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Traditional Midwives: Partners for the
Delivery of Essential MCH Services
With the current scarcity of professionally
trained health manpower, especially in the remote communities
of Liberia, the need to improve the capacity of traditional
midwives to deliver essential community based Maternal Child
Health (MCH) services cannot be over-emphasized.
USAID provides funding to four international
nongovernmental organizations (NGOs)-World Vision International,
Save the Children Fund/United Kingdom, AFRICARE, and the International
Rescue Committee-for the revitalization of primary health
care services. These four international NGOs are supporting
74 health facilities that are providing primary health care
services to residents of 1,307 remote communities in Lower
Lofa, Bomi, Grand Cape Mount, Montserrado, Margibi, Bong,
and Nimba Counties with the estimated population of more than
1.5 million inhabitants. Statistics from these 1,307 remote
communities have shown that traditional midwives performed
about 75 percent of deliveries outside health facilities.
There has been training for traditional midwives
in Liberia focusing on clean and safe delivery since the 1950s.
These midwives now receive licenses from the Liberian Board
of Nursing and Midwifery which are renewed annually through
their respective supervisors. The responsibilities of the
supervisors include conducting regular training sessions to
upgrade the performance of the traditional midwives, periodically
inspecting their delivery kits and reviewing their delivery
records with the view of providing the appropriate on-the-spot
training.
Traditional midwives were trained to become
health promoters, community mobilizers and change agents for
health development. Topics discussed during training sessions
included: Malaria prevention and control, sexually transmitted
infections including HIV/AIDS, sanitation, community participation
and development, immunization, diarrheal control, identification
of high risk pregnancy, the benefit of prompt and appropriate
referrals, and child rights issues.
Professionally certified midwives, who tend
to be younger women based in clinics, made periodic out-reach
visitations to the homes of traditional midwives and provided
on the spot training. Certified midwives also facilitated
the process for traditional midwives to accompany their clients
to the prenatal clinics and participate in the antenatal assessment.
This formed part of the on-going training provided to the
traditional midwives and reinforced the team spirit between
them and the certified midwives. As a result of this, the
traditional midwives promptly referred complicated deliveries
to the certified midwives in the clinics for appropriate management
thus reducing maternal mortality in these remote communities.
The Liberian experience has revealed that
it is essential to work with traditional midwives not only
for clean and safe deliveries, health education, and early
detection of complications for prompt referrals, but also
to improve their capacity to use home-based life saving skills
for the prevention of maternal, neonatal, and infant mortality.
Most maternal and/or newborn complications cannot be predicted
and are life threatening so it is necessary for the traditional
midwives to be empowered with the requisite skills to take
the appropriate action.
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