History favoring mothers and newborns was made in March 2013 in Sokoto, Nigeria, when Nigeria’s Health Minister, the Executive Governor of Sokoto State, a representative of the Sultan of Sokoto, and community leaders launched Nigeria’s (and Africa’s) first large-scale community-based distribution program for chlorhexidine digluconate 7.1% gel to prevent umbilical cord infection in newborns and misoprostol to prevent postpartum hemorrhage in mothers. These two medicines are typically applied within the first hour of childbirth—the ‘golden hour,’ when maternal and newborn lives are either secured or lost—as too many are in Nigeria.
Following the launch, Nigeria’s Federal Ministry of Health issued a public call-to-action for all state governors to emulate Sokoto State and take bold steps to procure and distribute these two medicines and 11 other low-cost, high-impact medicines that the United Nations Commission for Life Saving Commodities, which is co-chaired by Nigerian President Goodluck Jonathan, designates as highly important.
In the spirit of accountability, let us take stock of what has happened for newborns and their mothers in Nigeria in the past year. In April 2013, Sokoto State government rolled out its community-based distribution of chlorhexidine gel and misoprostol tablets to all its 244 wards. By January 2014, 2,440 community-based health volunteers and 1,000 volunteer community drug keepers had provided nearly 56,000 mother-newborn dyads with chlorhexidine and misoprostol in places where more than 9 of every 10 deliveries occur at home. Many of these women had never received medicine to prevent postpartum bleeding. Early analysis of the data on more than 35,000 early beneficiary newborns in Sokoto suggest that over 99% percent of newborns who received chlorhexidine lived to their first calendar month of life. Sokoto has set funds aside for these medicines through 2015, and will serve another 56,000 mother-newborn dyads.
In November, the Sokoto State government, assisted by USAID, the Bill & Melinda Gates Foundation, and JSI Research & Training Institute, Inc. (JSI)/Targeted States High Impact Project (TSHIP), opened its doors to other Nigerian state governments for 3-day study tours of their program. Government delegations from 15 states representing 61.3 million Nigerian residents joined the tour, meeting with women and men who manage community-based distribution programs through 244 ward development committees. The delegates also met with clerics from the Nigeria AID Group/Jama’atu Nasril Islam, public servants, and NGO representatives. These encounters provided the first reality-based validation of the recently adopted National Maternal Newborn Policy.
By December, Bauchi State had launched a program of nearly 3,300 community volunteers who had 75,000 units each of chlorhexidine gel and misoprostol tablets. By the end of February 2014, Bauchi had recorded and celebrated 6,000 mother-newborn dyads who had received these medicines.
The governments of Yobe, Gombe, Kebbi, and Adamawa states have also set funds aside for such programs. Kano, Plateau, and Benue states have submitted proposals to their respective executive governors. Without question, the Sokoto study tours greatly influence these decisions. This march of progress for Nigeria’s mothers and newborns has begun to deliver positive results. State governments have seen the value and are poised to send market signals to prospective suppliers.
As for the fomentation of local manufacture of chlorhexidine gel, which is not yet available in Nigeria, progress has been remarkable. Twelve local companies responded to an expression of interest by Nigeria’s National Food and Drug Agency, United States Pharmacopeia, JSI/TSHIP, and PATH.
JSI/TSHIP formed an informal network of manufacturers interested in chlorhexidine gel production to accelerate market development. The network exchanges research and development information, details of the national newborn policy, demand from state governments, and demand forecasting. This forum also serves as a platform for government-private sector partnerships, and fosters “co-option” between manufacturers. On March 25, 2014, the Federal Minister of Health announced that regulatory approval had been granted to local firm Drugfield Pharmaceuticals Ltd, to begin manufacturing chlorhexidine digluconate 7.1% gel. Two more firms have prepared their own formulations and are in the stability testing phase.
In short, the demand for chlorhexidine gel will be met by a rise in local supply. This is good governance powering to prolong newborn lives, as it should be. The march to reach all newborns in 36 states of Nigeria with chlorhexidine gel and other simple, low-cost high-impact interventions is well on its way. All states must act in unison to support chlorhexidine use and all life saving commodities so that no newborn in Nigeria will be lost. We must renew the call-to-action to state governors issued in March 2013 by the Federal Ministry of Health.
Dr. Nosakhare Orobaton is based in Sokoto and Bauchi, Nigeria.
Access the FMOH Call-to-Action of March 2013