Challenges of training Midwives in Africa By Peter Waithaka Public Health Specialist and HRH Specialist

Back ground Midwifery, a practice so ancient that it features in early Egyptian and Roman scrolls, is seeing a long awaited increase in global attention. Decades of neglect of the role of midwives, either because of the over-medicalization of pregnancy care or a lack of resources, has left a legacy of high rates of maternal and newborn mortality in developing countries. While these rates have fallen in recent years, more progress must be made in Asia and sub-Saharan Africa, where fewer than 50% of all births are assisted by a skilled birth attendant.

Fundamental challenges 1.What are we trying to address – Shortages of midwives – Quality of midwives Globally only 30% of practicing midwives have completed a full three-year training course; only 25% of those who are fully trained meet International Confederation of Midwives (ICM) competencies; only 15% of nurses who undertake midwifery duties meet the ICM core competencies, ( The state of the world's midwifery 2011 report)

2.Who do we need to train a)Traditional midwife/TBA – Attends more than 50% of deliveries – Perceived to be more friendly – Enviroment is user friendly – Perceived to be cheap – Major contributor of mortalities and morbidities – Training s cheaper and shorter b) Formal Midwife – Attends lees than 50 %deliveries – Perceived as unfriendly – Environment is perceived as unconducive – Less morbidities and mortality – Training expensive and longer

Types of midwives Formal Midwives -Range from community midwives to Specialists -Have curriculum of training -Structured training facilities -New graduates are usually young -May be male or female Non -formal “Midwives” - Traditional birth attendants - No curriculum -No training structured mainly apprenticeship -Elderly women

Facts and perceptions Formal Midwives Less than 50% deliveries Less morbidities and mortalities Perceived to be expensive – rural population Monetary payments Perceived to be un-friendly Perceived to be in-experinced Environment perceived to be unfriendly Statistically in short supply Non –formal “ Midwives” More than 50% of the deliveries Higher morbidities and mortalities Perceived to be affordable Payments in kind Perceived to be very friendly Perceived to be experienced Homely environment Seems to be always more or adequate

3. How many do we need Training of midwives is rarely based on forcasting How many we need informs – Training institutions capacity – Faculty capacity – Clinical placement

4. How much Once we know how many over what duration we can inform how much is needed to bridge the gap Informs advocacy for resources coupled with statics – the language of politicians and economists Informs planning

5. What to train and how Informs curricular Training approaches – Classroom Vs Distance Vs E-mode Informs roles as well as jobs descriptions Informs evaluation of training success Informs regulation

6. what to focus on Learner Learning Environment Teacher Quality

Conclusion To improve on the teaching quality of midwives we have to consider all these factors – Who/what we put in – How we process – What comes out/product These will determine the quality of midwives training in Africa.

Thank you.