Protecting Pregnant Women: The ‘Health Rangers’ of Ifedore

July 19, 2011

  • A pilot program in Nigeria’s Ondo State leads the way in saving mothers and children
  • In Ifedore, the program has seen a 15-fold increase in skilled birth attendance in 15 months
  • It’s a sustainable model to improve care of pregnant women for just $40 per woman

WASHINGTON, July 19, 2011—Justinah Chukwudi is from Idule village in the rural Ifedore area of Nigeria’s southwestern Ondo State. She is married to Godwin, a trader from the southeast. The couple was expecting their fourth baby last year, and had registered with Ifedore’s recently overhauled maternal and child health program.

A government ‘Health Ranger’ visited their home to check on Justinah. Finding she had very swollen ankles and other signs of a complicated pregnancy, the ‘Health Ranger’ asked Justinah to get a scan done quickly.

At the hospital, Justinah was surprised to find that she was carrying three babies, not one. When her time came to deliver, she was taken in an ambulance to Akure hospital, where her triplets were delivered by C-section by a qualified doctor. She recovered well and was able to return home with her babies.

This is a story with a happy ending, but if the difficult pregnancy had gone undetected and arrangements had not been made for medical care during the delivery, Justinah might not be alive now to tell it.

If not for my ‘Health Ranger’ and the doctor, I would have died,” said Justinah, who is also grateful to the Governor of Ondo state for the health care she received thanks to the work of these government-funded healthcare providers. “They saved my life and (that) of my children.”

Abiye: A new model of care

When Dr. Olusegun Mimiko, Ondo State Governor, was told by the World Bank that women in Ondo were dying of pregnancy-related causes in higher numbers than in nearby states, he was appalled, because lush, oil-rich Ondo also produces more professors per capita than any other Nigerian state.

He swung into vigorous action to keep mothers and babies alive through the Abiye (Safe Motherhood) program, and in 15 months, has demonstrated a locally designed model of care that can potentially save millions of lives across Nigeria.

The program, piloted in Ifedore in late 2009 with World Bank support, aims to get past the obstacles that prevent expectant mothers from low-income families from seeking help during pregnancy.

To begin with, the government conducted a mass registration of pregnant women like Justinah, sensitizing communities about the importance of staying healthy during pregnancy, but also raising awareness among them about the services available to them.

Then, fifty trained ‘Health Rangers’ were each assigned 25 pregnant women, whom they visited in their homes, giving advice and tips on nutrition and checking for possible complications.

Flesh and blood, not statistics

The pregnant women of Ifedore have become real human beings to us,” said Dr. Mimiko, speaking at the World Bank in June 2011, “They are flesh and blood now, not just statistics.”

Registered women were given cell phones with toll-free access to ‘Health Rangers’, health facilities, or even the Governor himself, who has received many a call from a woman surrounded by an excited household.

With all this attention from the government, their cause is much more visible in their communities.

Once in a health facility or at the hospital, women are seen by trained, incentivized, and well-equipped nurses or midwives, or by doctors who can conduct C-sections. Patients are discharged quickly, reducing wait times for others. And—another hurdle cleared—they do not have to pay.

Homegrown and cost-efficient: A challenge to other states

Women have been traveling to Ifedore even from the distant North as news of Abiye has spread.

When registration of pregnant women goes up seven-fold, and skilled attendance of births rises fifteen-fold in as many months, I call these ‘results’ in a country that has a tenth of global maternal and child mortality,” said Obiageli Ezekwesili, World Bank Vice-President for Africa, herself a former Nigerian cabinet minister.

What Ondo State has done is to pose a challenge to the other states of Nigeria.”

World Bank Country Director for Nigeria, Onno Ruhl, applauds Abiye’s sustainability.

The Mother and Child referral Hospital might look like Grey’s Anatomy when you walk in,” he said, “But this is not a boutique hospital; the model is homegrown and very cost-efficient.”

The cost of care per patient (whatever the mode of delivery) is a mere $40, excluding staff salaries. And the referral hospital is more efficient than many other public hospitals. It has only eight doctors, but has done nearly 4,000 deliveries in one year.

All we need to scale Abiye up from Ifedore to all 18 local government areas in Ondo State is $7.1 million,” Dr. Mimiko said.

The program must evolve to further reduce maternal deaths and to save costs by measures such as distributing SIM cards rather than phones, which women tend to want to keep.

And it may need to attract more doctors like the private-sector chief medical officer from Lagos who moved to work for much less in the Akure hospital, and has set up its medical protocols.

According to Dr. Mimiko he came because “Abiye could give him something that money can’t buy.”