By Bashir Hassan Abubakar
Maternal, Perinatal and Child Death Surveillance Response (MPCDSR), is a World Health Organization (WHO) initiative designed to account for every maternal, perinatal and child deaths where ever it occurs, be it at health facility or home.
MPCDSR initiative is aimed to bring out information on identification, notification and determining the causes of all maternal, perinatal and child deaths. Information generated from this enquiry is being use]d to respond with actions, through informed decisions, with a view to preventing future occurrences of such deaths.
With several other programs and innovative approaches being devised to improve Maternal, Newborn and Child Health (MNCH) across all levels of healthcare services, the MPCDSR is yet another measure that emphasizes on Quality of Care (QoC) and Quality Improvement (QI) in healthcare services.
The burden of maternal and child mortality and morbidity is quite huge in Bauchi State. This can be seen in all relevant surveys and studies carried out in the NDHS 2018 and MICS 2021.
Though at the moment there is no reliable data on maternal deaths in Bauchi State, but projections from other current surveys on maternal health status of women in the State has indicated an insignificant change in the indices that is supposed to spur all stakeholders to action in the quest to mitigate maternal mortality rate in Bauchi State.
According to the current Multiple Indicator Cluster Survey (MICS) of 2021, delivery assisted by any skilled attendant in Bauchi State is only 17.4 percent, while antenatal care (ANC) (at least 4 visits) by any provider is 43.3 percent and ANC (at least 1 visit by skilled provider is 42.5 percent. The MICS 2021 also indicated that post natal health care check for mothers is 40.4 percent. The survey also revealed that, women aged 15-49 years who received appropriate care in Bauchi State are less than the Northeast region and National rates.
The survey indicated that early childhood death rates are higher in Bauchi State compared to the rates for the north east and national rate of children dying.
As contained in the MICS 2021, under-five mortality per 1000 live birth is 153 which is above the national average of 102 and the entire north east that stands at 114. Child mortality rate in Bauchi stand at 70 per 1000 live birth and infant mortality rate is 89 per 1000 live births. Post neonatal and neonatal mortality rates in Bauchi State are 43 and 45 per 1000 live births. (MICS 2021).
From the above statistics, perinatal and early childhood death rates are higher in Bauchi State compared to the rates for the north east and national rate of children dying.
Most of these deaths, according to health experts are not reported as pregnancy or birth related deaths at the community or, even health facility levels.
The above validated statistics is more than enough reasons to upset any right-thinking Government or concerned stakeholders in the health sector of Bauchi State. This is because pregnancy or giving birth are not diseases and most of these deaths are preventable.
Role of Media in Reversing the Negative Trend
The media has been identified as one of the veritable tool in changing negative perceptions, advocating good practices and holding Government accountable to its responsibilities, thus, leading to formulation of sound policies and implementation.
Over the years, health reporters in Bauchi State under the aegis of a Civil Society Organization (CSO) known as Journalists for Public Health and Development Initiative (J4PD) had played significant role in advocating for concerted efforts from the Government and non State actors for improved health care system in Bauchi State.
It can rightly be said without any fear of contradiction that the history of health reportage in Bauchi State cannot be complete with mentioning the modest contributions of J4PD and their associates.
A few cases to buttress the above point was the role members of J4PD played during the campaign against wild polio virus that paved the way for certification of Nigeria as polio-free Nation. Not only do they report on their findings on the field during vaccination campaigns, members of J4PD , then known as Journalists Against Polio (JAP), practically resolved non compliance cases and shared their experiences during review meetings. These efforts were rewarded through a certificate of commendation awarded to the Journalists by the Bauchi Field of WHO.
Another effort of J4PD was when, after a field visit to some primary health care facilities, came face to face with cases of severe acute malnutrition (SAM) afflicting under five children, leading to mortality cases. The SAM cases were aggravated then, due to stock out of Ready to Use Therapeutic Food (RUTF) supplement used for the cure of SAM patients. J4PD immediately packaged their reports and syndicated it to various media platforms. That singular action prompted Bauchi State Government into allocating Millions of Naira for the procurement of RUTF.
Other outstanding feat of J4PD include: advocacy for 15% budget allocation to health sector and releases, creating awareness on uptake of family planning and other MNCH services in remote communities, calling government attention on omitted MNCH budget line, that was incorporated back into the state budget, and so many community based interface highlighting the importance of accessing health care services at the nearest facilities.
It was little wonder then, when USAID IHP Bauchi decided to support Bauchi State in resuscitating the activities of the MPCDSR Steering Committee, they saw the need to mainstream J4PD into one of the subcommittee of the newly reinvigorated MPCDSR Committee.
The first thing USAID IHP did was to organize an intensive capacity building training for members of J4PD to acquaint them with the concept of MPCDSR.
The objective of the training was to deepen knowledge of the Journalists on the gravity of maternal, newborn and child deaths as well as exposing them to the use of MPCDSR as an evidence-based approach towards preventing such deaths.
Other areas of focus during the training was discussions on the role and contribution of media towards reducing the burden of MNCH deaths and, defining modalities of media reporting of MNCH deaths.
At training, the State Technical Director of USAID IHP Bauchi, Dr. Ibrahim Alhassan Kabo said that journalists have the power to change nations through investigative and well researched stories, but pointed out that, “without research, right knowledge and information, the media has little or no impact to make in the society”.
Dr. Kabo urged the Journalists to leverage on the knowledge gained at the MPCDRS training to embark on an in-depth investigation in order to have accurate report on the challenges, strengths, weaknesses and opportunities inherent in mitigating MNCH deaths in Bauchi State.
Part of content of the training was a field visits to a secondary and primary health care facilities where participants engaged service providers on how they conduct MPCDSR at their facilities.
During the field visit, question and concerns on the minds of the participants was, how do facilities report maternal, perinatal and child deaths that occurs at the community level.
USAID IHP’s Human Resource Advisor Dr. Robinson Yusuf was on ground to answer participants that, though MPCDSR initiative is designed to report all MNC deaths at both the facility and community level, that at the moment the State MPCDSR Steering Committee is trying to institutionalize the initiative at facility level before moving into the community. That for now, MPCDSR facility committee service providers have to relay on what the community reports through Ward Development Committees (WDCs) structures regarding such deaths.
Dr. Robinson also said that community sensitization and awareness on MPCDSR is an area where the media can play an important role.
As innovative as MPCDSR concept is, implementing it even at the facility level is faced with challenges.
One of the major challenge in the implementation of MPCDSR is the absence of a budget line for MPCDSR in the State. This was disclosed by the Secretary of the State Steering Committee Zuwaira Baba when she was giving an overview of MPCDSR in the State.
Another challenge affecting effective implementation of the MPCDSR is the persistent changes in Commissioners of health whom , by default , are the Chairmen of the MPCDSR Steering Committee. Just when a commissioner is settling in to grasp in the importance of MPCDSR activities, he or she will either be deployed to other ministry or a cabinet will be dissolved and that, in turn, affects implementation processes when a new Commissioner assume that same position.
Though, despite all the challenges Zuwaira Baba said that, with the support of implementing partners, led by USAID IHP, 17 secondary health facilities in Bauchi State are now reporting deaths using MPCDSR concept since 2022, with the prospective of more health facilities keying in.
It is instructive to note highlight some of the key outcome of the Three Days capacity training that is likely going to fast track MPCDSR implementation in Bauchi State.
At the end that training J4PD developed a 6 Months SMART work plan that was strictly tailored towards evidence based advocacy to the state government to, among other things, create a budget line for MPCDSR in the 2024 budget. The work plan also resolved to carry out facilities/community visits to further acquaint stakeholders on the need to imbibe the culture of reporting MNC deaths.
While appreciating USAID IHP for building J4PD’s capacity in the areas of MNCH, Health Financing and the concept of MPCDSR , the Coordinator of J4PD Ms. Elizabeth Kah said that members are now well informed and ready to carry out media advocacy on strengthening MPCDRS at both the health facilities and communities.
The J4PD Coordinator said that members intend to be carrying out routine facility/community visits to ascertain level of implementation of MPCDRS with a view to bringing stakeholders’ attention to evidence generated during such field visits.
Ms. Kah also pledged J4PD’s commitment to keep advocating to the Bauchi State Government for a budget line for MPCDSR and institutionalizing the initiative at all levels of health care, the community and down to household level.
She then said that every participant is now aware that MPCDRS is a medical health audit concept designed to identify the causes of deaths in pregnant women, new-born and under five children, with a view to forestalling reoccurrences of such deaths.
Already, J4PD, inline with it’s 6 months MPCDSR work plan, is on the verge of stepping down the training to other journalists and sharing knowledge on the concept. Other activities to be carried by J4PD will be centered around community interfaces and town-hall engagements with both state and non state actors. In all these activities, J4PD agrees that evidence will be used to sway attention on the need to strengthen MPCDSR as a renewed effort geared towards reduction of maternal, perinatal and child mortality in Bauchi state.
Suffice to say, the tremendous technical support J4PD is getting from USAID IHP Bauchi since inception of the intervention has actually paved the way for synergy between these group of Journalists and the MPCDSR State Steering Committee.
Also, the consistent interface between members of J4PD and IHP’s Knowledge Management and Communication (KMC) Specialist, Boniface Kassam has created an enabling environment for the Journalists to showcase their skills in reporting USAID IHPs health interventions in Bauchi State and this was duly acknowledged when USAID IHP presented J4PD with a commendation certificate.
It is also worth mentioning the contributions of Dr. Alhassan Siaka, the State Director of USAID IHP by readily making himself available to J4PD’s requests for technical support for enhanced performance in reporting activities of the health sector in Bauchi State.
At one of such meeting with members of J4PD, Dr. Alhassan advised them to focus their activities in Bauchi State at the moment because of their in-depth knowledge of the environment and the health sector in particular.
With the combined efforts of the State MPCDSR Steering Committee, that is being supported by USAID IHP and the skills of J4PD members in packaging their stories and advocacy messages for target audience, a significant improvement in curbing Maternal, Newborn and Child mortality and morbidity in Bauchi State, through implementation of the MPCDSR, is feasible in no distance future.
Hassan is the Knowledge Management and Communication (KMC) Advisor of J4PD