This blog introduces one of the 2014 International Midwife Award winners Sister Agnes Kasaigi. The awards were sponsored by The International Confederation of Midwives and Save the Children. This blog was adapted from Agnes' application submitted by her nominator, Sylvia Nabanoba. The award winners were announced at this year’s International Confederation of Midwives 30th Triennial Congress in Prague, Czech Republic on June 3rd. Click here to learn more.
"One day while I was on the ward, a pregnant woman came to give birth. She had not attended antenatal care at our hospital. She was severely anemic and I wondered whether she had had any antenatal care at all. What kind of health worker would let a pregnant woman deteriorate to that level without doing something about it?” recalls Sister Agnes Kasaigi, head of the Maternity Unit at Buwenge Hospital in Jinja district, Central Uganda.
Agnes goes on to explain that the case was too complicated to be handled by her hospital and immediate referral was sought. “Our ambulance was down, and the woman’s relatives did not have money. We tried our best to ensure that we got her to a referral hospital in time. We approached the local council chief who was willing to give us some money, and hired a car that took her to hospital. Unfortunately, she died before she could give birth to her baby. The baby died too,” continues Sr. Kasaigi. Because of this tragic incident, Agnes works to ensure pregnant women seek proper antenatal care, and she teaches women the risks that place pregnant mothers’ lives and those of their babies in danger.
When Agnes Kasaigi recalls the maternity unit at Buwenge Hospital in Uganda’s Jinja District a few years back, she remembers a disturbing pattern: babies would die during labor and within a short time of being born. “We did not know how and were not equipped to save these lives. We used to get many stillbirths because we did not have the knowledge and equipment for resuscitating babies,” she remembers. The start of trainings on newborn resuscitation were a turning point for Sister Kasaigi, head midwife working in the hospital's maternity ward. She says that many at Buwenge hospital just accepted these deaths but she thought that something more could be done. After training, she committed to put in place a resuscitation area, and decided to ask the hospital’s matron-in-charge to invest in a mattress and equipment to help babies breathe at birth.
Sister Kasaigi’s was granted these resources and after taking part in the training of others in her hospital on this life-saving skill, she confidently assures that no stillbirths have occurred under her watch. “Today the way we conduct our work is different – and so is the situation in our hospital. Initially, I would register one or two stillbirths per month under my watch. But now, I can spend months without handling a mother with a stillbirth,” Sr. Kasaigi confidently says.
Last week, Sister Kasaigi became one of the two recipients of the 2014 International Midwife Award at the 30th Triennial International Confederation of Midwives (ICM) Congress last week.
Her award and achievements are especially impressive because Agnes faces daily struggles in her rural hospital in Central Uganda. “We face many challenges every day. A lack of midwives is a big one.” According to the recent report, State of the World’s Midwifery, when trained and supported by a functional health system, midwives could provide 87% of the essential care needed for women and newborns, and could potentially reduce maternal and newborn deaths by two thirds.
Sister Agnes takes part in the training of nurses and midwives, alongside managing the maternity unit, which cares for 60-70 neonatal cases a month. Her contributions at the hospital have not gone unnoticed by her colleagues. Rahil Kirunda, in-charge at Buwenge hospital proudly says: “I have worked with Agnes for 10 years now, and she has showed great love and respect for her role as a midwife to the community. They have embraced her and trusted her with their lives during pregnancies. Our hospital serves an area which is mostly rural poor, and many are affected by HIV and face the stigma for the disease.” Agnes also delivers interventions that prevent the transmission of HIV from mother-to-child, and is respected and trusted among the community and surrounding areas.
“It is a miracle. When an HIV-positive mother comes to me for proper antenatal care, takes her required medication, and delivers a live, healthy baby,” Agnes says. “One of these mothers has in fact delivered not one but three HIV-negative babies, and they are happy and healthy children.”
Agnes Kasaigi receives the 2014 International Midwife Award from Mary Higgins, Board Member of the International Confederation of Midwives, left, and Prof. Joy Lawn on the London School of Hygiene & Tropical Medicine and Senior Advisor for Save the Children, center, at the ICM 30th Triennial Congress in Prague on June 3rd. Photo: Bex Morton/Save the Children
Agnes thinks that people interested in midwifery should be compassionate towards mothers and their babies, approachable, and determined to help babies survive. They should also “be kind and so lovely”, says Agnes who accepted the international recognition at the ICM Congress in Prague.
This blog was originally published In The Lancet Global Health Blog
Maternal and neonatal survival have been in the headlines again this week as the Institute for Health Metrics and Evaluation and WHO released new figures and Save the Children published its annual State of the World's Mothers report. May 5 was International Day of the Midwife: what can skilled birth attendance do for maternal and neonatal health and how can it be scaled up? Recent figures from WHO indicate that the proportion of under-5 deaths that occur in the first month of life increased from 37% in 1990 to 44% in 2012, resulting in 2.9 million neonatal deaths annually. One of the strategies to reduce neonatal mortality is promoting the provision of essential newborn care by skilled birth attendants (SBAs). However, with an estimated 46 million women who are likely to deliver alone or without adequate care, one wonders whether promotion of skilled birth attendance is being prioritised enough to bring about the much desired reduction in global neonatal mortality.
In a systematic review estimating the effect of various childbirth care packages on neonatal mortality due to childbirth-related events in term babies, Lee and colleagues reported that skilled birth care could reduce neonatal mortality by 25%. The review also reported the potential in the provision of comprehensive emergency obstetric care and basic emergency obstetric care to reduce these deaths by 85% and 40%, respectively.
However, many developing countries struggle to provide basic care for women and their babies. In a cross-sectional survey of 378 health facilities in Kenya, Malawi, Sierra Leone, Nigeria, Bangladesh, and India, Ameh and colleagues reported that only 23.1% of the health facilities aiming to provide comprehensive emergency obstetric care were able to offer the nine required signal functions and only 2.3% of health facilities expected to provide basic emergency obstetric care provided all seven signal functions. The picture is not different in many other sub-Saharan African and Asian countries. The global shortage of health-care providers certainly does not help the situation.
In addition, there is evidence of a “skills gap” for many SBAs in countries where most of the neonatal mortality occurs. In a study that mapped out cadres of health-care providers considered to be SBAs in nine sub-Saharan African countries, Adegoke and colleagues found that a total of 21 different cadres of health-care provider were reported to be an SBA. Most of these cadres lacked the skills to provide the signal functions of emergency obstetric care and early newborn care. Utz and colleagues also reported similar findings when they did a similar study in four countries in southeast Asia.
Task shifting is one of the strategies recommended by WHO to improve availability of emergency obstetric care and newborn care services. Lower-level and middle-level health-care providers such as community health workers are trained to perform specific tasks that may otherwise be performed by higher-level staff that take longer and cost more to train.
In the continuum of care, because newborn care is closely related to maternal care, training of lower-level health-care providers also provides the additional benefit of addressing challenges related to both demand for and supply of maternal care.
It is on this premise that the Making it Happen programme, which is being delivered by the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine, UK, is helping health-care providers in developing countries to increase their knowledge and develop skills in the provision of basic and comprehensive emergency obstetric care and early newborn care.
A short competency-based "skills and drills" training package for health-care providers in resource-poor countries was developed in 2006 by the centre in collaboration with the Royal College of Obstetricians and Gynaecologists and the Department of Making Pregnancy Safer at WHO. The package focuses on the signal functions of emergency obstetric care and early newborn care. With the support of UK Department for International Development, the programme has been rolled out in 12 sub-Saharan African and Asian countries.
In a before-and-after study involving 222 health-care providers in Somaliland who were trained in the Making it Happen programme, participants were evaluated on change in knowledge, skills, behaviour, and functionality of their facilities during and immediately after training, and at 3 and 6 months post-training. There was improvement in 50% of knowledge and 100% of skills modules assessed. Availability of signal functions for basic and comprehensive emergency obstetric care in participating facilities improved from 43% and 56%, respectively, to 100%.
For the long-term success of interventions, it is crucial that they follow the guiding principles of the forthcoming WHO Every Newborn Action Plan. In line with these principles, the Making it Happen programme ensures ownership of the intervention by training some of the higher-level health-care providers as trainers so that, with the aid of training equipment that is also supplied to the participating countries, they can continue to build skills within their countries even after the programme. Additionally, the monitoring, evaluation, and feedback mechanisms that have been built within the programme enables the Centre for Maternal and Newborn Health and other stakeholders to continuously refine and innovate for even better delivery and impact.
Finally, with current evidence suggesting that training of health-care providers is effective in increasing availability and quality of maternal and newborn care services, this strategy should be placed higher on the newborn health stakeholders’ list of priorities, and continued improvement of skilled birth attendance in developing countries should be supported.
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This blog is part of a series introducing the 2014 International Midwife Award sponsored by The International Confederation of Midwives and Save the Children. These blogs were adapted from the applications of finalists. The award winners were announced at this year’s International Confederation of Midwives 30th Triennial Congress in Prague, Czech Republic on June 3rd. Click here to learn more about the winners.
Finalist, Professor Address Malata, is a Nurse, Midwife and Professor from Malawi. As the Principal of the University of Malawi, Kamuzu College of Nursing (KCN), Address has been essential to the advancement of the nursing and midwifery workforce in Malawi. Her leadership has led to establishing six new masters programs, and launching a PhD program at the University.
In addition to her leadership in education, Address has made substantive contributions to the improvement of health care of women, children, and persons with HIV and AIDS through research, publications, and presentations. She has initiated training in essential newborn care, resuscitation, and kangaroo mother care. She has been first author or co-author on numerous publications focused on maternal and child health care, and care related to HIV and AIDS. As a consultant to numerous organizations including the Malawian Ministry of Health, the United Nations Family Planning Agency, the World Health Organization, and the United States Agency for International Development, the Commonwealth Secretariat, and other non-governmental organizations, Address has furthered midwifery education, reproductive health policy, human rights, child survival, and program evaluation.
Prof. Malata is a dynamic, motivated and passionate leader in nursing and midwifery, and has improved midwifery and neonatal care for the people of Malawi. Through her leadership, Malawi has highly qualified Midwives providing hands-on newborn care at the bedside, work essential to reducing the country’s infant mortality rate.
Congratulations to Address Malata on her nomination to this year’s 2014 International Midwife Award.
Read about other International Midwife Award finalists by clicking below:
This blog was written by Address' nominator, Alice Kadango. Alice is a Registered Nurse Midwife working as a Lecturer in Maternal and Child Health at The University of Malawi, Kamuzu College of Nursing in Malawi (AMAMI). Currently she is the Publicity Secretary of The Association of Malawian Midwives that nominated Professor Adress Malata as a contender for to receive an award for improving Maternal and Child Health delivery services in Malawi.
This blog is part of a series introducing the 2014 International Midwife Award sponsored by The International Confederation of Midwives and Save the Children. These blogs were adapted from the applications of finalists. The award winners will be announced at this year’s International Confederation of Midwives 30th Triennial Congress in Prague, Czech Republic on June 3rd.
Finalist, Njumbe Benedict Ngyia, is a man who has dedicated his life to the care of women and children. He has been a nurse-midwife since 1994 when he started taking an active role as primary midwife to provide prenatal, postnatal and birth care for local tribal populations in Cameroon. Njumbe founded Nightingale, a community-based birth clinic. He currently provides midwifery and nursing care to high-risk antepartum, intrapartum, and postpartum women from ethnically diverse populations in the Sub-Sahara Africa.
"We must remove barriers to midwifery education in order to improve outcomes for mothers and babies." - Njumbe Benedict Ngyia.
Njumbe is also the Clinical Director of the first private “Clinical Training Center for Family Planning (CTCFP)” project authorized by the ministry of public health. The CTCFP is created to prepare graduate and undergraduate nurses and midwives to manage a woman’s normal obstetrical and gynecological needs during the childbearing years, manage the care of the normal newborns, and provide primary care to women. Njumbe has dedicated his whole life to saving the lives of women in Cameroon, a country with a high burden of maternal and neonatal deaths.
Njumbe is a positive role model-dynamic, motivated, passionate, and an agent for change. He encourages staff growth, mentorship, learning, and development. His leadership qualities and impact for newborn care has increased access to affordable disease prevention, counseling, family planning, gynecological and prenatal care for women and care after birth.
Congratulations to Njumbe Benedict Ngyia on his nomination to this year’s 2014 International Midwife Award.
Read other stories of finalists:
This blog was written by Njumbe's nominator, Dr. Gwewasang Che Martin. Dr. Martin is an independent practicing clinician. For more than 20 years he has been working in public health sector on community based family planning/immunization integration, long acting family planning, and adolescent issues. He has also played a major role in bringing innovative approaches to increase access to modern contraceptive methods, especially LA/PMs, in the non-profit health sector in Cameroon.
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