Strengthening Primary Health Care Services in Rural Nigeria: The Potential of Using Midwives as Skilled Birth Attendants

Abstract

Introduction: The study objective was to assess the potential of using midwives as skilled birth attendants in providing access to maternal health services in rural Nigeria using the Subsidy Reinvestment and Empowerment programme on Maternal and Child Health (SURE P MCH). Method: Baseline survey of 1000 primary health care (PHC) facilities located across all states in the country was conducted before the programme started in 2012. Improvements made on the core indicators for maternal health services were assessed after a follow-up survey. The survey results were also compared to data from rural areas from the 2013 National Demographic Health Survey (NDHS) report. Findings: Total number of antenatal care (ANC) visits at follow-up survey increased by 42%, new ANC visits increased by 39% and four or more ANC visits increased by 30%. Births by skilled birth attendants were up by 56%, postnatal visits increased by 33% and number of women using contraceptive methods increased by 66%. When compared to data from the 2013 NDHS, access to skilled birth attendant and use of modern contraceptives were significant at p<0.0001. Access to antenatal and postnatal services were not significant. The median scores for the core indicators from the geographical zones were significant at p<0.05. Key Conclusions and Implications for practice: Women are more likely to have more supervised births and use more contraceptives in rural facilities when midwifery services are present. The programme model has the potential to strengthen and improve access to maternal health services in rural communities where the need is greatest. Keywords: Midwives; Rural health facilities; Maternal health