Nigeria Midwives Service Scheme
Author: National Primary Health Care Development Agency
Nigeria has had a very poor record regarding maternal and child health outcomes. An estimated 53,000 women and 250,000 newborn die annually mostly as a result of preventable causes.
The National Primary Health Care Development Agency (NPHCDA), under the 2009 Appropriation Act, was tasked with establishing the Midwives Service Scheme (MSS). The MSS is a public sector initiative and a collaborative effort between the three tiers of government in Nigeria. A memorandum of understanding between the Federal, State and Local governments sets out clearly defined shared roles and responsibilities, which are supported by the strategic partners of the MSS. The MOU has been signed by all 36 states of Nigeria and is designed to mobilize midwives, including newly qualified, unemployed and retired midwives, for deployment to selected primary health care facilities in rural communities. The aim is to facilitate an increase in the coverage of Skilled Birth Attendance (SBA) to reduce maternal, newborn and child mortality.
A Technical Working Group (TWG) meets to receive updates, review progress and advice in order to provide strategic direction, support and guidance for the implementation of the MSS. The secretariat of the MSS is responsible for day-to-day management, whilst state focal persons serve as contact people for the midwives in the MSS.
The MSS is based on a cluster model in which four selected primary healthcare facilities with the facility to provide Basic Essential Obstetric Care (BEOC) are clustered around a General hospital with capacity to provide Comprehensive Emergency Obstetric Care (CEOC). A midwife is deployed to each selected PHC, ensuring 24 hour provision of MCH services and access to skilled attendance at all births to reduce maternal, newborn and child mortality and morbidity. The MSS currently covers 163 clusters, which have 652 PHCs and 163 general hospitals. The MSS hopes to strengthen the PHC system by distributing basic equipment (midwifery kits, BP apparatus etc.) to 652 facilities through the vaccine logistics system. The MSS has established/reactivated ward development committees at all MSS PHCs to ensure community participation and ownership in its implementation.
2,488 midwives were successful in applying to the MSS and were deployed to PHC facilities. The midwives were then given an orientation to familiarize them with the scheme. As of July 2010, 2,622 midwives had been deployed to PHC facilities in rural areas. MSS provided capacity building by the creation of a training framework, which was aimed at improving the skills and proficiency of midwives in provision of quality maternal and child health services. The midwives then underwent competency training through Principals of Schools of Midwifery. The MSS plans to implement ICT support to improve communication and has articulated an M&E framework for the scheme. There has been a two-pronged approach to programme communication focused at political leaders/decision makers and clients respectively through radio/TV, billboards, community out reach, health centre branding and posters.
The MSS faces five key challenges, namely: implementation of the Memorandum of Understanding, availability of qualified midwives, retention of midwives, capacity building of midwifes and sustenance of linkages. There needs to be more support and commitment from officers in relevant government departments, which can be achieved by ensuring clarity on the objectives and aim of the MSS.
Over the years, several initiatives and programmes have been introduced to reduce mortality among mothers and children in Nigeria. Despite these efforts, poor maternal and child health indices has continued to be one of the most serious development challenges facing the country. Progress has been accomplished in the implementation of the MSS initiative however and best practices identified under scheme will further be consolidated with a view to overcome challenges.