Ensuring Support and Recognition for Midwives in Uganda

Women in Uganda are nearly 40 times more likely to die during childbirth than women in the UK.  Over the last decade there have been significant improvements in maternal mortality rates, with more births being attended by skilled personnel at a health facility. However, many women still die from preventable causes such as sepsis, pre-eclampsia and haemorrhage.

We know that health care providers play an essential role in preventing these deaths. Yet right now many providers working in obstetric care in Uganda feel stressed and unsupported in their work, and lack of training, high staff turnover, workforce shortages and high workloads are common. In addition, the equipment and supplies necessary to provide quality maternity care are frequently unavailable. This is putting women’s health at risk and, in the worst cases, having a dramatic and even fatal impact on their lives.

Midwives and nurses constitute the majority of the maternal health workforce in Uganda and provide crucial care to mothers and their newborns during pregnancy, birth and follow-up. However, once in-service these vital cadres receive very little additional professional training or skills development.

To address this, the Royal College of Obstetricians and Gynaecologists (RCOG) partnered with Kitovu Health Care Complex and Masaka Regional Referral Hospital to deliver training on emergency obstetric skills to health care providers in the Masaka district. The training modules focused on how to recognise and treat obstetric emergencies and provide respectful care and supported the improvement of referrals to the regional referral hospital. The aim of the partnership was to develop a pool of highly skilled Master Trainers who would be able to cascade training to their peers and fill the gap in professional skills development identified by maternity care providers.

The project’s main achievements include:

• 112 health care providers trained on emergency obstetric skills
• Over 90% of trainees improved their skills on partograph and EWS chart use and neonatal resuscitation
• Health care providers reported feeling more confident to treat or refer women for maternity services
• Women reported being very satisfied with the maternity services being provided and would recommend the facilities to a friend

This project will have a sustained and long-term impact on the sexual and reproductive health and rights of women and girls in Masaka. Increasing the skills and knowledge of frontline health care providers not only directly strengthens local health systems, but ensures that women and girls are able to access quality services that are responsive to their needs. By implementing train-the-trainer (TTT) methodology, health care providers can share their new skills and knowledge with other staff in their respective facilities and to a wider audience, encouraging local ownership and retaining and embedding these skills within the health system. Perhaps most importantly, the project has fostered a strong relationship between RCOG and Kitovu and Masaka hospitals, and given maternity care providers the support and recognition they deserve and the skills they need to continue saving the lives of women and girls.

[From the training] I got all the skills I had gaps in, especially manual vacuum aspiration and early warning scores. I feel confident to handle everything from tomorrow! – Training attendee, midwife

[i] http://hdr.undp.org/sites/default/files/2018_human_development_statistical_update.pdf