We have a global shortage of midwives. Mentoring programs can close the gap.

Midwives are essential links to their communities and are often the first face families meet in the healthcare system when they come for family planning, newborn care, or Antenatal Care (ANC) services.

In fact, midwives who are educated to international standards and work in a functional health system can meet 87 percent of all women and newborns’ healthcare needs.

Recognizing their vital role in preventing death and supporting the wellbeing of communities, the World Health Assembly has designated 2020 as the International Year of the Nurse and the Midwife. This year, as we celebrate the work of nurses and midwives, we also want to highlight the challenges they face and promote investment in the nursing and midwifery workforce.

A mother and her child at an ANC visit in a village in Uganda.

According to the World Health Organization, in order to achieve universal health coverage by 2030, we need to train and employ 9 million more nurses and midwives around the world. Some of the greatest gaps are found in parts of Africa, South East Asia, and Latin America. In many of these countries, midwives and skilled birth attendants may be the first and only point of care for women.

The rise of COVID-19 has put health systems under incredible strain over the past few months and only further highlighted the health workforce gaps that exist, especially in low- and middle-income countries.

Women in much of the world are still more likely to die of preventable childbirth complications than they are of complications from COVID-19. However, the pandemic’s disruption of women’s routine care could be devastating.

Researchers from the United Nations Population Fund have projected the direct impact COVID-19 could have on health services in a recent report. For women in low- and middle-income countries, for every three months the global lockdown continues, up to an additional two million may be unable to access modern contraceptives.

Maternal deaths in low- and middle-income countries could increase by 8.3 percent each month, if routine services are reduced by just 15 percent, according to a pre-print article in The Lancet. If services are reduced by almost half, deaths could increase by over 38 percent. For children under five, monthly deaths could increase between 9.8 and 44.7 percent.

That is why it is important to continue to support midwives as they provide quality services for women and children throughout the pandemic. Health systems must be functional and able to protect midwives and skilled birth attendants from unnecessary virus exposure, so they can continue to provide quality care.

Traditional birth attendants counsel a pregnant woman on her postpartum family planning options.

Traditional birth attendants counsel a pregnant woman on postpartum family planning.

Mentoring programs for frontline workers

CHAI is working with our partner governments across more than 10 countries to help build the capacity of midwives and skilled birth attendants to provide quality reproductive and maternal and newborn health services – during the pandemic and beyond.

Mentoring programs provide hands-on support for midwives and skilled birth attendants who work directly with women and their families. Depending on the country, the program may use mentors from CHAI or the ministry of health, but the goal is the same: to help midwives strengthen counseling and clinical skills, readily access emergency referral systems, manage their local supplies, and readily access emergency referral systems, to ensure the women in their communities benefit from the best possible care.

Rather than traditional classroom training, mentors work side by side with midwives and skilled birth attendants as they meet with patients.  Training alone does not always translate into better care in the challenging settings where midwives frequently work. A mentor can help problem solve in real world settings. They can demonstrate how new skills can be integrated into the services already being provided to help midwives provide better quality healthcare.

A Village Health Team supervisor reviews maternal health data with a Village Health Worker in Malangala, Uganda.

A Village Health Team supervisor and staff review maternal health data in Uganda.

Examples from the field

Mentor support provides midwife with new skills in Uganda

During a challenging birth for a 28-week pregnant woman at a hospital in Mubende, a midwife and mentor worked together to help the woman deliver a stillbirth and provide immediate postpartum care. After receiving postpartum family planning counselling, the woman opted for a contraceptive implant. However, the midwife had no experience with the product. Following a demonstration by the mentor, the midwife was able to conduct the procedure under close supervision.

Thanks to the mentorship program, the midwife was able to provide the exact care that her patient needed during a difficult time.

The mentorship program in Uganda uses a comprehensive clinical and quality development model that addresses gaps in childbirth and family planning services by improving clinical skills and systems of care. The Ministry of Health, together with professional bodies and with support from CHAI, has provided updated maternal, newborn, and reproductive health training for 81 percent of frontline health workers. Remaining workers will be trained through on-site mentorship In the coming years.

Mentorship program adapts to coronavirus in Zambia

In Zambia, as social distancing has become part of the COVID-19 response, CHAI has taken its mentorship program online. Mentors have continued to work with healthcare workers using WhatsApp groups. The groups allow midwives to communicate with their district mentors, as well as senior mentors outside the district.

Recently, in Chilubi district, the system was put into practice to save a woman’s life. After the woman safely delivered her baby, she began bleeding heavily. The midwife was unable to stop the bleeding with her usual treatments. She applied a non-pneumatic anti-shock garment – a skill she had recently learned – and then called her mentor. He directed more advanced treatment, which the midwife performed, controlling the bleeding. The woman and newborn both survived.

CHAI will continue to support midwives and skilled birth attendants through our maternal, newborn and reproductive health program. With mentorship programs across our partner countries, we are working to close the gap on workforce shortages while ensuring the rights of women and newborns to safe deliveries and quality postpartum care.

Women and children suffer the greatest burden from disease globally. Learn more about CHAI’s work to provide them with the healthcare they need, when and where they need it.