The fate of graduate midwives in Uganda

In Uganda, more than 80 percent of midwives working in the healthcare facilities are certificate and diploma holders who are trained to manage normal pregnancy, labour, postnatal and newborn care. 

However, they are not comprehensively trained to manage pregnancy complications such as postpartum haemorrhage, septicemia/infections, hypertensive disorders of preeclampsia and eclampsia and obstructed labour, among many others that develop during these different periods. 

Yet, these complications are the leading direct causes of maternal and neonatal morbidity and mortality.

As such, in Uganda, we now have around six universities offering a Bachelor’s of Science in Midwifery and Masters in Nursing (Midwifery & Women’s’ Health) courses. These include Lira, Aga Khan, Victoria, Clark, Finns and Makerere universities. Midwives trained at those levels are not only trained to manage normal pregnancy, labour, postnatal and newborn care but they are also to manage complicated obstetrical emergencies and handle gynaecological procedures like manual vacuum aspirations. 

These midwives also screen, assess, and manage mothers with gynaecological complications like bleeding disorders and newborn emergencies. 

Furthermore, graduate midwives are trained to initiate, promote, and conduct research in reproductive, maternal, and newborn health. 

They also provide quality leadership, management, and governance within the health care delivery system and conduct teaching, training, and mentorship of students in the nursing and health training institutions in general.  

Whereas these universities have done a tremendous job to train midwives at graduate and postgraduate levels, the current scope of practice for nurses and midwives in use does not incorporate them, and worst of it all, their roles and responsibilities are not fully established in this scope. 

Additionally, on December 27, 2017, the Ministry of Public Service released and rolled out a circular of the revised schemes of service for the nursing and midwifery cadre to all districts across the country. This revised schemes of service included midwives at bachelor’s level but not at masters prepared level. 

However, the implementation of this schemes of service is still facing a lot of challenges. Surprisingly, more than three years down the road, there are still many districts in Uganda which aren’t adhering and implementing this revised schemes of service. 

Positions for midwives at bachelor’s level are never advertised, and neither are these midwives recruited. This not only affects midwives at bachelor’s level, but the same problem is faced by the nurses at the same level and above. 

Sadly, government continues to record great challenges in handling maternal and child health even with the availability of such great human resource, especially during this Covid-19 pandemic, which has impacted negatively on maternal child and neonatal health with the biggest impact seen in complications of pregnancy, stillbirths and low birth weight for infants. 

Covid-19 possess challenges in pregnancy, delivery and postnatal periods, with vaccination, which requires mothers to be fully screened and monitored closely post vaccination and delivery. This kind of care can only be rendered by highly trained midwives.  

However, we strongly recommend the Health Service Commission, Ministry of Public Service and the Local Government to add more efforts in pushing for the full implementation of the schemes of services for the nursing and midwifery cadres in Uganda. 

We also recommend the Uganda Nurses and Midwives Council with Ministry of Health to fast track the processes of finalising the nursing and midwifery scope of practice. We await to see a Ugandan healthcare system with employed graduate midwives.

Ms Harriet Akello (BSc trained Midwife working with St. Mary’s Hospital Lacor) and Ms Lilian Nuwabaine Luyima (BSc trained Nurse, MSN-Midwife and Women’s’ Health Specialist)