Tapping into the power of nurses and midwives

Victor Mwibese, 22, a third-year student at St Magdalene School of Nursing and Midwifery in Kagera narrates to Your Health his passion and commitment to work in rural health facilities and assist in reducing maternal deaths in women and children.

He believes that modern health methodologies that he will acquire after completing his nursing course will enable him to handle complex complications related to delivery more precisely.

Mwibese’s major concern is about a critical shortage of skilled maternal health services providers which he himself perceives it as a driving factor attributing to maternal deaths burden in the Lake Zone and other parts of the country.

“Ignorance and lack of education on reproductive health among some nurses and midwives particularly in rural areas, are key factors that attribute to maternal deaths,” Mwibese tells Your Health during an interview.

As a young and inexperienced health professional, Mwibese uses his holidays to work at a health facility in his village in assisting the maternal health services providers to handle deliveries and complex complications that endanger the life of both mother and unborn child.

“The problem is that we (young nurses) sometimes face difficulties to work with senior nurses in the facilities because they don’t trust our capacities to handle maternal matters just because we are still learning,” says Mwibese.

Backing up Mwibese’s arguments, Grace Mliambate, who is also a third-year student at the school, says the existing shortage of skilled health professionals in rural areas is attributable to a shortage of modern learning equipment in the country, as a consequence, the schools produce incompetent graduates.

“Availability of modern learning equipment is essential in facilitating the acquisition of modern health methodologies among students,” says Mliambate.

Health workforce issues particularly the substantial shortage of maternal health service providers with nursing and midwifery skills jeopardize the government’s efforts to scale up coverage for maternal, new-born and child health. Based on a recent visit to Missenyi District, in Kagera, Your Health interviewed the District Medical Officer (DMO) Dr Hamis Abdallah about the shortage of health professionals.

The DMO confirmed that the district is hit by a critical shortage of health professionals including maternal health services providers.

“Health professionals’ unwillingness to work in unreached areas like islands is another factor attributing to under-staffing in the lake zone particularly in rural areas,” says Dr Abdallah.

According to him, there are 32 islands with a population of over 300,000 people in Missenyi District.

“During the 2017/18, only 12 healthcare providers were distributed to the district. The demand for health services is still high in the district, therefore I call upon the government to distribute more professionals,” says Dr Abdallah.

The existing shortage of health professionals in the district, particularly in the rural, is also contributed by lack of graduates with good competencies to cover the gap, according to the DMO.

Due to the shortage, the Lake Zone that comprises Mwanza, Mara, Kagera, Simiyu, Geita and Shinyanga regions continue to be the country’s part with the greatest burden of maternal ill-health.

According to recent statistics availed by Ministry of Health, Community Development, Gender, Elderly and Children, a total of 1,744 maternal deaths occurred in Tanzania Mainland in 2018.

At least 262 out of the deaths occurred in the Lake Zone, whereby Mwanza region alone recorded 151, becoming the region with the highest number of maternal deaths.

World Health Organisation (WHO) data indicates that the main direct causes of maternal death in Tanzania are haemorrhages, infections, unsafe abortions, hypertensive disorders and obstructed labours.

Henceforth, the availability of skilled health providers particularly midwives, nurses and doctors is critical in assuring high-quality antenatal, delivery, emergency obstetric and post-natal services in the region.

Indeed, the Sustainable Development Goals (SDGs) for maternal health is unlikely to be achieved without attention to the recruitment and retention of health professionals.

In this context, St. Magdalene School of Nursing and Midwifery in Muleba District, Kagera region has embarked on modern methodologies to recruit more young and competent nurses and midwives to deal effectively with the maternal burden in the Zone.

“The causes of maternal mortality and morbidity are well known, and mainly result from the inability of a health system to deal effectively with complications, especially during or shortly after childbirth,” says Renata Scarion, the St. Magdalene School’s Principal.

According to her, the school offers nursing and midwifery education in Diploma and Certificate levels. Currently, the school has registered 142 students pursuing nursing and midwifery education.

The school is among 10 private medical institutions in the region that benefited from the $32 million (equal to Sh70 billion) project dubbed ‘Maternal and Child Survival Programme (MCSP)’ led by Jhpiego in partnership with the health ministry and the Regional Administration and Local Government, funded by the USAID.

The organisation under the project donated lab skills equipment such as Mankins to facilitate learning in medical schools.

The schools also benefited through various training programmes aimed at building capacities of teachers to ensure they effectively equip the students with modern health methodologies related to reproductive health.

Referring to the positive impacts of the project, Ms Scarion reveals that the school performance in providing quality education pertaining to nurse and midwifery has increased from 48-94 per cent.

However, she further reveals that the school is hit by a critical shortage of funding.

“Majority of boys and girls in the region are keen on joining the school, but they are unable to afford the fees. I, therefore, call upon the donors and private institutions to offer scholarships to them,” says Ms Scarion.

Speaking to Your Health, Mr John George, the MCSP project director advised the school management to market itself through social media platforms, radio and television in order to increase enrollment of students.

Meanwhile, Mr George further noted that Jhpiego in collaboration with the government of Canada under ‘More and Better Midwives project’ was determined to continue offering scholarships to young Tanzanians pursing health courses.

Indirect effects of shortages in maternal health care

According to, Ms Placidia Muganguzi, a Reproductive and Child Health (RCH) in charge at the St. Joseph Hospital-Kagondo, in Kagera, an increasing workload within the health facilities due to a shortage of maternal health services providers can affect both the quality and safety of maternal care.

“This is especially relevant for rapidly evolving programmes in reproductive health, HIV/AIDS and tuberculosis, where strategies must be reinvented and re-taught, due to the loss of key personnel and the resulting loss of continuity,” says Ms Muganguzi.

Adding, “Staff may also need to work unpaid overtime to complete work to the level they are satisfied with.”

She further called for health sector reforms and macro-economic development policies to focus on curbing maternal deaths in the country.