Improving obstetric care at the district hospital, Ekpoma, Nigeria. The Benin PMM Team.

PRELIMINARY STUDIES: Facility reviews and focus group discussions revealed several factors at the district hospital contributing to maternal deaths in Ekpoma District, Nigeria. INTERVENTIONS: In response, the necessary equipment for the operating theater, labor suite and laboratory were repaired or purchased. A blood bank and standby generator were repaired. Drugs and consumable material were purchased and a revolving fund established. Refresher courses were held for medical officers, nursing staff and laboratory technicians. At a later stage, community interventions focused on improving access and reducing delay in seeking care. RESULTS: The number of cesarean sections performed increased from zero in 1990-1991 to between seven and 13/year in the period 1992-1995. The number of women with major obstetric complications seen at the hospital increased from seven in 1990 (5% of obstetric admissions) to a high of 29 (20% of obstetric admissions) in 1993. These gains were not sustained, however. In 1995, only 12 women with complications (9% of obstetric admissions) were seen. COSTS: The cost of improvements was approximately US $12,800, of which 41% was paid by the government and the rest by the project. CONCLUSIONS: Improving obstetric care at the district hospital can increase use by women with complications. However, sociopolitical and economic problems can hamper success.

Emergency loan funds to improve access to obstetric care in Ekpoma, Nigeria. The Benin PMM Team.

PRELIMINARY STUDIES: Focus group discussions in the community identified difficulties in paying for transport as a major barrier to seeking and reaching emergency care for obstetric complications. INTERVENTIONS: After emergency obstetric services in local health facilities had been upgraded, the clans in Ekpoma were mobilized in 1995 to set up emergency loan funds for women with complications. Funds were managed entirely by the clans, with ongoing monitoring and supervision by project staff. Two percent simple interest was charged. RESULTS: Of the 13 clans contacted, 12 successfully launched loan funds. Total donations amounted to US$793, of which four-fifths were contributed by the community. In the 1st year of the operation, 456 women/families requested loans (ranging from US$7 to US$15), and 380 (83%) were granted. Three-hundred and fifty-four (93%) loans were repaid in full. In addition to being used for transport, loans were used to help pay for drugs, blood and hospital fees. COSTS: The cost of establishing the loan fund was US$1360, including initial donations to the loan funds. The PMM project paid 55% of the total. CONCLUSIONS: With relatively little outside financial input, communities can set up and administer loan funds for emergency obstetric transport and care. However, sustaining the funds over the long term requires continuing effort and involvement with the communities.