The Abiye (Yoruba:Safe Motherhood) Programme is a home-grown comprehensive health initiative formulated to tackle the challenges of maternal mortality and morbidity in Ondo State, Nigeria. It was initiated in 2009 by the Mimiko administration in response to the 2008 Nigeria Demographic Health Survey (NDHS) which put Ondo State as having the worst maternal and child health indices in the southwest of Nigeria. The Abiye programme was also intended to achieve the Millennium Development Goals 4 and 5 by 2015. It is a free health program for pregnant women, and young children up to age 5. The Abiye initiative aims at ensuring that maternal health care service delivery in Ondo state is accessible and efficient enough to effect a reduction in the rate of maternal and infant mortality The Abiye model has been recognized by the World Bank as a viable template for achieving the targets of the Millennium Development Goals on maternal health within the African continent Ondo State is the only state in Nigeria that met the MDG indicators of reducing maternal death in the country, surpassing the goal with a 75 percent reduction. By 2016, the Ondo State Government had reduced MMR by 84.9 per cent; from 745 per 100,000 live births in 2009 to 112 per 100,000 live births in 2016 through the Abiye Initiative. The programme is funded by the Ondo State government.
Background
The 2008 Nigeria Demographic Health Survey NDHS put Ondo State as having the worst maternal and child health indices in the southwest of Nigeria, with its Maternal Mortality Ratio MMR far above the national average of 545 per 100,000 live births. With the 10th highest Maternal Mortality Ratio MMR in the world and without an efficient and effective national health system, attaining the Millennium Development Goals was a tremendous challenge for Nigeria In 2009, at the inception of his administration, a research study commission set up by Governor Mimiko in order to discover feasible solutions to maternal health, the realization of the MDG goals, and the health system of the State, resulted in the formulation of the Abiye (safe motherhood) Initiative The Abiye Initiative, home-grown health policy was launched in 2009. The initiative was piloted in Ifedore Local Government of Ondo state on 28 October 2009. The programme was scaled up to cover the entire 18 Local Government Areas of the State after the first year.
Structure and operations
The Abiye Programme caters to pregnant mothers and young children up to age five. It is tripartite in structure, flowing from the Abiye basic maternity health centers health to regular hospitals and culminating at the Mother and Child Hospital (MCH). They are all linked via specially trained community health extension workers known as the Health Rangers, communication tools- majorly mobile phones, and a variety of transportation means. The model is a comprehensive policy formulated to address four critical delays that contribute to maternal mortality and morbidity, namely:
-The delay in deciding to seek care (primary phase): Twenty-five pregnant women are assigned to one health ranger who serves as an intermediary between them and the Abiye maternity health centres, and who visits and monitors them regularly. To ensure contact with the health rangers and health care providers, each woman is provided with a mobile phone upon her registration at primary health care centres for toll free calls to the healthcare personnel or sometimes the Governor himself. The phones are prepaid by the government, linked to a caller-user group, and tracked by trained personnel who monitor the calls.
-The delay in reaching care (secondary phase): To reach pregnant women in the rural areas who have difficulty commuting to the health facilities, health rangers and health facilities are equipped with transportation means that are appropriately suited to the area of operation. These range from motorcycles and low-tech tricycle ambulances (locally manufactured in Ondo State), to four wheeled ambulances
-The delay in receiving appropriate care on arrival (tertiary phase): This is tackled in two parts; through the improvement of health care facilities- via the renovation of existing health facilities, the construction of new ones, and the provision of medication and equipment; and through capacity building via the recruitment of health personnel and training of existing health workers, including underutilized community extension workers