governor Uduaghan’s led administration which had barely spent six months in office; a cardinal point of the administration’s three point agenda and a firm commitment to the cause of motherhood. Today, the programme is five years old and has recorded remarkable degree of success as reflected by the steady decline of the maternal mortality rate.
Since its inception, the state government has strived to improve the quality of care that pregnant women receive before, during and after they bring life into the world. The program has tremendously increased access to skilled birth attendants and has also led to availability of adequate necessary infrastructure, medical expertise and  equipment in secondary healthcare facilities in the state. It is currently been implemented in 57 state hospitals. It is a comprehensive package covering antenatal care and delivery including caesarean section, post natal care and treatment for ectopic pregnancy and complicated abortion, all free of charge.
Experience has shown that when services are offered free of charge there is increased utilization by people who hitherto would not patronize such services for fear of cost.  Presently, from available data, large populations of women now attend ANC services and deliver in state hospitals. So far in the last five years, we have recorded:
More than 250,000 booked ante-natal cases
More than 700,000 routine ante-natal cases
More than 100,000 deliveries as well as 100,000 live births

There is an observed significant drop of 48.5% in the Maternal Mortality Ratio i.e. from 456/100,000 in 2007 to 221/100,000 in 2011.
Computations are presently on-going to determine this year’s vital statistics. The other data as at 26th of November, 2011 compared to figures one year after commencement of the programme is as stated below:

s/n
Maternal indices
One year after  commencement of programme i.e. Nov, 2008

Four years after commencement of programme i.e. Nov, 2011
1
Perinatal mortality
48/1,000 live births
41/1,000 live births
2
Caesarean Section rate
10%
12%
3
HIV prevalence
3.6%
2.8%

Statistically, over the years the identified major causes of maternal deaths were:
Eclampsia – 39.5%

Haemorrhage – 22.1%

Sepsis – 6.4%

Prolong obstructive labour – 12.8%

Measures taken to address and thus reduce death from these causes include:

The introduction of MgSO4 as part of our armamentarium in the fight against hypertensive diseases/eclampsia in pregnancy
Provision of blood to avert death from haemorrhage; also there is plan to establish a state blood transfusion service
Emphasis on active management of labour with early intervention and improved infection control measures

However, majority of these death occur amongst the unbooked mothers and as a way out, enlightenment of the benefit of early booking is continuously carried out. Suffice to say, that Her Excellency, the 1ST Lady, Mrs Roli Uduaghan, undertook extensive enlightenment campaign at the initiation of the programme in all the 25 local government areas of the state as part of her contribution to save motherhood from preventable maternal deaths.

MANPOWER AND TRAINING
Like all things that are free, there has been a massive turn out of women accessing this service, thus stretching the manpower and facilities in our various hospitals to their limit, overwhelming medical personnel and facilities. Particularly affected are the Central Hospitals in Warri, Sapele, Ughelli and Agbor and the General Hospitals in Ekpan and Okwe-Asaba. These six hospitals alone accounted for (61.48%) of the total bookings and (55.9%) of the total deliveries. Influx of patients from neighbouring states such as Anambra, Edo and Bayelsa have been observed respectively in General hospital Okwe, Central hospital Agbor and Central hospital Ughelli.
Consequently, strengthening the state medical workforce by way of engagement of doctors, nurses, pharmacist, laboratory scientist and other health personnel through painstaking recruitment process, have been undertaken to meet up with this challenge.
Several training workshops to strengthen the capacity of our doctors and nurses have  been held from time to time. One of such, was  training workshop on the use of magnesium sulphate and misoprostol which was organized as a response to tackle the major causes of maternal mortality which was pregnancy induced hypertension/eclampsia. This action alone contributed immensely to the much improved results we have today.

PROVISION OF EQUIPMENT
The increased number of  patients have placed high demand on existing equipment and facilities and as such government embarked on specialized upgrading of equipment amongst which was the provision of sonicaid fetal monitoring devices, delivery beds, cardiotocograph and other obstetric’s equipment. Expansion and renovation of existing facilities were also undertaken to accommodate this persistent challenge of patients upsurge. Still not relenting on its oars, dedicated generators were provided for the six Central Hospitals including General hospitals Okwe and Ekpan to ensure uninterrupted service delivery at the labour room.

MONITORING AND EVALUATION
Monitoring remains critical in the success of the programme as it not only ensures that women do not have to pay at the point of receiving care but also ensures that the treatment guidelines is adhered to. The data generated in the various hospitals is evaluated monthly.
Thus, at the zonal level, the hospitals hold monthly meetings at their zonal headquarters in order to deliberate on the data generated by the hospitals in each zone with particular emphasis on the review of mortality and proffer solutions for averting re-occurrence after which a copy of the report is made available to the Ministry. The programme, thus, provides a reliable source of regular data for monitoring and evaluation of maternal health in the state
At the State level, meetings with the Obstetricians and other health personnel involved in birth attendance at the various hospitals were held with a view to improving the programme.

PROVISION OF DRUGS
The Delta state government through its Drug Revolving Fund (DRF) has continually ensured that drug supply to the hospitals is constant so that pregnant women are assured of genuine drugs and are not compelled to pay for drugs outside due to problems of out of stock.

CHALLENGES
This ranges from influx of patients from neighbouring states which have greatly increased the total number of patients beyond our projection to delay in referrals from churches, prayer houses and TBAs. These outlets are ill-equipped with poorly trained personnel to recognize and manage high risk patients. Often they are reluctant in referring patients until it is too late. However, there is still a fraction of women who prefer delivering at home or with a TBA. This as it were has also had its own share of unfortunate stories.

CONCLUSION
The target of the Millenium Development Goal 5 is reduction by 75% of the Maternal Mortality Ratio (MMR) by 2015. As it stands, the MMR for the State is 221 per 100,000 as against 456 per 100,000 at inception of the programme. Thus, we have been able to achieve 48.5% reduction of the MMR before the deadline of 2015 – a significant achievement.
Further reduction of the MMR to attain the goal of MDG 5 by 2015, will require sustenance of the political will of government, enduring commitment of health personnel, continued patronage by our pregnant mothers, diligent coordination by the Ministry and the support of the media.
Our gratitude goes to God for the achievement so far and all hands are on deck to realize the target sooner than 2015.

Thank you very much and may God bless you all.