Midwives are the Face of Health Systems

Micah Matiang’i

Micah Matiang’i has led Amref Health Africa’s Virtual Training School for nine years, and during that time he has seen a lot of changes in Kenya.

“Looking back 10 years ago,” Micah says, “we had relatively few nurses, and most of the nurses and midwives were of certificate level… about 70 percent; and the Ministry of Health and other stakeholders felt that having so many in the nursing and midwifery cadre at the certificate level had a direct impact on the quality of care delivered in health facilities.”

However, the Government of Kenya faced a daunting task to train more nurses and midwives beyond the certificate level. At the time, the trainings were organized into 100 person cohorts that lasted 18 months, and with a nursing and midwifery workforce of nearly 22,000 people, training everyone would not happen quickly.

During a stakeholder meeting with the Ministry of Health, the Nursing Council of Kenya, Amref, and leading medical colleges, the idea to use a blended elearning approach to training was proposed. This is when Amref’s Virtual Training School began, and Micah has not turned his back on his passion for supporting nurses and midwives ever since.

“Nurses and midwives are the face of health systems,” says Micah, “if you go to the remote areas of this country, the communities don’t differentiate between a nurse and a doctor. So, a midwife who is there is the doctor, is the lab technician, is the physiotherapist, is the nutritionist… is everything.”

Since 2012, Amref has been a partner on the USAID-funded Leadership, Management, and Governance (LMG) Project. During that time Micah has seen many different tools adopted by nurses and midwives who have participated in the LMG for Midwifery Managers Certificate Course—a five day workshop on assertive communication, advocacy, coaching and mentoring, database management, change management, and strategic problem-solving skills—but one of his favorites is the Challenge Model.

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“What I like about the Challenge Model tool is that, we could be applying so much effort to bring about change in what we do, but at the end of the day you don’t get so much change,” says Micah, “but the Challenge Model is addressing performance… how can we improve our performance for better outputs at the end of the day.”

“For example, I look at two cases in Zimbabwe: one of the participants was doing a project to address the issue of antenatal mothers coming to the facility, and we had another participant doing a quality improvement project to increase the supply of commodities needed for skilled birth attendance. At the policy level, someone might think it is maybe because you do not have good roads, that’s why mothers are not coming to the facility. Or, at policy level, somebody will think, ‘we don’t have enough supplies in a facility because the government is not giving enough resources,’ but from the two projects it came out very clearly that it’s the small things which we ignore and that are solvable by a midwife, that we have ignored for a long time, and they are leading to lower attendance of mothers for their first ANC visit or are leading to poor resource availability for skilled birth attendance.”

After so many years supporting nurses and midwives, Micah has learned just how sound management improves health services. “One of the midwives in the project for increasing commodities suggested increasing awareness among managers in the facility on the importance of those commodities so that they can be given priority in terms of procurement, and it soon became clear that what was causing the shortage is just that those who are in charge of procurement were not aware of how important these resources are in terms of skilled birth attendance, so they were focusing elsewhere. So once they became aware, the resources were flagged, they were given priority, and this reduced the shortage… This is a very typical example of a situation whereby if we don’t do a proper root cause analysis of a situation, you’ll end up investing a lot of resources and energy on the wrong intervention.”

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