Midwives are privileged to be part of the most amazing event that will happen to a woman giving birth. However, in East Africa, childbirth is also a time of fear, pain and vulnerability for women. East Africa has some of the highest rates of maternal deaths in the world, higher than the rest of Africa and much higher than the global average of 216 deaths per 100,000 live births.
Midwife means ‘with woman’ and we as midwives should be advocates for the women in our care, supporting and nurturing them through pregnancy and birth. It is saddening therefore to read that disrespect and abuse of women in pregnancy continues to be a prevailing public health issue in many African countries.
Women have reported in many studies that abuse is common and that has impacted on their decision to access safe childbirth facilities. Along with policy and practice change at political level to empower women to address this, there is a need to sensitise nurses and midwives to realise that such behaviour, however well meaning, is unacceptable.
At Aga Khan, we empower our students using international benchmarks, to act in a respectful professional manner to promote respectful care and challenge abusive behaviours in other professionals.
A report by the United Nations Population Fund shows that when nurses and midwives are educated and regulated to international standards, they are able to meet 87 per cent of the need for essential health services in East Africa. Other reports show that skilled midwives with family planning expertise could potentially reduce maternal deaths and stillbirth by up to two thirds. A global report by the World Health Organisation includes a key recommendation to ensure that education of health professionals is of the highest quality, matches the needs of populations and ensures that health workers can work to their full potential.
With the shortage of doctors an issue across East Africa and calls for increased wages for nurses and midwives, the future may seem bleak for the healthcare sector. Behind the scenes, however, steps are being taken to ensure that nurses and midwives are working effectively.
In November, the government launched the Business, Technical and Vocational Education and Training (BTVET) Strategic Plan 2011 – 2020 also known as Skilling Uganda. The aim is to create employable skills and competencies relevant in the labour market. Nursing and midwifery training institutions fall under this plan – showing the government’s commitment to improve healthcare delivery.
The School of Nursing and Midwifery at Aga Khan University (AKU SoNaM), launched in the year 2000, is feeding into that vision. It gives registered Ugandan nurses and midwives a chance to upgrade their education and competence while continuing to work and support their families. Nearly 2,500 students have graduated from the programme, with a majority getting promoted at their workplace within two years of graduation. More than 100 are currently employed in senior leadership positions within the East African nursing and health professional workforce. It is more than just getting a degree. AKU SoNAM graduates have shown improved professional knowledge, clinical skills, personal and professional confidence, and career prospects.
Another way of empowering nurses is through multi-lateral partnerships. The Ministry of Health in Uganda is working together with a broad range of partners, including Aga Khan University, to bring change to the nursing and midwifery professions. They are bringing together a wide range of stakeholders, including nurses and midwives in clinical practice from across Uganda, to drive forward regulation, training, enhanced working conditions and innovation.
There is a famous African proverb that says, ‘If you want to go fast, go alone. If you want to go far, go together’. It takes a collective effort to positively impact the health of Ugandan people. Investment in more nurses and midwives, quality education and training, regulation, and enhanced working conditions will empower Ugandan nurses and midwives to contribute to the provision of better health care and help Uganda achieve the goals of the SDG’s.
Dr Edwards is a professor of Midwifery Education and Practice at the Aga Khan School of Nursing and Midwifery, East Africa.