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By Tolu Adebayo
The journey to the Umuihi community within Imo State is a vivid portrayal of determination and evolution in Nigeria’s rural healthcare environment.
The remote location of the community, reachable only by a tarred, potholed road running through dense undergrowth, characterizes the working limitations of the majority of Nigerian rural communities. Despite these seemingly impenetrable impediments, maternal health and overall health achievements within the community have experienced a stellar transformation.
The rates of maternal mortality in Nigeria in the past have been astronomical, with a rough estimate that one woman dies every 13 minutes from preventable causes related to pregnancy and giving birth. It was nearly impossible for decades to count maternal deaths even in remote rural villages like Umuihi, leaving thousands of women vulnerable due to delays in receiving emergency care.
Nonetheless, it is the absence of maternal death this year for the first time that makes the achievement of Umuihi an outstanding one given the remoteness of the locality. This narrative is a beacon that reflects well on the use of a community participatory approach in the delivery of health services by the community to each other, as a result of which there exists a high degree of ownership that is leading the delivery of sustainable health services to them. Local citizens contributed labor and resources during the construction of the health facility, thus creating a sense of community investment in their women’s and children’s health and well-being.
This model based on community has encouraged trust and confidence within the health system, which is often lacking in most other rural settings.
Collaboration with Love for Health Organization (LHO), a voluntary private international organization committed to the decrease of maternal and child mortality, has been fundamental in this shift. LHO’s method is the upgrading of facilities at local levels to Comprehensive Maternal and Child Care centers with the ability to perform emergencies such as cesarean sections. Recognizing that delays in the response to emergencies are fatal, LHO discovered physicians and skilled medical staff among the community members and made them available for prompt and effective treatment when needed. They also involved the community in the management of facilities through management committees, which provided the local leaders with autonomy to manage day-to-day operations. Through the collaboration, the health facilities were well maintained, resources were used effectively, and community members were made to feel a sense of ownership.
One of the most important determinants of success has been the recruitment of maternal health promoters—women who were formerly traditional birth attendants and well respected in their community. The promoters were trained in pregnancy danger signs, the importance of antenatal care, and the benefits of delivering at health facilities. They set up support groups that would meet regularly, encouraging pregnant women to register, present for antenatal checkups, and deliver at the health facility. Their integrity as respected members of the community allowed myths and misconceptions regarding modern medical procedures to be eliminated, leading to increased facility-based deliveries. Today, approximately 85% of women in the community deliver at the health facility, a stark contrast to previous years when the majority of women ended up delivering at home with associated risks.
The health facilities operate on a shift basis, ensuring round-the-clock availability of trained health workers without overburdening personnel. Physicians, midwives, and laboratory technicians work in shifts, delivering round-the-clock emergency services. Staff training is continuous, through collaboration with institutions such as the Maternal and Child Surveillance Program and USAID, which offer advanced training in obstetric emergencies, family planning, and other key skills. LHO also awards scholarships to auxiliary nurses after three years of service, promoting ongoing professional development and retention of qualified staff.
The collaboration between LHO and the Imo State government, as seen through memoranda of understanding, has created a sustainable system of operation. The government supports the hosting of health workers and provides some personnel, while LHO provides facilities and assets. The system offers access to support from international donors, offering a steady supply of required commodities for maternal and child health. Despite some challenges, including the government’s failure to fully live up to staffing commitments, the community’s engagement, and LHO model have enabled a high rate of safe deliveries, with up to 90–100 monthly births now occurring in the health facility.
This remarkable transformation demonstrates that even the remotest communities are capable of making extraordinary strides toward the decline of maternal mortality if local leadership, community participation, strategic partnerships, and innovative health models get in sync. It offers a good example of Nigeria’s broader ambition to achieve the zero preventable maternal deaths target, with the insistence on the availability of community-based care as the key to the reformation of rural health outcomes across the country.
