Progress Reports

Progress Reports are submitted annually to THE ROTARY FOUNDATION and to the German Government as requested. These reports are also sent to AVENTIS FOUNDATION and to all sponsoring Rotary, Rotaract and Inner Wheel Clubs. Since 2008 we collect monthly data from the ten selected hospitals which are analysed and semi-annually published in a 'Hospital Report'. This Report is discussed by representatives of the ten hospitals in regular review meetings. In a benchmarking process the causes of maternal and fetal mortality are
stepise more and more reduced.

The project is monitored by the German/Austrian project team in close cooperation with the local project team and project staff. All members of the German, Austrian and Nigerian project teams are volunteers, Rotarians and Rotaractors.



Nigeria

PMC carried out a radio serial drama project in Nigeria in collaboration with the Rotarian Action Group on Population and Development (RFPD). PMC produced and broadcast Gugar Goge (“Tell it to me Straight”), a 70-episode radio serial drama addressing reproductive health, family planning, and obstetric fistula in northern Nigeria. Obstetric fistula is a condition commonly resulting from early childbirth that makes its victims incontinent.

Gugar Goge was broadcast over regional government-owned and private radio stations in Kaduna and Kano states from June 2006 to February 2007. By mid-September, 47 percent of new reproductive health clients indicated they were listening to the program. Clinic monitoring data determined that Gugar Goge served as the primary motivation to seek health care services for 33% of family planning/reproductive health clients and 54% of fistula clients.

The endline evaluation of the program showed that 91.9% of the population in Kano and Kaduna states had heard at least one episode of the program. This equates to approximately 9.3 million people in Kano state and 6.2 million people in Kaduna state, for a combined total of 15.5 million exposed to the program out of a population of 16.9 million. Even more impressive was the fact that 82.1% of those interviewed reported listening to the radio serial drama weekly (four or more episodes per month). The endline evaluation also found that:


When asked their opinion as to whether “a woman with fistula should be part of the community like everyone else,” more male listeners (32.1%) “strongly agreed” with this statement than did non-listeners (17.6%).
When asked if they or someone they knew had “ever sought treatment for fistula,” more female listeners (59.7%) said “yes” compared to non-listeners (48.5%).
A significant difference was found between male listeners (92.8%) reporting knowing of a place to get a male condom compared to non-listeners (75.0%). A significantly larger percentage of female listeners (96%) also knew of a place to get condoms compared to female non-listeners (64.4%).
When asked if a condom was used the last time they had sexual intercourse with “any other man” in the last twelve months, significantly more female listeners (79.5%) said “yes” compared to female non-listeners (35.6%).
When asked if it is “acceptable or not for information on condoms to be provided,” significantly more female listeners (87.2%) compared to female non-listeners (49.1%) said it is “acceptable.”

A post-broadcast qualitative evaluation, which consisted of participatory sketching and photography with avid listeners of Gugar Goge, demonstrated the personal impact of the obstetric fistula storyline. Many listeners, both in their sketches and photos, fo­cused on the interrelated themes of early marriage and pregnancies, the development of obstetric fistula, and the debilitating (and often fatal) consequences of such practices.

In addition to Rotary support, the project was funded by the Conservation, Food and Health Foundation and the David and Lucile Packard Foundation.

PMC is now carrying out a second serial drama project in northern Nigeria in 2007, with continuing support from the David and Lucile Packard Foundation and the Conservation, Food and Health Foundation and new support from an individual contributor. The new program, Ruwan Dare (“Midnight Rain”), began broadcasting in Kano, Kaduna, Katsina, and Sokoto states on July 31, 2007.

PMC is also developing a second project dealing with obstetric fistula with support from the United Nations Population Fund (UNFPA). It will involve a radio talk show and capacity building among community leaders for promoting behavior change to prevent fistula.



A Qualitative Assessment Report

At the website of Soul Beat Africa (http://www.comminit.com/en/node/269041/304), you can find the following article on PMC’s work in northern Nigeria.


Participatory Assessment of Gugar Goge, an Entertainment-Education Radio Soap Opera in Nigeria: A Qualitative Assessment Report

Author

Arvind Singhal, Sarah Hurlburt, Radha Vij

Publication Date
April 2007

Summary
This report documents the results of a participatory assessment exercise conducted in Nigeria to gauge audience reception of Gugar Goge (“Tell It To Me Straight”), an entertainment-education radio soap opera produced by Population Media Center that sought to promote education for girls, the delay of marriage and pregnancies, and the adoption of family planning and maternal health services to both prevent and treat obstetric fistula. The assessment exercise, which used participatory sketching and participatory photography, aimed to assess how frequent listeners engaged with the radio programme, and how they derived personal meanings from its plot, characters, and educational messages.

According to the authors, the results of the qualitative report are not meant to be generalised to the entire population of Gugar Goge audience members. The research, at best, can suggest how certain (self-selected) viewers of the radio programme engaged with, and reflected upon, the content of the programme, providing insights that could not be gained from traditional, quantitative impact evaluations.

Three research questions guided the study. These questions, and their respective answers are provided below.


Click here to download this report in PDF format.

Summary

"Research Question #1: What is the radio drama Gugar Goge about?
Our participants’ sketches and photos suggested that those who were regular listeners (1) comprehended the various intersecting plotlines of Gugar Goge, (2) could describe the attributes of its main characters, and, in so doing, (3) could articulate its various educational messages: that is, overcoming the harmful reproductive health practices of early marriage and multiple pregnancies; the importance of safe motherhood and the seeking of professional care, detection and treatment of obstetric fistula, and how youth can prevent infection with HIV, and stay away from vices such as drugs and alcohol.

Research Question #2: As a female (or male) listener, which scene from Gugar Goge was most meaningful to you and why?

Our participants’ sketches suggest various degrees of emotional and personal resonance with the key plotlines and characters. Our participants freely talked about the debilitating health consequences for a woman (1) if her husband does not get her the professional medical attention she needs at the time of delivering a child, (2) if she is withdrawn from school and married off at an early age. The overwhelming emotional sentiment of our participants toward reproductive health of women was reflected in the pithy phrase: "Education as Protection".

Research Question #3: How has your life changed as a result of listening to Gugar Goge?

The sketches, photos, and narratives of our participants, especially those of regular listeners of Gugar Goge, suggest that listening to the radio program affected their lives in various ways. Listeners emphasized that they learned about, or were reinforced in, the following: The importance of (1) educating girls, (2) delaying marriage until a woman’s body is mature, (3) having a small family, (4) pre and ante-natal care, (5) early treatment of obstetric fistula, and (6) male responsibility in not marrying young girls, and assisting their partner in seeking professional reproductive health services when she becomes pregnant."



Furthermore, several metrics are monitored, regularly, to assess the results of the activities. These metrics are laid out in progress reports:


Number of trained doctors, nurses, birth attendants, health workers and traditional birth attendants
Number of healed fistula patients / new fistula cases
Percentage of appropriately attended births in the target area (today 19 %, target 20 %)
Frequency/number of caesarean cut births
Assessment of the contraceptive prevalence rate
Assessment of the mortality rate in the target area
Number of the rehabilitated fistula patients, post surgery



Progress Reports



Download the progress report 2008-2009 to the Rotary Foundation
Download the progress report 2007-2008 to the Rotary Foundation
Download the progress report 2005-2006 to the Rotary Foundation


Donated Equipment and List of VVF Repairs

Download the Donated Equipment
Download the List VVF Repairs





Hospital Reports:

Kano State, Kaduna State and FCT Abuja Maternal and Child Health Hospital Report 2011

Kano State and Kaduna State Maternal and Child Health Hospital Report 2010

Kano State and Kaduna State Maternal and Child Health Hospital Report 2009

Kano State and Kaduna State Maternal and Child Health Hospital Report 2008


Statistics:

Maternal Mortality Ratio - reduced by 60% - January 2008-December 2010

Maternal Mortality Ratio - showing improvements - January 2008-June 2009

Maternal Mortality Figures - showing improvements - January 2008-June 2009










Rotary International Project “Improvement of Maternal Health - Prevention and Treatment of Obstetric Fistula”

In Kaduna and Kano State 2005-2009


Report on Rotary International´s activities in the field of VVF in Nigeria
UNFPA suggested to Prof. Dr. Robert Zinser in 2004 to contribute to the campaign ‘End Fistula’ when he visited the UNFPA Headquarter as Chairman of the Rotarian Action Group for Population Growth & Sustainable Development (RFPD). Zinser then initiated a project.

A) General Remarks

Project and Sponsors

The Rotary project “Improvement of Maternal Health –Prevention and Treatment of Obstetric Fistulae in Northern Nigeria” aims to reduce maternal mortality and morbidity including VVF and fetal mortality in this region.
It is sponsored by 100 Rotary, Rotaract and Inner Wheel Clubs of Germany and Austria.
Co-sponsors are THE ROTARY FOUNDATION, German Government, Aventis Foundation and International Association for Maternal and Newborn Health (IAMANEH). The Project amount is one million Euro. Contribution of Rotary satellite projects and contributions of stakeholders run up to additional 2 million Euro. The project runs from July 2005 till December 2009.
The projectwas started in full compliance with the “National Strategic Framework and Plan for VVF Eradication in Nigeria” edited by the Nigerian Federal Ministry of Health in December 2004. We also were aware of the results of the UNFPA Fistula Fortnight Nigeria from 21st February thru 6th March 2005.

Project Area
The project area comprises Kano State and Kaduna State.

Organization and Personnel (voluntary and paid staff)
Project offices are in Kano, Zaria, Kaduna and Abuja. The project is headed by Dr. Kola Owoka as the National Chairman in Nigeria and Prof. Robert Zinser as the German-Austrian- Nigerian coordinator. Attached please find the Organigram of the Nigerian project-team.

B) Prevention

1. Prevention by Awareness Campaign

Education of the public by advocacy and awareness campaigns to political, traditional and religious leaders

From the beginning there was close collaboration with the Commissioners of Healththe Directors of Hospital Management and the Commissioners of Women affairs and social development, both in Kano and Kaduna State. The Emirs of Zaria and Kano were always important partners and were briefed regularly on all activities. All LGA representatives were visited and information was given on the aim of the project.

Public awareness in villages, markets and schools
To get to the grass roots our fieldworkers visited villages, announcing their visits to the village heads and chiefs. Community dialogues brought together the villagers, women, men, youth and the TBAs of the village and information on the causes of VVF was passed on to them. In addition they were advised in good nutrition in pregnancy, antenatal care and early detection of risks before delivery. In schools the issue of family health and AIDS prevention was addressed.

Radio serials
A radio serial has been broadcasted by Radio companies in Kano and Kaduna State in Hausa language. In a sensitive and emotional way the issue of reproductive health was dealt with by a PMC-made Educational soap opera called “Gugar Goge” (tell it to me straight). Baseline studies revealed that information in the rural regions can be passed on best by radio. An evaluation of the Ohio university found out that fistula patients visited our fistula centers after listening to the radio serial.


2. Prevention by Antenatal Care and early Caesarean section

We realized that Fistula repair and awareness campaigns on this issue will not lead to a significant reduction of Fistulae in Nigeria. Prevention by improving obstetric services will bring the best results because the most important cause of a fistula is obstructed unrelieved labour.

Identification of five hospitals in Kano and Kaduna State
In Kano State the partnering hospitals are Kano Sheik Jidda, Wudil General Hospital, Gaya General Hospital, Sumaila General Hospital, Takai General Hospital. The Supervising Hospital is Aminu Kano Teaching Hospital, Kano

In Kaduna the hospitals are Zaria Hajiya Gambo Sawaba Gen. Hospital Kofan Gayan, Kaduna Yusuf Dantsoho Mem. Hospital, Lere Alhaji Dabo Lere Hospital, Saminaka
General Hospital Kafanchan, Birnin Gwari General Hospital. The Supervising Hospital is Ahmadu Bello University Teaching Hospital, Zaria

Training of the staff
All hospitals have been upgraded in their equipment. In all hospitals the staff of the obstetric department have been trained in recognition and management of risks during pregnancy and labour as well as in life saving skills.

Introduction of a system of quality improvement
A system of quality improvement has been established by data collection and data evaluation on quarterly basis and review meetings of doctors, nurses/midwives every 6 months. The quality of structure, process and outcome has already improved.
The goal is to establish an Institute of Quality Assurance in Obstetric services.


C. Repair

Centres for Fistula repair

In Kano and in Kaduna State in each one centre for fistula repair has been established. In Kano it is Wudil General Hospital which started repair operations in 2007. This hospital received complete equipment for the operation theatre including operating bed, instruments, trolley and sterilizer.

In Kaduna repair operations already started in 2005. In 2006 the State Government of Kaduna provided a newly built operating theatre building which was completely equipped by the Rotary project in Hajiya Gambo Sawaba General Hospital in Zaria.
We also brought down a borehole and erected a 40.000 litre overhead water tank to ensure water supply for the hospital and improve hygienic conditions. A big generator guarantees the power during the time of surgery.

In cooperation with skilled fistula surgeons the project also sponsored repair operations in Murtala Mohammed Specialist Hospital in Kano. Until July 2009 a total of 1350 Women have been repaired by the Rotary project.

D. Rehabilitation

Centres for Rehabilitation

In Kaduna State a brand new centre for Rehabilitation of repaired Fistula patients was built in cooperation with FCEIS (Family Care Eduvision International Services) and sponsored by the Japanese Embassy. In this centre all repaired patients are rehabilitated medically and many of them receive vocational training in different skills like sewing, knitting, spaghetti making and preparing meals with the wood saving stove “Save 80”.

In Kano State also FCEIS created a building for vocational training. The Local Government later transferred rehabilitation to a different place in Wudil. The same vocational training as in Kofan Gayan is offered. Until now more than 150 Patients received vocational training in both centres.

Some of the patients were given a micro credit to enable them to start some business ensuring their living themselves.


E. Sustainability by Training of Fistula Surgeons and Introduction of Vouchers

Training of fistula surgeons with the involvement of theatre and ward nurses

The Chief Consultant to the Nigerian Government, Dr. Kees Waaldijk, served as the trainer for doctors who wanted to step in or improve their skills in fistula surgery. In total 10 doctors have been sponsored to be trained, some of them several times.

We are in discussion with the University Teaching Hospitals in Kano and Zaria to Include training of fistula surgeons into their curricula of medical students. This has also been discussed with government and stakeholders.

For including repairs in these teaching hospitals we sponsored repairs there by issueing vouchers. At the same time we regard these vouchers as a pilot project for the introduction of vouchers with which the patients can select the surgeons and by which more surgeons take interest in repairing fistula.


Training of TBAs (Traditional Birth Attendants)
Because most of the neglected deliveries occur in the villages during home deliveries we made strong efforts to get in touch with Traditional Birth Attendant (TBAs) and train them on early risk recognition and in avoiding first and second delay.

F. Cooperation with stakeholders (Motto: “Nobody can do it alone”)

The Rotary project team emphasizes on cooperation with as many stakeholders dealing with maternal health as possible, including Federal and State Government as well as traditional rulers. Right from the beginning of the project in 2005 each year Prof. Zinser met, escorted by other members of the German-Austrian/Nigerian Team, with representatives of UNFPA, USAID, UNICEF, Population Council, Engender Health, ACQUIRE, Pathfinder, The David and Lucile Packard Foundation and others to coordinate activities of our project with their own in the field of Fistula repair and training of doctors in repair surgery. In 2009 several meetings took place, in February, August and October.


Prof. Dr. Robert Zinser
Past Governor of Rotary International

Project Coordinator


Click here to download the report in PDF format.




Distribution of Mosquito Nets in cooperation with BASF






Cooperation with Rotary Malaria Action Group



Report to REMaRG

Introductory remark:
The maternal health project in Kaduna and Kano state, NIGERIA, implemented by D9120, sponsored by hundreds of German and Austrian clubs and cofounded by TRF, German government and Aventis foundation tackles malaria as one of the main causes of maternal and child mortality. This project was initiated and is supported by RFPD. When combating malaria RFPD keeps close contact with REMaRG. The project below is an example for overlapping but coordinated work of RAGs.

Country work:
in March 2008 Rotary clubs of D9120 have distributed 3.000 long lasting insecticide treated mosquito nets to hospitals as well as to mothers and their children in villages of the target area. In August 2008 another 3.000 nets were donated to the Emirate in Zaria, Kaduna state, during a ‘turbaning ceremony’ for PDG Robert Zinser. In August 10.000 nets were transported to Nigeria which presently are distributed by the clubs supported by the project staff to hospitals and villagers as part of the maternal health project. The project goal is to combine the Millenium Goals 4, 5 and 6. This project which was beforehand closely discussed with the Nigerian National Polio Committee Chair, Busuyi Onabolu, contributes at the same time to overcome remaining resistance against polio immunizations in this region.

Success:
With the nets donated by the producer BASF hospitals can now protect their patients, all mothers were very grateful to Rotary for giving them nets and they showed their readiness to let their children be immunized. See our photo gallery.

Frustration:
We agree with the Nigerian National Polio Committee Chair that after our pilot project a large project only meets the needs. Understandably mothers who could not get a net for their babies and themselves were frustrated.
September 2008

Robert Zinser, PDG D1860
RFPD Vice Chairman




Abstract FIGO Quality Assurance in Obstetrics


Quality Assurance in Obstetrics: A Model to reduce maternal and fetal Mortality and Morbidity in 10 Hospitals in Kano and Kaduna State, Nigeria

Hadiza Galadanci, Wolfgang Künzel, Dolapo Shittu, Manfred Gruhl, Robert Zinser

Achieving the MDGs 4 and 5 has continued to be a challenge in Nigeria, with maternal mortality ratio being one of the highest in the world.

Objective
The activities are aimed to establish an Institute of Quality Assurance in Obstetrics to improve the outcome of mothers and their children.

Methods
The project commenced in January 2008 with 5 hospitals from Kano and 5 hospitals from Kaduna state of Nigeria, with analysing the structure of the hospitals, then raising the quality of obstetrical services to improve the quality of process and outcome. The hospitals participate in a continuous monthly data collection of maternal and child mortality and morbidity. In addition maternal death forms are filled for each maternal death to provide further insight into the maternal deaths. In a half yearly quality circles, staff from the participating hospitals discuss under supervision the “blinded” results of each hospital.

Results
The structure of the hospitals exhibited deficits in many areas, such as equipment in the delivery rooms, operating theatres and staff. There were great variations in the maternal statistics across the 10 hospitals. The average MMR reduced from 1790/100,000 in the first half of 2008 to 1630/100,000 in the second half of 2008. The average FMR increased slightly from 849/1000 to 886/1000. There was an inversely proportional relationship between the total number of deliveries in a hospital and MMR. Also the FMR decreases with increase in deliveries. The average CS rate decreased from 7.18% to 6.12% respectively.

Conclusion
Quality assurance in obstetrics is a continuous process of analysing and discussing the MMR and FMR under guidance of an Institute of Quality Assurance. This might be a model to reduce the unacceptable high MMR and FMR.

Keywords
Quality Assurance in Obstetrics, Maternal Morbidity, Maternal Mortality Ratio, Caesarean Section Rate, MDG, Nigeria, Fetal Mortality Rate



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