A dire shortage of skilled nurses and lack of life-saving equipment are putting maternal mortality goal out of reach
When Juster Joseph graduated from nursing college, she felt excited to get a job in a government hospital. But after two years at Mugana district hospital in Tanzania’s Lake Zone, she feels disillusioned. Her course did not give her the practical skills to save lives on the maternity ward. The hospital also lacks certain life-saving equipment.
“I usually feel helpless and heartbroken when I cannot help a dying pregnant woman or a newborn baby in an emergency condition because I don’t know something or the hospital lacks some medical equipment,” she says.
In another district of Tanzania, about 150km (93 miles) from Lake Victoria, Lena Nchonchama, a senior nurse at Biharamulo district designated hospital (DDH), feels overwhelmed. A registered nurse for seven years, she is in charge of the maternity ward. She, too, knows why some pregnant women or newborn babies may die in hospital.
“I work with only two registered nurses in this labour ward I supervise. At times we receive more than eight emergency cases at once but we are supposed to handle them all no matter how few we are. So we usually rely on birth attendants who receive just short-term minimal training on labour-ward routines – but not the actual handling of emergency situations,” she says.
According to a report counting down to the expiry of the millennium development goals next year, Tanzania is making insufficient progress in achieving goal five – to reduce by three-quarters the maternal mortality rate – and the biggest concern now in the country is that most women die during childbirth because they cannot access a skilled nurse or midwife.
According to Tanzania’s latest demographic and health survey (2010),only 51% of deliveries (pdf) are assisted by a trained professional and four midwives are available for 10,000 patients countrywide.
The government has launched a major national drive to end maternal and child deaths, and aims to prevent an additional 14,500 child deaths and 1,400 maternal deaths by next year.
Under its Making it Happen scheme , the UK-based Centre for Maternal and Newborn Health (CMNH) has been offering training to about 800 of the nurses to improve their life-saving skills in Tanzania’s coastal and Kagera regions since 2012, but the project ends next year.
Dr Mselenge Mdegela, a clinical lecturer with the CMNH, says governments in low-income countries like Tanzania need to capitalise on training more skilled nurses now, as the surest way to cut deaths.
However, he adds: “How do you train midwives, who are also few in numbers, to play the role of a doctor or anaesthetist?” Stakeholders must realise that the concept of training and retaining midwives in low-income countries “is still complex and needs context-specific ideas”.
Back at Biharamulo DDH, the medical officer in charge of the hospital, Dr Gresmus Sebuyoya, says the maternity ward needs at least 12 qualified nurses to function to its optimal level, but the hospital relies too much on ward attendants who are less skilled.
Sebuyoya says: “About three-quarters of qualified nurses at this hospital work temporarily. You could think they come to buy time as they look forward to other high-paying jobs in cities and other health projects.”
A recent report in the journal PLOS One, The Impact and Cost of Scaling up Midwifery and Obstetrics in 58 Low- and Middle-Income Countries, suggests that deploying more skilled midwives in the world’s poorest countries could save many lives of mothers and newborn babies.
“Even deploying a relatively small number of midwives around each country could have a profound impact on saving maternal, foetal and newborn lives,” according to Dr Linda Bartlett, a lead researcher of the survey.
• Dr Syriacus Buguzi is a health journalist for the Citizen in Tanzania
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