6 August 2012

Tanzania: More Skilled Midwives Needed to Guarantee Safe Delivery

"NO woman should die while bringing life" is an appealing slogan that is often uttered by safe motherhood activists and politicians during their various meetings countrywide.

Recent reports say that 24 women die every day in the course of delivery, due to pregnant related complications which is an average of one woman in every hour. Data also have it that in every woman that dies, there are six newborns dying. It is, however, important to note that the 2004's Tanzania Demographic Health Survey shows that out of every 100,000 live births some 578 women die in labour or in complications related to childbirth.

The number has now gone down to 454. While the annual infant mortality rate has come down from 99 deaths per 1,000 live births reported in 1999 to a figure of 68 deaths in recent years, the mortality rate among children under the age of five has also been reduced to 112 deaths from 140 per live births in the 1990s. The mortality rate among newborn babies remains high at 32 deaths per 1,000 live births.

This means that 44,900 deaths of newborn babies are recorded annually, comprising approximately 47 per cent of all infant deaths in Tanzania. The White Ribbon Alliance for Safe Motherhood Tanzania (WRATZ) Country Coordinator, Ms Rose Mlay says that these figures are unacceptably high and heads must keep on rolling in quest of achieving zero deaths. She pointed out some key factors contributing to the high level of maternal and newborn deaths in Tanzania as including limited access to reproductive health care, insufficient number of skilled health workers, poor quality of health-care services and limited community involvement.

It is, however, important to note that there is no single intervention can address all the above factors contributing to maternal and newborn deaths, but interaction among stakeholders can make a significant contribution. On its part, the Wratz recently carried out a pilot campaign in three regions of Ruvuma, Mtwara and Mwanza advocating for importance of secondary school students to study science in a bid to qualify for joining midwifery courses that would lead to increased number of midwives and eventually save lives.

But what transpired in the campaign is that the nation is at a crossroad and it is likely that the optimism that people may have for the better future is far from being achieved as studying sciences has remained a dream. Schools are in acute shortage of science teachers, laboratories and favourable learning environment making it hard for those dreaming to become scientists to make it to their expectations.

"There is no doubt that an acute shortage of skilled health workers is a thorn in a flesh on the current maternal and newborn deaths, the government has agreed to directly employ those who complete their midwifery courses, but it seems the pool is not there and thus despite this policy being a nice one we cannot achieve our dreams," said Ms Mlay. She noted that unless otherwise the government is investing massively in the science teaching the policy of employing all the qualified midwives will not help as the trend shows that only few are qualifying to join such courses.

"We are grateful for your awakening campaign for us to study science, some of us are very eager to become scientists, to help reduce these deaths but we are not supported to achieve our goals as schools are not equipped to groom scientists," said Rahel Richard, a student at Nyabulogoya Secondary School in Mwanza Region. In all the schools where the campaign teams went it was found out that schools had between zero to three science teachers and bad enough most of these schools are located in urban areas.

The Mwanza Secondary School which is one of the oldest schools constructed at the heart of Mwanza City which is now having 2,400 students has seven teachers of science giving it a ratio of almost 1:343. At Mustafa Sabodo Secondary School in Mtwara Rural District with 700 students there are two teachers of science only and there is no laboratory. "The answer to all these challenges is simple, the government should look at investment in science teaching a crucial area for the country's development especially at this era of science and technology," advised a teacher at Msimbati Secondary School in Mtwara, Mr John Mayala.

Sources from Nursing Training Centre (NTC) in Mtwara and Geita Nursing School in Mwanza had it that the government has issued directives to colleges to capitalize in training midwives at certificate as experience shows that in the recent years a number of students qualifying to join diploma is not promising. Ms Mlay noted that capitalizing in certificate level may throw the nation into a questionable future and even more dangerous for the health of mothers and newborn as the certificate dosage does not give enough knowledge to handle complicated cases.

At the NTC, for example, a shocking data was revealed that out of the 270 applicants who applied for the last year's midwifery courses at diploma level only 43 sailed through. The NTC Outgoing Principal, Ms Hasina Mshamo said that bad enough is that the perception in the society has been that midwifery courses are for failures, which is not the case. "Some parents were shocked when they heard that their children failed to qualify for enrollment in our institute, but the fact is without better performances in science subjects, there is no shortcut" she said.

The Mtwara District Executive Director, Mr Iddi Mshili noted that lack of qualified students in science subjects has made the districts efforts to get qualified health workers including midwifery a mere dream. "Our target is to have as many qualified health workers from among local communities here so that we can have people who will be willing to work in their areas unlike the situation on the ground which is difficult to retain outsiders especially in rural areas," he said.

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