Nigeria 2015

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Global Health Charities:

Nigeria: $34.45 dollars a day = a life

About Global Health Charities                                                                                                                              

Patty Williams saw first-hand the results of global poverty while growing up in Asia and later working for Trinity Health International. As President and Founder of Global Health Services Network (GHSN), she made a commitment to herself that she would start a foundation that would provide sustainable solutions—not just temporary relief–to individuals and communities that seemed all but forgotten. Backed by expertise and contacts gained at the helm of an organization that helps governments and private organizations in developing countries improve the quality and efficiency of their healthcare services, she knew she was well positioned to make a difference.

Motivated by the knowledge that lives could be saved, Global Health Charities was founded in January 2014.

 

About our proposed Nigeria project

Global Health Charities seeks to fund and launch a program in Nigeria to increase the number of trained midwives, Community Health Extension Workers (CHEWS) and Traditional Birth Attendants (TBA’s) in the north. Nigeria is among the top ten countries that together contribute 54% of total world births and unfortunately also account for 67% of all stillbirths (Source: WHO. World Health Statistics 2010).

To create a sustainable solution to address the high incidence of infant mortality and maternal deaths, we realize we must address the severe shortage of trained and skilled health workers. Our program is closely modeled after the Helping Babies Breathe initiative, a joint project of the American Academy of Pediatrics and the World Health Organization. We have met with Dr. Jay Eastman, who serves on GHSN’s Advisory Board and who is part of a team that brought Helping Babies Breathe to Guatemala, training traditional birth attendants and village health promoters in childbirth emergencies and essential newborn care. We are fortunate as Dr. Eastman has agreed to guide us as we launch this program in Nigeria and serve as one of our key educators in “Training the Trainers.”

The Situation in Nigeria

  • The majority of high-risk deliveries take place in rural Nigeria where skilled attendants are lacking and where patronage of traditional birth attendants is high. Source: Federal Ministry of Health Abuja. Saving Newborn Lives in Nigeria. Save the Children, ACCESS; 2009. 
  • Every 10 minutes, one woman dies during pregnancy or childbirth in Nigeria, resulting in a total of 53,000 deaths per year. This means about 800 women die in every 100,000 live births.
  • Nigeria’s newborn mortality or death rate – 528 deaths per day – is one of the highest in the world. According to CIA – The World Factbook: Infant Mortality Rate (2013 est.), there are 74.09 deaths per 1,000 births in Nigeria. For comparison’s sake, in the U.S. there are 6.17 deaths per 1,000 births. In Nicaragua, there are 20.36 deaths per 1,000 births. In Iran, there are 39 deaths per 1,000 births. Tragically, yet a finding that offers hope for future babies, about 9 out of ten of newborn deaths in Nigeria are preventable.

According to The State of the World’s Midwifery 2014: “The vast majority of women and newborn deaths could have been prevented with proper antenatal care and the presence of a skilled midwife during delivery”

The country has undertaken initiatives to improve the situation, including providing additional midwives in rural communities, but Nigeria’s ability to meet Millennium Development Goals (MDG) #4 (Reduce Child Mortality by two thirds) and #5 (Reduce the number of women dying in childbirth by two thirds) is unlikely. Please reference chart below showing Maternal Mortality progress in Nigeria:

When these deaths are analyzed by location within the country of Nigeria, it is clear that the maternal and infant mortality rates in the northern regions of Nigeria are of critical concern. The main reasons:

  • North Nigeria is predominantly Muslim, while South Nigeria is predominantly Christian. Attitudes about women and education on neo-natal care and birth are not progressive.
  • Health professionals are less willing to live and work in rural areas, and despite efforts to incentivize workers to stay in the profession and Nigeria, the attrition rate is larger than the rate of increase due to new graduates.
  • Rural areas in the north do not draw as many nurse-midwives and midwives (“Skilled Birth Attendants” or SBA’s) due to Muslim males’ customary regard toward women. The presence of Boko Haram in the northeast is a major deterrent to those wishing to provide aid.
  • Even when a Skilled Birth Attendant is available, the policy of requiring payment for services discourages poor women from using them.

Fortunately, Traditional Birth Attendants (TBA’s) are active in these areas. Their numbers are hard to track as many TBA’s do not register with the local government. Still, studies show that only 22% of live births were attended by a TBA. The World Health Report 2006 recommends that to achieve 80% skilled attendance at birth, one midwife or TBA is recommended for every 175 births per year. Nigeria has one midwife or TBA for every 500 births, a ratio that is likely much lower in the north. 

 

How Global Health Charities proposes to save lives:

With a grant from the Gerard Foundation, Global Health Charities plans to:

– Reduce the current daily infant mortality rate by 5% in 2015. That is 26 babies saved per day or 9,490 in 12 months.

– Reduce the maternal mortality rate by 5% in 2015. That is 7 mothers saved per day or 2,650 in 12 months.

Our proposed approach is based on two key facts: 1.) Enhanced skills training is needed by current health workers and 2.) Additional health workers are needed to provide care.

Phase I:

Keeping these two urgent needs as our focus, we will train 200 community health education workers (CHEW’s) in the north, 50 per quarter. The curriculum for community health workers will focus on basic neo-natal care, plus basic and emergency maternity care. Once trained, community health workers will return and spend time practicing with the midwife or TBA’s in their communities.

Phase II:

After a period of time in which the community health education worker feels they can provide coverage for three days, we will then bring a total of 100 TBA’s and midwives from the North to a central training location for a two-day skills enhancement course, thereby training 25 individuals per quarter.

The curriculum for TBA’s and midwives will focus on more advanced birthing practices and emergency maternity care. An assessment of these health workers current skills will be done on site and programs customized to maximize their “takeaway” from the program.

Comprehensive birthing kits will be provided to all that attend. We will provide “Birth Cards” to the providers that cover the cost of hiring a birthing professional for poor families.

We will purchase equipment from The Natalie Collection, a birth simulating learning kit that facilitates interactive learning by providing practical hands-on training. NeoNatalie (the infant) is an inflatable simulator designed to teach the initial steps of resuscitation in the first ten minutes of a newborn’s life. Mama Natalie can be strapped onto an “operator”, who takes the role of the mother, and manually controls the training scenario and the following features:

  • Bleeding
  • Positioning and delivery of the baby
  • Delivery of placenta
  • Fetal heart sounds
  • Cervix landmark
  • Urine bladder catheterization
  • Uterine massage and compression

 

How much it will cost?

$418.224 or $34.45 per life. 

Midwives are the unsung heroes of maternal and newborn health. They can prevent about two thirds of deaths among women and newborns. And midwives deliver much more than babies. They are the connective tissue for communities, helping women and girls care for their health, from family planning all the way through the postpartum period. —United Nations Population Fund

 

How we plan to measure our success:

We will conduct a pre-and post- survey in the communities where the intervention takes place. Although tracking of maternal and neo-natal mortality is often not well-recorded, we will make this a condition of participating in our training. Post-reporting will take place 16 weeks after training is concluded and health care workers return to their communities.

We will capture pre- and post- data such as number of neonatal and maternal deaths, nature of complications, medical approaches used, and outcomes. We will also gauge general numbers of mothers seeking health provider services and amount paid for service.

 

Thank you for your kind consideration of our proposal.

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