Ensuring right skills, attitudes in maternal, newborn care

Reducing maternal and newborn illnesses and deaths is high on the agenda of the Malawi Government, with President Joyce Banda repeatedly saying ‘No woman should die while giving birth’.

But if the country’s maternal mortality ratio is to be reduced from the current 675 per 100 000 live births, there is need to invest more resources in order to reach Malawi’s Millennium Development Goal (MDG) target of 155 by 2015.

The Malawi Health Sector Strategic Plan 2011-2016 indicates that the maternity MDGs are unlikely to be met without significant additional investment to increase access to emergency obstetric care.

With less than 1 000 days remaining to the MDGs deadline, interventions such as the UK’s Liverpool School of Tropical Medicine (LSTM), Maternal and Newborn Health Unit ‘Making it Happen Programme’ may just be what Malawi needs to achieve MDGs four and five —reducing infant deaths and improving on maternal health respectively.

Working in close partnership with the government’s Reproductive Health Unit, selected training institutions, district medical officers, nursing officers and safe motherhood coordinators, the Making it Happen programme is training health workers in the provision of essential emergency obstetric and newborn care in order to reduce maternal and newborn deaths and illnesses.

So far, 90 health workers have been trained and about 400 are expected to be trained by 2015. The training targets doctors, nurse midwives, clinical officers, nurse midwife technicians and medical assistants, as well as lecturers and midwifery tutors.

In the past two weeks, one of such trainings has been underway at St Luke’s Hospital in Zomba. Charity Mtawali, a midwifery tutor from St Joseph Nursing School in Nguludi, Chiradzulu, was one of the participants. She said the training is helping the participants to improve on their skills, knowledge and attitudes towards patients.

“It is very hands on and as a tutor, I will confidently impart the knowledge to my students and also advise the students correctly when faced with situations in the wards. A tutor without updated knowledge is likely to face challenges,” said Mtawali.

LSTM technical officer for Lilongwe, Sheila Bande, said St Luke’s Hospital is hosting the current training because it is one of LSTM’s key partnering institutions which will receive training equipment for students and the emergency obstetric care skills for tutors.

“We are providing back-to-back training to two groups of 32 health workers each, ending this week. Our aim is to strengthen their skills and knowledge,” said Bande.

She said for the trainings, the programme is targeting health care workers in Mwanza, Neno, Mulanje and Mangochi districts as well as academic staff from Malawi College of Health Sciences Blantyre and Zomba campuses, Mulanje Mission Nursing School and St Luke’s Nursing School.

Head of LSTM Maternal and Newborn Health Unit, Professor Nynke van de Broek, who visited the country last week, said the Making it Happen programme realises that having existing health structure is just one part of the equation.

“We have noted that sometimes women will not seek medical care because of poor attitudes of health workers, so apart from the skills, the training ensures that health workers have a good attitude towards patients,” said Van de Broek.

She said evaluations have shown that in health facilities where the programme is implemented, the number of women dying from pregnancy-related complications has reduced by 25-50 percent, stillbirths reduced by 20 to 35 percent, and the number of women visiting hospitals to seek skilled health care increased by 50 percent “because they knew that in these health facilities they would meet skilled health workers who would treat them sympathetically”.

Another participant at the St Luke’s training, Gift Kathumba, a clinical officer from Mangochi District Hospital agreed that the skills acquired will help him tackle emergency obstetric and newborn care with better attitudes and more confidence.

“We might have learnt some of the things in school but because of lack of equipment, we never had the chance to practice them. Thus, this training will help me work with confidence and I will also impart my knowledge and the practical skills to my colleagues at the hospital I work in,” said Kathumba.

However, the programme, which was launched in July last year, is being currently implemented in four districts only, with a possibility of extending to Blantyre next year.

But for a country with one of the highest maternal deaths, five out of 28 districts is not enough for an essential programme such as Making it Happen.

Malawi’s high maternal and infant deaths are attributed to several factors such as long distances to health facilities, especially in rural areas, lack of skilled health care providers, poor infrastructure in many health facilities and referral systems for emergency care, poor attitudes of health workers which forces pregnant women to opt for unskilled birth attendants, high rates of premature births, and high nurse to patient ratios.

Board chair of White Ribbon Alliance Lennie Kamwendo was quoted in The Nation last week as saying Malawi currently has 10 400 midwives against a childbearing population of three million, which represents a nurse to patient ratio of 1 to 288.

“The ideal would be one nurse to five patients,” she said.

In May this year, Malawi was described as one of the riskiest places to be born by Save the Children’s State of the World’s Mothers report because of its ‘unusually high ‘ rate of premature births.

The report also notes that insufficient health care for mothers in sub-Saharan Africa has been a factor for the poor status of mothers and newborns.

“On average, only half the women in the [sub-Saharan] region receive skilled care during birth,” the report says.

The report calls on Malawi Government to focus on childbirth and the first 28 days of birth to sustain the progress made so far in the area of safe motherhood.

“Malawi is on track to meet MDG 4, but as newborn deaths become a growing percentage of under-five deaths, sustaining progress towards the MDG will require increased focus on childbirth and the first 28 days,” reads the report.

As Making it Happen programme winds up in 2015, government needs to think of ways of further building on the progress that has been made in maternal and newborn health. Efforts such as Making it Happen need to be scaled up so that more lives are saved. n