Community-Based Distribution of Low-Cost Family Planning and Maternal and Child Health Services in Rural Nigeria

There is a need for low-cost family planning and maternal and child health (MCH) in rural Nigeria where the crude birth rate is 50/1000 death rate is 20/1000 and infant mortality rate is 111/1000; population growth is 3% and physician density is 1/60000 people. A program to train nurse-widwives in the supervision of community agents in MCH/family planning delivery of service information and supplies was tested in Akinyele North Local Government Area population 85000. Maternity centers supervised 18-32 agents who were equipped to give 1st aid primary care for malaria cough anemia worms and diarrhea for a voluntary nominal fee and free information. 1/3 of the agents were male volunteers 2/3 female traditional birth assistants (TBAs). Directed by the personnel of the Department of Obstetrics and Gynecology of University College Hospital Ibadan with foreign funding and technical assistance the project included a 2-week training course (to be reinforced by practical training) for the agents after their selection by village leaders during which they were trained to execute health education on a wide range of subjects from environmental health to contraceptive use and trained in the use of medical kits. Recordkeeping included inventory records for supplies especially drugs. Agents had some authority to refer patients to a health facility. Results of a 1980 preliminary survey showed a continued pronatalist sentiment and opposition to family planning decreasing slightly with age and education but with developed postpartum abstinence and prolonged breastfeeding. Involving village leaders in the project has apparently been effective and there is evidence of lives saved by agent referrals. During June 1985 over 1100 were treated for illness and 50 became new family planning acceptors. The initial field results will be useful as planning feedback.