Bill & Melinda Gates Foundation

Good Governance and Protecting Newborns in Sokoto

December 05, 2013

This post was originally published at Weekly Trust. 

On the mid-September morning we met Baby Rukayatu in Zangalawa village, 30 minutes from Sokoto Town in north-western Nigeria, the desert sky was blue and visibility was as good as it gets. The ground, still soaking wet from a recent downpour, hosted a riotous festival of flowers and vast armies of towering, green stalks of millet in bloom. The quiet slumber around the village was periodically awakened by the chatter of young children, the bleat of goat kids and by the sound of mortars pounding.

 As drug keeper, I can tell you that the first stock of medicines I received from the dispensary is used up. I am now on my third batch. The government needs to realize that this program is important to us. It is working to save the lives of babies and mothers. It is important for this program to continue.Hawau Umaru MaigioroWrapped in a royal purple clothing the arms of Mohammed YarKurna, her father, Rukayatu’s navel was strikingly clean and well healed. At birth, two weeks earlier, Rukayatu received Chlorhexidine 4%, an antiseptic gel that was applied to her freshly cut umbilical cord stump. This simple application prevents cord infection, a cause of one in three neonatal deaths in Nigeria. Rukayatu is the 20,000th baby to receive Chlorhexidine 4% gel since late April this year, which could cut neonatal deaths by as much as 18 to 23 percent. This intervention was realized through Africa’s largest, ongoing community-based distribution program at scale, financed by Sokoto State government with support from USAID and a consortium of organizations led by John Snow, Inc. Rukayatu’s mother also received inexpensive Misoprostol tablets, to prevent postpartum bleeding, which causes 25% of maternal deaths in Nigeria. Sokoto’s approach to scale-up is quite novel because it leverages prior and ongoing improvements in the health system; it also encourages managers to adjust the program in real time with learning supplied by experience.

“I have to be frank, I did not at first care for these medicines,” Rukayatu’s father said. “When I informed the dispensary health assistant that my wife had just delivered a baby, he really encouraged me to try them for my wife, and for my girl. Now, I am happy he convinced me to use them.” 

Hawau Umaru Maigioro, the elderly community health volunteer and long time traditional birth attendant, supplied the medicines to Rukayatu’s father. Just under five feet tall and clad in a long blue print cloth and a marigold scarf that doubled as a hijab, her breakout smile outshined the old smallpox scars on her face. The multi-sized callouses on her hands hinted at a life of struggle and survival.  “These medicines are a lot of help,” she said. “The assistance needs to be continued.” Hawau collected her supply of these medicines from Mallam Tudu Abakar, who was appointed by the community to be their drug keeper on 24-hour duty. “These two medicines are miraculous,” Mallam Tudu said.  “As drug keeper, I can tell you that the first stock of medicines I received from the dispensary is used up. I am now on my third batch. The government needs to realize that this program is important to us. It is working to save the lives of babies and mothers. It is important for this program to continue.” 

Sarkin Garba Bagarawa, the tall, regal-looking district head of Kwacar Lalle, spoke to us in his palace.

“We were consulted on this program at every step of the way. We nominated community health volunteers and drug keepers to be trained. We also know what is going on. We believe in it.” 

In this program, what good governance has initiated, trust-based community ownership has so far maintained. That such a program is rapidly producing remarkable results in an environment as imbued with the nuances of culture, socio-economics, gender and power relations as this one, is a testimonial to what is possible elsewhere in the country. With approximately 5 million births every year in Nigeria, the journey that has begun in Sokoto needs nurturing, and be adopted by other state governors. As Nigeria and the global community dwell on progress towards to the UN 2015 Millennium Development Goals, we would all benefit from lessons learned here. The federal and 36 state governments in Nigeria will do well to ensure the timely supply of these medicines to satisfy the increasing demands of communities for the safe delivery of babies and their mothers. A little governance for tots will count for lots of tots’ lives saved.

 
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