Quality of Care: The Role of a Midwife
Fellie Mpiriirwe Buregyeya, a midwife from Uganda, attended the Acting on the Call conference in Addis Ababa, Ethiopia, to speak about the importance of improving quality of care in maternal and newborn health from her perspective as a midwife.
I have been a midwife for the last 34 years. I work in a hard-to-reach area called Kigezi region, found in South Western Uganda, more than 500 km from Kampala, the capital of Uganda. Kigezi is very hilly. Some areas are completely inaccessible by car, and we use bicycles or motorbikes, called boda bodas. Others, not even a motorbike or bicycle can reach. And in other places, we must use boats or canoes.
With such terrain, it can be very hard for women to access health services, especially if they are not offered at health centers within their community. Some women must travel long distances to receive quality health care that will increase chances of a safe pregnancy and delivery.
Midwives are central in providing quality health care, however, their voices are rarely heard. It was therefore an honour to attend the Acting on the Call Conference to represent thousands of midwives. We must be valued as part of the solution in ensuring quality of care for women and newborns.
Uganda loses 17 mothers and 106 newborns every day from preventable causes such as bleeding, eclampsia, sepsis and asphyxia. This kind of loss takes a toll on all segments of society, but especially the families of those lost and the midwives who confront this tragedy every day. As a midwife, losing a mother, especially to a preventable cause, is devastating. Knowing that such deaths can be prevented with the provision of quality basic and comprehensive emergency obstetric and newborn care is very distressing.
Currently, Uganda has a maternal mortality rate of 336 deaths per 100, 000 live births, way above the global target of 70 per 100,000 live births. Uganda is not alone in having such worrying maternal mortality figures. Several other countries mostly in Sub-Saharan Africa, have such high maternal mortality rates. However, a number of initiatives and strategies have been employed to address this challenge.
Initiatives to address high maternal and newborn mortality
One of these initiatives is the Acting on the Call (AOTC) movement, which brings together governments, faith-based and civil society organizations, to end preventable deaths of mothers and children. AOTC was launched in June 2012 by the governments of Ethiopia, India and US, in collaboration with UNICEF and supported by partner organizations such as Bill and Melinda Gates Foundation, USAID, NGOs as well as private sector players.
Every year, they hold a conference to celebrate the progress, share best practices, lessons learnt and challenges and identify key steps in reaching the maternal and newborn targets of the sustainable development goals (SDGs).
This year, the AOTC conference was held at the African Union Conference Centre in Addis Ababa, Ethiopia, from August, 24th-25th, 2017 in the presence of the President of the Federal Republic of Ethiopia, under the theme, Overcoming Critical Barriers to Maternal and Child Survival.
One of the objectives was highlighting of successful approaches to increasing the use of high-impact Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) with equity, quality and sustainability. I had an opportunity to speak about my experience as a midwife in improving quality of care for mothers and newborns at the session about improving quality, focusing on what works and what doesn’t.
Midwives and quality care
The role of a midwife starts well before pregnancy and goes beyond birth with the midwife offering guidance and care for women as they start to plan their families. It continues as these women welcome their newborns into their homes. It’s the desire and responsibility of midwives to provide the highest quality care for the mother before, during and after pregnancy. And this means health care must be safe, effective, timely, efficient, equitable and people-centered.
As a supervisor of health centers, I have facilities under my charge that do not meet these standards of quality care, as much as midwives try to ensure that mothers and newborns survive and thrive.
Midwives aspire to provide quality care that will ensure their survival of mothers and newborns. But, to succeed, they need a conducive working environment with adequate tools to enable them to deliver quality care. Frequently, midwives experience challenges or barriers in providing quality care — such as a lack of basic medicines and supplies, poor or no equipment, poor housing, and low pay. On average, a Ugandan midwife earns the equivalent of 125 dollars a month, yet works long hours due to under-staffing at many health facilities. It is a struggle to survive on this little money.
We are glad that organizations like White Ribbon Alliance Uganda (WRA Uganda) are working with other civil society organizations to campaign for better working conditions of midwives, particularly in rural areas. They are working to improve our working conditions and ensure recruitment, motivation and retention of midwives and other health workers.
Involving midwives in ensuring quality
One thing we’ve learned is that it’s important to involve midwives in identifying solutions. And it is encouraging to note that midwives are working in partnership with women to ensure quality.
As a registered midwife employed by the government, WRA Uganda has helped me and other midwives to work in partnership with communities, particularly women, to identify the gaps in delivering quality health services for mothers and newborns. We are working together with policy makers, community members, district leaders, health workers and the media to address these gaps. This has taught us that while women are experts on their health, midwives are the experts in providing the quality care. More midwives need to be engaged as part of the solution. All of our voices matter.
As health workers, we now regularly talk to people about what is working and what is not. For the first time in my district, health workers, citizens, policy makers, district leaders and media have all come together to work as one team, without fear of blame. We have collected evidence on providing life-saving care for women and newborns and are using this evidence in advocating for quality care. Our efforts have resulted in recruiting 7 doctors, from none, two years ago. We have also made improvements in stocking medicines and supplies for life saving care, critical renovations and built new health facilities.
Midwives play a pivotal role in ensuring quality of care for mothers and newborns, but must be supported with the tools needed to provide that care. That means the right equipment, being treated with respect, receiving adequate pay, having sufficient staff numbers, medicines and supplies, and decent housing. There is no quality without equity and no equity without dignity.
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