In the rural areas of Ethiopia, nurse midwives face the crisis in maternal health alone.
Most pregnant women receive no antenatal care. Most women deliver at home, and many die in childbirth. Many more infants die. There are no doctors, and the nearest hospital is hours away. Nurse midwives, with minimal education, no supervision or mentorship and little in the way of equipment and supplies, deliver babies in rural health facilities. If the delivery is complicated, babies often die and sometime mothers die.
Supporting Nurse Midwives Through Mentorship
In 2021, we tested nurse midwives working in health facilities in the West Omo Zone, one of the poorest and most remote parts of Ethiopia. We assessed their basic maternal obstetric and neonatal resuscitation skills. All nurse midwives flunked their skill checks. None of them had the lifesaving skills essential to keeping mothers and babies safe before, during, and after childbirth.
In response, we created the Skill Check, Training, and Mentorship (SCTM) Program. The plan for the program was the brain child of our longtime partner, Yared Deyas, who is himself a nurse midwife. Yared works at the Mizan Tepi University Teaching Hospital (MTUTH) where he runs our education and training programs in southwestern Ethiopia. He insisted that nurse midwives on the front lines needed support, targeted intervention, on the spot training and ongoing mentorship.
Skill Checks and On-the-Spot Training
Through the SCTM Program, Yared and another master nurse midwife trainer from the MTUTH travel to each of eight healthcare facilities in the West Omo Zone four times per year. They skill check two nurse midwives in each facility and provide on the spot training when deficits are found. These nurse midwives, in turn, are expected to share their knowledge and skills with other providers in the health facility. Yared and his collegues provide ongoing support. Scores are tracked and monitored in our new SafeClinicToolkit application on an iPad that can be used in the field. Nurse midwives who are identified as needing extra help are referred to our three-week JHPIEGO Basic Emergency Maternal Obstetric and Neonatal Care (BEMONC) training program at the MTUTH in Mizan.
We started the program in 2022, and we are already receiving feedback from the field. The nurse midwives participating in the program feel nervous about the testing, but are gaining more confidence through the training and support that is being provided. They are asking for equipment and supplies and for specific training and help with difficult cases. It is our hope that the confidence and skills that they are gaining through the SCTM Program will help further our goal of improving access to clean, safe and effective healthcare for all pregnant women in the West Omo Zone.
