An evaluation of community midwifery program in Sindh, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


An evaluation of Community Midwifery Program in Sindh, Pakistan. Background: Community Midwifery (CMW) program was started in realization of Government of Pakistan's commitment with international community to achieve MDGs, particularly MDG 4 and 5. Presence of trained skilled birth attendant at the time of birth and reduction in maternal mortality are directly proportional as proven from the experiences of various countries and most of them have brought significant reduction in maternal mortality through deployment of community based skilled birth attendants at community level. The availability of trained skilled birth attendants ensures access to quality care to women in an enabling environment in terms of equipment, medicines and availability of transport for referral to emergency obstetric care, if required; while operating within a positive political, and socio- economic environment. Despite huge investment in training and deployment of CMWs, various assessments have shown sub optimal performance of CMWs; hence, we have conducted a study by using SWOT analysis to understand the causes of this dismal situation and formulate recommendations for program management. Methods: A qualitative descriptive exploratory design was used, and Khairpur district was purposely selected because maximum numbers of CMWs are deployed in this district and it was the district where first batch of CMWs was deployed. FGDs were conducted with CMWs and community women and in depth interviews were conducted with various stakeholders mainly involved in implementation and policy making. Findings: Major findings that have emerged are that the CMW Program has developed infrastructure, curriculum, deployment guidelines, MIS and monitoring and supervision systems. • iv However, there are some gaps in implementation, monitoring and supervision systems which subsequently lead to poor quality of training thus resulting in lack of confidence among CMWs; delayed deployment leading to de-motivation and drop outs; unavailability of equipment and supplies leaving CMWs on mission without arms; delays in payment of stipends and weak monitoring and supervision systems which contribute further in worsening the situation. The CMWs have over the years struggled hard to establish themselves in the communities and they are self-motivated and passionate to learn and serve the communities, they feel that community is recognizing them and respecting them. Conclusion: Placement of skilled birth attendants at community level is proven as a successful intervention by which many countries have achieved significant reductions in maternal mortality. Hence, this initiative is taken in Sind also and a number of CMWs trained and deployed at community level. Though CMWs are striving hard to establish themselves as skilled birth attendants but still there are some gaps in implementation of CMW Program but there is time to revamp the strategy and bring in investments for further strengthening of CMW Program because it is an opportunity to reach poor and marginalized women at their door steps through CMWs which should not be missed out.

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