Experiences with Universal Health Coverage of Maternal Health Care in Ondo State, Nigeria, 2009-2017.

I am pleased that the theme of this maiden conference of the Association of Feto-Maternal Medicine Specialists of Nigeria (AFEMSON) is the reduction of maternal and perinatal mortality. Practising in our setting can be particularly challenging due to the weak health system which leads to frustrating outcomes, with high rates of avoidable maternal and perinatal morbidity and mortality. For practitioners of fetomaternal medicine to deal with this as a major public health concern, the focus should not just be some cold statistics, but rather it must be addressed as a true everyday human story and societal tragedy. In a recent publication1, Elliot Main, a Stanford Professor of Obstetrics and Gynaecology, and founder of California Maternal Quality Care Collaborative was reported as saying: ―When you've had a maternal death, you remember it for the rest of your life - all the details‖ Perhaps, practicing in our setting (like in most low and middle income countries) you may not remember ―all the details‖ because of regularity of occurrence. However, I am sure that each of you, frontline practitioners here gathered, has had a few unfortunate human angle stories - details of which get imprinted in your memory for the rest of your life. In my practice, I also had my own experiences, which were part of the reasons that I decided to temporarily set aside the practice of clinical medicine to get involved in top policy formulation for health and overall societal development. As reported by Olu Obafemi2 in his recent publication of my experiences: "Those days I will tell people that I could never forget the cry of a woman when she loses her child at night, because at a stage, I was living within my clinic. It was harrowing, especially at night, between 1-2am." As Governor of Ondo State, southwest Nigeria for 8 years (2009-2017), working with other stakeholders, we proved that even in resource-restricted settings like Nigeria, it is possible to achieve positive outcomes in terms of systematic reduction in maternal and perinatal death mortality. The Centre for Strategic and International Studies (CSIS), in its publication on the first year of ABIYE3, succinctly encapsulated this by saying ―With leadership, progress is possible.‖ Specifically, under my leadership as Governor of Ondo State, we commenced a unique Abiye maternal health program that offered free maternal and child health services to pregnant mothers and children less than five years old (including sophisticated referral care) that brought maternal and child health care to the doorstep of every citizen in the state. The consequence was a significant reduction in maternal mortality in the state, enabling the state to achieve the target of Goal-5 of the Millennium Development Goals. But this was not achieved without some noteworthy challenges. The purpose of this presentation therefore is to describe the philosophy that led us to focus on the delivery of free maternal health care, to summarize the methods and challenges in its implementation and to make recommendations on ways to build political will for improved delivery of maternal health care and the reduction of maternal and perinatal mortality in Nigeria. I believe that the recommendations made will be useful for policymakers elsewhere to understand the social context of health care and to prioritize the delivery of maternal health care as a social justice and human rights requirement of citizens.