Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality

This is the third article in The Lancet’s series on Midwifery. It reviews four countries’ efforts to improve maternal and newborn survival through investments in midwifery: Burkina Faso, Cambodia, Indonesia, and Morocco.These are countries which deployed midwives as a key component of their strategies to improve maternal and newborn health. The authors conducted their review by identifying key interventions in health system strengthening related to investments in midwifery and maternal health. These interventions identified were then cross-checked through a structure literature review and key informant interviews. Key findings from the review include:Common interventions for improving maternal and newborn health identified across the four countries: 1)      Extension of close-to-client networks of health facilities, which led to an increase in facility births and hospital care for complications. This was the foundation of improved effective coverage.  2)      Scale-up of the workforce able to provide birthing care and meet the growing demand.3)      Reduced financial barriers to accessing care.4)      Efforts to improve quality of care.The quality of care challenge:Efforts to improve quality of care took place some-time after the countries had already begun increasing uptake of care. Only recently have these countries focused on promoting respectful women-centred care and what midwives and doctors could do to restrict over-medicalisation e.g. high numbers of caesarean sections.Implications for policy:All four countries currently have a strong level of political commitment to improving maternal and newborn health and the expansion of midwifery. However, this has only come about recently as the success of deploying midwives became clear and civil society became more vocal.What is clear from the experiences of these four countries is that a strategy for improving maternal and newborn health depends on the design and investment in the whole service delivery network, rather than merely a choice of the professional cadre to be scaled up. The deployment of the workforce as part of this service delivery network will need to consider pace, cost and quality.To read this article, click here. Free registration is required.To read a blog about the study by one of the authors, click here.To read the other articles in the Series, click here.van Lerberghe, W., Matthews, Z., Achadi, E., Ancona, C., Campbell, J., Channon, A., de Bernis, L., De Brouwere, V.,Fauveau, V., Fogstad, H., Koblinsky, M., Liljestrand, J., Mechbal, A., Murray, S, F., Rathavy, T., Rehr, H., Richard, F., ten Hoope-Bender, P., Turkmani, S. (2014). Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. The Lancet, The Lancet, 384(9949),1215-25.