High maternal mortality calls for more and better nurses and midwives

Project title: Development of a Novel Nursing and Midwifery Graduate and Postgraduate Training Program in Malawi, Zambia and Zimbabwe.

Background

The maternal mortality ratios are high in the LMIC partner countries according to national statistics official figures; 675/100.000 in Malawi, 440/100.000 in Zambia and 960/100.000 in Zimbabwe. The neonatal mortality rates are 31/1000 in Malawi, 30/1000 in Zambia and 31/1000 in Zimbabwe. In addition the countries have a high disease burden which is partly contributed by high prevalence of HIV and AIDS. Nurses and midwives comprise the bulk of health workers in these countries. However, in the three countries the population of nurses and midwives as well as other health workers are very low as evidenced by high nurse-patient ratios. According to WHO, for developing countries, the recommended ratio for nurse-patient is 1:1000. But in Malawi the ratio is as high as 1:2300, in Zambia it is 1:1864 and in Zimbabwe it is 1:1136. The population of midwives per 10.000 women of child bearing age is 3 in Malawi, 7 in Zambia and 10 in Zimbabwe. Consequently, the mothers and new-born babies are dying from treatable pregnancy and birth related complications in these countries. Furthermore, the three countries are lagging behind in the attainment of the MDGs.

A key strategy to improve nursing and midwifery care is to train more competent nurses and teachers. I.e. a study conducted in Zimbabwe shows that 55 % of the midwives could not manage the 3rd stage of labour (postpartum bleeding), which is the major cause of maternity mortality. Results further show that 66 % of the midwives could not provide standard new-born care. This situation is similar in the other two countries as shown in high maternal and neonatal mortalities.

One of the factors contributing to the high maternal and neonatal mortalities is that the nurse midwives are not properly prepared for the real life challenges during pre-service training. The current nurse-midwife training curricula do not address the current and emerging challenges. Therefore there is a need to improve the curriculum to make it more competent and evidence based.

Addressing gaps in the training of nurses and midwives in Malawi, Zambia and Zimbabwe through focusing on building capacity within research, which will feed into more competence and evidence based teaching programmes

The project aims at addressing gaps in the training of nurses and midwives in Malawi, Zambia and Zimbabwe with mentorship from Universities of Tromsø and Oslo, Norway. A novel, competence and evidence based nursing and midwifery curricula at M.Sc. and PhD level will be developed and current B.Sc. curriculum will be strengthened to make it competence and evidence based. A bridging program for registered general nurses and midwife technicians will also be developed. The nurses and midwives will be trained in partnership among the participating countries through exchange of teachers and clinical supervision of staff, thus complementing each other in their areas of strength. Faculty will strengthen their qualifications through PhD Fellowships. The novel training program that will be developed will serve as a model for adaptation and upscaling to other LMICs. In addition the project will develop capacity in the implementation of multi-institutional research projects and will build capacity among faculty members in undertaking nursing and midwifery research through competitive research grants.  

It is envisaged that the novel nursing and midwifery program will produce nurse and midwife graduates who are capable of solving both the current and emerging health challenges and to improve the quality of nursing and midwifery care which in turn will improve the quality of life in the three countries.

Key goals and achievements:

Overall goal
Improved quality of life and survival for mothers and new-borns in Malawi, Zambia and Zimbabwe.

The objectives of the project are:

1. Nursing and Midwifery education training strengthened in the participating higher education institutions in Malawi, Zambia and Zimbabwe
2. Nursing and Midwifery research strengthened in the participating higher education institutions in Malawi, Zambia and Zimbabwe