How govt, traditional birth attendants can reduce infant mortality –Nutritionist

A nutritionist and health specialist with the United Nations Children’s Fund, Lagos Field Office, Dr Ijeoma Agwu, speaks with DAUD OLATUNJI about recent reports that showed that Ogun State and other South-West states were worst in infant mortality

You raised concerns about the rise in infant mortality in Ogun and other South-West states. How did you arrive at that?

When we looked at the health indicators across the South-West states, we saw that Ogun State had performed sub-optimally in different indicators. If you look at institutional deliveries in Ogun State, it is quite low. When you look at the mortality rate, one in 20 children die before their fifth birthday and this is unacceptable. No child is expected to die, especially from preventable causes. When you go on to look at immunisation, their Penta3 coverage is very low and their Penta1 coverage is too. These are all interventions that if well implemented from birth to five years of age in children, will not have them dying from preventable causes. A lot needs to be done and UNICEF is coming to give its support.

What do you think is responsible for the state’s poor performance in the health sector? Does it have anything to do with its geographical location?

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I would like to commend the leadership of the governor; he’s done a lot for health. He has done so much for health, but then there is still a lot that needs to be done when it comes to improving primary health care services as well as the risk that we can see. I won’t use the word, ‘last’. I will just say it is sub-optimal and there is always room for improvement. A lot needs to be done and that’s one thing we are committed to doing. Yes, it is a border state, so we find out that there is a lot of free flow movement across the borders. Every day, people come in.

In terms of the documentation, we may not have an accurate population within that state. Some children may be vaccinated today and may move across the border, while others come in and this comes with a lot of issues. So, that is one thing we are committed to supporting – order immunisation – and looking at other interventions we can bring across borders.

Are there other issues?

Another issue we see around human resources for health is dwindling capacity and distribution. Advocacy is being done in terms of recruitment, and in terms of distributing the healthcare workers, as I mentioned earlier, in terms of linking the communities with the health facilities; that is something we are working very closely across health and social behaviour communication change.

How is UNICEF helping the affected states in the region, especially Ogun?

Seeing how we can bridge that gap, we work very closely with our community leaders and influencers to see that they take the information out to the community and see that they actually change their practice when they have children, who need the interventions, which is immunisation, the antenatal. They actually need to visit the PHCs and if needed, they are referred to the higher level of care to get healthcare.

Is the brain drain in the health sector also one of the causes of this problem?

The thing is that we have become a very global community. People keep moving in and out of the state and country for different reasons. Yes, it is an issue but we can’t attribute that totally to being the reason for the sub-optimal case that we have seen. While these people are leaving, we are still training a lot of health workers within our institutions. They can always be brought on board to take up these vacancies. So, looking at recruitment and distribution, even though it was said they are not enough, in our more organised local governments, you will find more health workers than in the rural areas.

There are reports that 21 per cent of children in the region were delivered outside health facilities, thus, contributing to infant mortality. What is your take on that?

Definitely, we are still a country that has religious and other beliefs. We still visit other places to give birth outside of health facilities. We have faith-based institutions and traditional birth attendants. So, those are some of the reasons we have some optimality when it comes to birth attendants. And that is when you see the government working hand in hand with some of these groups ensuring that they are registered under more organised groups. We are looking at ways that we can work in a complementary manner together.

Information is also given to ensure that nobody goes outside of their areas of work. I know Ogun State has been working quite closely and a lot of other states like Lagos and a few others are working quite closely with these groups – traditional attendants and other groups – to see how they can bridge that gap whereby they see patients from outside or, where it is a severe case, they are referred timely and promptly to get better care.

Is 21 per cent something to be worried about?

We won’t call it alarming. What this rate does is like a report card for us to know where we are and what we will work on.

Over the years that UNICEF has been sharing the data with the government, what has been the level of implementation in an attempt to reduce the rate?

The National Bureau of Statistics conducted this study, of course with support from partners and UNICEF is one of the key partners when it comes to the survey and once it’s being disseminated, it is disseminated from the national level. At the state level, we are doing the same with our respective states. We also have technical working groups at different maternal and newborn child health centres in the areas where this is being disseminated and this is used to plan for activities that we are going to implement to improve the indices that we see.

How does the South-West region’s current performance compare to previous reports?

Different indicators have different levels. Some have remained stagnant. Some have improved and some have gone. Across different states, we have had immunisation. It has stayed stagnant at some point. For skilled birth attendants, it is not improving in Ondo State as well as Ogun State.

When we look at this, like a report card for us to see, as we did well before, it helps us to look at what we are not doing right and what we can do to improve it. And where we are stagnating, we want to be better; it will just help us to plan and put our resources better.

Are you satisfied with the level of access to public health centres for residents of the South-West?

The government is doing a lot to improve access and UNICEF is supporting in that regard. UNICEF is supporting in terms of where it is hard to reach. We support through outreach programmes to take primary health centres closer to the people. And this is usually done every week. When it comes to health financing that is where they have their state health insurance schemes. They are advocating for the population to start to take advantage of them so that when it comes to spending on health, it is not catastrophic for them.

What should residents of the region expect from UNICEF going forward?

One of the basic things we are also looking at is how to strengthen leadership when it comes to managing maternal and child health programmes. We are also looking at how to improve health financing. We know that there are a lot of issues around human resources for health, so, it is one thing we are looking at supporting in seeing how we can look at other ways to augment the human resources for health that we have.

Coming down to demand, we need to bridge the gap, even in our communities and health facilities, and see how we can improve them and the PHC services. We can’t do anything without the communities; they are very important but if they are not being used, one will not have a good rate within our states. So, we are looking at how to bridge it. So, UNICEF is doing a lot around that. We have a very strong team working with our community influencers and key community leaders in seeing how we can ensure that our mothers bring their children and utilise the place.