Good morning and thank you for inviting me to speak today about ‘the Role of Technology in Improving Mother and Child Healthcare in Nigeria’.  

My name is Toyin Saraki and I am the Founder-President of the Wellbeing Foundation Africa and Global Goodwill Ambassador for the International Confederation of Midwives, and a special adviser to the Africa Regional Office of the WHO, with a committed purpose to transforming health in Africa towards realising universal health coverage for all.

Within all my roles and from years of frontline engagement with the challenges faced across Nigeria, and some successes, I have seen how digital technology can, at its best, ensure that quality and standards of care are improved and maintained – the ability to track, trigger actions and provide accountability empowers midwives and other health workers to lead the way with quality care, adapting to their own situational awareness. 

I am also particularly delighted to join you today because I see this event as an opportunity. Of course, I am eager to share with you how technology facilitates the work of midwives and the Foundation, but the condition of mother and child healthcare in Nigeria means that I must consider this as an opportunity. In this room are technological experts, leaders in the corporate field and young entrepreneurs. So, I hope that today you will tell me what you can do, and what we can do, together, to improve mother and child healthcare. Let’s talk, let’s partner, let’s save and change lives.

Before we do so, however, I would like for us to take stock of mother and child healthcare in Nigeria and sub-Saharan Africa. For us to be able to apply technological solutions we must first understand the challenges currently faced and the impending factors which will further exacerbate the dangers for women and infants. 

Around 20,000 babies will be born in Nigeria today – each one of them a blessing. Today, however, we will also lose about 2,300 under-five year olds and 145 women of child-bearing age. UNICEF rightly points out that although the rate of newborn deaths has improved, to 37 per 1000 births, this national average hides the differences between our 36 states and the slow progress in some of them. Whilst these figures are already startling and should constitute a national emergency, Nigeria’s growth rate of 3.2 percent annually means that our nation will, according to USAID, reach a population of 440 million people by 2040. As a nation which is currently unable to keep its mothers and children safe and healthy, we must urgently seek solutions to the scale of the challenge we are about to face. 

It is these very statistics, and the absence of crucial detail within the raw statistics, that led me to establish the Wellbeing Foundation Africa in 2004, pioneering two key copyrighted and trademarked tools at its core: the patient custody IMNCH and now RMNCAH Personal Health Records, and the Mamakit Clean Delivery Solution.  

A well-designed civil registration and vital statistics (CRVS) system is an essential component of a successful health system which delivers for mothers and children, and to inform Government policy on where projects must be implemented. Only with the collection and dissemination of accurate data can we hope to ensure effective delivery, evaluation and monitoring of sustainable, effective public health strategies. 

My approach in 2004 was not revolutionary or entirely new, as in the late 1950s, Professor David Morley had developed the ‘Road to Health’ chart here in Nigeria for monitoring the growth of infants and young children. This home-based chart was originally designed to monitor growth in resource-poor countries, but developed into a record of a child’s growth and development, kept by parents – it was revolutionary in its time. At the WBFA we took that concept and designed the Personal Health Record (PHR), a book in which the medical records of each mother and child are recorded and stored for future reference and analysis. The PHR evolved from a child immunisation and growth record to a comprehensive CRVS tool. So, what is the value of a statistical life? Without a centralised health database for many families to rely upon and keep them informed of the necessary health processes in a child’s first thousand days of life, the PHR came as an innovation that placed this knowledge directly into the mothers’ hands, and empowered her to provide, analyse and follow-up on her own data – to be in control of her own situational analysis. The digitisation of the PHR to inform similar nationwide efforts by qualified midwives would place Nigeria at the forefront of improving maternal and infant health outcomes. It would be fitting to imagine the impact of scaling and achieving comprehensive coverage of data for health here in Nigeria, where the idea for a home-based record was developed and has since been successfully deployed in countries like the UK and Japan.

The importance of registering births and linking birth registration to vaccinations cannot be overemphasised, as Nigeria is currently battling with a situation where only 1 in 4 children, of our population of 198 million citizens, is immunised against preventable disease, a crisis in the making, and right at the primary health frontline, where the battle to save lives, and deliver demographic dividend will be won, or won. 

The second component I mentioned alongside the PHR – our Mamakits – provide the essential tools to take a safe delivery, and indeed ensure clean births and healthy infants. The impact on clean births without Sepsis was immediate and huge, leading, through its deployment by the NPHCDA’s Midwives Service Scheme, to a sharp drop of mortality rates by 40% between its adoption in 2010, and 2015.

However, we found that the instant popularity of these kits, designed to equip public health medical teams, which were adopted into government policy and replicated across the nation, had an unexpected responsibility shift, as when health agencies chose to distribute directly to mothers, these resulted in medical facilities growing irresponsibility in shirking the provision and budgetary Appropriations of the most basic of essential medical supplies in reliance of a mother to bring her own kit, without the healthcare facility providing their own materials on-site. We have therefore now restricted our distributions to licensed birth attendants,  hospitals, IDP camps and humanitarian dignity situations. 

Technology should be present at every stage of the life cycle of every child – which begins of course with pregnancy. From pregnancy to partograph and beyond, technology such as Philips’ Mobile Obstetrics Monitoring service – or ‘Mom’ for short’ – transforms health outcomes, allows for real-time situational awareness and provides accountability within the health sector. MOM, which features two mobile phone apps, in addition to training and education applications, allows midwives to collect vital measurement data such as weight, blood pressure and temperature, and sync it to the MOM web portal.  This data is tracked and the condition of a woman’s pregnancy is reviewed – while specialists at regional primary care centres can also monitor and assess high-risk pregnancies via a dashboard interface. At the Wellbeing Foundation our midwives also have experience of InStrat Global Health’s CliniPAK Mobile Electronic Health Records, a tablet computer-based data capture and decision support tool which allows health workers to capture patient health information and share the data to remote servers via mobile networks. That system also allows for an immediate alert for at-risk patients and swift onward referrals, as well as up-to-date and accurate health data

We must however also get the basics right. More than 80 per cent of new-born deaths are due to prematurity, asphyxia, complications during birth or infections such as pneumonia and sepsis. These deaths can be prevented with access to well-trained midwives during antenatal and postnatal visits as well as delivery at a health facility, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact, proper cord care, and good nutrition. A shortage of well-trained health workers and midwives means that many Nigerians do not receive the life-saving support they need to survive. Whenever I talk about our MamaCare midwives and the work they do, I always consider how difficult it is to properly convey the level of their care and their innovative use of technology. The results are clear to see – over 200,000 women have taken part in our MamaCare classes, achieving the now standard number of eight visits recommended by the WHO, and we are yet to lose a single one to death in childbirth. Long may that continue. Furthermore, our midwives prove that even relatively simple technology can transform maternal and child health outcomes over a huge area. The Wellbeing Foundation WhatsApp groups have, for example, proven to be hugely popular with expectant and new mothers. Questions and worries are aired within that community 24 hours a day – and handled expertly by our qualified midwives. Of course, whilst our MamaCare classes do not yet operate throughout Nigeria, friends and family of those already in the group from all over the country are added, giving a huge scope to the community – which is constantly changing, as mothers leave to make space for newly expectant mothers. It also allows MamaCare midwives to attend to emergencies swiftly and discreetly. 

The potential of using mobile phones to reach mothers with key information has of course been recognised for some time. The WBFA was a proud partner and supporter of the Mobile Alliance for Maternal Action – or MAMA – which remains an excellent example of a successful public-private partnership between USAID, Johnson & Johnson, the UN Foundation and BabyCenter. With a core set of messages timed and targeted to pregnant women and mothers, MAMA shared vital information exactly when it is most needed and successfully reached millions of women and families with free and modifiable messages. They were also able to demonstrate the knock-on effect of the scheme, with improved health behaviours from MAMA country program subscribers, including higher rates of exclusive breastfeeding, delivery in clinics or with skilled birth attendants, adherence to recommended pre- and post-natal care visits, and recommended vaccinations for mother and child. Importantly – and I believe we will hear from Nigeria’s Honourable Minister of State for Health, Dr Osagie Ehanire, later today – these technological innovations can be adopted and implemented nationwide by Government. 

Whilst we are here to discuss the role of technology in the future of health, we cannot ignore the role of Government – not only in creating the right environment to encourage and adopt successful technology, but in ensuring that Nigerians can access it. Whilst internet access has increased, again the statistics are skewed by certain regions, whilst others lag behind in infrastructure. According to Nigeria’s Communications Commission, over 200 communities which are home to about 40 million people lack access to basic telephones and internet access. Our challenge is not therefore solely in producing technology to save lives but in ensuring that it can be used where it is most needed. 

Technology informs the care of a mother and her infant and can benefit the training of health workers themselves. Last week I visited Gwagalada School of Nursing and Midwifery in Abuja to assess the use of another InStrat Global Health initiative deployed by the WBFA – video training, or VTR. VTR is available both as a mobile app and on the web. Whilst our focus is on midwifery and nursing students, its application also extends to teachers. The cost of upskilling teachers by sending them to a training centre is prohibitive or impossible for many institutions, an issue significantly reduced by VTR. As you can see from the slide, the students at Gwagalada very much enjoy the multi-media training content, which includes text, audio and video – with quizzes and tests, of course. Two students were unable to show me the programme from the beginning, because they had already progressed so far. The goal is not of course simply convenience or to operate within economic constraints, but to produce excellence – training health workers to a global standard so that they can save lives and empower powers and infants. A 2015 Human Resources for Health study of the use of an mHealth tutorial application to improve the knowledge and attitude of frontline health workers to the Ebola virus found an 11% improvement in average knowledge levels, and significantly improved knowledge retention. The connection between data, training and health policy is an exciting one – and one we must make the most of to improve maternal and child health. 

As we examine the broad applications of technology to transforming health outcomes, I still believe that there is no substitute for hands-on experience. I would therefore like to briefly mention the Foundation’s hugely impactful experience of technology and training -driven public-private partnerships. 

Since 2014, the WBFA has joined forces with the Liverpool School of Tropical Medicine, the oldest and most established school of tropical medicine in the world, and Johnson & Johnson, one of the largest global health companies. Together we implemented the Emergency Obstetrics and Newborn Care (EmONC) training programme in Kwara State. This is a unique partnership model, bringing together an esteemed higher-education institution, the private sector and a civil society organisation. I mentioned earlier that the majority of infant deaths are preventable; so too are maternal deaths. 80% of all maternal deaths result from five complications which can be readily treated by qualified and trained health professionals: haemorrhage, sepsis, eclampsia, complications of abortion and obstructed labour. Our EmONC training takes place in-house and equips doctors, nurses and midwives, as a collective team, with the skills needed to overcome these obstetric emergencies. At a recent impact assessment visit to Kwara, I asked a Doctor how the use of models and the training had affected his outcomes. His reply was both instructive and chilling. Before the use of this technology, live births had been the training ground for nurses, midwives and doctors. The demonstrations I witnessed in Kwara were wide-ranging and innovative – I was particularly impressed with the simple inexpensive and innovative use of a condom catheter balloon filled with saline to control postpartum haemorrhage, the excessive bleeding after birth which is the leading cause of maternal mortality and affects up to 5% of women. Together with Liverpool School of Tropical Medicine and Johnson & Johnson has trained 600 ‘master trainers’ in nine local Government Areas in Kwara State, establishing ten EmONC Skill Laboratories in ten selected Core-Training Medical Facilities. These 600 master trainers have gone on to train a further 62,800 health workers. The number of up-skilled frontline health workers continues to percolate, as the impact in lives-saved grows. Imagine a Nigeria where this technology and training was available across the nation. 

“My vision is to combine the strengths of each virtual and physical technology experience and create a fully inter-connected PHC chain. The WBFA has produced a business plan to achieve exactly that – to bring global standards of training, referral, care and accountability to communities across Nigeria.”

I would like to finish today by addressing one of the most serious challenges to maternal and child health outcomes in Nigeria – water, sanitation and health, or ‘WASH,’ in healthcare centres. Here in Nigeria, the WHO found that 29% of healthcare facilities do not have access to safe water and toilets, whilst a WaterAid survey revealed that half of primary health facilities do not have handwashing facilities in delivery rooms. Pregnant women and new-borns are thereby placed in huge danger and at risk of sepsis, which is a leading cause of death in hospitals. Rita’s quote on the slide here is quite right: midwives cannot save lives if the conditions they work in are not sanitary. When it comes to patients, among the most vulnerable are pregnant women and newborns, both at great risk of sepsis — a leading cause of death in hospitals. I have launched a new, global WASH campaign, initiated by the Wellbeing Foundation Africa in partnership with the World Health Organization, Global Water 2020 and others, which aims to transform water, sanitation and hygiene in healthcare centres and schools around the world. I call on all of you here today to work on making existing technologies available to Nigerian healthcare centres and developing new ways of making giving birth safe. Thank you once again for inviting me to address you here today. The scale of our challenge is significant but not insurmountable, and technology will play a key role in Nigeria’s future success story.  I look forward to your questions, your ideas and your innovations, as I imagine the impact in Nigeria, and imagine the impact of innovation, at scale.

Thank you.