In the dead of night in 2014, panic spread through Irono, a small community in Ekiti State, reliant on the services of a single Primary Healthcare Centre (PHC). After a mother had just given birth at the PHC, an intruder attempted to steal a newborn. The baby's sharp cries drew nurses and community members to intervene quickly. Although the child was saved, the damage was done, and the incident significantly affected the community's trust in the facility.
Over the following years, Irono PHC and other healthcare facilities became a symbol of neglect. The lack of security, with no perimeter fences, and the community's glowing distrust in institutional healthcare compounded an already existing problem of healthcare access in the state.
Many facilities in the state also struggled with a shortage of skilled health workers, no thanks to the current brain drain in Nigeria's healthcare system. Pregnant women were often forced to rely on traditional birth attendants, and complications often led to maternal and neonatal deaths.
However, according to Dr. Oyebanji Filani,' Commissioner of Health and Human Services, Ekiti State, the state focused on three key strategies to improve its residents' maternal and childcare outcomes: strengthening the healthcare supply chain, increasing demand for health services, and enhancing governance and accountability.
Critical assistance arrives
Maternal mortality remains a crisis not only in Ekiti, but across other states in Nigeria, with states like Kano, Benue, and Bauchi grappling with poor healthcare infrastructure, financial barriers, and service delivery gaps. In Ekiti, 2020 was one of the years that saw a sharp increase in maternal deaths despite more pregnant women seeking healthcare.
For every mother who joyfully carried her baby home, another was left mourning a loss. Data revealed that neonatal mortality stood at 42 per 1,000 live births, while under-five mortality was as high as 95 per 1,000 live births. This meant that one in 24 infants did not survive their first month, and one in 11 children did not reach age five.
However, after almost a decade, Irono PHC, among other healthcare centres, tells a different story. A secure fence has been built to restore safety, and trained midwives and nurses now ensure that quality medical care is always available for mothers and their babies.
According to Dr Kester A. Peters, Medical Officer of Health and PHC Coordinator for Ado-Ekiti Local Government Health Authority (LGHA), "monthly deliveries have increased from 8 to10, to 50 to 60, and immunisation rates have drastically improved, with only a handful of defaulters remaining."
The three-pronged approach
Data from the 2023 Nigeria Demographic and Health Survey reveal a significant improvement. Over the past five years, Ekiti State has reduced neonatal, infant, and under-five mortality rates by more than 50%. This progress signifies that approximately 45,000 under-five children, who would have been at risk just a few years earlier, are alive today because of the state's efforts using the following three strategies.
1. Strengthening supply: No more stockouts
Ensuring that health facilities are well-equipped has been a priority for the state. "In terms of Infrastructural development, the state government has upgraded the Ikole Specialist Hospital to a Federal Medical Centre, as well as the upgrade of the Ekiti State Drug and Health Supplies Management Agency warehouse to a pharma-grade facility," Dr Filani explained.
He added that the state has also improved the availability of equipment and infrastructure in state-owned facilities to prevent stockouts. Stock shortages, particularly of essential drugs, vaccines, and medical supplies, had hindered the effectiveness of healthcare services in the past. He noted that by addressing these gaps, the government has ensured that facilities remain functional and capable of handling routine and emergency cases.
2. Driving demand: Ensuring healthcare access for all
Ekiti State did not just improve facilities, it made healthcare services widely accessible and acceptable within communities. All 177 wards in the state have at least one facility offering insured services, ensuring broader healthcare coverage for residents. "[The state has] guaranteed a defined package of services that everyone in the state can access," Filani noted.
However, access alone is not enough, as people need to be aware of these facilities and willing to use the services. "To achieve this, the state has taken a broad approach, leveraging the influence of traditional leaders, religious leaders, lawmakers, market women, and various community associations." The Ulerawa health insurance has also improved patronage. Mrs Okuazo, Officer-in-Charge at Okeoniro PHC explained that "complaints about cost that kept many women away from the facility is no longer an issue. We have seen antenatal, and immunisation rates increase because they are not paying anything."
3. Strengthening governance: Using data for action
At the heart these improvements is a strong governance framework driven by data and accountability. "Every Tuesday, I sit down with the entire team: state health insurance and their directors; state primary healthcare development agency and their directors; drug management agency and directors; the hospital management board and directors, and the Ministry of Health. We go through the data together. Everybody knows what's going on within the system and knows that we are holding each other accountable," Filani explained.
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He recounted a recent example that illustrated the impact of these weekly meetings. "Few weeks ago, we noticed that our stock level for vaccines had dropped, and the State Immunisation Officer had to quickly write to the National Primary Healthcare Development Agency (NPHCDA). If we hadn't been monitoring the data closely, we would have faced stockouts not just in the warehouse but also in health facilities, leading to missed opportunities for a number of children."
A bold step with some challenges
Across Ekiti State, the transformation of their healthcare system is evident. Women who once feared seeking care now arrive with confidence, knowing they will receive the support they need before, during, and after childbirth.
However, challenges such as staff shortages, high patient loads that sometimes overwhelm available resources, and issues with service utilisation persist, as some community members are still hesitant to fully embrace healthcare services.
Therefore, the journey is far from over. With continued investment, community engagement, and health system strengthening, the state has shown that contextual, data-driven interventions can transform maternal and child health outcomes.
