African Woman and Child Feature Service

That there is a need for skilled health care for maternity services cannot be over emphasised. Today the world needs more midwives to fight maternal deaths and disabilities occasioned by maternal causes. This is the message in the recently released UNFPA report on the state of the world’s midwifery.

“A proficient, motivated and supported midwifery workforce is a major key to success in tackling this heavy toll of death and disability,” says the report.

The report reiterates that the numbers of midwives impact on the quality of maternal care. In over 58 countries surveyed, there is a shortfall of 112,000 midwives in 38 countries. This shortage means that even where there are trained midwives to attend to mothers and their children, the quality of services is compromised.

Inequalities exist in the distribution of staff in rural areas as compared to urban centres. This further worsens the situation for expectant women in marginalised areas who need midwifery services. The shortage of midwives has led to many women in rural areas and urban slums to turning to traditional birth attendants. This is a situation that puts them at risk when they need emergency care.

There are huge inequalities in the health system that need to be addressed. The report states that less than 17 per cent of the world’s skilled birth attendants are available to serve women in need of these services.

Kenya is no exception in these statistics on skilled care staff shortages. However, the irony is that newly graduated midwives and nurses still struggle for find employment. According to the report, in a bid to improve maternal health services, the Kenyan government has committed to recruit and deploy an additional 20,000 primary care health workers.

“The ideal ratio of midwives to women seeking maternity care is one to four but the Kenyan situation provides a ratio of 1:15,” says Donald Epalat, a practicing nurse and a member of the Commonwealth Nurses Federation Board representing East Central and Southern Africa region. He adds: “The result is a heavy workload and burnout.”

Perhaps this burnout could be contributing to some nursing staff mistreating women who go to facilities that offer maternal care.

“Respecting the rights of women seeking maternity care is both a human rights obligation and central to ensuring that the Government meets its public health goals,” argues Elisa Slattery, Regional Director for Africa at the Centre Reproductive Rights.

The burnout is also facilitated by working conditions in facilities that provide maternal care are inadequate. Some facilities lack running water and electricity supply, especially those in rural areas.

“This compromises care and safety of patients,” says Epalat.

The situation is made worse by migration of nurses who perform most midwifery services in Kenya to other countries. Poor salaries and working conditions as well as heavy workloads and lack of career development prospects are some of the factors that contribute to the migration of nurses, including midwives.

“The pull factors in those countries being better pay and opportunities for professional development,” observes Epalat.

However, achieving the Millennium Development Goal targets of reducing maternal and child mortality remains a big challenge.

According to Dr Pape Amadou Gaye, President and CEO of IntraHealth International the issue of skilled health care workers migrating to greener pastures is a global problem.

“Globally speaking, there is a big shortage all over the world of skilled health care workers including in the United States,” observed Gaye. He added: “Africa has 24 percent of the disease burden but only 1.2 to 1.5 of the skilled health workers.”

He said shortage of health workers is everywhere in sub-Sahara Africa and it affects services and access.

“No single country in sub-Sahara Africa has reached the World Health Organisation recommended standards. This has had a direct impact on maternal health,” observed Gaye.

To achieve Millennium Development Goals Four and Five on reducing child mortality and maternal deaths respectively, 95 percent of all births should be by a skilled attendant. Much as midwifery is offered at both diploma and degree levels in Kenya, postgraduate training in this field is currently being designed.

“This is a challenge as there is limited academic and research capacity in midwifery in Kenya. Nurse midwives are often not allowed to engage in part-time practice,” says the Epalat.

He calls for strengthening of regulatory frameworks to benefit midwives and women who need their services.

However, Gaye says that in the last four to five years there has been a notable increase in awareness with regards to need for skilled health care personnel.

The good news is that everybody is advocating for maternal health. However, according to Gaye, the bad news is that there has been very slow progress in trying to stop the brain drain. He says the good news once gain is that countries have developed human resources or are in the process of developing plans.

“Even though this is going on we are not seeing yet the impact of human resources in health programmes,” Gaye explained.

He reiterated that most countries are now moving to task shifting. “Some nurses responsibilities have been shifted to lower cadre workers. This is very successful in Mozambique but is also being seen in countries like Burkina Faso and Senegal,” explained Gaye. He added: “A lot more focus is now being given to community health workers and this is helping particularly in rural areas.”

Gaye was speaking to a team of journalists from African Woman and Child Features Service at the Communications Consortium Media Centre offices in Washington DC.

However, bringing down maternal and child deaths remains a responsibility that must be taken jointly by all stakeholders.

This means that governments must take bold steps to ensure better working conditions if they are to attract and retain midwifery staff in our countries to help us achieve these goals.

They must also eliminate financial barriers that limit women’s access to health care.

“It is crucial to address financial barriers to those seeking maternal healthcare and ensure that fees — either formal or informal — do not impede women’s access to health services,” argues Slattery.  She adds: “Removing user fees for maternity care in all public health facilities would be a very important first step.”

Her sentiments are echoed by United Nations Secretary General Ban Ki-Moon who says: “Ensuring that every woman and her newborn have access to quality midwifery services demands that we take bold steps.”