The reasons are not far-fetched: Far too many pregnant mothers reel in poverty, illiteracy, poor nutrition, and poor sanitation, while governments provide inadequate health care and health education owing to ineffectual leadership, poor governance, and corruption. These factors increase delays in seeking, accessing, reaching, and referring care, which eventually lead to deaths from preventable and treatable conditions.
In 2000, world leaders established Millennium Development Goals 4 and 5 for reducing child and maternal mortality rates to one-third of their 1990 levels and set 2015 as the target. But according to various studies, the slowest improvements have occurred in Africa as a whole and Nigeria in particular. This is confirmed by a recent study, sponsored jointly by the World Health Organisation and the Bill and Melinda Gates Foundation, which pinpoints Nigeria as the second worst case in neonatal deaths. The study concludes that it may take countries like Nigeria some 150 years before they could meet up with newborn survival rates in the USA or the UK!
However, rays of hope are emerging as new health facilities focus on reducing maternal and child mortality rates. In the forefront of such facilities is the Mother and Child Hospital, Akure, which the representatives of the World Bank and the United Nations Children's Fund have described as a model not just for Nigeria but also for Africa and even the world. Although originally conceived as the apex of the now famous Abiye (Safe Motherhood) Programme, it has since taken a life of its own, attracting patients beyond this base and even beyond the state. More importantly, it has reduced maternal and child mortalities much faster, and at rates higher, than comparable facilities in Nigeria and beyond. And it has been able to record these achievements by maximising costs and the utilisation of resources. Today, the MCHA is a tourist attraction, in addition to being a pregnant mother's dream hospital.
To better appreciate MCHA's contributions, a tour of the facility and an appraisal of its operations are necessary. This appraisal is based on four visits to the hospital, the most recent of which were on August 20 and 21, 2011, and on extended interviews of the Chief Medical Director, Dr. Olawale Lawal Oyeneyin, who provided invaluable historical, policy, and statistical data. The appraisal also benefited from several conversations with Ondo State Governor, Dr. Olusegun Mimiko, who created the MCHA as the apex of the Abiye Programme. A World Bank finding, before he assumed office, that Ondo State had the worst maternal and child mortality rates in the South-West made the programme's implementation the more urgent.
Construction work on the MCHA commenced within three months of Mimiko's assumption of office and the hospital opened for business by the end of his first year in office. According to Oyeneyin, "the MCHA is a premier, purpose-built, state-of-the-art, 100-bed facility dedicated to the care of pregnant women and children less than 5 years of age". Its primary objective is to provide qualitative and critical medical interventions to pregnant mothers and babies in order to reduce maternal and child mortalities in the state by 50 and 30 per cent, respectively, by the year 2013.
The MCHA was designed, equipped, and staffed precisely to achieve this objective. The main hospital building is a sprawling, comprehensive, and integrated facility, housing ante-natal, labour, post-natal, neo-natal, and paediatrics wards. In addition, there are an out-patient clinic and a casualty room. Strategically located around these units include an intensive care unit; anaesthesia unit; operating theatre; pharmacy; a blood bank; laboratory; radiology; and a dietetics department. There are also service units, including general administration, accounts, internal audit, stores, transport, tailoring and laundry, and maintenance departments.
The hospital's staff strength has also increased from a handful at the beginning to 250 permanent staff 18 months later. This includes 16 doctors (nine in obstetrics and seven in paediatrics), 95 nurses, 40 health attendants and 50 janitors. According to the CMD, "aside from the janitors, we operate at a staff strength hovering between 50 and 70 per cent of the optimum".
What has been attracting attention to the MCHA is the use to which the facility has been put by this relatively small group of dedicated staff, the outstanding results achieved so far, and the vision and dedication of relevant actors. By September 4, 2011, 12,963 pregnant women and 16,877 children (3,611 as paediatric inpatients) had been registered and treated. 6,952 safe deliveries had been conducted, 1,196 by caesarean section. With an average of 20 deliveries daily, the MCHA is now the busiest maternity centre in Ondo State and one of the busiest in the country. Twenty per cent of patients are non-residents of the state, a testimonial to the hospital's increasing popularity and its safety perception index.
The 47 maternal deaths encountered so far yielded a maternal mortality ratio of about 680 per 100,000 deliveries. This is less than the national average of over 800. Even much less is MCHA's pre-natal mortality rate (that is, losses from about 7 months of pregnancy to the first week of birth) at 66 per 1000 births, about half the national average. Compared to older facilities, such as university teaching hospitals, the MCHA is clearly ahead of the curve in reducing maternal and child mortality rates.
These achievements have drawn universal applause. It is only appropriate to give the last words to some of the hospital's numerous visitors. Shreelata Rao Seshali, Social Development Specialist, The World Bank: "I did not expect to see such an efficient and excellent hospital today, so I thank you for this experience. This is a tribute to political will teamed with professional dedication". Margaret Hempel, Director Ford Foundation Group: "This is an impressive facility that will help women here and around the country". Dr. Ogunbayo, Nigeria Governors' Forum, Abuja: "Highly functional and impressive hospital, clearly well thought out". Moshe Ram, Ambassador of Israel: "The most impressive hospital I've visited in Nigeria". Finally, Professor O. Akinkugbe, Emeritus Professor of Medicine: "This is revolutionary, well thought out, and a glowing testimony to team work. Congratulations".
