 session to be able to just to know a little bit about who's here and who isn't and where you're from and it does help us very much in in our statistics. So I'm just going to clear the answers on this slide. You open it and if you just all just type in the answers where you're from. USA, India, Canada, UK, UK, UK, Yana, what else wants to type in where you're from? Ireland, it's thank you. Go to the next poll and we're going to talk about what is your main occupational role. If you choose other, please type it in the chat box if you are an other. So as it was at the last session, we have a lot of midwifery students, midwifery manager, midwifery educators, clinical midwives, and a couple of others. Me being one of those others, I'm an other educator, not a midwife, but I do work in health and human services and as an instructional designer. All right, so and now we're going to go to the final poll and it's this way. Where are you accessing this from? Where are you coming from? International volunteer midwife, thank you Anya. Clear this. Here are all answers. So where are you joining the Virtual International Day of the Midwife Conference? Through another minute and there you go. So thank you very much. I'm just going to type these now. Thank you. So I'm going to pass it over to you then, Catherine. Okay, so I did not get another response email from Bouquet, but I am going to take that as an indication that we will go ahead and proceed and as soon as she's able to join us she can take over. So Bouquet Afalabe is a 38-year-old registered nurse, registered midwife and public health nurse with a bachelor's degree in nursing science. She is a senior nursing officer on the labor ward of Obafemi Awa Loa University Teaching Hospital complex, and that's in Ile'iki, southwest Nigeria. She has a special interest in nursing and midwifery research. And as you know, you know, Africa, the continent of Africa is an area with many, many challenges in the way of good outcomes for maternal child and neonatal health. So Bouquet's presentation deals with issues and challenges and initiatives, the maternal neonatal and child health initiative, which is taking place in Nigeria. Okay, so you see her outline here, but we're going to jump right into the body of her presentation. So the acronym IMNCH stands for Integrated Maternal Neonatal and Child Health for the as an integrated approach for the care of mothers, newborns, and children. And I think we would all agree that the health and well-being of the mother is inextricably linked with the health and survival of the child. And the IMNCH is in line with the United States Agency for International Development Bureau for Global Health's flagship maternal neonatal and child health program. This program focuses on reducing maternal neonatal and child mortality and accelerating progress towards achieving the MDGs 4 and 5. Catherine, I think we see Bouquet now. I'll just bumper up to presenter. Bouquet, okay. Yes, bumper up to... There you go. Bouquet, you have presenter status now. If you just want to set up your mic, you can take over. Thank you so much. Okay, we're still in the introduction. So you're here just in time in your brief time. Hello. Good afternoon. I'm Adebukwala Falabi, presenting from Obakame Aulau University Teaching Hospital in Leiffel, Shun State, Nigeria. Like Catherine I've started, my presentation is on integrated maternal neonatal and child health IMNCH in Nigeria issues and challenges. I will pick up from where Catherine... I will start from the introduction. Thank you very much. I am NCH. I'll pick up from where Catherine stopped our I am NCH, integrated maternal and child health, supported programming in maternal and newborn and child health immunization, family planning, malaria, nutrition, and HIV-AIDS in addition to evidence-based intervention that are likely to improve maternal neonatal and childhood survival and nutrition. Next slide please. Most newborn deaths in Nigeria occur within the first few weeks of life, reflecting the intimate link between the survivor of the newborn and the quality of maternal care. The integrated maternal newborn and childbirth strategy is Nigeria Initiative. The government of Nigeria started implementing the integrated maternal and childbirth strategy in Nigeria in the year 27 through the Federal Ministry of Health. Nigeria's development of IMLCH is aligned with the World Health Assembly World Health Assembly resolution, which all these members state to, among other things, speed up action to ensure that maternal, newborn, and childbirth interventions are available everywhere. The government created Nigeria. This strategy was put up to fast-track intervention packages that include nutritional supplements, immunization, the use of insecticide-treated nets, and prevention of mother-to-child transmission of HIV-8 in order to achieve the fourth and fifth MDG goals. The fourth and fifth MDG goals, as we all know, is concerned with reducing childhood mortality rate and maternal mortality rate by two-thirds and three-quarters respectively. While contributing to the achievements of millennial development goal of goal one, which has to do with eradication of extreme poverty, goal six, environmental sustainability, goal six, which has to do with prevention, treatment of endemic diseases, goal seven, which has to do with environmental sustainability. IMLCA strategies addresses six conditions responsible for 90% of maternal death. These are these, MRH, infection, obstructive labor, hypertension, malaria, and anemia, as well as the most common condition responsible for over 90% of undefined mortality, like malaria, pneumonia, diarrhea diseases, measles, and the underlying contributing facts such as malnutrition and HIV-8. In establishing their goal, the integrated maternal and child health strategy selected intervention with wide coverage packages, and these packages are delivered in three-degree modes. We have the family-oriented community-based services. That is, you know, in most people that access healthcare in Nigeria, they have the people at the grassroots, at the local government level. So, involving the family and the community in those services is part of the implementation of IMLCA. Then, population-oriented outreach services, which can be scheduled, and number three, critical services, giving one-to-one basis. Therefore, IMLCA strategies set out, set out to weave together all intervention that will improve maternal, newborn, and child health implementation. Before now in Nigeria, maternal, newborn, and child health intervention have been implemented and separate and individual infusion. Therefore, the Federal Ministry of Health, the government of Nigeria, discovered this gap, and instituted integrated maternal and child health to reach the gap. Guiding principles of integrated maternal and child health strategies. The principles include continuum of care. That is, care, continuity of care. Then, it involves integration of proposed priority intervention. Proposed priority intervention, women and child rights, women and child rights, rights-based planning to ensure the protection of the most vulnerable. The most vulnerable category in Nigeria include the mothers, the pregnant women, the newborn, and the children. And part of the principle has to do with accuracy, ensuring that mothers, newborn, and child, they have equal access to and they have a universal coverage to quality of health care for enhanced maternal, newborn, and child survival. Part of the guiding principles involve multi-sectoral collaboration with other sectors required to achieve health, outcome, and development. These sector are all, apart from the Federal Ministry, collaborating with other ministries in the Federation of Nigeria, like the Agricultural Ministry, the Judiciary Ministry to work hand in hand for the tools, achievements of this integrated maternal and child health. As well as partnership, partnering with non-governmental organizations to promote a synergy of efforts and action that leverages resources and avoids waste and duplication. Why do we have to consider integrated maternal and child health in Nigeria? Why is it important in Nigeria? Nigeria is Africa's most populous country with estimated population greater than 78 million 516,904 in habitat as of July 2014. That's why Nigeria is regarded as the giant of Africa and one out of every five Nigerians of five Africa is in Nigeria. Nigeria has 23% women of child bearing age 20% children under 5 crude batch rate of 40.6 per 1,000 and total fertility rate of 5.7. The country loses about 2,300 children under 5 of age and about 145 women of child bearing age every day to preventive diseases and pregnancy related causes. Out of every five children born in Nigeria, one dies before their fifth birth day, this presents about 10% of the global total. Majority of these on the five births of all at home and annually an estimated 52,900 Nigerian women die from pregnancy related complications. This is about 10% of the total global rate of disease. A woman chance of dying from pregnancy and child birth in Nigeria is about morning 13. Nigeria is the second largest contributor to on the five mortality rate and maternal mortality ratio in the world. Improving care for pregnant women however, improving care for pregnant women at home in their health facility has far effect on their health and development in addition to reduction in sickness and death. And as we all know that there is a tricky link between mothers newborn and children and because of this link their care requires an integrated approach. The goal of MNC 18 Nigeria the goal is to together an evidence based maternal and maternal child health framework in a practical continuum. In order to reduce maternal maternal and child mortality so as to achieve the United Nations development goal four and five. The goal is targeted to achieving 75% and 65% reduction in maternal mortality and under five rates respectively. And it was hope that integrated approach will improve the delivery of maternal newborn and child health services better than previous approaching based on separate efforts. Division of INNC Catherine you want to pop in again? Seemed to have lost her presenter. My headset back. Okay so the vision of the IMNCH is to ensure that in Nigeria pregnancy and delivery do not pose a threat to the lives of mother and the newborn. That children are healthy and able to grow and develop to their full potential thereby contributing to the nation's socioeconomic development. And there are seven strategic objectives to the IMNCH and remember this is an integrated strategy. One improve access to good quality health services. Two ensure adequate provision of medical supplies drugs bundled vaccines reproductive health commodities and insecticide treated nets and other basic equipment. Those of you who were on for the previous session where students were talking about access in Laos. Okay Buki is back. I'm going to let her take over now. Buki do you have a mic? Apology for the break was into internet problem. Objective of integrated maternal and child health strategies. There are seven strategic objectives and there the objectives is to improve access to good quality health services to ensure adequate provision of medical supplies drugs bundled vaccines reproductive health commodity and insecticide treated nets and other basic equipment and other basic equipment. Part of the objective is to strengthen individual family and community capacity to take necessary action at all and to seek healthcare in a timely manner to improve capacity for organization and management of maternal and child health services. Then establishing a financing mechanism that ensures adequate funding affordability equity and efficient use of phone from the various sources. Strengthening supervision of this program strengthening supervision monitoring and evaluation system to report ongoing progress towards the maternal and child health MVG and to establish and sustain partnership to support the implementation of IMCH strategy. Implementation of... Buki, we've lost your microphone. Are you having an internet connection? She's still in the room though so let's give her a minute. Whoops. We just lost her. I'll keep an eye on her in the participants of you just on the picture. She talks about the different levels of government that the IMCH is being implemented at and that would be federal, state and local and the existing intervention packages are being revised as necessary so as to implement high impact interventions at all levels. Here she is back again. Do you see her down there in the participant window? I was having trouble grabbing her so there we go. Okay. So Buki is back. Whenever you're ready Buki. The primary health is a structure for the implementation of integrated maternal and child health strategy and this is being done through the minimum world healthcare packages at this level as been developed by the primary health care development agency. In Nigeria we have the federal, the state and the local government. At the local government that is the grassroots where we have people who access health care and within this local government the government is divided into different roles. So for this implementation of this IMCH the primary national primary health care development developed minimum world healthcare packages so that this implementation people at the world get direct access to it. Some of the intervention of the strategy are also being implemented at the referral facility level. Priority actions for IMCH there are three priority actions for integrated maternal and child health strategy. We have the pregnancy care. Under the pregnancy care we have the focus and the nature care. The activities under the focus and the nature care include the giving of T3 immunization to the pregnant women screening the pregnant women and management of species and other sexually transmitted diseases. Under the pregnancy care we discover patients with preeclampsia and appropriate management have been instituted. Then during this mental care we give intermittent preventive treatment that is IPT the use of anti-malaria for pregnant women and it's been given to them during the second trimester. So before a woman delivers the women have two doses of this IPT and during anti-malaria care a certified treated mosquito net are being given to pregnant women so as to prevent malaria diseases and also at the anti-malaria care that there is prevention of mother to child transmission of HIV A. During this period we do voluntary counseling tests to pregnant women and we counsel them on the need for them to be tested to have their HIV status done and those who are positive by chance have been referred to the Institute of Human Biology of Nigeria to the hospital. Part of the priority action for integrated maternal mental childbirth is the childbirth care. During the childbirth care first level delivery care the patients are being managed through the use of patograph. Active management of labor is being undergone as well as active management of full stage of labor in order to prevent post-pattern hemorrhage. Then injectable antibiotics as a prophylaxis in order to prevent infection and the use of magnesium sulfate in the treatment of preeclampsia ranging from mild to severe. Then during the childbirth care we have backup emergency maternal and unitary care including the use of back home instruction manual removal of placenta manual back home aspiration. There is also backup emergency care for autistic unitary care including all functions plus caesarean section where necessary as well as blood transfusion. At the childbirth we have under the childbirth again care for the newborn care and this includes immediate newborn care that is which of all thermal protection called care access given initiation of exclusive breastfeeding prevention of infection then active neonatal resuscitation and during this newborn care information are given to the delivered models breastfeeding, hygiene and advice are being given to them usually at discharge signs of emergency and follow-up. There are also been cancelled on the importance of immunization for their newborn and immunization is being given according to the national guideline. Then let me let up to you we have exclusive breastfeeding whereby you educate a delivered model emotional model to exclusive breastfeeding for the first 6 months without giving water or any other thing and to continue with complementary feeding until 2 years of age then we teach them we educate them on importance of appropriate hygiene then recognition of dangerous signs during puperium as well as prevention and management of any form of puperium. At the child schools if the parent reaction during the childhood period will give the integrated management of childhood illness and are the guidelines to follow in the treatment of this childhood illness then prevention of management of childhood illnesses and care of HIV exposed child children. HIV exposed children are being admitted to the special military unit and immediately they are delivered they are being given their command on antivitroviral drugs then we have immunization during childhood up to 2 years then nutrition intervention so that during that nutrition intervention also enhance their growth then we also have education on water sanitation and hygiene although we have not gotten to where we are going when it comes to implementation of this I am integrated maternal and childhood in Nigeria however we have some certain achievements that have been achieved so far and this includes reduction in maternal mortality ratio from 545 deaths per 100,000 from 800 deaths per 100,000 to 545 deaths per 100,000 then we have reduction to the implementation of integrated mother and child health that has been reduction in under 5 mortality rates 157 deaths per 1000 from 201 deaths per 1000 there has also been reduction in infant mortality rate and it has been reduced to 75% deaths per 1000 although we have not gotten to there but we believe with full implementation we will get there part of the achievement in the implementation of integrated maternal and child health in Nigeria improved human resources at the primary health care level through the midwifery service team the midwifery service team involves the employment of newly graduated midwifery enough from basic school of midwifery as a prospective student from school of nursing or as a graduate from the university they have been employed for one year they have been deployed to rural areas in the community to state care of mother, newborn and child recently through the implementation of integrated maternal and child health about 4000 midwifery also community expansion workers have been deployed at the primary health care facility not just deploying those people to the community they have also been capacity building for this midwifery in large-scale skill as well as training in integrated maternal management of child group in to enhance their performance so as to provide quality care and as part of the implementation there is an upward review of the implementation into schools of midwifery in Nigeria and as a strengthening supply of the productivity, maternal, maternal and child health commodity also procurement of anti-shock in the prevention of postpartum hemorrhage part of the play achievement so far is procurement and training of health workers in the use of magnesium sulfate in order to prevent complications from preeclampsia as well as eclampsia and also the use of misoprostore in order to prevent postpartum hemorrhage as part of the achievement there are the distribution of midwifery kits to the midwifery in the rural area these midwifery kits consist of consumables that are necessary that are important for them to use in the rural area and also the distribution of contraceptive commodity in order to prevent unwanted pregnancies part of this achievement is procurement and distribution of anti-mitroviral drugs this is readily available in most parts of Nigeria once a woman is being diagnosed with a virus positive the patient refers to the the virology unit of the hospital and the patient's viral load is being accessed a patient with high viral load is being commenced on anti-mitroviral drug and the use of a chemistry combined therapies for the treatment of malaria in the rural area part of the achievement is health financing national health insurance scheme national health insurance scheme we initially have the national health insurance scheme at the federal level this has been moved to the community whereby some of the market women and actress can benefit also benefit from this insurance and this community based health insurance are in some rates in part of the country part of our achievement is the millennium development go conditional grants scheme and we have improved the improved budgetary allocation to health allocation to health in Nigeria has been increased from 5% which is in 2006 has been increased to 7% in 2011 then we have research poverty implementation research poverty implementation of research projects on protection of mother to child transmission maternal and neonatal child health are currently going on in Nigeria however despite this achievement there are lots of challenges we will be facing and part of this challenges are insufficient health capacity insufficient health system capacity because of our large population fragmented responsibility then availability of quality of services we see how challenges in that area then access and utilization of services there are still areas in the rural area we have people are still finding access very difficult then we have insufficient human resources despite the midwifery service scheme the human resources is not yet enough then poor knowledge and taxes at the health level and now overall there has not been enough community participation because of the highlighted challenges here are the following recommendation as well as call to action towards full implementation of my integrated maternal and child health in Nigeria at the state level at the state level at the state level we are started with both to maintain continuity providing activation of adequate funds for maternal and child health improving access to health care delivery ensuring quality health services are available functioning and available for family in the state educating the girl child which is the goal to the minimum development goal instituting its health system with capacity to plan, implement and supervise a state health plan of action ensuring that health facilities are available appropriately equipped functioning and affordable for families in the states providing skilled health workers distributing them equitably especially to the rural area then facilitating a two way referral if a woman needs to be referred to a higher health facility she is able to be referred there and be referred back to the referral center then motivating health workers in rural and hard to reach areas at the local government level because our system of government we have at the federal at the state at the local government level instituting a local government health team with capacity to plan implement and supervise a local government area health plan of action providing functioning affordable health facility in rural and hard to reach community in order to improve the physical and financial access facilitating easy evacuation of emergency cases to hospitals where they can be properly treated outside the rural area then ensuring that newborn and children are registered and they are appropriately immunized in order to prevent this childhood emergency as well as provision of safe water they have safe water but they are not adequate so we hereby recommend that provision of safe water and ensuring adequate sanitation in the communities in conclusion the quality of health care that both mother and newborn receive during pregnancy at delivery and in the post later period is very essential to ensuring women remain healthy and that children get a strong start in Nigeria however there is now high political commitment to improve maternal, newborn and child health evidenced by the initiation and implementation of the health sector reform and as well as the recent passage of national health bill in Nigeria that has just been passed is another landmark achievement in Nigeria which is a great step forward in achieving the integrated maternal, newborn and child health objectives the bill in addition to defining clear roles and responsibility for the three tiers of government and the enactment of the basic health care insurance scheme provide for the establishment of primary health care development with explicit pronouncement, procurement and how the fund will be utilized all these will greatly help in putting integrated maternal and child health in Nigeria in place finally through implementation of integrated maternal and child health in Nigeria up to 72% unit a day more than 30% on the five days and to 12% 62% maternal a day that is an absolute stand if integrated maternal and child health in Nigeria is fully implemented about more than 200,000 models and 6 million life can be saved by 2015 if full attention is directed towards the implementation of integrated maternal and child health in Nigeria thanks for listening are questions for Buki? the attendees are still typing waiting for their questions yes to support to support international midwifery community that's a great question Buki so how can the international midwifery community support you what are you doing? you've got us here yes I'm getting you international midwifery community will be supported in Nigeria this will be supported through advocacy advocacy to our government to further and encourage midwifery motivation of this can be done through motivation of midwifery and the countries motivation of midwifery in the country through advocacy yes the training of the 4000 midwifery were not done at one time they were done in batches and at different states there are 36 states in Nigeria at different times to the different geopolitical zones in Nigeria but the total estimates at a time were 4000 midwifery aside the midwifery that are working the 4000 midwifery they were the one training they were the one training to the midwifery service team to offer services at the rural area these members they are different from the midwifery working either at the state level or at the federal hospitals yes the autonomy of the autonomy of Nigeria of Nigeria midwifery is the question but is the question especially at the federal level but recently there has been capacity building training midwifery and how to be a good world manager training them to build their capacity to man their capacity there are however most teaching hospitals most teaching hospitals the autonomy of midwifery being query however at the state and at the local government the midwifery to perform their responsibility based within their jurisdiction within their scope of service yes we have there are two types of midwifery training in Nigeria there are better I can see your question there are two types of training in Nigeria three types of training we have the basic midwifery training we have the student coming after secondary school into three years basic midwifery training we also have post baby midwifery training after registered nose after being acquired as a registered nose you go for post baby midwifery training which is a three months training then at the university level as part of the certificate to be acquired at the degree level the midwifery training is also being incorporated yes yes I talked about motivation that midwifery should be motivated two capacity building in service training position of midwifery kids then empowerment autonomous and this is our request from the federal government of Nigeria I'm afraid we're going to have to call this to an end now this has been absolutely wonderful let's give Buki a big round of applause thank you very much thank you so much and thank you for trying to keep coming back even though our technology was messing up we do need to move on to get ready for the next session thank you very much for the opportunity I'm very grateful and I'm happy to be part of this great international conference thank you so much thank you Buki and here's her references and that's great