Guest Columnist: Dr. Goke's story
As an introduction to a renewed discussion on the ever puzzling matter of high maternal newborn and childhood deaths in Nigeria, I am publishing a reader’s response to my serialized articles on ‘Agenda for Health in Nigeria’. ErhunwmunseeAideyan, the CEO at ValueFirst Nigeria Ltd, wrote the following interesting remarks on the subject matter and gives an insight on how ICT tools usage can come to the rescue
“I have recently read several of your Health Matters article and I agree that a lot of things need to be done, most will require more funding, some more information and some a change of attitude. Though ValueFirst is an ICT firm with focus on Mobile solutions, we have been developing and have tested several ICT mobile solutions targeted at the health sector, our focus has been mHealth mainly reduction of Maternal & Child mortality by simply using mobile phones to remind people of due antenatal, postnatal and immunization date, while also educating mothers on breast-feeding, ORT, Treated mosquito nets, other immunization booster campaigns etc. Not to mention the enormous data that can be collected on the populace
“The general idea is that if we increase usage of what we presently have on ground that must at least count for the saving of some lives, in the hope of this we have written many letters, many proposals and documents to Federal, States and even Corporations to take this up as an intervention. It may interest you to know that we have been writing these letters since 2008 and now 4 years to 2015 we still have no takers, even though we have modified, redesigned the solution over and over to meet the operational realities on ground…..” and he so lamented.
The major gist of an article, written by same, on the potential role that a concerted application of Information Communication Technology (ICT) could play towards substantially improving the unpalatable health indices in Nigeria is captured below.
UNICEF’s State Of The World Children Report, 2009 had this to say on the global health appraisals with respect to Nigeria: "one out of nine global maternal deaths occurs in Nigeria", Nigeria also has the second largest maternal mortality rate in the world, with about 144 girls and women dying everyday from complications at childbirth.The story is not different with child mortality, according to the UN inter-agency’s Child Mortality Report, 2010: “Under-five mortality is increasingly concentrated in a few countries. About half of global under-five deaths in 2009 occurred in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China; India, with 21 percentand Nigeria, with 10 percent, together account for nearly a third of under-five deaths”. This is the grave picture of Maternal and Child Mortality in Nigeria.
Why are we here?
Research and several papers on why the high Maternal and Childhood related deaths all appear to agree that most of the deaths are completely avoidable and can be mostly linked to delay in seeking healthcare, such as non-attendance of antenatal care, low Healthcare facility deliveries, low attendance of post-natal care (critical in the 1week of birth), immunization etc.
A simple solution to theabove dilemma is to improve/increase usage and attendance of women and children of existing healthcare facilities and Health programmes such as antenatal, immunization, child welfare clinicsetc, which will go a long way at reducing the aforementioned indices.A situation where it is reported that medical supplies such as vaccines and family planning kits expire is an aberration which should not exist in Nigeria with our kind of health indicators.
What is to be done?
The question then is what needs to be done? It’s been noted that advocacy and increased awareness will help to increase attendance by mother and child, thus there has been an increased interest by the Federal Government, state governments and others who have taken the mantle upon themselves to increase advocacy and awareness amongst women and other stakeholders; yet more tools can be deployed, indeed one key tool is clearly missing in this fight - the use of ICT
Improving health with ICT
Data gathering and Improving Geographic Intervention – ICT can greatly improve how data is gathered and in essence allowing remote data gathering in rural areas, this has a direct influence on how it is used for planning and research. For example with data we can identify locations with high incidence of diarrhoea and then take appropriate action as a matter of urgency.
Direct Communication and Information Dissemination – One way in which ICT communication differ from advocacy and awareness is its ability to personalize communications - this makes for better response to calls to action, for example ICT can make for personalized communication such as “Mary, your next antenatal clinic is on 27/06/2011, attending clinic is important to safe delivery” or “Mama Alex, Alex must take 10weeks immunization today o, I beg take am go hospital so dat we go keep am from sickness” this kind of communication has been proven to be very effective in increasing attendance.
This brings us to the subject of what is the appropriate ICT technology to deploy in the fight against maternal and child mortality, and achieving the MDGs 4, 5 & 6 in Nigeria. Like most developing countries, Nigeria is one in which internet penetration and usage is low compared to the widespread reach and usage of mobile phones (according to the National Communication Commission, we have over 80million telephone subscribers in Nigeria); thus any ICT solution needs to make use of the qualities of both the internet and mobile technology, what is otherwise referred to today as eHEALTH&mHEALTH respectively, which have been deployed in the health sector for health communication and information and other Healthcare service delivery such as
Education and Awareness
Disease and Epidemic Outbreak
Communication and Training for Healthcare workers
The mPREVENT PROJECT is an eHealth/mHEALTH project targeted at using ICT to support the fight against Maternal and Child Mortality, it aims to increase the number of mother and child who seek healthcare from our existing healthcare facility, by capturing and forming an Antenatal Registry;alerting mothers on appropriate time for antenatal clinics, immunization reminders, disease surveillance etc. It further aims to gather health data from the field directly to be used for planning, research and statistics as well as an early warning signal for disease surveillance.It makes use of both the internet and the mobile phone technology.
ICT is one more very cost effective way Local governments, State Governments, Federal Government and other stakeholders should deploy in their fight against Maternal and child mortality toward achieving the MDGs 4-6.“Time is of essence 2015, the target year for achieving the Millennium Development Goals, is around the corner and at ValueFirst Nigeria Ltdwe sincerely hope that by 2015 we would not look back at missed opportunities and realized that we haveas well succeeded in helping the world to miss the MDGs 4, 5, 6 target; that would almost certainly be a shame.’’
I cannot but largely concur with the above passages from ErhunwmunseeAideyan; hence, in furtherance of my proposed agenda for the health, it is recommended that versatile minds like the ones in crying out in the wilderness of ValueFirst be engaged at all levels of public health delivery, in the immediate, for the purpose of channeling the way forward on how best to deplore ICT tools in our quest for a better health system in Nigeria.