Inaugural Commonwealth Nurses Conference Our health: our common wealth 10-11 March 2012 London UK Mr MARAKA MONAPHATHI Nurses views on improving midwifery practice in Lesotho In collaboration with the 9 th CNF Europe Region Conference Supported by the Royal College of Nursing UK
Lesotho Nurses Association VIEWS OF NURSES REGARDING MIDWIFERY PRACTICE IN LESOTHO Monaphathi Maraka
Background Defined as with woman midwifery is a major part of nursing practice in Lesotho; Improved midwifery is key to Lesotho s ability to meet MDG 4s & 5 and reduce maternal and infant mortality; Public representatives seek alternative means to conventional ones to strengthen midwifery; LNA identified need to assess nurses views on midwifery;
Lesotho s Performance on MDG 6) Mixed Progress, with Education and Gender MDGs improved while others are challenged; MDG 5: Reduce maternal mortality by 2/3 -OFF TRACK No. of women who die from pregnancy and birth related causes increased immensely since 1990; Presently, 1/32 women die of pregnancy and child birth; Neonatal mortality is among the highest in the region, with 1,155 deaths per 100,000 live births; Lesotho targeted to reduce maternal deaths to 300 deaths per 100,000 live births by 2015 but not likely with present trend; A weak health system, shortage of skilled staff and other resources pose challenges in reducing maternal mortality; MDG 5 is the worst performing of the eight.
Objectives To assess opinions of Nurses and Midwives regarding ways to strengthen midwifery through - training - supervision - regulation Identify key areas for strengthening Midwifery practice as a way to improve community level care for improved performance on MDG 5;
Methodology Data Collection: A survey using a purposive sampling design with a self-administered questionnaire; Analysis: Qualitative, SPSS used to derive frequencies, with inference and identification of key themes;
Findings 1 - Demographics Respondents: N= 57 Age: Average is 38 years Gender: F= 66.6 % M=26.4% Designation: 22 different job titles Year Graduated: From 1971 to 2011 ranging between 1 to 3 respondents per year Qualified as a Midwife: Yes 82.4 % No 10.5% Additional Qualification: Yes 80% No 18.1%
Findings 2 Standards & Competencies What is the standard of midwifery practice in Lesotho? Excellent 8.8% Average 65% Poor 19.3% N/S 1.8% Should Nursing Assistants be trained in Midwifery without General Nursing? Yes:5.2% No: 84.2% N/S: 5.2% What motivated you to become a midwife? (mostly a pre-packaged post-basic trend, e.g
What motivated you to do midwifery? It was compulsory, and before I did it I worked at a rural clinic and the community needed nurses to have midwifery It was only specialty offered and I liked it I liked the duties of midwives, it was part of training So to professionally be able to care for mother to child To be well equipped as a nurse midwife To complete my studies To contribute on maternal and child health To have the totality management of a human being
Findings 3 Roles of Stakeholders How can community based maternal and child health services be improved? A: Mostly by: Knowledge and Skills Building through Workshops, Sensitizing Local Authorities, Supervision and Incentives for CBWs, Re-Integration into MoH What must be the roles of MoH, Nursing Council, Nurses Association, CHAL to strengthen Midwifery? A: Mostly in line with the organizations primary functions, cross cutting actions were Recruitment, Finance, Empowerment and Authority and Responsibility support
Service Provider: cross-tab 1: Gender * What do you think midwifery should be to improve maternal care in Lesotho? Gender Mandatory Optional Tot Male 8 7 15 Female 34 3 37 NR - - 5 Total 42 (77.2%) 10 (17.5%) 57
Service Provider: Cross tab 2: Gender * Are you qualified as a Midwife? Gender Yes No Tot Male 9 4 13 Female 36 2 38 NR - - 6 Total 45 6 57
What is a nurse without midwifery? A nurse is incomplete without midwifery Burdens the system because this person will be lacking other skills and will not monitor women in labour Cannot be placed in the clinics where she will have to be independent therefore does not overcome shortage Cannot care for pregnant women and newborn babies hence increase maternal deaths Cannot run a clinic independently in mountainous areas Cannot take good care of pregnant, labour and deliveries Cannot work efficiently through mountainous of Lesotho She becomes inefficient and challenged in terms of supervision, her performance is limited and less marketable
What is a nurse without midwifery? As shown, majority (42%) favour midwifery being mandatory Main themes identified: - specific country geo and resource context - Professional independence at work - Human resource issues - flexibility - Community expectations of services - Communicating with other professionals
Poor Standards of Midwifery Who Cares? Lesotho Nursing (and Midwifery) Council has in 2012 already 2 professional misconduct cases involving mother and child issues; So far in 2012, four (4) national newspaper headlines were on issues related to health workers and mother and child issues;
Conclusion Despite its limitations, the study Draws useful inputs for planning, consultation and creates awareness to improve midwifery to overcome challenges to MDG 6; Identifies need for more HR development, high level support and finance to improve quality of care; Midwifery is popular and an essential qualification to benefit health service users; Nurses DO NOT support midwifery skills building to lower cadres without prior general nursing course;
Recommendations Continued dialogue on Midwifery informed by: - Review of the role of midwifery in meeting MDG 6 based on What s a nurse without midwifery? - Sensitize nurse leaders to improve mother and child care (MDGs 4 and 5) where they work; Issue LNA position paper based on findings and on bench marks of practices in the region and globally; Advocacy for strengthening midwifery education, service designs and practice in Lesotho; Proportionate financing and systems support the desired outcomes for MDG 4 and 5;
Sources: http://www.un.org.ls/mdgs/mdgs_lesotho.php Lesotho Nurses and Midwives Act (1998) GOL, Maseru Public Eye Newspaper - 2012 Sunday Express newspaper 2012 Lesotho Times newspaper - 2012 Thank you