Insightful Dialogue at Bangla Academy on Midwifery

This year from the 3rd to the 5th of May, the National Conference on Sexual and Reproductive Health and Rights, 2016 was organised by the Embassies of Sweden, Kingdom of Netherlands, UNICEF and UNFPA. 

UNFPA and the Daily Star jointly organized a policy dialogue titled, “Quality Education For Professional Midwives” at this conference on the 5th of May which is also known as the International Day of Midwives. On behalf of the Daily Star, public health expert Shamim Ahmed moderated the dialogue and the keynote  paper was presented by Pranita Rani Raha, Nursing Instructor from the National Institute of Nursing Education and Research. The esteemed panel board included Sathya Doraiswamy, Chief Health Advisor, UNFPA; Nelofar Farhad, Deputy Director at DNS;  Dr. Jahir Uddin Ahmed,  Interim Chairperson, Department of Midwifery and Nursing, BRAC University, Dr. Nurun Nabi, Vice Chancellor of Begum Rokeya University, Rangpur; Dr.Sayed Rubayet, Project Director of Saving Newborn Lives, Save the Children; Shamsunnaher, Principal, Nursing Institute Mitford; Dr. Mohammad Mofizullah, Director of Nursing Services; Marcela Lizana Bobadilla, First Secretary of Sweden.

Pertinent issues like the progress of midwifery education made since the program was introduced in 2010 and the current obstacles that midwives are facing as well as what needs to be done in order to make improvements in the education and profession of midwifery were discussed in length.  Starting in 2013, approximately 597 students have graduated in last December. Since 2010, six nursing institutes and colleges have been providing the six-month post basic certified midwifery course and currently 32 more nursing institutes and colleges have also started this program. But the problem lies with having dedicated midwifery faculty that is still non-existent in the country. This problem is faced by these institutes where the faculties are all nurses by profession. Although they have the midwifery education background and clinical experience, as per the ICM definition they are not recognized as midwives. This brings us to the next issue of quality of education and the necessary logistics required for providing quality education. Investments need to be made in faculties, and the necessity of creating opportunities for professional careers and knowledge development activities such as research and publication by midwives was thoroughly discussed by the discussants. What the midwifery educational programs currently require are faculty developments, international mentors, curriculum revision and faculty development plans and respectful maternity care that can only be achieved by midwifery led care. 

Sathya Doraiswamy, Chief Health Advisor, UNFPA in his deliberation highlighted the fact  that the framework of UNFPA's support comes from the strategy directions of the country in response to Honourable Prime Minister's commitment that led to the creation of  midwifery as a new profession in this country with 3000 posts created in 5 years. The fact that the National Nursing Act is now at a very advanced stage of becoming a Nursing and Midwifery Act is a great way forward and UNFPA has played its role in terms of policy advocacy in this matter. With the support from Sweden this year partnering with the Lana University, in two years' time UNFPA hopes to have 30 midwifery faculties who have postgraduate degree in midwifery. To start with the five centres of excellence the support has at least been provided to ensure minimum quality standards. Midwives need an enabling environment to be able to practice midwifery and currently there is no clear model of a midwifery led care in the country. The centres of excellence will have three components to it; one is the educational institute itself, the second is a clinical site where the midwifery students can learn the clinical aspects of midwifery and the third is a deployment site that is the upazila health complexes where midwives are currently deployed. Therefore, the midwifery association or society has a key role to play.  UNFPA will be supporting the national efforts.

In this regard DNS has already deployed 600 midwives and has already started working with DGHS and Family Planning and with their support the deployed nurses feel secure in the environments that they have to work in.

While talking about BRAC University course, Dr. Jahir Uddin Ahmed, Interim Chairperson, Department of Midwifery and Nursing, BRAC University said that BRAC introduced midwifery course in 2012.  The concept and usefulness of midwifery was not understood very well and that is when the BRAC University came forward. Students were enrolled following the guidelines of the BNC and ICM (International Confederation of the Midwives) but the main problem was the faculty and how to complete a three-year diploma course that included 6 semesters. It was a difficult job but BRAC recruited nurses, midwives and developed many modules and followed curriculums developed by BNC on the basis of ICM guidelines. BRAC coordinates with the government to make sure all government programs are implemented and followed in accordance. In the future BRAC wants to collaborate with the government, UNFPA to develop a class of very high quality of faculties so that high quality of education can be given  to make the midwives competent. 

Bangladeshis have accepted and come forward to support public health programs and there is no need to be concerned about the people's response to midwives. Midwives need proper job descriptions and aides, monitoring tools and working environments. The success of the first and second batches of the midwives will set the standard for others.

Experts suggested that midwives must be able to conduct 20 deliveries independently otherwise they will not be allowed to appear for competency exams for license. Focus needs to be put on the development of a good curriculum for the future midwives and more importantly the environment let that be external or internal.

The Swedish government recognises the importance of midwives or specialized midwives in playing a part when it comes to reducing maternal and child mortality rates. The Swedish Embassy has identified the key roles that UNFPA and the ministry of health plays and in collaboration with them is trying to motivate the institutes to improve the quality of midwifery education. In collaboration with UNFPA they have introduced a master's program in sexual and reproductive health and rights in which already around 35 midwives are already enrolled.

The challenges and constraints with regards to human resource, logistics as well as financial allocations that the government is facing currently have also been discussed in the session. The government has a lot of evidence based intervention regarding maternal and neonatal death reduction. Midwives will help reduce the maternal and neonatal mortality rates because the causes are known, and the government has the required interventions to implement them in the facilities as well as at community levels.  The government is currently trying to establish a separate institution for midwives.

RECOMMENDATIONS: 

- Bangladesh needs dedicated midwifery faculty

- Investments need to be made in high quality faculties, create opportunities for professional careers and knowledge development. 

- Create opportunities for research and publication by midwives

- Create enabling environment to practice midwifery. 

- Ensure proper monitoring of their activities

- Develop good curriculum for midwives 

- Improve quality of education