1. Enlightenment of the Publics
Primary objective of the project “Reduction of Maternal and Child Mortality - Prevention and Treatment of Obstetric Fistula in Northern Nigeria” is a comprehensive enlightenment of the population, particularly of the 5 million birth giving females of the target area. This enlightenment aims at informing about preventive health care, child spacing, pregnancy, birth and the period thereafter, including HIV/AIDS prevention. The enlightenment is conducted by skilled health care workers throughout the entire project duration. Thus, it is important to integrate dignitaries and traditional rulers into enlightenment and awareness campaigns, so they can support the endeavour. Furthermore, training and education will be provided to employees of the national Health Care Service and to traditional birth attendants. So far, “radio serials” proved to be the best in-depth tool for such public awareness campaigns as they are produced and broadcasted by the Population Media Centre (PMC).
Main objective of these informational campaigns is to create awareness among opinion leaders and the public about key health care aspect such as HIV/AIDS prevention, health care for pregnant women, problems associated with early marriage, female genital mutilation and “obstetric fistulas”. Therefore, relationships are being established and maintained with the traditional rulers aiming at holding enlightenment seminars even on a village level.
2. Equipment procurement
Another important aspect of the project is the procurement of material for the enlightenment campaigns, such as posters and flyers, medical equipment for the Rotary Fistula Centres and the Obstetric departments of the ten selected hospitals as well as contraceptives. For women who face complications during home deliveries (about 70 % of all deliveries in the target area), transportation facilities are required to make sure patients can be provided treatment in a timely manner.
3. Education and training
An additional key initiative is the education and training of medical staffs in the target area's hospitals and of members of the national health service organisation who are engaged in dealing with pregnant women. Special education of nurses for the treatment of fistula patients in four hospitals is planned. On top of that, 150 additional health workers and 150 traditional birth attendant will be trained to better understand pregnancy related issues, infection prevention and the development of fistulas. Also, certified nurses will be trained to perform caesarean cut operations and vaginal-surgery practices in remote areas in cases of emergency. Finally, in each of the 67 project counties, two employees of the health care authorities will be trained to become instructors in topics of birth attending and medical support.
4. Rehabilitation and integration
Another important program of the project “Maternal Health Care in Northern Nigeria ” is the rehabilitation of 1,000 fistula patients and their successful re-integration into their rural society. Successfully treated patients will be educated to act as health workers and subsequently as “ambassadors” for a co-ordinated approach to pregnancy and birth attendance. In state-owned rehabilitation units, healed fistula patients can enhance basic qualifications such as sewing and knitting, and they can improve their literacy skills to make a better living, thereafter. For such women, micro-credits can be made available.
A Comprehensive Approach is necessary to tackle Maternal Mortality successfully. For our project “Improvement of Maternal Health - Prevention and Treatment of Obstetric Fistula” we have chosen this approach. Our project is running from 2005-2009 in Kaduna and Kano State, Nigeria, a target area with one of the highest maternal mortality in the world. In a rural hospital we found out a MMR as high as 8.000/100.000. This Project is funded by numerous Rotary clubs mainly from Germany and Austria.The core project amounting to 1 Million Euro is co-funded by THE ROTARY FOUNDATION, AVENTIS Foundation and the German Government. It is a joint project with Nigerian Rotary volunteers. We coperate with many stakeholders like Traditional Rulers, Government and Non Governmental Organisations (NGOs), Foundations and UNFPA.
The numerous factors influencing Maternal Mortality and Morbidity go far beyond the percentage of attended births or reachable emergency services. Our approach addresses all of them including social behaviour, infrastructure and quality of prenatal and antenatal care. We identify the main risks of pregnant mothers in our target area. Our activities are: Advocacy and Public Awareness, Behaviour Change, Training of Health Personnel, Delivery of Medical Equipment, Improvement of quality of structure and process, Safe Water Management, Vouchers for Fistula Patients.
Our main Objectives are: Reduction of the number of obstetric fistula by surgical repair. Our focus is on prevention as arising new cases cannot be repaired in a foreseeable future. We work upon: The increase of well attended pregnancies and births also in rural areas. Better accessibility to health facilities by pregnant women in labour. Education with blanket coverage about child spacing, avoidance of early marriage and behaviour change in general by radio serials. One of our interim evaluation reports demonstrate that patients watch radio serials and change their behaviour. Routine HIV/AIDS test and Prevention from Mother to Child Transmission (PMTCT). Rehabilitation of fistula patients. Satellite projects are rounding up our core project and increase not only the amount of the project but its effect.
Partnership and collaboration is required for Maternal Mortality. No single NGO or government agency can do it all-alone. Before we started our project we informed all stakeholders, invited them to a meeting and we keep in touch with them. We strongly believe that too often efforts and resources are spoiled by lacking cooperation between stakeholders, by actions which are not coordinated, by not sharing best practices. We would like to share with the conference attendants our experiences so far: Stakeholders are ready to join common efforts, Reduction of Maternal Mortality is last not least a management challenge with skills of planning and organization, mobilization and motivation, logistics and coordination which might have been neglected so far. In theory all aspects of maternal mortality are well known. In practice they have to be put together to find most successful ways and means of a comprehensive approach. As there are many causes for maternal deaths the interventions have to be comprehensive. Governments will realize best that their contributions are indispensable in a comprehensive approach.