23 January 2013

Zimbabwe: 'Mentoring in Midwifery Critical'

Photo: Nyani Quarmyne/UNICEF
A girl and her mother, in Niger.

Southern Africa demands effective mentoring in midwifery to ensure safe health of mothers and their offsprings amid growing concern over the quality of the existing crop. Donors, the Zimbabwe Confederation of Midwives and senior health officials roundly spelt the need for mentoring to enhance the competency of midwives.

"We can fight to train thousands of midwives per year but are we producing quality or quantity? We are ending up producing half-cooked midwives who are not trained according to the International Confederation of Midwives essential competencies," said Zimbabwe Confederation of Midwives President, Mrs Grace Danda.

Faced with this scenario, should Government stop training midwives until enough tutors are available even when mothers do not stop giving birth?

"Not at all, we use experienced midwives to fill in the gap while we train more tutors," said the Secretary for Health and Child Welfare Dr Gerald Gwinji.

The veteran health practitioner said Government embraced the need for mentoring and is in the process of having it better organised.

"Mentorship is critical in health care and we have plans to have it better organised," Dr Gwinji said.

Government, said Dr Gwinji, has incorporated mentorship in the Health Transition Fund.

HTF is a pool of donor funding aimed at responding to major challenges bedevilling the health sector.

Dr Gwinji said Zimbabwe wants to put together teams of pediatricians, surgeons, gynecologists and obstetricians to assist junior level doctors.

He said a national study to assess the quality of care in maternity services was underway.

The study tested knowledge, made observations on how certain procedures are performed and did exit interviews on clients to assess the competence and skills of health practitioners.

Zimbabwe's case is parallel to others in the region.

A study carried out by the East Central and Southern Africa-Health Community (ECSA-HC) in partnership with the Ministry of Public Health and Sanitation in Kenya in 2006, revealed that health-provider knowledge on maternal and neonatal healthcare was at 63 percent.

The study showed that competency levels of health workers in performing basic life-saving skills were low.

It also showed that 55,9 percent of the Kenyan health workers who took part in the study had knowledge on active management of third stage of labour, 32,8 percent knew how to remove placenta manually and 22,9 percent knew how to conduct a bi-manual uterine compression.

According to the research, 45 percent of the workforce had knowledge on the immediate care of a newborn.

The study spawned a mentorship programme to boost the competencies of nurses and midwives in the country.

Similar studies were also conducted in Tanzania in 2008 and the results were similar to those of the Kenyan study.

In Tanzania, knowledge on maternal and neonatal care was 56 percent while competency levels of health workers in performing life-saving skills were also minimal.

Average scores for various life-saving skills ranged from 25,4 percent to 55 percent.

Although Zimbabwe is awaiting results from the national integrated health facility assessment, which is expected to bring out the issue of competence and skills among health practitioners, Dr Gwinji said these results were fairly representative of the Zimbabwe situation although the magnitude may vary.

The manager for human resources for health and capacity building at ECSA-HC, Ms Sheillah Matinhure, attributed the limited knowledge of professionals to various reasons.

She cited the limited number of qualified midwifery tutors in schools, among other reasons.

She said this shortage has resulted in a discrepancy on teacher to student ratios.

"As a result of health workforce crisis, nursing and midwifery colleges have been instructed to increase their intake without critically analysing the available midwifery tutors," Ms Matinhure.

She also attributed the cadres' limited knowledge on life-saving skills to lack of teaching resources in the training institutions.

The resources range from books to journals, poor Internet services and ill-equipped laboratories.

"The attitude of learners is another problem. As much as the teacher can deliver content, if the learner is not motivated and has no interest for the job then it will be very difficult for this learner to concentrate and gain the necessary skills. Some students join the profession because they have failed to enter into other professions, which they wanted to pursue," she said.

Ms Matinhure, however, said someone can graduate with appropriate skills, but as she/he practices there is need for continuous professional development to update the skills to match changes occurring in the health sector.

Realising the gap that exist in skilled midwifery tutors, ECSA-HC in collaboration with the Commonwealth Secretariat is working on a five-year project on enhancing midwifery capacity to reduce maternal and neonatal mortality in the region.

ECSA-HC is providing technical support to universities in the region to start a midwifery educators' programme at master's level to impart appropriate knowledge and skills to midwives undergoing training.

Zimbabwe is among countries in the ECSA-HC that will benefit from this programme and so far two Universities namely: National University of Science and Technology and University of Zimbabwe have adapted the ECSA-HC prototype curriculum.

The Universities plan to commence the programme in January 2013.

Zimbabwe's maternal mortality ratio continues to increase from 725 per 100 000 live births to 960 (Zimbabwe Demographic Health Survey 2012).

According to ZICOM, research has proved that a well-supported, properly trained, empowered and remunerated midwifery workforce will facilitate reduction of almost 90 percent in maternal mortality.

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