There have been continued efforts to reduce the high levels of maternal mortality in Nigeria , yet progress has been slow and the country's maternal mortality rate remains one of the highest in the world. This issue remains an urgent concern in Nigeria, highlighting the need for sustained attention and accelerated action to ensure that no woman must die in childbirth from preventable causes. Women in Nigeria face a number of challenges during pregnancy and childbirth, including limited access to high-quality healthcare, financial constraints, and inadequate access to quality maternal medicines.
According to a study, postpartum haemorrhage (PPH) is the leading cause of maternal mortality, accounting for 23% of maternal deaths. In 2023, the World Health Organisation (WHO) estimated Nigeria's maternal mortality ratio to be 1,047 deaths per 100,000 live births, the world's second-highest. These indices reflect a concerning situation, especially given the potential attainment of the Sustainable Development Goals (SDGs) target of less than 70 deaths per 100,000 live births.
As a result, the need to accelerate progress towards reducing maternal deaths by 2030 becomes and even more critical issue, which requires the implementation and scale up of maternal health innovations.
During the recent policy dialogue themed, "Scaling Maternal Health Innovations in Nigeria: Learnings, Challenges, and Opportunities," convened by Nigeria Health Watch, health experts and stakeholders in the health sector came together to share insights in progress and challenges in improving maternal health in Nigeria. Discussions focused on opportunities to scale up existing maternal health innovations.
Scaling up for progress
Discussions focused on identifying effective solutions to significantly reducing maternal mortality rates and enhance overall health outcomes in Nigeria. By exploring successes, challenges, and opportunities, participants aimed to accelerate the scaling up innovations for progress.
At the 77th World Health Organisation (WHO) Assembly, a resolution was passed to improve maternal and child health, by strengthening primary healthcare and expanding access to universal healthcare, especially given the slow progress in reducing maternal and infant mortality globally. Addressing this pressing issue, Dr. Walter Kazadi Mulombo, Nigeria's WHO Representative emphasised the need for concrete action, rather than repeated discussions, to achieve the SDG targets by 2030. Innovation was highlighted as being key not only in terms of new technologies, but also in rethinking how proven interventions are applied. "Innovation is not just about new things, it's also about doing things that work [in a] different way", he stressed. Stakeholders were encouraged to move from talk to action and "to walk the talk".
The need for joint action and partnerships in the march towards ending maternal mortality in Nigeria was highlighted by Dr Salma Ibrahim Anas, Special Adviser to the Presidency on Health. "Women's health, maternal death, newborns' death is not a woman's issue. It is an issue for the whole family, it is a community issue, it is a developmental issue", stated Dr Anas.
Dr. Charity Chenge, Maternal Health and Child Health Lead at the Bill & Melinda Gates Foundation, Nigeria, stressed the importance of rapidly scaling up innovations in maternal and newborn health to achieve desired goals, "our efforts have led to the prioritisation of four innovations. They include multiple micronutrient supplements, postpartum haemorrhage bundles, maternal azithromycin and the newborn bundles".
Breakthrough in PPH management -- the E-MOTIVE bundle of care
Addressing the three critical delays in PPH management, which involve delayed diagnosis, delayed intervention, and delayed escalation to advanced care, the E-MOTIVE Trial revealed a novel innovation for PPH management in low-and-middle-income-countries. Conducted in Nigeria, Kenya, Tanzania and South Africa, it trialed a bundled approach to PPH management (as opposed to previous sequential approaches). This approach included Early detection using a calibrated drape, uterine Massage, Oxytocic, Tranexamic acid, IV fluids, and Examination & Extraction.
The trial led to a 60% reduction in severe PPH, prompting important changes in policy and practice. As a result, the WHO revised its guidelines on PPH management, and the Nigeria Federal Ministry of Health and Social Welfare (FMoH&SW ) is implementing a new national guideline on PPH care and management.
During the policy dialogue, Professor Hadiza Galadancci, a principal investigator on the study, presented the findings from the study, stating, "...early detection and treatment of postpartum haemorrhage using the WHO E-MOTIVE first response bundle is the answer to reducing the thousands of women that die from excessive bleeding... We need to really implement this across board".
Considerations for scale up and diffusion
When considering advancements in maternal health innovations, the recommendations made during the dialogue stressed the need to rapidly scale up the implementation of the E-MOTIVE bundle across the country. However, achieving this goal would require sustained government intervention to ensure implementation, even at the subnational level. Speaking during the policy dialogue, Dr Binyerem Ukaire, Director of Family Medicine, FMoH&SW, discussed the government's efforts to integrate the E-MOTIVE bundle into existing maternal health programmes.
"We have quickly integrated the emotive bundle into our safe motherhood strategy document... we have also developed a guideline for health workers to make use of, in managing postpartum haemorrhage and we have prioritised the emotive bundle", Dr Ukaire stated. Collaborations, partnerships, logistics management, and monitoring and evaluation systems will be crucial for successfully implementing this at national and sub-national levels. It is important to work closely with state governments to ensure effective coordination.
The results of the E-MOTIVE trial are unquestionable and the rapid adoption by global and national bodies is commendable. However, there will undoubtably be challenges in scaling up and diffusion of the initiative. Delays in seeking and accessing maternal healthcare can often be attributed to various socio-cultural and systemic barriers. These barriers include lack of awareness, financial constraints, and poor transportation infrastructure. Research also highlights that inadequate healthcare infrastructure, insufficient medical supplies, and a shortage of skilled healthcare providers all contribute to the poor quality of maternal health services. These challenges can directly affect the scale-up of the bundle.
Ms Fatima B. Mohammed, Consultant, Accelerating Nutrition Results in Nigeria (ANRiN) and Adolescent Health Project, Society for Family Health, emphasised the importance of coordinated advocacy at all government levels to ensure the successful implementation of these innovations in primary healthcare centers (PHCs). She stressed the significance of equipping PHCs with adequate manpower and proper equipment, including effective storage for essential medication like oxytocin, misoprostol and tranexamic acid.
The concerns about adaptability were raised, with Ms Mohammed emphasized the importance of implementing E-MOTIVE with adaptability, especially in rural areas. She also highlighted the need for relevant data collection to drive informed decision-making and ensure effective implementation.
In the same vein, Dr. Habib Sadauki, former president of the Society of Gynecology and Obstetrics of Nigeria (SOGON), emphasised the importance of tackling the barriers to accessing health care. He pointed out that many women give birth without the assistance of skilled birth attendants, and he stressed the need for strong political will to implement E-MOTIVE. Dr Sadauki called for extensive advocacy to engage policymakers, beyond the health sector, highlighting that without adequate funding and strengthened supply chains, even the most promising innovations will fall short of their intended impact.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
According to Dr. Sadauki, it is crucial for "the federal government needs to talk to the governors, especially now with the new approach for providing direct funding to local government...If we don't do that, the E-MOTIVE is there, people are trained but they cannot perform because the supplies are not there".
The discussions concluded with several proposed policy and practice recommendations:
1. Incorporate the E-MOTIVE Treatment Guideline into Undergraduate Curriculum: Integrating the developed treatment guideline for PPH, with emphasis on the E-MOTIVE bundle into undergraduate curriculum will ensure wider dissemination and implementation within the healthcare sector.
2. Ensure Sustainable Financing: Sustainable financing strategies are essential for scaling maternal healthcare innovations in Nigeria, ensuring long-term impact, resource optimization, and resilience, ultimately improving maternal health outcomes across state-level healthcare systems.
3. Leverage local manufacturing: Engagement of local manufacturers in the production of the E-MOTIVE calibrated drape in Nigeria aligns with the Unlocking Healthcare Value-Chain Initiative (PVAC) and the FMoH&SW's four point agenda.
4. Incentivise mothers towards facility delivery: Community sensitisation, alongside providing incentives to mothers will motivate mothers to prioritise facility deliveries over home deliveries.
While there have been promising innovations in maternal health in Nigeria, there is still significant work to be done, especially as Nigeria strives to attain the SDG targets for reducing maternal mortality by 2030. By fostering multisectoral partnerships, renewing political commitment and collective ownership and drive, Nigeria must urgently accelerate progress to reduce maternal deaths and ensure that every woman can give life without fear of losing her own.
Read full event report here
