Part 3: Strengthening a Tanzanian Midwife’s Work Environment and Conditions: Yasinta’s Story

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By: Petra ten Hoope-Bender, Director of Reproductive, Maternal, Newborn and Child Health, ICS Integrare; Sheetal Sharma, Research and Knowledge Management Associate, ICS Integrare

This post is part of our “Continuum of Care” blog series hosted by the Maternal Health Task Force

A Midwife’s Story

This morning it’s been a rush to open the clinic where I work at the district health post of Iringa, [Tanzania]. There are already women waiting; long queues… which mean a long day for me. I still need to check if we received iron and anti-malarial tablets we were supposed to, oh… and the pregnancy tests. My name is Yasinta, I am a nurse-midwife and this is a typical day for me.

Yesterday I had an interesting consultation with a young woman, Esther; she had a million questions. She’s probably in the early stages of her first pregnancy, but I couldn’t give her the pregnancy test to make sure! Some of her questions made me think about what we could do better to inform her and ensure we’re well-equipped to meet her needs. I would have liked to spend more time with her, but there’s too little time and too much paper work: Have I given her iron tablets? Tick. Given nutrition advice? Tick. Explained that she should not to work too hard in the shambaa (field)? Tick. The day is almost over, I need to rush, file my reports, talk to the health visitor and then go pay my rent before heading home. I often struggle to make ends meet at the end of the month.

This is just a small glimpse of the issues that race through the minds of midwives and other health care professionals as they face everyday realities: a heavy workload; shortages of supplies and equipment; inadequate workforce planning; lack of support and supervision; little remuneration for long hours and no professional associations to advocate for better, safer working conditions. More evidence is needed on how to best support midwives.

The State of the World’s Midwifery 2014

The State of the World’s Midwifery 2014 (SoWMy 2014) provides some of this evidence. This report calculates the amount of antenatal, intrapartum, and postnatal care needed globally between 2012 and 2030, to evaluate whether the projected reproductive, maternal, and newborn health (RMNH) workforce will be sufficient to cover population needs.

In Tanzania, where Yasinta lives, to achieve universal access to sexual, reproductive, maternal and newborn care, midwifery services must be able to respond to 3.6 million pregnancies each year by 2030. In 2012, Tanzania counted 2.6 million pregnancies a year with 84% of the population lives in rural areas.  Seeing the story of Yasinta’s day, the challenges the health system faces to meet the needs projected for 2030 are considerable.

SoWMy 2014 estimates that Tanzania currently covers 74% of the need for RMNH care.  In order to increase coverage—especially in light of a growing reproductive health need—SoWMy 2014 recommends four interventions:

  1. Effective family planning to reduce the number of pregnancies
  2. Doubling the number of student midwives, nurses and doctors
  3. Increasing the efficiency of health care providers by 2%
  4. Halving the number of workers who leave the health care sector over the next 5 years

With these four interventions, 98% of the reproductive and newborn health needs of the population could be covered by 2030. However, action needs to be taken now in order to ensure this desired outcome.

SoWMy 2014 includes Midwifery2030, a pathway that illustrates the health needs of women from the time they are young girls until they have completed their childbearing years. There are 10 pillars to support that pathway, some of which are the prioritization of midwifery care in the national health budget, the need for a fully functional work environment (with constant availability of supplies) and a collaborative team of midwives and doctors working together to provide first level and referral care in a supportive and respectful manner. These things are essential for Yasinta to do the best job she can in taking care of Esther.

How to strengthen or develop midwifery services to support midwives like Yasinta?

Midwifery is an enabling factor for achieving the MDGs and is key to the new post-2015 targets for sexual, reproductive, maternal and newborn health. Professional organizations, such as the International Confederation of Midwives (ICM) supports, represents and works to strengthen professional associations of midwives throughout the world, strengthen services and ensure quality across the continuum of care.

In order to hear the perspective of Ester, the patient, read the previous posts from this series.