Date of Award

12-2020

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Sarah Saleem

Second Advisor

Ms. Anam Feroz

Third Advisor

Farina Abrejo

Department

Community Health Sciences

Abstract

Introduction: Access to antenatal, delivery and postnatal care is crucial in decreasing maternal and newborn death. World Health Organization emphasizes skilled care at birth by health care providers including a trained doctor, nurse or midwife during pregnancy, delivery, and postnatal period to decrease maternal and newborn deaths. In recent years, the number of maternal and newborn mortality has significantly decreased with introduction of midwifery led models worldwide. Most of the countries like Sweden, China, Iran, Thailand, Sri Lanka Cuba and Malaysia, have improved their maternal mortality ratio, by increasing investment in training and deployment of midwives. Many countries in Asia have also developed the model of training and introducing community midwives in their health system and have made significant improvements in MMR. To address the issue of high maternal mortality, the Government of Pakistan initiated Community Midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. In the low-income setting of rural areas of Pakistan, where people cannot afford services of obstetrician, community midwives can reduce maternal and newborn mortalities within their communities through services to childbearing women, at a primary care level. There is less data concerning CMWs training, deployment and services utilization within rural areas for maternal and newborn health. The evidence is important in the planning and implementation of health policies and their strategies addressing sustainability of services provided by midwives to promote and improve maternal and newborn health.
Study Objective: The study aimed to understand the current role of midwives in providing maternal and newborn services and to explore facilitators and barriers influencing CMWs services utilization in district Thatta.
Methodology: The study is a qualitative exploratory research design. Data were collected through semi-structured interviews using purposive sampling. The data collection technique included key-informant interviews and individual in-depth interviews. In-depth interviews were conducted with midwifery students; community midwives working in their own field; non working community midwives not working in their own fields or not in job; and community married women from district Thatta. Key Informant Interviews were conducted with District Health officer, District coordinator of MNCH program, Principal of school of midwifery; district Thatta, General Secretary of Midwifery association of Pakistan and Director, General nursing and midwifery program. The study data were analyzed using thematic analysis approach.
Results: The major hindering factors for CMWs services utilization included CMWs skills and competencies, ownership and supervision of CMWs program, community acceptance and support and dynamics between CMWs and other health care providers. All the study respondents identified deficiencies in CMWs training particularly in clinical hands on training. The enrollment criterion of students is inappropriate and there is lack of quality of midwifery teachers according to standard guidelines. Regarding support to CMWs program, all the participants in KIIs and CMWs communicated about lack of ownership and of service structure for CMWs in the form of a specific regulatory body for only CMWs in Pakistan. They expressed that this impedes CMWs educational and professional growth. The young age of a novice CMW also hinders their acceptability in communities. Demeaning behavior of practicing doctors and TBAs in the area are other challenges, which CMWs have to face on day-to-day basis.
Conclusion: Study finding suggests that there is a lack of support to midwifery students for clinical training and there are administrative weaknesses in training of CMWs. The lack of supervision and ownership of CMWs program is a major hindering factor for utilization of V CMWs services. The monitoring and supervision by program planners and policy makers for CMWs training and deployment is insufficient. Thus, to achieve universal health coverage for pregnant and delivering women, there is an urgent need of mainstreaming the services of CMWs in the health system of Pakistan, and to recognize the importance of this cadre to provide the maternal and newborn health services in the rural and far of areas in Pakistan.

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1

Last Page

107

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