Opinion

Uganda needs more midwives

5 May 2017

By Umar Weswala

Today, Uganda joins the international community to commemorate the annual International Midwifery Day – 5th May. The national event is being held at Boma Grounds in Fort Portal Town – Kabarole District under the theme: “Midwives, Mothers & Families: Partners for Life’’.

I believe celebrations are in order because in Uganda, the maternal mortality rate has gone down from 438/ 100,000 women to 336 per 100,000 live births (UDHS 2016). Midwives have had a tremendous contribution to this decrease.  

About seven out of ten women now (74%) deliver with assistance from a skilled birth attendant (UDHS 2016) compared to 42% in 2006 and 58% in 2011. I personally witnessed this at Kagote Health Center III in Fort Portal where current records indicate that the facility conducts about 40 deliveries per month compared to just 7 in 2014.

Credit goes to the Ministry of Health for not only investing in improving safe motherhood services but also bringing on board partners like UNFPA and the Swedish government that have supported the training of more Midwives and the equipping of maternal health sections among other interventions.

Since 2009, UNFPA with support from the Swedish government has worked with the government to improve midwifery standards in the country by providing support to over 18 midwifery schools. A total of 510 midwives have been trained since 2010, of which 336 (66%) have completed training and qualified. 247 of these (74%) have been bonded to various health facilities located in hard to reach or underserved communities across the country.

Nadunget HCIII in Moroto is one of the beneficiary health facilities. It manages to handle the 10 or more daily delivery cases because of the presence of four UNFPA/SIDA supported Midwives. It should however, be remembered that all is not well in these facilities. The midwives are still very few compared to the workload.

According to a UNFPA Policy brief, Uganda has about 1,043 midwives. This means that the country needs 3,000 more midwives to meet the required minimum staffing norms. Due to this shortfall, it is estimated that one midwife handles between 350 and 500 deliveries a year, yet WHO recommends that a one midwife should handle not more than 175 deliveries a year.

At busy health facilities like Kagote HCIII, three or more mothers can turn up at once yet there is one midwife on duty. Under normal circumstances, one midwife cannot handle three mothers at ago. I was told some of these are always emergency cases which require referral or PPH. Apparently, these are not the only duties lined up for the midwife. She also has to handle OPD cases, family planning, antenatal and postnatal cases among others.

Some midwives have successfully managed such situations but under highly risky and difficult circumstances. There is particularly a high risk of compromising the quality of care given to the mothers. The government of Uganda should therefore provide sufficient resources for training and recruiting more midwives, especially in the underserved districts so that pregnant women who choose to give birth at health facilities do not regret that decision.

Umar Weswala is the founder of www.thecommunityagenda.com