Midwifery care providers' competencies in sub-Saharan Africa and global perinatal health outcomes

Abstract

Background: Maternal and newborn mortality and morbidity remain critical global health issues, particularly in sub-Saharan Africa where many countries are struggling to meet the maternal and newborn related Sustainable Development Goals targets. To improve survival and well-being of women and newborns, concerted effort needs to be made in the education of health workers to ensure quality care is provided. Furthermore, recruitment and equitable distribution of health workers must be prioritized to guarantee equal access to universal health coverage. Aim: Firstly, to assess midwifery care providers pre-service curricula according to the International Confederation of Midwives International Standards (Study I) and competencies of midwifery care providers in Benin, Malawi, Tanzania and Uganda (Study II) in order to inform the Action Leveraging Evidence to Reduce perinatal morTalityand morbidity in sub-Saharan Africa (ALERT) project midwifery training packages. Secondly, to assess the burden of perinatal adverse health outcomes focusing on preterm birth (Study III). Thirdly, to assess the relationship between health workforce densities, and maternal and perinatal health outcomes in the aforementioned countries (Study IV). Methods: Data were obtained by the following methods: mapping review and in-depth interviews (Study I), self-administered questionnaire and skills drills simulations (Study II), statistically derived preterm birth estimates (Study III) and comparative analysis of health workforce densities and maternal and perinatal outcomes (Study IV). Results: Study I identified significant gaps in the pre-service curricula of the study countries, while Study II found that providers in ALERT project facilities lacked important knowledge, skills and behaviours related to childbirth care. Study III estimated that the global prevalence of preterm birth was marginally higher in 2020 (9.9% of live births (95% credible intervals (CrI): 9.1-11.2)) compared to 2010 (9.8% (95% CrI: 9.0-11.0)). Study IV found that while the need to strengthen recruitment, capacity and motivation of health workers were heavily prioritized by all human resources for health policies, the workforce densities appear to have little to no effect on perinatal outcomes. Conclusion: Due to gaps in pre-service curricula, resource scarcity and poor organization of health systems, midwifery care providers lack the competencies required to provide quality care contributing to the continued high levels of adverse maternal and perinatal health outcomes.