"My husband and I have always known that I would deliver at the hospital," says Azeema Hussaini, 25, while sitting on a bed in a muddy two-room house, nursing her three-week-old daughter, Maisara, whom she gave birth to at the General Hospital Jahun, Jigawa State. The mother of three had her previous deliveries at the same hospital. Three years ago, when she had her second child, she had to undergo a caesarean section. Her husband Hussaini Muhammad, a trader who regularly travels to nearby villages for business made an arrangement with Halima Adamu, a women leader in their village of Bordo. He informed Adamu of his plan to have his wife taken to the hospital if she goes into labour while he was away.
On a Wednesday afternoon in early September, as she started having labour signs, Hussaini sent for Adamu, who immediately came with the driver, Yunusa Uba and they made the 35 kilometre-journey to Jahun, where she delivered her baby within an hour of arrival. Hussaini is one of the hundreds of women from Bordo and five surrounding settlements that have been transported to the hospital for deliveries in 2020, thanks to a vehicle herself and other women contributed money to buy in December 2019.
Bordo village, in Tauro Local Government Area of Jigawa State has had challenges for three years, while taking pregnant women in labour to the hospital for delivery. "We have lost several women and their babies," said Alhassan Haruna, the traditional leader of the village. Between 2010 and 2016, the village had a vehicle solely for that purpose and women were transported safely to hospitals for deliveries. The vehicle was donated by the Jigawa State Government in 2010 through the Haihuwa Lafiya or safe delivery program, which was initiated by the state government to ensure women, especially those living in rural communities, are transported safely to the nearest hospitals for deliveries.
The vehicle was involved in an accident in 2016 and even though no life was lost, it was damaged beyond repair, according to Haruna. Since then, as there was no vehicle in the entire village, women in Bordo had to be transported in wheelbarrows or motorbikes. The pregnant women had to travel through approximately five kilometres of untarred roads which get wet and muddy during the rainy season, to nearby Aujara village. They would then have to hire another vehicle to take them to Jahun General Hospital. According to Adamu, aside losing their lives, many women had given birth on their way to Aujara, while some ended up with complications like fistula, which has serious implications on their future pregnancies.
A resilient village despite challenges
Bordo is an agrarian village surrounded by small rivers, farmlands and settlements. It is neither connected to the electricity grid, nor does it have pipe-borne water. There are however three hand pump boreholes serving the village. It has a small primary school with two teachers, while the closest junior secondary school is about three kilometres away. The long distance to the schools serves as a deterrent for children, especially girls to go beyond primary education in the village. When it rains, Bordo is inaccessible as the only road leading to the village from Ajuara becomes difficult for cars to navigate. However, Bordo's biggest problem is its health facility. Aside from the completely dilapidated building with leaky walls and falling ceilings, the facility has no equipment and only one bed in the designated antenatal room. Worse still, the facility has had only one health worker since it was built in 2004, who conducts antenatal classes, immunisation and other services, with the help of a volunteer worker who comes around twice a week. According to the health worker, Saminu Usman, the facility operates between 8am and 3pm on weekdays while it is closed on weekends. On rainy days, especially in the morning, work hours are cut short or the facility is completely closed due to the inability of Usman, who lives in Ajauro, to ride his motorbike to the village.
Taking their destiny into their own hands
The community requested for a new vehicle from the state and from their local government to replace the one that was damaged. Despite multiple requests, there was no response from the government officials. So, the people of Bordo, led by their traditional leader and Imam decided to take action rather than just wait. In August 2019, they agreed to contribute money themselves to buy a new vehicle. The economic conditions of the people in the village made this seem like an unachievable goal, and they were unable to raise any funds.
In September 2019, the Federal Government's conditional cash transfer programme, under which the poorest people in some communities across the country are given five thousand naira (N5,000) monthly, reached Bordo. Four hundred and seventeen women from the village were identified and enrolled in the program. Bordo's traditional leader and Imam requested that the women enrolled in the programme, contribute one thousand naira each for two months to buy the vehicle. Adamu and her deputy Ramatu Alhassan related this request to the women, and they graciously agreed to it, according to Alhassan. By the end of November 2019, N834,000 had been raised. At the request of the traditional leader, some indigenes of Bordo trading in Kano augmented the funds the women contributed to make the total funds raised one million naira (N1,000,000). The money was used to buy a new vehicle in December 2019 and it has been in use since then.
According to Uba, who drives the vehicle, from December 2019 to September 2020 more than 280 women have been transported with the vehicle from Bordo to Jahun General Hospital for delivery, saving the lives of the women and their children. He added that no woman has lost her life so far while on the way to the hospital, and no baby has been lost either, a positive change compared to between 2016 and 2019. "Even when a woman delivers at home before being taken to the hospital, we make sure she and her baby are taken to the hospital to get checked," said Alhassan. This was what happened to Aisha Abdullahi. The 20-year-old delivered her baby at home while the vehicle was on the way to pick her. She was taken to the hospital after she and her son, Adamu were cleaned. On arrival, the health workers noticed Adamu's unbiblical cord was not properly cut. Adamu and his mother had to stay in the hospital at Jahun for two days for him to be treated.
To maintain the vehicle, the people of Bordo agreed that every husband pays N1,500 to transport their wives to the hospital. Out of the money, N1,000 is used to fuel the vehicle, N200 is given to the driver as an incentive while N300 is kept with the traditional leader to maintain the car when the need arises. "Through this, we have kept the car in good condition and the driver motivated," said Haruna.
Delays leading to maternal mortality
Lack of access to health facilities for women in labour, which includes the inability to reach the facilities on time is second of the three delays contributing to maternal mortality worldwide. Nigeria accounts for nearly 20% of maternal deaths globally. The condition of Bordo village is not peculiar to many rural communities across the country, where the absence of functional health facilities and poor access roads leads to the deaths of many women while giving birth. According to Honourable. Garba Babale, the councillor representing Bordo in Tauro local government council, rehabilitation of the village's health facility has been in the plans of the council for years, "but due to unavailability of funds, it has not been possible". He added that a request will be made by the council to the Jigawa State Government to rehabilitate the health facility.
Tauro local government and the Jigawa State Government should complement the efforts of these courageous women by carrying out a comprehensive rehabilitation of their health facility, as well as constructing the five kilometres access road to the village. However, even if the facility is rehabilitated, it will not be able to operate 24-hourly with only one staff. Efforts must therefore be made by Jigawa State and the local government to build residential quarters for the health workers in addition to posting more health workers to the village. This would enable the women in Bordo to access timely maternity care, including being able to give birth with the help of a skilled health worker. In addition, they would only have to make the journey to Jahun, if they are referred for more specialist care due to complications that cannot be dealt with in the nearby health facility.
The courage and passion of the Bordo women to act and ensure that women in their community are safely transported to a health facility to give birth safely is inspiring. Although initiatives like this provide short and medium-term solutions, it may not be sustainable in the long term. For instance, what happens if the federal government's conditional cash transfer stops and the present vehicle becomes unusable? How will the village derive funds to acquire another vehicle? In addition, the potential challenge of ensuring that the vehicle is serviced must not be overlooked.
The people of Bordo and indeed rural communities across the country must push for children, especially girls from their villages to go beyond primary and secondary education, to get the necessary training that would enable them to work in the local health facilities.
Achieving this will ensure that the villages will not be short of female health workers and will have more voices to advocate on their behalf in the local councils. One of the reasons that the health facility in Bordo has not had an adequate number of staff over the years, according to Honourable Babale, is the unwillingness of health workers to work in rural communities that are not theirs. "Nobody wants to be posted here," he said. This should serve as a wakeup call for people of Bordo and other rural communities across Nigeria. Health workers who are indigenes of the village would probably be more willing to serve their community. With available health staff, the money gathered by the women and supported by other indigenes could have been used to fix the village's dilapidated health facility which would be more beneficial in the long run, despite the undisputed fact that health infrastructure remains the responsibility of the government.
Yet, the actions of these 417 women is an incredible example of civic responsibility and has shown them taking ownership of a problem that has challenged their community and led to untold hardship for pregnant women. The community will continue to reap the benefits of the funds provided by the women in the community of Bordo and surrounding villages. For now, and in the immediate future, women in Bordo will not have to worry about getting to the hospital when they are in labour. This will provide the women and their families with much needed peace of mind that every woman about to give birth in Nigeria, has a right to.
Do you know of other inspiring civic actions that women are making for the health of other women in their communities? Share with us in the comments below or on social media, @nighealthwatch on Twitter and @nigeriahealthwatch on Facebook and Instagram. Use the hashtag #GivingBirthInNigeria.