Health and Healthcare Systems

How midwife mentors are making it safer for women to give birth in remote, fragile areas

Midwife examines patient, pregnant women, smart phone; maternal health.

Kemal Hassan, a midwife mentor in Ethiopia, examines a patient while using an app developed as part of a programme to boost maternal health. Image: Mulugeta Wolde

Anna Cecilia Frellsen
Chief Executive Officer, Maternity Foundation
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Ethiopia

  • Access to quality healthcare can be difficult in remote, impoverished or conflict-affected regions.
  • The increased chances of maternal death under such conditions means midwives need better skills and training – particularly when it comes to helping women with birth complications.
  • By combining mentoring with skill-based learning and digital training, one programme is hoping to improve healthcare standards for women giving birth in Ethiopia’s Afar region.

Imagine being a midwife in a remote, fragile context, like the Afar region in Ethiopia. This hot, low-land and desert like area has been affected by conflict, driving up the headcount poverty rate to 30%. This has worsened food insecurity for Afar’s population, who mostly make a living as livestock farmers and are often dependent on government support already. The conflict conditions have also damaged thousands of healthcare facilities in the northern part of the country.

Most maternal deaths happen in poor and fragile settings, but the majority can be prevented with access to quality care. However, many of the midwives working in Afar’s local health centres lack the necessary skills and knowledge to manage birth in the best and safest way possible. They often have to refer women with birth complications to larger hospitals that are far from their homes.

Building quality care through mentoring

Through a national flagship catchment-based mentorship programme, the Ethiopian Ministry of Health is seeking to improve the quality of care provided to mothers and their newborns, particularly in remote, fragile areas such as the Afar region.

This programme is about transferring knowledge from experienced midwives to those that are new or less experienced, while also helping them to practice their skills in managing pregnancy, births, and complications.

Kemal Hassan is a 26-year-old midwife who works at the hospital in Asayita, one of the bigger cities in the Afar region. He has been part of the mentorship programme for three years and currently has six mentees at a local health facility in Afar’s Afambo district.

“New midwives often lack practical experience. As a midwife mentor, I help identify and fill the gaps in my mentees’ skills and knowledge and, together, we help ensure safer births for more women and their babies,” Kemal says.

As part of the mentorship programme, Kemal supervises his mentees’ handling of live cases at these local facilities. His mentorship is already having a significant impact: “Kemal has changed me,” one of his mentees explains. “Before, I was scared to handle birth complications such as excessive bleeding. I lacked practical experience. But now, after having Kemal as my mentor, I work confidently.”

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Adding skills-based practice and digital learning

Both Kemal and his mentees agree that skill-based practice is crucial in building up the necessary skillset for midwives. One of Kemal’s mentees says: “Many trainings are just showcasing how to handle different scenarios concerning pregnancy and birth. It is not practical, and then you don’t learn."

That’s why Maternity Foundation is working with the Ethiopian Ministry of Health and partners including UNICEF and UNFPA to implement this mentorship programme in Ethiopia’s Somali and Afar regions. We are strengthening the mentorship programme by combining it with our Safe Delivery+ programme, which offers hands-on, skills-based practice and provides access to a digital tool called the Safe Delivery App. This free app also works offline once downloaded.

Building on the Safe Delivery+ programme, Kemal and other midwife mentors can combine mentoring with practical exercises on subjects including newborn resuscitation and management of excessive bleeding after birth. Kemal also uses the Safe Delivery App for guidance on how to handle birth and common complications. It offers simple, animated instruction videos, descriptions of practical procedures and action cards, among other features.

A group of midwives perform a practical exercise using an app and a doll.
Kemal Hassan and his mentees complete a practical exercise as part of a midwife mentorship programme that aims to boost maternal health. Image: Mulugeta Wolde

Kemal asks his mentees to go through specific modules in the app, both before and after doing joint practical exercises. He also asks them to complete the app’s MyLearning sessions. Here, the mentees are quizzed on their knowledge and can achieve a formal certification after passing all modules at expert level.

The app can also help mentees with live cases when the mentor is unavailable. “When Kemal or my colleagues are not there, I can always go to Safe Delivery App for answers,” one of Kemal’s mentees explains.

The combination of the mentorship programme with skills-based practice and continued digital support through the Safe Delivery+ Programme is showing promising results. The midwives at the local health facility in Afar’s Afambo district tell us that they are now referring less women to the district hospital. The same experience has been shared by midwife mentees in other local health facilities.

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Scaling up the midwife mentorship programme

Building on experiences from Somalia and the Afar region, Maternity Foundation, together with the Ethiopian Ministry of Health and other partners, is exploring how to further streamline and scale this programme.

The combination of the catchment-based mentorship programme with the hands-on practice and continued learning offered by the Safe Delivery+ programme is helping provide people with access to better quality care. In poor and fragile settings like Afar, tools that improve the skills, experience and knowledge of midwives are a crucial lifeline for women and babies.

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