The promise of a more equitable world, as outlined in the United Nations Sustainable Development Goals, hinges significantly on the health and rights of women and children. However, this promise remains unfulfilled, marked by gaping inequities which fuel global health crises. Without addressing these disparities, our aspiration for a healthier, safer, and fairer world by 2030 will remain fleeting.

Despite a 38% decline in the global maternal mortality ratio from 2000 to 2020, the pace of reduction falls short of the target needed to achieve the Sustainable Development Goal of 70 maternal deaths per 100,000 live births. In Nigeria, the situation reflects this global trend, with maternal mortality rates remaining unacceptably high. Data from Nigeria underscores the urgency of the situation, with an estimated 1047 maternal deaths per 100,000 live births, the third highest in Africa(1). This stark reality emphasises the pressing need for accelerated action to address maternal health disparities and improve outcomes for mothers and newborns across the country.

The landscape of maternal and newborn health in Nigeria is characterised by both challenges and triumphs, and while progress has been made, particularly through the efforts of dedicated healthcare professionals, policymakers, and international partners, exemplified by initiatives such as the Federal Government’s National Emergency Maternal and Child Health Intervention Centre #NEMCHIC and State Emergency Maternal and Child Health Intervention Centres #SEMCHIC, which serve as catalysts for change at both national and grassroots levels, the persistence of high mortality rates underscores the need for sustained community action on the frontlines, which the Wellbeing Foundation Africa champions as the leading non-governmental organisation advocating to reach the most vulnerable populations, and implementing programming for quality maternal, newborn and child healthcare.

Central to these efforts is the promotion of community midwifery, which plays a vital role in delivering essential care to expectant mothers, particularly in rural areas. The Wellbeing Foundation Africa Midwives, trained and supported by WBFA, not only provide the World Health Organization recommended antenatal and postnatal classes through Mamacare360, alongside other clinical services but also serve as trusted members of their communities, working with adolescent in bolstering Personal, Social, Health and Economic #PSHE and Water, Sanitation and Hygiene #WASH, education, while addressing socio-cultural factors that impact maternal, newborn, child and adolescent wellbeing.

The Wellbeing Foundation Africa has been instrumental in driving progress for initiatives such as Basic Emergency Obstetric and Newborn Care #BEmONC and Emergency Obstetric and Newborn Care #EmONC, a set of seven key obstetric services, or ‘signal functions,’ a life-saving intervention, introduced by the WHO, UNICEF, and UNFPA in 1997 as an organising framework for the delivery of evidence-based clinical services, as a critical component of any programme to reduce maternal and newborn mortality, with skilled birth attendants providing these services within the context of community-focused and facility-based health systems, enabling timely prevention of and intervention for these complications and saving the lives of mothers and newborns(2). Supported by community midwifery and strategic partnerships, WBFA is committed to providing universal access across Nigeria to EmONC, which is considered essential to reduce maternal mortality and requires that all pregnant women and newborns with complications have rapid access to well-functioning facilities that include a broad range of service delivery types and settings(3).

Receiving care at health facilities is crucial for maternal and newborn health, but it involves more than just access. Factors such as the organisation of facilities, the quality of care provided, and the availability of trained staff and essential equipment play pivotal roles. Efficient management of obstetric emergency situations relies on addressing these factors comprehensively. However, it’s essential to acknowledge that success in maternal health programmes require facility readiness but also addressing the three delays: delay in seeking care, delay in reaching care, and delay in receiving care. The strategic partnership between the Wellbeing Foundation Africa, the United Nations Population Fund, exemplified this, as together, we have continuously orchestrated transformative advocacy and policy campaigns, rooted in the essence of SDG 3, Good Health and Well-Being, to tackle all three delays, as without doing so, the effectiveness of any safe motherhood programming will be limited.

Given these essential evidence based learnings, the Wellbeing Foundation Africa is looking forward to implementing our new programme, Advanced Emergency Obstetrics and Newborn Care competency-based curriculum for resident doctors in obstetrics and gynaecology at the National Postgraduate Medical College of Nigeria, in partnership with our long-standing allies, the esteemed Liverpool School of Tropical Medicine in 2024.

The overall goal of the project is to improve the availability of quality advanced EmONC at national and sub-national hospitals by strengthening the capacity of the National Postgraduate Medical College of Nigeria to deliver advanced EmONC competency-based curriculum to resident doctors in Obstetrics and Gynaecology, taking significant strides towards strengthening Nigeria’s healthcare workforce.

A project of the Global Health Workforce Programme Grant, funded by the UK Department of Health and Social Care and managed by the Tropical Health and Education Trust and Ducit Blue, the programme has the ambition of achieving more resilient health systems for post-pandemic recovery and supporting progress toward Universal Health Coverage, and will engage experts from the Royal College of Obstetricians and Gynaecologists and experienced master trainers in advanced EmONC from LSTM.

The objectives of the project include engaging with stakeholders in post-graduate medical education in OBGYN to agree and adapt the training package for revision courses and examination OSCE, identifying host institutions in Abuja and Lagos to establish one advanced EmONC Centre of Excellence (CoE) in each site, establishing a sustainable system for operating the CoE for postgraduate OBGYN revision courses in advanced EmONC, supporting the NPMCN in providing training to residents and ensuring quality assurance of the training at the CoE, and evaluating the programme for accountability and dissemination purposes.

Post-training, health workers will be equipped with the knowledge and skills to provide timely and appropriate care for pregnant women and newborns, including identifying and managing complications, conducting safe deliveries, and providing postpartum care. The Advanced EmONC training programme is expected to impact maternal and child health outcomes in Nigeria significantly, reducing the risk of maternal and newborn deaths will improve overall health outcomes for women and children in the region. The programme’s success will be testament to the commitment and collaboration of the Federal Ministry of Health and Social Welfare, national and international partners, and the dedicated health workers in Nigeria. Alongside this, the commitment shown by the NEMCHIC and SEMCHIC demonstrates a crucial political will to extend the gains achieved in Primary Health Centers, where the seven skills and drills are most needed. This concerted effort is essential for ensuring that maternal and newborn health initiatives are effectively implemented at the sub-national level with policy and advocacy at the national level, thereby making significant strides towards reducing maternal and newborn mortality rates throughout Nigeria.

The greatest lifetime risk for a mother and her baby occurs during childbirth, therefore as we continue our work in achieving the 2030 Agenda, sustained investment in community midwifery, alongside strategic partnerships and training-led, data-driven interventions, is essential to overcoming the barriers to maternal and newborn health in Nigeria. By honouring the promise of motherhood and ensuring access to quality care for every woman and child, we can transform the landscape of maternal and newborn health for generations to come across Africa.
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(1) World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 2000 to 2020 WHO, Geneva, 2023.
(2) World Health Organization. Making pregnancy safer: the critical role of the skilled attendant: a joint statement by WHO, ICM and FIGO. World Health Organization, 2004.
(3) Campbell, Oona MR, and Wendy J. Graham. “Strategies for reducing maternal mortality: getting on with what works.” The Lancet 368.9543 (2006): 1284-1299.