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Six years of Quality Assurance in Obstetrics in Nigeria

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...based upon Rotarian Friendship

“Be a friend” – the Rotary International Theme of 1994/95, when Bill Huntley was our President, maintained a special meaning for two Rotarians who met for the first time as class mates of Huntley’s International Assembly of 1994. The then incoming Governors, Emmanuel Adedolapo (Dolapo) Lufadeju from Nigeria and Robert Zinser from Germany, have ever since been close friends and successful partners in one of the challenging global problems: to improve mother and child health care in developing countries according to the UN Millennium Goals. Since their first encounter the two have met about 25 times visiting each other in their homes, meeting each year at the RI conventions and several times on other occasions. For two decades now they are bridging continents and generations, one of them being today 65 the other one 87 years of age.

The class mates of 1994 took the first coffee break to talk about “problems of the world”. Dolapo drew the attention to one of the main concerns in his country: unsustainable population growth. DGEs of other developing countries threw in information on just the same problem. Robert asked them to send him project proposals to tackle that problem and submitted the one from his Nigerian friend to the Incoming Club Presidents at the District 1860 PETS (Presidents Elect Training Seminar). Nearly all of them agreed on sponsoring what started in 1995 as a pilot project on “Child spacing and Family Health” in Nigeria.

Robert came to visit the project area in Nigeria in 1995 and Dolapo attended Robert’s district conference in Germany. In the same year, the two Governors flew to Dakar, Senegal, for the Population Conference of Rotary International funded by The Rotary Foundation. There they met conference chair PDG Buck Lindsay, USA. Dolapo, Robert and Buck together followed the 500 Rotarians at this conference who unanimously voted that Rotary should take up “population issues” and founded the Rotarian Action Group (formerly Rotarian Fellowship) for Population & Development (RFPD).

From 1995 to 2000, Dolapo and Robert accompanied their “Child spacing and Family Health” project in two local government areas (LGAs) in Kaduna State, Nigera. It was funded by a Matching Grant from The Rotary Foundation and co-funded by the German government (BMZ). The results of this pilot project were amazing, the contraceptive prevalence rate (CPR) increased from 3 to 27 percent according to a neutral evaluation by a professional NGO. They then motivated other Past Governors to replicate this model in six states of Nigeria from 2000 to 2005 with a 3-H-Grant from The Rotary Foundation and funds from the European Union. Again a neutral evaluation confirmed that the outcome and impact of the project, which helped many thousands of beneficiaries, was outstanding.

Dolapo and Robert took it as a special compliment for themselves as well as for Rotary when attendants of Non-Rotarian conferences sometimes told them: “Seeing you both, an African and a European, always friendly together dedicated to your issue, we realize why Rotary is able to implement such crucial projects.” Rotarian Friendship and Rotary’s worldwide network were both identified as a basis for extraordinary project work!

It was ten years ago that people in Nigeria and their traditional rulers addressed the two PDGs and asked for a maternal and child health (MCH) project. At the same time, the UNFPA approached RFPD to tackle the problem of obstetric fistulas, so that Dolapo and Robert started to develop a plan to address both issues in one project. The project team established two Rotary Fistula centers to treat fistula patients and improved antenatal care services – as prevention is the key to avoid obstetric fistulas - with proper equipment in selected hospitals of the two states Kaduna and Kano. With the expertise of the gynaecologist Wolfgang Künzel from the German RFPD section they included quality assurance in obstetrics into their comprehensive approach. The project team convinced hospital staff that – no matter how understaffed they were – relevant obstetric data needs to be collected on a monthly basis from the hospitals. The data was analyzed and discussed in a benchmarking process during semi-annual review meetings.

The project results were a reduction of maternal mortality by 60 % and newborn mortality by 15 % in these hospitals, meaning that several thousand lives of mothers and new-borns have been saved in these hospitals. The Rotary Foundation called this a “Lighthouse Project”. Other stakeholders call it a model requesting to scale it up. The CEO of FIGO (the International Federation for Gynaecology and Obstetrics) finally defined it as a “masterpiece”. The project was published several times in Nigerian media and in the international newsletter of FIGO in 2010. The Emir of Zaria, the traditional ruler of this region, recognized Rotary for its MCH program by conferring Robert Zinser with the title “Shahon of Zazzau”, since he was the driving force behind the project and managed to get the necessary funds including funds from other (non-Rotarian) sources.

Since November 2012 and July 2013, two scaling up projects of the Rotarian model project to reduce maternal and new-born mortality rates are on their way, thanks to new sponsoring clubs that shared the dedication of Dolapo and Robert. These are RC Bottrop-Wittringen and RC Bielefeld-Süd in Germany, several Austrian clubs, RC Trans Ekulu, Nigeria, and District 9125 (Nigera) that joined D 1860 (Germany) in starting the MCH project work. The 1st scaling up project covers north and central Nigeria and is co-funded by the German government (BMZ). The Else Kröner-Fresenius-Stiftung (EKFS), Germany, co-funds a 2nd scaling up that started last year in Enugu state in the southeast of Nigeria. Following the wish of the Nigerian government, a 3rd scaling up is under preparation in the southwest of Nigeria. These projects in different parts of Nigeria are supposed to pave the way for the inclusion of the Rotary model for reduction of maternal and new-born mortality into the states' health system and - in the long run - also into the national health system of Nigeria.

RFPD's work is dedicated to the improvement of “Maternal and Child Health”, now being one of Rotary's six areas of focus. With its expertise gained over the years of project work, RFPD is a resource for clubs and districts in this important area. RFPD helps clubs to find the indispensable reliable contacts which are necessary to achieve such projects. Dolapo is still serving as RFPD board member and Chair of the newly founded National MCH Committee of Rotary Nigeria. Robert is CEO of RFPD and Senior Advisor of the MCH scaling up projects in Nigeria.

Robert and Dolapo can be regarded as MCH pioneers in Rotary and the 2013/14 RI theme fits their 20 years of joint work and friendship perfectly: “Engage Rotary – change lives”. For two decades now, they jointly changed the lives of uncounted mothers, children, families and communities in Nigeria. And that truly has changed their lives as well.



by Matthias Schütt (Rotary Magazin, Germany)



Promising collaboration in maternal and newborn health

Every day about 800 women worldwide die from complications related to pregnancy and child birth. This equals 1.5 times the number of passengers fitting into an Airbus A380 or 2.5 times the number of passengers in the Boeing 787 Dreamliner. 99 percent of these maternal deaths occur in developing countries and most of them are preventable. With the worldwide start of its Future Vision Programme on 1st July 2013, Rotary International takes up the challenge of accelerating progress towards attaining the Millennium Development Goal (MDG) 5, including 5b and the associated MDG 4, with the area of focus 'Maternal and Child Health'. The Rotarian Action Group for Population & Development (RFPD) - one of Rotary's official resources for this area of focus - joined forces with the International Federation of Gynecology and Obstetrics (FIGO) to combine two important factors in improving maternal and child health: FIGO's medical expertise, Rotary's network and RFPD's experience in implementing successful maternal and newborn health projects. The collaboration between FIGO and RFPD was sealed with a Memorandum of Understanding at the end of 2012 with the aim of promoting and supporting best practices that sustainably reduce maternal and newborn mortality and morbidity. (Read more)



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