1. PRESENTED BY SUSAN

2.  BACKGROUND  RATIONALE FOR INTRODUCING CMA?  SUCCESSES  CHALLENGES

3.  The Millennium Development Goals 4 and 5 focus on improving maternal and child health.  In Malawi, Shortage and poor retention of midwives is a challenge for achieving these MDGs.  This also contributes to a shortfall in skilled birth attendants.

4.  One mechanism developed by Malawi government to try to increase skilled attendance at birth, particularly in rural areas, was the introduction of CMA training (18-month training programme).

5.  CMA training started as a pilot program in 2011  25 female students enrolled at St. Joseph’s College of Nursing and Midwifery  23 at St. Lukes College of Nursing and Midwifery  All deployed now  Currently enrolled at St. Joseph, MCHS, Ekwendeni, st.Johns, Mulanje, Phalombe, St.Lukes, Nkhoma.

6.  To reduce MMR currently 675/100 000 live birth and neonatal mortality rate 33 per 1000 live births  To increase skilled birth attendants in the rural areas.

7.  80% of population live in rural areas  Challenges to access health services due geographical and infrastructure problems

8.  Many midwives refuse to work in rural settings  CMA understands community cultural background.  CMAs stay in communities

9.  CMAs are adding to number of skilled attendants in the communities.  Curriculum revised to incorporate care of emergencies

10.  Mentorship training for NMTs to mentor CMAs  Support from local organisations.

11.  No grass root level infrastructures for CMAs to practice close to their communities.  Retention of CMAs poses a challenge as most of them are young and will get married or want to continue with education.

12.  Mentors not always available to give the necessary support  Recruitment done at a district level and not at local level.  Curriculum still in draft form.

13.  Provision of infrastructures for CMAs to practice in their communities after six months of working with a mentor- this will improve access to skilled attendance at grass root level.

14.  Finalise curriculum  Revise retention strategy

15.  ZIKOMO