Maternal care in Nigeria: “If not for this facility, I would have been dead and gone”

The Kushari Comprehensive Emergency Obstetric and Newborn Care (CEMONC) facility opened its doors in June 2024 with a 30 bed-capacity that can be tripled  over time. The referral facility provides free, lifesaving care for pregnancy-related complications such as pre-eclampsia, postpartum hemorrhage, pre-term or obstructed delivery, and postpartum hemorrhage.

“Most complications we see are related to either anemia, malaria, or pre-eclampsia,” said Janada James, an MSF midwife. “Malaria is a real issue: if a pregnant woman has malaria, it affects the placenta, causing nutritional deficiencies for the baby and anemia in the mother—sometimes severe anemia. Managing such cases is complex, and often requires blood transfusion.”

“One woman came in with severe hemorrhage and anemia,” said Rhoda Awanyah, MSF midwife supervisor. “After delivering her baby, we couldn’t stop the bleeding. The doctor used every available technique to manage postpartum hemorrhage, and eventually, the bleeding stopped. When she returned for her follow-up, she said, ‘If not for this facility, I would have been dead and gone.’”

The only free specialized referral center in the region

Operated by the Borno Ministry of Health with support from MSF, the Kushari center is the only free, specialized referral facility of its kind in the region. It serves as a critical step toward reducing the staggering maternal and neonatal mortality rates in Maiduguri.

In its first six months, the referral center saw a steady rise in admissions, notably during and after the massive flooding that affected the city in September and October 2024. 

"Given the financial difficulties people face in Borno, which have worsened after the flooding, offering free care here is key for many people,” said James. "We took care of a baby born weighing just over 2 pounds, whose survival would have been improbable without specialized care,” she added.

Most of patients admitted to Kushari referral center are transferred from 11 basic maternal and obstetric facilities that MSF also supports in Maiduguri. But because a vast number of women in Maiduguri continue to give birth at home, many patients with complications do not reach the facilities—and sometimes die at home or arrive too late. This has led MSF to promote links between maternity units and traditional birth attendants to encourage women to seek care early, rather than waiting for problems to arise. This holistic approach aims to build community trust and ensure long-term sustainability.

Laying the groundwork for sustainability

From the onset, the Kushari referral center has been integrated into the public health system. Most staff members are from the Ministry of Health, with MSF providing financial support and specialized medical training. This collaboration and authorities’ active investment  in the project ensure that Borno state’s Ministry of Health can fully take over the facility within five years.

Reducing maternal and neonatal mortality will require more investment to improve access to health care in Borno, including to prenatal care, while addressing other factors such as the alarmingly high rates of malnutrition among pregnant women and mothers.