Hadiza Haladu’s first pregnancy almost ended in a double tragedy when she went into early labour. The closest health centre was 16 kilometres — about 30 minutes to one hour — away; and with only a traditional birth attendant (TBA) in attendance, Haladu lost her baby. She nearly bled to death from post-partum haemorrhage but for the timely intervention of the Jakadun Lafiya and the Driver Haiyuwa Lafiya under the Maternal and Neonatal Emergency Transport Scheme (MANCENTS). They ensured that Haladu was taken to Kazaure General Hospital, where she received the care she needed.
Haiyuwa Lafiya
Haiyuwa Lafiya is a general term locally used to describe all the transport schemes that the Jigawa State government has implemented over time, to help transport women in labour to the hospital, free of charge. It was the failure of one of such programmes that motivated the women of Bordo community to raise funds to buy a car to sustain the practise of ensuring that women are transported safely to the nearest hospitals for deliveries.
The Maternal and Neonatal Emergency Transport Scheme locally known as Haiyuwa Lafiya was birthed in 2019 to address the unique factors that drive inequalities in access to healthcare services among women and new-borns in hard-to-reach areas in Jigawa State. The aim was to combat the state’s infant and maternal mortality indices.
Jigawa State has about 12,000 hard-to-reach settlements where bad roads make access to basic services like quality healthcare near impossible. Maternal and neonatal health is especially impacted as women in those communities mostly depend on the services of TBAs — who have no medical training and when a pregnant woman has complications during her pregnancy, they are not qualified to provide the necessary care — throughout their pregnancy journey. These factors contribute to the state’s troubling maternal and infant mortality indices which available data has estimated at 1,100 deaths per every 100,000 live births and 83 deaths per every 1000 live-births, respectively.
MANCENTS is a community-led initiative that operates as an informal transport and ambulance system. Under the scheme, community leaders and private car owners help to transport women in labour to a hospital which is typically about 16–26 kilometres away from their settlement. The community leaders are known as ‘Jakada Lafiya’ which means health ambassador, while the car owners are called ‘Driver Haiyuwa Lafiya’ — safe delivery drivers.
How it works
In each community, the scheme is coordinated by the Jakada Lafiya who gets notified first when there is an emergency and is responsible for alerting the nearest driver. “At the point of call the nearest available driver gets to pick up the pregnant woman to the hospital. It’s a village and they are mostly around when they are called upon,” says Umaru Mohammed, Jakada Lafiya Malamawa in Kazaure Local Government Area (LGA).
To participate in the scheme, a driver must be a registered car owner and must live in or close to the community he wishes to serve. There are usually more than two drivers around each settlement. “We have a total of 2,500 registered drivers on the scheme with at least 2 drivers in some settlements while in some, there are up to 6; depending on the number of people with cars who show interest,” says Dr. Kabir Ibrahim, Executive Secretary, Jigawa Primary Health Care Development Agency.
Ayuba Ismail, driver, Haiyuwa Lafiya, in Lafiya settlement Taura LGA, was never optimistic about the scheme but he now describes it as a ‘saving grace’. “My car was only used to transport my farm produce, but today we are using it to save lives and also earning from it…No one ever thought the scheme will last for a year, or that drivers will be paid promptly. Interestingly, as a driver my payment comes as at when due.” The emergency transport scheme is funded through a line item in the state’s annual budget. Ali Ibrahim, Director of Clinical Services at Kazaure General Hospital, says that the success of the scheme was dependent on the availability of drivers when there is an emergency. Therefore, prompt payment is one way to guarantee their availability.
Health workers taking responsibility
Pregnant women are sensitised and made aware of the services the scheme offers during antenatal classes. This is done in the local language by the local government educator, while the community health ambassadors help to educate and sensitise men when they come together to pray.
As soon as a woman in labour arrives at the hospital, maternity ward staff and doctors take over and work to ensure that she gets the required care that she needs. Saudat Yahaya, Matron, Gumel General Hospital, Gumel LGA, who has been involved in the scheme since its inception says the number of hospital deliveries has increased. “We take in about 70–90 cases of women in labour and other pregnancy-related cases monthly.”
Nura Ahmed, a visiting gynaecology expert to Rigim General Hospital describes the scheme as a proactive response toward eliminating cases of infant and maternal mortality and morbidity. “On many occasions, we have had to use the caesarean process on some women to help protect the mother and the baby during delivery. This is something TBAs can’t do, so the lives of pregnant women and their babies are at risk when complications arise.”
“From 2019 till-date, we have documented over 10,000 pregnant women who have delivered under the scheme with an average of 2000 to 3000 annually. For each pregnant woman transported to the hospital, drivers are paid N4,000 which is paid into their account at the end of the month,” states Dr Ibrahim highlighting the impact of the scheme across the 12,000 hard-to-reach settlements. New mothers can use the scheme up to 40 days after delivery, should the mother or baby require emergency care.
Khadija Ibrahim, one of the beneficiaries of the transport scheme
Varied experiences
Maimuna Mohammed who lives in Gaizo community, Jahun LGA, has had a seamless experience using the scheme twice. “My first experience was in December 2019, when I was transported to the hospital and the second was when my sister came to visit, and her labour started,”
However, Aisha Hikma, a resident of Malamawa village in Taura LGA, was not so lucky as her first experience ended in pain. She decided to use the scheme in 2021 after hearing several positive reports and was being transported to the hospital when her baby was delivered inside the vehicle. Sadly, the baby died before they were able to reach the hospital.
Hikma attributed the loss of her baby to the bad roads and appeals to the government to do something about it. “They should help construct an access road for easy transportation during emergencies so that women won’t have to live with terrible experiences.”
A permanent solution
A woman in labour is in a delicate state and travelling on bad roads for several kilometres is a high risk for her. Distance to health centres and hospitals is one of the three delays women experience in accessing maternal care. The time it will take to get to a health facility might be the difference between life and death. While evidence indicates that MANCENTS is recording some success in addressing this delay, this is a temporary fix.
Stakeholders in the public and private sectors must come together to work on a permanent solution — building functional primary health centres (PHC) in these communities, to ensure that pregnant women have access to timely, quality, affordable and equitable healthcare.
Zainab Ali, one of the midwives in the scheme
According to Dr. Kabir, the Jigawa State government is planning to construct more health facilities close to the people to discourage long-distance travel during labour and patronage of TBAs. “5,000 midwives are currently under the sponsorship of the state government, this is to help provide each community with at least 2 midwives in the coming years”.Funding is a key factor for achieving this and he urges the government to consider increasing the health budget as there has been a decline in the funds budgeted for health in the state.
Maternal mortality is preventable. Although efforts are clearly being made to reduce it, there is still a lot more to be done. For Jigawa State, sustaining MANCENTS and ensuring that it is properly implemented while also focusing on doing the hard work of establishing PHCs to increase the accessibility, availability, and affordability of quality care will boost the number of successful births and guarantee the wellbeing of mother and child, no matter their location.
