Celebrate Solutions: Service Scheme Increases Midwives in Rural Nigeria

By:  Smita Gaith, Women Deliver

Nigeria’s maternal deaths account for 14% of the world’s maternal mortality, with the risk of dying from complications in pregnancy and childbirth as high as 1 in 29. However, a new service scheme is beginning to show some promise. 

The solution is called the Nigerian Midwives Service Scheme (MSS).  This is a public program established by the National Primary Health Care Development Agency (NPHCDA), and run as collaboration between Federal, State, and Local governments of Nigeria.

Understanding that many rural women often lack access to skilled birth attendants and birthing facilities, the MSS works to build capacity in rural areas so that more women have the care they need while in labor. Many skilled midwives and nurses often choose to work in urban centers, rather than rural outskirts. Often times, these skilled professionals prefer not to leave the comforts of the city, leaving a large gap unfilled in rural areas. Rather than reorganize these midwives and move them from cities to rural areas, the MSS offers an opportunity for midwives who are not working, such as those who have become newly qualified and those who are unemployed or recently retired (but still able), the opportunity to start working and to fill this gap.

Midwives are assigned to select Primary Health Centers (PHCs) with the capacity to provide Basic Essential Obstetric Care (BEOC), which are based near General hospitals that can provide Comprehensive Emergency Obstetric Care (CEOC). With a constant rotation of midwives around the clock, there is 24-hour availability in each facility, ensuring skilled attendance at birth and fewer maternal and newborn deaths. The current model includes 163 general hospitals, surrounded by 652 PHCs.

By July 2010, more than 2,600 midwives have successfully applied to the MSS program, and have been assigned to PHCs. The MSS created training modules to build capacity by improving skills and proficiency of midwives in providing high quality maternal and child health services, and then midwives underwent competency training. Nigeria hopes to build on the program by distributing medical apparatus, such as midwifery kits, blood pressure measurement devices, and others, to the 652 PHCs.

According to the World Health Organization (WHO), a partner of the project, there are five challenges that the MSS must overcome:  fulfilling the need for implementation of the Memorandum of Understanding, availability of qualified midwives, retention of midwives, capacity building of midwifes and sustenance of linkages. WHO also notes a need for support and commitment from government officers. Despite this, there has been progress in reducing maternal and newborn deaths, and best practices will be identified to overcome these challenges.

Other project partners include Jhpiego, US AID, and the Department for International Development (DFID), among others.

More information about the program is available on the WHO website, and through PLoS.

Flickr photograph via DFID UK.

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