I am delighted to join our partners, the Liverpool of Tropical Medicine, Johnson and Johnson Global Health, the Kwara State Government and all stakeholders today as we disseminate the results and impact of our 5-year program to improve the availability and quality of maternal newborn care services delivered by health workers in Kwara State.

From the first moment I witnessed the impact of hands-on anatomically delivered simulation model training globally, I knew that building a community of well-practised multi-disciplinary delivery teams could address the local frontline barriers to improving care services rapidly and wholeheartedly, at both the health system and societal level, in Nigeria.

Thus, in 2015, my WBFA leapt at the golden opportunity to partner with the Liverpool School of Tropical Medicine, CMNH-LSTM Nigeria and Johnson and Johnson Global Health to up-skill health care practitioners in the area of certified Emergency Obstetric Care Skills and Drills. The main drive of the project pioneered across Kwara State, Nigeria, was to equip doctors, nurses and midwives to recalibrate a collective team and introduce the skills needed to overcome these obstetric emergencies.

With hopes to improve maternal health significantly, we have continued to identify and lift away the barriers that limit access, availability and quality of maternal and newborn health services.

80% of all maternal deaths are a result of five complications, all of which can be managed by adequately trained healthcare professionals.

Haemorrhages, sepsis, eclampsia, complications of abortion and obstructed labour are among the common aetiological factors of maternal and neonatal complications, but they also contribute to mortality and morbidity, too.

The introduction of specialist professional and regular training acts presents a form of diligence while reinvigorating frontline workforce autonomy.

As we focused our intervention on local government areas within the state with the largest population of women of reproductive age, we landed in Kwara located in north-central Nigeria, It’s 3 million inhabitants and an estimated 120,000 births per year, coupled with my own personal state-centred nostalgia and birth experience, made it the perfect beginning for such a dissemination of key skills and learning.

Through a partnership with the Liverpool School of Tropical Medicine and with support from Johnson and Johnson Corporate Citizenship Trust, Wellbeing Foundation Africa implemented a project to increase the availability and quality of care for mothers and babies at public and private healthcare facilities in Kwara State, Nigeria.

The project was to consolidate the achievements and gains made in strengthening Emergency Obstetric and Newborn Care and the quality of maternal and newborn care services in 21 health care facilities (HCFs) across 7 Local Government Areas in Kwara state. The project was implemented in 27 Health Care Facilities (HCFs) in 9 additional Local Government Areas (LGAs). In collaboration with the University of Ilorin Teaching Hospital (UITH), we strengthened the capacity of faculty to provide quality teaching and support the integration of Emergency Obstetric and Newborn Care training into both undergraduate and post-graduate medical education. At the end of the 30-month programme, all 16 LGAs in Kwara have been supported to provide quality emergency obstetric and early newborn care services. The capacity of medical doctors at the UITH was strengthened through the extended Emergency Obstetric and Newborn Care training.

As with previous programmes, LSTM engaged the professional medical and nursing/midwifery associations and regulatory bodies, to advocate for the recognition of Emergency Obstetric and Newborn Care training as a key component of continuous medical education. Specifically, LSTM engaged both national and state bodies to promote this.

Operational research was conducted to measure what works, where and how. Research findings and evidence will be widely disseminated, to inform best practice and sustain these interventions in Kwara state.

The overall objective was to increase the availability and quality of care for mothers and babies at selected Comprehensive Emergency Obstetric and Newborn Care and Basic Emergency Obstetric and Newborn Care HCFs in 16 LGAs in Kwara State.

The specific objectives are to:

• Improve the quality of Emergency Obstetric and Newborn Care in forty-eight (48) HCFs across 16 LGAs in Kwara State.
• Improve the capacity of hospitals in Kwara state to provide comprehensive emergency obstetric and perioperative care.
• Strengthen the capacity of health care providers in the targeted HCFs in maternal and perinatal death reviews.
• Support the University of Ilorin Teaching Hospital to strengthen the capacity of its faculty, to improve the quality of its Emergency Obstetric and Newborn Care teaching, and integrate Emergency Obstetric and Newborn Care components into its curriculum.
• Promote the development of a framework to institute regular and mandatory training of maternity care providers in Emergency Obstetric and Newborn Care.
• Generate evidence through operational research on effective and sustainable approaches to enhance the capacity of health care workers to provide quality maternal and newborn care services.

The key achievements:

• In-service competency-based training in Emergency Obstetric and Newborn Care and Newborn Care: 450 Health Care Providers (HCPs) were anticipated to be trained; 452 were trained. 32 Master Trainers were anticipated to be trained, 35 were trained.
• Build capacity of health workers at UITH to provide Comprehensive Emergency Obstetric and Newborn Care, provide support for Emergency Obstetric and Newborn Care at other facilities: 64 were targeted – 69 Medical Doctors were trained in Emergency Obstetric and Newborn Care and Newborn Care. 10 were targeted – 20 Master Trainers were trained. 48 were targeted – 60 Medical Doctors were trained on the Advanced Emergency Obstetric and Newborn Care.
• Quality improvement (QI): 90 participants completed workshops in QI. QI teams were supported to conduct a standards-based audit, and maternal and perinatal death audit, to identify areas for quality improvement, and develop and implement work plans to improve the quality of care.
• National Maternal and Perinatal Death Surveillance and Response (MPDSR)
• Skills room: 5 Skills room were set in 5 LGAs
• Monitoring and Evaluation: Routinely collected healthcare facility data and data from programme outputs are aggregated quarterly to inform the log frame indicators, where applicable and to monitor progress with programme implementation as well as effectiveness.
• Facility Improvement Funds (FIF): 27 Health Care Facilities were donated with basic equipment to aid them in their daily health care services.
• Refresher training: 50 were targeted, and 63 were trained

Having sustained the early and encouraging impact being made by the introduction of Emergency Obstetric and Newborn Care skills and drills training, and expanding the program in 2018, we continued by paying joint advocacy visits to the Kwara State House of Assembly to advocate at the sub-national level for the training espoused by our Emergency Obstetric and Newborn Care program which was pioneering sustainable change across 21 public HCFs in the state. I hope that our strong evidence now demonstrates that anatomical models based skills and drills training must be recognised as a professional education curriculum requirement, and fast.

As we conclude the 5th year of this pioneering introduction in Kwara State, we now have convincing proof of a concept beyond suitable for whole nation deployment. The results are clear: we’ve recorded a 38% reduction in facility stillbirth rate since 2015, and we know that the improvements and upskilling in Kwara can, must and will inspire change across the country.

I thank our partners, the Liverpool School of Tropical Medicine’s Centre For Maternal and Newborn Health, and Johnson and Johnson Global Health, for the trust and confidence invested in the Wellbeing Foundation Africa and United Nations Every Woman Every Child Commitments to the Global Strategy on Women and Childrens’ Health, which powered our partnership, and their arrival to Nigeria to implement such a significant program.

I beam with pride and with a grateful heart at the readiness demonstrated by a robust frontline, and look forward to the actualisation of a continuum of care that will contribute to the total zeroing of maternal and neonatal deaths in Nigeria.

It is often said that the true test of innovation and impact is sustainable local engagement, so I am delighted that the partnership was able to establish skills laboratories and centres of excellence at selected facilities.

I congratulate our partners and the National Council of Nursing and Midwifery as the program impact progresses, again supported by Johnson and Johnson Global Health, on the strategic and intentional path towards national pre-service training scale.

Towards holistically aligning and guaranteeing mothers access to higher quality respectful maternity care, the Wellbeing Foundation Africa continues to strengthen, deepen and widen its independent community midwifery-led Mamacare Antenatal and Postnatal Education Program, educating expectant and nursing mothers, ensuring they access and achieve the WHO recommended 8-visits throughout their childbirth journey – with the confidence of knowing that their professionally qualified delivery attendants are upskilled to deliver a safe, healthy and therefore happy outcome.

We must continue on the quest to lift and leap over barriers, to deliver new life safely, and ultimately save millions more lives.

Thank you all.