Kumiko Nakano1, Yasuhide Nakamura2, Akiko Shimizu3, Sojoud Mohamed Alamer4. 1. Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Miyagi 980-8575, Japan kumiko@med.tohoku.ac.jp. 2. School of Nursing and Rehabilitation, Konan Women's University, Kobe, Hyogo 658-0001, Japan nakamuraya@konan-wu.ac.jp. 3. Japan International Cooperation Agency, Nibancho, Chiyoda-ku, Tokyo 102-8012, Japan shimizu.akiko@jica.go.jp. 4. ational Reproductive Health Program, PO Box 303, Khartoum 1111, Sudan sojoudalamer@gmail.com.
Abstract
INTRODUCTION: Home birth remains a strong preference and village midwives are the only option for maternal and neonatal care for many rural women in Sudan. This study assessed whether interventions such as strengthening linkages among health facility/staff, skilled birth attendants and village midwives (VMWs); strengthening the supervision system; and strengthening the governance capacity of local health departments improved their service delivery, and it examined factors linked with improved performance of VMWs in their communities. METHODS: This descriptive study comprised a cross-sectional baseline survey, two intervention years and an endline survey. Data collection involved in-depth, semi-structured questionnaire interviews. Fifty-seven VMWs and 151 community women were targeted for the study in Sinnar, a south-eastern state of Sudan. Participants were interviewed about demographic information, perceptions of operational barriers, training provided, function in the community, supervision and referral for emergency cases. RESULTS: Results showed the monthly average number of VMW-assisted home births increased from 1.4 at the baseline survey in October 2011 to 3.3 at the endline survey in October 2013. The annual average number of emergency cases referred by VMWs increased from 1.6 to 3.5, and the percentage of VMWs using official monthly reports increased from 33% to 80%. VMWs reported improved bonds with their supervisors and relationships in the community. CONCLUSION: Improved service provision may be associated with development of supervision systems for VMWs, active provision of community activities, strengthened linkages between health facilities and VMWs and enhanced community trust of VMWs. Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in particular settings, international communities should focus on strengthening capacity of community midwives for home births as a realistic measure.
INTRODUCTION: Home birth remains a strong preference and village midwives are the only option for maternal and neonatal care for many rural women in Sudan. This study assessed whether interventions such as strengthening linkages among health facility/staff, skilled birth attendants and village midwives (VMWs); strengthening the supervision system; and strengthening the governance capacity of local health departments improved their service delivery, and it examined factors linked with improved performance of VMWs in their communities. METHODS: This descriptive study comprised a cross-sectional baseline survey, two intervention years and an endline survey. Data collection involved in-depth, semi-structured questionnaire interviews. Fifty-seven VMWs and 151 community women were targeted for the study in Sinnar, a south-eastern state of Sudan. Participants were interviewed about demographic information, perceptions of operational barriers, training provided, function in the community, supervision and referral for emergency cases. RESULTS: Results showed the monthly average number of VMW-assisted home births increased from 1.4 at the baseline survey in October 2011 to 3.3 at the endline survey in October 2013. The annual average number of emergency cases referred by VMWs increased from 1.6 to 3.5, and the percentage of VMWs using official monthly reports increased from 33% to 80%. VMWs reported improved bonds with their supervisors and relationships in the community. CONCLUSION: Improved service provision may be associated with development of supervision systems for VMWs, active provision of community activities, strengthened linkages between health facilities and VMWs and enhanced community trust of VMWs. Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in particular settings, international communities should focus on strengthening capacity of community midwives for home births as a realistic measure.
Entities:
Keywords:
Sub-Saharan Africa; Sudan; capacity building; community; home childbirth; maternal mortality; midwife; supervision; traditional birth attendant; antenatal care
Authors: Caroline Se Homer; Sabera Turkmani; Alyce N Wilson; Joshua P Vogel; Mehr Gul Shah; Helga Fogstad; Etienne V Langlois Journal: BMJ Glob Health Date: 2022-01