Exclusive Insights: Innovations in Safe Motherhood-How Nigeria is driving innovations to crash maternal mortality and improve maternal health outcome

Discover how Nigeria is making efforts to improve maternal health through innovative solutions and strategic partnerships. In this exclusive interview, Dr. Samuel Oyeniyi, Director of the Reproductive Health Division and erstwhile Head of the Safe Motherhood Branch, Federal Ministry of Health and Social Welfare, shares the impactful initiatives and collaborative efforts driving significant progress in reducing maternal mortality and improving health outcomes for women and children across the nation

TAConnect: Sir, could you please introduce yourself and your role as the head of the Safe Motherhood Unit?

TAConnect: Tell us about the Safe Motherhood Unit, particularly, what you’re doing to improve health outcomes for women and children in Nigeria.

Dr. Oyeniyi: Okay, our mission and vision in the Safe Motherhood Unit of Federal Ministry of Health is to reduce maternal mortality and ensure women receive necessary care for a safe pregnancy and childbirth. This we do by improving access to high quality service for pregnant women at all levels of healthcare policy formulation, guideline and manual development. We guide the states to ensure these policies and guidelines are implemented to enhance safety, reduce maternal mortality, and improve the quality of care.

When we started, Safe Motherhood was seriously down, so we needed to oversee and coordinate with the states. The first step was to ensure we had Safe Motherhood coordinators in each state.  After achieving this, we realized the need for a Technical Working Group (TWG). With the support of TAConnect and other partners, we repositioned the Safe Motherhood sub-TWG, which now feeds into the national reproductive health TWG. We have also stepped up our indicators in DHIS2, ensuring data gaps were addressed. For example, there was no data on eclampsia before, but we alerted the DPRS and included it in the DHIS2. We analyze our indicators and present our performance quarterly or every six months.

Effective communication is another key area. We use social media to communicate with the states, helping to commemorate Safe Motherhood Day at the state level. We provide topics and guidelines for the states to prepare for their own Safe Motherhood Day. TAConnect and other partners have also supported the development and distribution of pamphlets in four languages, which were sent electronically to the states for adaptation and use.

In terms of policy, we developed a Safe Motherhood strategy for Nigeria, which did not exist before. We also created guidelines for PPH and eclampsia, quantified all maternal health commodities as well as developed the specifications for the calibrated drape. We achieved this quantification without any foreign technical assistance. We now have a five-year quantification plan for 44 commodities, state by state. We moved all our achievements, including training manuals and guidelines, to websites for easy access. Capacity building is ongoing, with the development of the Life Saving Skills (LSS) training manual.

Overall, the support from partners has been instrumental in our achievements, allowing us to present our work at international conferences. This has significantly helped the Safe Motherhood Unit to fulfill its functions and move forward.

A section of participants at the 3-day Safe Motherhood stakeholders’ workshop in Lagos, Nigeria to finalize the National guidelines for Postpartum Hemorrhage (PPH), Preeclampsia, and Eclampsia, which are two leading causes of maternal mortality in the country.

TAConnect: In your experience, what have been some of the major challenges in improving maternal and newborn health and reducing the mortality rate in Nigeria?

Dr. Oyeniyi: We have both administrative and technical challenges, but I’ll begin with the administrative ones. The Nigerian constitution places health on both concurrent and non-concurrent residual list which means states are independent. This means that while the federal government can create policies, states have the autonomy to decide whether to adopt and implement them. This is a great challenge because it delays a lot of implementations. We have come up with great ideas that are difficult for the state to pick up, and even if they do, there are still challenges with scaling and allocating a budget for the state to own it and cascade it to the community. This delay in implementation is a serious issue because, at the federal level, we want these initiatives to reach the community to make an impact.

The second challenge is the structure needed to implement these changes for sustainability at the state level, like what we have at the federal level. Since 2018, we have been working to make these structures available at the state level. Only five states have been able to establish a Department of Family Health. This non-availability at the state level is a serious setback. The states that have established it can allocate funds to safe motherhood activities and are experiencing better coordination, implementation, ownership, sustainability, and policy change adaptation. In states without this department, it is challenging to allocate funds and coordinate activities to reduce maternal mortality. Funding is another significant challenge. Targeted funding from the federal or regular budget is a serious issue.

Coordination is also a challenge. While we have good coordination at the federal level, state-level coordination has been difficult. Mapping partners to bring everyone to the table is essential, and we want the Department of Family Health to coordinate this.

Regarding the health system, we have made progress with funding from TAConnect. We have resuscitated emergency obstetric care and developed clinical protocols for obstetric services. These protocols can be used across all health systems, from tertiary to primary levels. Socio-economic challenges include poverty and the need for health insurance. We have invited health insurance representatives to our programs to reduce out-of-pocket expenses for pregnant women. Transportation and referral systems are also major challenges, especially in areas with poor infrastructure. Addressing these challenges requires a collaborative effort from various ministries, including finance, justice, environment, agriculture, and works and housing.

TAConnect: Over the past year, how have partners contributed to advancing the mandate of the Safe Motherhood Unit?

Dr. Oyeniyi: I will just say that when you are able to get things moving and people see the progress, the partnership gets stronger and stronger. Using the sub-TWG as a foundation for coordination, we bring all the partners together, inform them about what we are doing, the challenges we face, and where we need their help

TAConnect: In your opinion, how has this partnership contributed to advancing Nigeria’s goal of reducing maternal mortality?

Dr. Oyeniyi: Okay, our goal in the strategy is to achieve a maternal mortality ratio of 140 per 100,000 live births by 2030. Nigeria is aiming for this target, while some countries are aiming for 70. What we are doing, especially at the state level, has significantly contributed to reducing maternal mortality. States now know what to do and can take up from where we stopped. Implementation happens at the state level, so our coordination with the states and Safe Motherhood coordinators, along with policy development and laid-down processes, has been crucial.

We have four levels of healthcare: tertiary, secondary, primary, and community health systems. In the sub-TWG, the NPHCDA is a critical member. We also have representatives from hospital services and other areas to ensure dissemination through tertiary institutions. For the secondary level, apart from the Safe Motherhood coordinator, there is no Department of Family Health to support them, but we are managing, and they report to the commissioner.

Specifically, for PPH, supported by TAConnect and other partnerships, we wrote to all states about the early detection of PPH using calibrated drapes. We stopped virtual estimation for blood loss and moved to calibrated drapes. We provided the states with the manufacturer’s address, invited manufacturers to sub-TWG meetings, and assessed their capacity. The highest contributor to maternal mortality is PPH, so using calibrated drapes is crucial. States have started buying and using them, and we are optimistic that this will show positive results in a few years.

Participants in a group session during a stakeholders’ workshop in Lagos, reviewing the national guidelines for Postpartum Hemorrhage (PPH), Preeclampsia, and Eclampsia, two leading causes of maternal mortality in Nigeria

We have written to all states to include calibrated drapes in their 2025 budgets. For example, Kano state has confirmed it is in their budget. While the impact of calibrated drapes may not be immediately visible in data, it will eventually contribute to reducing maternal mortality. Additionally, we are looking forward to LSS training to improve the quality of care.

TAConnect: What specific milestones or progress have been achieved in scaling MNH innovations because of this partnership?

Dr. Oyeniyi: I have talked about calibrated drapes in terms of innovations that we have achieved. Another significant innovation is heat-stable carbetocin. During quantification, we were able to quantify all the uterotonics, preeclampsia and eclampsia commodities, including magnesium sulphate and tranexamic acid. We also quantified heat-stable carbetocin.

With our interaction with NPHCDA during the sub-TWG meetings, we discussed the challenge with efficacy of oxytocin due to inability to keep it at optimal storage condition because of the challenge with cold chain. We are collaborating with NPHCDA to use the cold chain for vaccines to move oxytocin to the last mile. Wherever vaccines are stored, oxytocin will also be kept there, so facilities can pick it up when needed.

Another initiative is the Presidential Initiative for Unlocking Value Chain (PIVAC). We invited them to the sub-TWG meetings when developing specifications for calibrated drapes and quantification. They have included MNCH and SRH commodities in their local production plans. Our minister is working to ensure these innovations and technologies are brought to and produced in Nigeria. He specifically stated that no calibrated drapes should be imported; the technology should be brought to Nigeria and scaled up locally. We successfully submitted the specifications for this. These are some of the milestones we have achieved in scaling MNH innovations through this partnership.

TAConnect: What lessons have been learned from this collaboration that could be applied to similar partnerships in the future?

Dr. Oyeniyi: Okay, the great lesson is that we can manage resources ourselves very well to address the needs of vulnerable people, supported by the work plan and policies moving forward. Effective coordination is crucial for achieving good outcomes. You need to coordinate at every level involved. For example, we coordinated with tertiary institutions in developing LSS, and they supported us, seeing what we were doing. The states were involved from the beginning, and we carried them along.

We also learned that collaborative efforts with agencies are essential. The Safe Motherhood strategy we developed is the first ever in Nigeria. The minister read the document thoroughly, made comments, and we went back to meet at NPHCDA, calling everyone together. Partnership, collaboration, and effective coordination are key lessons moving forward. You don’t need the highest coordination body to move things; you can do it at the lowest level, which contributes to the highest level. We coordinated together at the branch level and achieved our goals smoothly without any trouble. We also learned lessons about staff working together with partners seamlessly. Partners can disaggregate functions and solve issues effectively. Sometimes, you may need to spend your own money to move things forward, and you do it happily because you see results.

In terms of capacity building, we learned the importance of competency training. During the PPH project, we realized it’s better to train trainers who can then train others at their facilities. We invited people working in labor wards for PPH training, ensuring they could apply what they learned immediately. This approach changed how we do capacity building.

Participants engaged in a practical session at the National Training of Trainers on Postpartum Hemorrhage Management in Abuja

We also adopted Group ANC to increase ANC coverage and developed ANC guidelines to support it, based on evidence from about 16 states in Nigeria. These lessons have helped us work together as a team, both the Safe Motherhood branch and TAConect as the financer and have moved us forward.

TAConnect: Briefly, what challenges have arisen in the process of implementing the new MNH innovations, and how have you tried to navigate them? How have you been able to address them?

Dr. Oyeniyi: The main challenge, as I mentioned, is funding. Changes in other sectors also affect our implementation. For example, the increase in flight ticket prices has made it difficult to meet our targets. To address this, we have had to meet with other partners to support areas we can no longer cover due to these changes. This challenge is within the system.

TAConnect: What are the next key priorities for the Safe Motherhood Branch to ensure the sustainability of MNH innovations?

Dr. Oyeniyi: The next priority, number one, is to scale up from what we have now. We have sensitized the states where implementation occurs, and the facilities are now ready to use the innovations. The next priority is to ensure these facilities use the innovations, particularly the uterotonics.

The second priority is integration. For example, we have laid down the PPH rollout, developed SOPs, and partners are moving to the states. We aim to create an enabling environment coordinated by the Safe Motherhood TWG for all partners working in each state. We want to integrate high-impact practices, such as postpartum family planning (FP) for those who suffer maternal health complications. We aim to move FP to maternity wards, targeting 54 tertiary institutions. We also want to create massive awareness among health workers. We have incorporated these innovations into the curriculum of the Nursing and Midwifery Council. We have sensitized tutors so that new graduates are aware of these practices before they enter the field.

Another priority is competency training for doctors coming out of school during their NYSC. We have found that iatrogenic causes contribute to many maternal deaths, such as those from CS. We aim to collaborate with NYSC to conduct competency training for these doctors, focusing on skills like CS and the management of eclampsia.

TAConnect: How can TAConnect and other partners further support the Safe Motherhood Branch to accelerate progress and achieve greater impact?

Dr. Oyeniyi: Okay, thank you very much. The major things we need are more funding, technical assistance, and support when we need it moving forward. Coordination and partnership are also crucial. When we call for meetings to give reports or feedback, we need their support. So, funding, technical support, coordination, partnership, and infrastructural support are essential for the branch moving forward. Reviewing and providing feedback on what we are doing is also important.

Funding is needed for both operational and implementation activities, as well as for the supply chain of commodities. Without commodities, we can’t do much since most of our activities are commodity driven. We need to address stockouts and reduce out-of-pocket expenditures for health. Someone needs to pay those bills.

There are two areas that have been taken away from Safe Motherhood, but I will mention them. We are trying to get them back. The issue of maternal death review (MPCDSR) is under Safe Motherhood but has been moved to the director’s office. We have made significant progress in MPCDSR, but challenges at the state level are affecting it. MPCDSR is crucial for reducing maternal mortality as it identifies gaps in commodities, training, and other areas. It should be a priority for the country.

Tanzania has made it a priority and is seeing results, possibly because their president is a woman who emphasizes it. Group ANC is another area where Tanzania has increased coverage by 83% due to strong political support. Nurses conduct death reviews in their language, identify areas for improvement, and move forward. Partners need to push for this at a higher level.

TAConnect: What has been the most rewarding aspect of working on this Safe Motherhood initiative, both for you personally and for the Safe Motherhood Branch?

Dr. Oyeniyi: The most rewarding moment for me is my contribution to the early detection of blood loss using calibrated drapes. When I look at all the things we have done, they are all fine, but this achievement stands out. We were able to develop it, share it at international conferences, and push it to the website. Some countries even want to come to Nigeria to see how our manufacturers are working.

This achievement is the beginning of success. If we can follow it up and ensure every pregnant woman has access to calibrated drapes at a cheaper rate, we can detect PPH early and act on time. This will help eliminate PPH from Nigeria. Once we achieve this, we can focus on addressing eclampsia and pre-eclampsia. This is the most rewarding aspect for me because India achieved significant progress through calibrated drapes and no longer attends PPH meetings.

Group photo of stakeholders at the end of the workshop in Lagos, Nigeria to finalize the National guidelines for Postpartum Hemorrhage (PPH), Preeclampsia, and Eclampsia,

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