By Sola Ogundipe
WHEN asked what legacy he was leaving in healthcare, Governor of Delta State, Dr. Emmanuel Eweta Uduaghan didn’t mince words. “What I’ll like to be remembered for is that, as a result of my programmes and policies, no woman must die during childbirth. This particular feat is what I would like to be remembered for assuming posterity wants to talk about me,” he asserted.

Several years ago, as a young medical doctor struggling to carry out his duty of saving lives, Governor Uduaghan witnessed an unfortunate incident involving a pregnant woman who was turned back from a private hospital because she could not afford to pay for the services.

The heavily unidentified pregnant woman had approached the hospital in question to seek attention for a complaint connected with her pregnancy, but she was sent away when it was discovered that she had no money. The woman went away, but a few days later, was rushed back to the same hospital in a more critical state.

The unborn baby had died in her womb and an emergency Caesarean Section was necessary to remove the dead baby and rescue the distraught woman from certain death. The woman very nearly lost her life and was saved just in the nick of time. It was later discovered she had obstructed labour because the baby was in a position described medically as “breech presentation” meaning the head was stuck and couldn’t come out.

Doctors acknowledged that in no way could she have had a normal delivery because she was in a life-threatening situation.

But, as a result of the woman’s inability to afford the cost of hospital delivery, she had been forced to exploit cheaper source of care and consulted Traditional Birth Attendants, TBAs, who were not able to determine on time that her case was an emergency that required hospital delivery.

In their own ignorance, the TBAs ended up pulling and pulling the baby until the neck was so long and the baby asphyxiated (lost oxygen). The baby died and still the TBAs could not evacuate the dead foetus. It was a breech presentation and when the woman returned with a dead baby in her, the hospital had to treat her because her life was at risk.

As a young medical doctor, Uduaghan witnessed this series of events and they touched him to the marrow. Although helpless to do anything significant at that point in time, that singular incident made such an indelible impression that he vowed to do everything possible to ensure that in his lifetime, never again would a pregnant woman in Delta State be denied access to services because she is unable to pay. He resolved to ensure that women would have unhindered access to adequate antenatal, delivery and post natal services free of charge, so that they and their babies no longer die as a result of lack of money to pay for the services.

This particular incident was what informed the Delta State’s policy on free access to maternal and child health services which Dr Uduaghan himself spearheaded and brought to reality when he became governor. This was in the realisation that apart from the fact a woman who gets pregnant must, inevitably, be delivered of the baby, where and how she delivers are choices that money helps the woman to make. So he realised he needed to make access to safe delivery free, including Caesarean Section. And that exactly is what he has done.

Since his inauguration, the Governor has displayed a rare commitment to the health and welfare of Deltans, as enshrined in his three-point agenda. The free maternal and rural healthcare programme is a classic example of how he has defined the true face of Delta State.

His strong belief that a healthy population is the basis for a wealthy society has paid off. In the State today, mandatory maternal health care services are available free of charge in all public hospitals under the Free Maternal Healthcare Programme.

This was one of the first policies he implemented as Governor. Under this scheme, all newly born and infants aged five and below, are treated free of charge by the state government. To date, free surgical treatment has been offered almost 20,000 beneficiaries in 94 communities across the state courtesy of the governments’ free rural health scheme.

During the first four years of the Uduaghan administration, the free maternal and child health policy contributed towards the drastic reduction of the maternal and infant mortality ratios and by the end of the first term of administration, the incidence of maternal death had reduced by half.

So successful was the programme that by 2012, Delta State had achieved the Millennium Development Goals, MDGs, set by the World Health Organisation, WHO, for maternal mortality. This is significant impact.

The state reduced its Maternal Mortality Ratio, MMR, that is, the rate at which pregnant women die from over 500 per 100,000 live births to 224 per 100,000 live births. This year the state is even expecting to reduce the MMR even further down to the 100s.

The Governor’s conviction is that no woman should die at all while giving birth. His words: “Our maternal mortality ratio is so low because we know how to deliver a woman of her baby. Pregnancy and to a larger extent, delivery, is a complete physiological process, but because of inadequate access to quality healthcare, some women and their babies still don’t make it.

A close look at the health records and statistics show that the free mother and child health policy has turned the tables on maternal and child health in the State. The policy does not even discriminate, as residents of neighbouring states are welcome to benefit. No one asks for ID cards or residential addresses before offering them service. The Governor’s attitude is that the right to life is the right to life.

“In Delta State, women are now going to the hospitals to deliver. Prior to this, there was the challenge of even doing the antenatal registration in the hospital, and because of poor access in the night and other difficult periods, some women still go to deliver with the TBAs even though the government is encouraging them to go to the hospital and deliver. It is still a challenge, but they are just a handful involved in this and the TBAs are being trained to know their competences.”

The Governor’s point of view is that hospital delivery is the way to go today.

“Every woman should be delivered in the hospital, even the future king or queen of England were delivered in the hospital. The argument is that you can bring all the doctors you have to your house, but because labour is unpredictable, anything can turn around during delivery.

“Things could change within a split second and it may not be possible to get the right setting and a bad outcome could result. This illustrates just how important a hospital delivery is,” the governor says.

Uduaghan’s Maternal Care Policy

The physician Governor has done so well in this perspective. He even extended the policy to free under-5 healthcare. Poverty actually makes a significant difference in terms of the quality of the human being. So having a good outcome delivery and support in the first five years can change how well the individual will do. So the importance of putting much in human resource which is part of the administration’s 3- point agenda is justified.

Low maternal infant and child mortality rates are typical of Delta State and this is really something the state government is shouting about. Human capital has been essential towards making sure the physician Governor got the best right from the start.

Uduaghan built a mother and child hospital in Warri, and another one is coming up in Ekpan, and there are 64 secondary health hospitals across the three senatorial districts of the state where free health programmes are being operated. It has really changed a lot in Delta state. Birth rates have gone up significantly.

In the past, cost was a huge barrier to access. If anyone needed to have an operation, that person would be asked to make a deposit of about N100, 000 or more. Even in the government hospitals, operations were not free. A patient may not even know he or she requires an operation. Usually operations are planned ahead but there are situations when you wouldn’t know you needed it. It requires, x-rays, scans and other preparatory tests.

That cost has been removed totally by the government’s policy. A study by the World Health Organisation, WHO, a few years ago showed that any woman who attends just two classes of antenatal care would have a significant beneficial outcome for her delivery, compared to the woman that attends none. So the government in realisation of the importance of attending antenatal care, ensures that pregnant women are always encouraged to attend. More than in the past, women now realise that the antenatal care enables them to know what the danger signs are, what a healthy pregnancy is and how to watch out to know if their babies are doing fine or not, such as monitoring the number of kicks, and other signs.

In the view of the Special Adviser to the Delta State Government on Health Monitoring, Dr. Rukevwe Ugwumba, “Education is one of the major reasons why we are dropping in mortality ratio and even if the women do not deliver in the hospital, we are still struggling to get them back into the hospital where it is free, and overcome the myths and make them come back.

“We are telling them what is safe so that they know that if they start to bleed, it cannot be normal. Or that if the baby is not kicking, or moving for the past 24 hours the way it moved previously, then it could be that the baby is getting distressed, or any other thing that the mother could not have been aware of.

“We look at things like HIV because we know that a in a pregnant woman with HIV, her child does not have to have HIV even though she is fully positive, because we know HIV is not genetic, but spread through contamination. There are so many things done in the hospital setting that the old mama in the village cannot do. These are the limitations. They have their role, but it is limited, we encourage and train them. For instance, we tell them to desist from using razor blade to cut the umbilical cord because it causes tetanus infection, and it is an on going training.”

WHY HIV PREVALENCE RATES ARE LOW IN DELTA

It is interesting to note that apart from having one of the lowest incidences of maternal and child mortality rates in the country, Delta State also has one of the lowest HIV prevalence rates. As gathered from state’s health authority, “the reason is not because the men are not being men and all that, but we are testing them for free and constantly and they are complying.”

The state has a robust HIV education and stigma reduction agenda. The slogan is this: “HIV does not kill, it is only when you do not know that you die.”

There are free drugs for persons living with HIV. There is free counselling, free testing and free follow up and monitoring, all for life. There are so many organisations in partnership with the state government to ensure HIV is controlled.

“We are trying to bring down the rate of HIV infection. We cannot restrict how men and women meet each other, but we realise that if there is HIV and it is not controlled, we are risking the spread,” Ugwumba explained.

2012 FLOOD DISASTER

What happened during the flood of 2012 was an emergency of unprecedented magnitude. It distressed a lot of people. No less than 53,000 persons were displaced and 11 communities submerged. The physician governor insisted that every camp must have a clinic and so that year turned out to be a blessing in disguise for the state in terms of rural healthcare.

Delta state has an interesting terrain where we have land mass, water mass and sometimes accessing the riverine areas can be challenging even though boats are often used. The flood uprooted everyone at the very fringes thousands were forced to flee to the towns.

As a result of this rural-urban displacement, some people had access to healthcare services for the very first time.

Prior to that incident, these people never had basic checks done. However, at the relief camps, they were checked for HIV, malaria, High Blood Pressure, and so many other things. Despite the magnitude of displacement and destabilisation there wasn’t a single case of communicable disease outbreak in any of the crowded camps. The government was very proactive about it all and it remains one of the proudest moments in healthcare in Delta state.

Pfizer Nigeria, actually took the opportunity to partner with the state government to ensure that vulnerable groups like children and women and people with chronic diseases, who were prone to infectious diseases such as pneumonia, were all immunised.

So the pneumonia shots exercise which is part of routine immunisation in developed countries was given free to all who should have it at the camps. It was an expensive venture but was made accessible for people at the camps. That was one of the very good stories about that episode – getting children immunised and getting them access to good quality healthcare for the period the camps lasted and making them know that there is follow up.

CATARACT, HERNIA AND FIBROID SURGERIES

The rural healthcare programme has been quite robust. The Governor and his health team regularly go around all the 25 local government areas where there are mobile field hospitals for carrying out operations on the spot.

At the 33-bed facility, there are cataract surgeries, hernia and fibroid removals carried out among others. The whole point is just to let the people of Delta state have a very good healthcare programme.

For instance, at each local government, there are Primary Healthcare Centres, PHCs and Secondary Healthcare Centres, SHCs. Delta State actually has over 400 Primary Healthcare Centres, so even for the people in the rural rural places, some do not know there is a health centre near them because they are not used to going there.

So during the rural healthcare activity, they are shown the nearest health centres, where they go to check their blood pressure free of charge. Although they pay for their drugs, the whole essence is to let them know what their health condition is and where they can go and follow up when necessary.

FREE IMMUNISATION

However, immunisations are always free. Information is available about what is required and the WHO standard for Primary Healthcare Centres is that there should be one PHC per square kilometre radius.

Delta state more that doubles that. For 18,000 sq ft, the state has over 400 Primary Healthcare Centres all of which are government owned and government-centred. The state government is targeting Primary Healthcare Under One Roof, PHUOR, and is still working on that.

The local governments have their role to play in the Primary Healthcare Centres but when a person dies, whether in Burutu or Asaba, the statistics belong to the state. A Primary Healthcare Development Agency run by the Ministry of Health controls the Primary Healthcare Centres.

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