Making pregnancy and childbirth safer in Mwayaya village

Monday October 19 2020
Pregnancy pic

Back in the days, people of Mwayaya village in Kigoma region, particularly pregnant women, were forced to walk 5kms to the nearby village, Mnanila, to access quality health services—a situation was attributed to a critical shortage of skilled nurse-midwives in the village.
The shortage of skilled nurse-midwives in the village persisted for many years until recently when Elizabeth Kaloza, 24, volunteered to work at the village’s dispensary as a certified nurse-midwife after graduating her two-year nursing and midwifery scholarship at Kisare School of Nursing and Midwifery in Mara region.
Elizabeth’s home village represents some hard-to-reach areas in the Lake and Western zones, which they are reported to experience a shortage of nurse and midwives. As per the Demographic Health Survey 2015/16, it shows that skilled assistance during delivery across country’s regions is small for Lake and Western regions as compared to other regions, with available data indicating that availability of skilled midwives, for instance, in Simiyu region stands at 42 per cent unlike Kilimanjaro (96 per cent) while Kigoma is at 47 per cent unlike Ruvuma (86 per cent).
Elizabeth received a fully-funded scholarship through Canadian funded ‘More and Better Midwives for Rural Tanzania (MBM)’ project, implemented in the zones by Jhpiego in partnership with the Ministry of Health and Local Government Authorities (LGAs).
The five-year MBM project (2016/20) mainly had focused on strengthening nursing-midwifery education curriculum in the Lake and Western zones to enable the students to acquire the nursing and midwifery knowledge, skills, attitudes and competencies and increase availability of competent nurse-midwives in the Lake and Western zones to ensure sustainable provision of skilled midwifery care to women and children and reduce maternal and newborn mortality ratios.

Elizabeth’s career journey impacted many
Upon the completion of her scholarship in 2018, Elizabeth returned to her home village and worked as volunteer at the village’s dispensary in an attempt to address the shortage of skilled nurse-midwives—while awaiting for government employment post.
She volunteered for about two years, today she is very delighted and proud to be a skilled and experienced nurse-midwife—regarded as a hero for her competency in providing skilled midwifery care to women and children.
Her decision to volunteer yielded a positive impact to the people of Mwayaya village, as she initiated several midwifery services including Emergency Obstetric Care (EmOC) and Essential Newborn Care (ENC), immunization and family planning services which were not delivered in the dispensary before.
“Sometimes I attend up to thirty women and children per day. They come for clinic sessions mostly,” Elizabeth tells Your Health in an interview.

Poverty nearly ended her dreams
With regards to the fact that Elizabeth comes from a poor family, her dreams to become a nurse-midwife was in danger to evaporate when she was disqualified to join government high school due to her poor performance in secondary education final examination.
Poverty and lack of support from her family were the main challenges for her, until when she secured a fully-funded scholarship to study nurse-midwifery courses.
According to the available data, Tanzania’s health sector, like most countries in Sub-Saharan Africa, is facing an acute shortage of health workers at all levels including skilled nurse midwives, hence the shortage directly affects the delivery of health care services to the Tanzanian people especially in the Lake and Western zones.
The data further indicates that one-third of the country (8 out of 25 regions) is operating with less than four nurse-midwives per 10,000 populations and three regions have less than 2.5 nurse-midwives.
The vacancy rate of nurse-midwives in hospitals and health centres in these underserved regions reach over 30 per cent due to the hardship conditions and lack of appropriate incentives to attract and retain trained nurse-midwives.
However, for some years now, the government has shown great commitment to fighting infant and maternal mortality, with the latest statistics from Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDEC) showing that the current estimated maternal mortality ratio is 556 per 100,000 live births and the newborn mortality ratio is 25 per 1000 live births.
The Lake and Western zones are leading with the highest ratios, whereby, according to United Nations Children’s Fund (UNICEF) 2019 data indicating that under-five mortality swings from 56 per 1,000 live births in the Northern regions and Zanzibar to 88 per 1,000 live births in the Lake regions.
The UNICEF data further indicate that the alarming mortality ratios are attributed to broad gaps in births assisted by skilled health professionals in rural and urban areas (55 per cent and 87 per cent respectively).
However, medical sources demonstrate that most delivery complications could be prevented or managed if women had access to skilled birth attendants during childbirth.

Government response to the shortage of skilled nurse-midwives
Assistant Director of Nursing Quality Improvement from the Ministry of Health, Mr Saturini Manangwa, pledged that the government would facilitate capacity building training of nurse-midwives in other country’s regions which were not reached by the project with a view to ensuring that women and children across the country have greater access to sustainable skilled midwifery care.
The director of preventive services in the Health Ministry, Dr Leonard Subi has reiterated the government commitment to continue employing graduated health professionals so as to address the existing shortage of health workforce in the public health facilities and improve the quality of health care provision among women and children in particular.
“In the past five years, we have employed about 14,400 health professionals in government health facilities and we will continue to employ many more whenever the employment opportunities become available,” says Dr Leonard.

Call for students to undertake nurse-midwifery courses
Secondary schools in the Lake and Western zones have been encouraged to sensitise students particularly girls to undertake science subjects as a prerequisite for the nursing course as research shows that Tanzanian girls are less 34 per cent in the nursing schools as compared to boys (66 per cent).