LAGOS, Nigeria — Lebabatu Musa has been delivering babies for 13 years in Kafur, a village in Northwestern Nigeria’s Katsina state. Her work is complicated by the fact that hospitals in the area don’t always have the necessary equipment to treat their patients, nor the personnel to offer additional trainings to staff.
The use of condoms as a form of birth control, for example, was a practice Musa was unfamiliar with until a recent training offered by a local foundation. It wasn’t a topic she had been taught in school, she told Devex, and although condoms are sometimes available in her community, their use has not been advocated for by the hospitals or community health centers she has worked in.
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Musa studied for three years at a school for health and nursing in Malumfashi to become a community health worker, but “there are no doctors in our schools, only health personnel,” Musa shared of her training.
As a result of inadequate health facilities and a lack of skilled personnel, 814 women will die for every 100,000 live births in Nigeria, according to a 2015 estimate from the World Health Organization.
Presently, less than 20 percent of health facilities offer emergency obstetric care and only 35 percent of deliveries are attended by skilled birth attendants. In Katsina, where Musa works, 5.1 percent of women were delivering their children in facilities in 2008, according to data from the United Kingdom government-funded, country-led Maternal and Newborn Child Health Programme. In 2017, the number had risen to 20.8 percent. Still, women across Nigeria’s densely populated northern region choose to give birth at home with the help of a traditional birth attendant.
Adepeju Jaiyeoba and Temie Giwa-Tubosun, two entrepreneurs who faced complications in their own pregnancies, are now leveraging technology to address the gaps in skills and resources that cost many new mothers their lives across the West African country.
Drawing on their personal experience, hyperlocal knowledge, and relying on simple innovations, the two women are determined to increase the odds of survival for new mothers, whether in urban Lagos or rural Zamfara.
The loss of a friend, and the birth of a low-cost delivery kit
Seven years ago, Jaiyeoba’s family friend opted to deliver her baby at Obafemi Awolowo University’s reputable teaching hospital in Southwestern Nigeria. The delivery would be safe, she thought, since the university is known for producing some of the most respected medical doctors in the country. But the young mother bled to death after a graduate doctor severed an artery while conducting a cesarean procedure and failed to take immediate action to repair it.
In response, Jaiyeoba, a lawyer by training, created a simple, low-cost Mother’s Delivery Kit targeted to low-income, rural communities who may not be able to afford institutional care or do not have access to any. This delivery kit helps women like Musa — community health workers and traditional birth attendants who are often the sole health care provider in rural areas — to deliver babies safely and hygienically. The kit is currently distributed to rural communities in 30 out of Nigeria’s 36 states.
Now, it’s Jaiyeoba’s own experience that drives her. While pregnant, she sought care at an expensive Lagos-based hospital to find out why she was tired, weak, and experiencing dizzy spells. She was told her blood pressure was low and given supplements to take. Jaiyeoba’s symptoms didn’t improve, and she would later find out on a medical trip to the United States that in fact, the iron supplements sold to her at a local Nigerian pharmacy recommended by the hospital were fake.
The Mother’s Delivery Kit — which costs 1,700 Nigerian naira ($4.74) but is provided for free to health workers during trainings — contains misoprostol, a life-saving pill used to prevent bleeding rather than control it. It also carries a mucus extractor used to prevent asphyxia in newborns. Adhesive pads are included in order to control bleeding temporarily in the event a woman needs to be transferred to a facility.
“With the kits, we have been able to not only encourage, but create behavioral change,” Jaiyeoba said in an interview at her Lagos home.
Before the kit, birth attendants in rural communities would attend to women on reused plastic sheets, for example, and then attempt to disinfect them with warm water and salt. Unknowingly, the practice put their next clients at risk of infection. The kit has provided an alternative in the form of a stark white, absorbent delivery mat, which stains immediately after use so attendants aren’t tempted to recycle it, Jaiyeoba said.
Alongside the Mothers’ Delivery Kit Jaiyeoba created, which was funded through grants from organizations such as the United States African Development Foundation, she also set up the Brown Button Foundation to train women on how to use the kit and any other skills they might be lacking. Brown Button also improves access to more formal health care by encouraging health workers to refer cases beyond their capacity to better-qualified facilities when the option exists, Jaiyeoba said.
Jaiyeoba’s work has not been without resistance or roadblocks. Given the religious, conservative nature of many rural Nigerian communities, she must first seek approval for her work from male members of the community. She is also often caught in competing political interests of different agencies or local government authorities — from which she must also seek approval — who seek to stake ownership of the work. For instance, a state health board and a local government chairman may delay launch because of a disagreement of who will present to the people, Jaiyeoba explained.
But Jaiyeoba has managed these setbacks, and others are already seeing the results of her work, according to Shafatu Abubakar, head of Sabon Gari Health Centre in Kano. Abubakar has observed an increasing number of skilled traditional birth attendants in her area referring complicated, potentially life-threatening cases to her center since Jaiyeoba began the trainings.
“Over 500 women have been saved,” she said in a phone interview. “As a result of training from the foundation, the woman are encouraged to go for antenatal care and hospital delivery as opposed to birthing at home so as to reduce the risk of infection and so on.”
Musa, since being trained by Brown Button, has learned that condoms can be an effective form of birth control, and can help the Northern Nigerian women she works with to plan and space their births. She has learned other best practices too, she said, and now knows to escalate a critical pregnancy case beyond her competency to a better-equipped facility, if one is available. She is teaching other women to do the same, especially those who have only known traditional, untrained birth attendants — mostly neighbors and friends — all their lives as the pinnacle of expert care.
A new bank for blood
While Jaiyeoba is connecting women to the right care, Giwa-Tubosun is ensuring that care is competently equipped.
A political science graduate and a health manager who previously worked with WHO, in 2016 Giwa-Tubosun founded LifeBank, a digital bridge between public hospitals, private hospitals, and blood banks, based in Lagos.
Nigeria is the second largest contributor to the global maternal mortality rate — postpartum hemorrhage, or heavy bleeding after birth, accounts for 23 percent of these deaths according to the African Population and Health Research Center. LifeBank is a resource for hospitals and health centers to find blood in the exact type required and from a blood bank close to their location. It has been commonly described as an “Uber for blood” by the media. Even in ultra-urban centers, hospitals typically experience shortages in blood for transfusions to save a hemorrhaging woman.
Giwa-Tubosun has spoken publicly about her own difficult birthing experience, which she believes she survived because the birth did not take place in Nigeria, where she might not have had access to expertise and the facilities that ensured her and her baby’s health.
LifeBank is a merger of technology, big data, and smart logistics to “save lives in hospitals,” Giwa-Tubosun said: “We help hospitals discover essential medical supplies like blood … we deliver it to them in the right conditions. We are the smart supply chain engine for Africa’s health system.”
The process kicks in when a customer makes a request and a LifeBank motorbike is immediately dispatched to the blood bank to collect the requested blood. At this time, the blood is preserved at 10 degrees Celcius in a cold chain system. Delivery, which costs $8, is then made in under 55 minutes to the hospital — no small feat in Lagos where multiple hour-long traffic jams are common. For safety, the blood is locked in a box that can only be opened via Bluetooth by the intended recipient.
LifeBank has generated a database of more than 40 blood banks and 300 hospitals and health centers on its marketplace app. It recently launched operations in Kaduna, Northwest Nigeria, but the entire process is not yet foolproof.
Giwa-Tubosun raised $200,000 in funding for LifeBank through a venture capital seeding round which included the fund EchoVC Partners and Fola Laoye, an angel investor. LifeBank was supported by Co-Creation Hub, a tech incubator focused on social innovation.
LifeBank depends heavily on hard-to-guarantee standards of blood banks. In 2016, the government ordered the shutdown of a hospital blood bank when it was discovered screened and unscreened blood were not properly separated.
LifeBank also periodically organizes voluntary blood donation drives, encouraging Nigerians to give blood — a foreign concept to many in the country. The reason a hemorrhaging mother may not get the blood she needs from a hospital is because in 2016, for example, out of about 1.8 million units of blood needed to service those in critical condition — birthing mothers inclusive — the National Blood Transfusion Service collected only 51,433 units, the national coordinator of the NBTS said in an interview with The Guardian.
LifeBank has moved 7,000 pints of blood from blood banks to hospitals and aims to move 106,000 pints in the next two years, according to Giwa-Tubosun. It has also recorded about 5,026 donors through its donation drives.
“Our goal at LifeBank is to ensure that we can save as many lives as possible for as long as possible,” Giwa-Tubosun said. “We plan and hope to be in every African city and be able to reach every village and town across the continent, saving lives by moving essential medical product to hospitals.”