Midwifery education, regulation and association in the Democratic Republic of Congo (DRC) – current state and challenges

Bogren, Malin; Ndela, Britou; Toko, Carla; Berg, Marie

doi:10.1080/16549716.2020.1717409

Cited by 29 publications

(52 citation statements)

References 24 publications

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“…These numbers can be explained by, among other things, poor healthcare quality [6], which in turn is partially due to a severely strained health system a icted by many years of political con ict [7]. With only one midwife per 20,000 persons, the midwifery workforce in the DRC is far from the minimum required for meeting the predicted need for midwives within maternity care [8], and for reaching Sustainable Development Goal (SDG) 3 on health aiming at a maternal mortality rate of fewer than 70 per 100,000 live births by 2030 [9].…”

Section: Introductionmentioning

confidence: 99%

“…These include a low academic level among the tutors within the programmes, including the midwifery educators and clinical preceptors. Furthermore, the midwifery profession is not yet regulated, and is thus not allowed to work as an autonomous profession within a de ned area of practice and competence [9,13]. This means that after completing an education programme, midwives are often obliged to work in areas that are not related to the midwifery area of practice [9].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the midwifery profession is not yet regulated, and is thus not allowed to work as an autonomous profession within a de ned area of practice and competence [9,13]. This means that after completing an education programme, midwives are often obliged to work in areas that are not related to the midwifery area of practice [9]. This situation for midwives in the DRC echoes ndings from a global consultation with 2,470 midwives in 93 countries (not including the DRC).…”

Section: Introductionmentioning

confidence: 99%

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Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo – An interview study

Bogren

Grahn

Kaboru³

et al. 2020

Preprint

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Background: The Democratic Republic of Congo (DRC) has high maternal mortality and a low number of midwives, which undermines the achievement of Goal 3 of the Sustainable Development Goals (SDGs) for 2030, specifically the health of mother and newborn. Scaling up the midwifery workforce in relation to number, quality of healthcare, and retention in service, are therefore critical. The aim of this study was to investigate midwives’ challenges and factors that motivate them to remain in their workplace in the DRC. Methods: Data were collected in two out of 26 provinces in the DRC through ten focus-group discussions with a total of 63 midwives working at ten different healthcare facilities. Transcribed discussions were inductively analysed using content analysis.Results: The midwives’ challenges and the factors motivating them to remain in their workplace in the DRC are summarised in one main category – Loving one’s work makes it worthwhile to remain in one’s workplace, despite a difficult work environment and low professional status – consisting of three generic categories: Midwifery is not just a profession; it’s a calling is described in the subcategories Saving lives through midwifery skills, Building relationships with the women and the community, and Professional pride; Unsupportive organisational system is expressed in the subcategories Insufficient work-related security and No equitable remuneration system, within Hierarchical management structures; and Inadequate pre-conditions in the work environment includes the subcategories Lack of resources and equipment and Insufficient competence for difficult working conditions. Conclusion: Midwives in the DRC are driven by a strong professional conscience to provide the best possible care for women during childbirth, despite a difficult work environment and low professional status. To attract and retain midwives and ensure that they are working to their full scope of practice, we suggest coordinated actions at the regional and national levels in the DRC and in other low-income countries with similar challenges, including: i) conducting midwifery education programmes following international standards; ii) prioritising and enforcing policies to include adequate remuneration for midwives; iii) involving midwives’ associations in policy and planning about the midwifery workforce; and iv) ensuring that midwives’ working environments are safe and well equipped.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo – An interview study

Bogren

Grahn

Kaboru³

et al. 2020

Preprint

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“…There is no legal regulatory structure to uphold the midwifery profession. It is therefore not possible to ensure a high-quality workforce of midwives in DRC [ 67 ]. - The midwifery association was established in 2000, is well connected and accepted, with 1700 members and a member of ICM, but needs more resources to function effectively.…”

mentioning

confidence: 99%

“…- Midwifery education is managed by two different government ministries: Public Health and Higher Education Ministry of Public Health (MoPH) Ministry of Higher Education (MoHEd) 1. Midwifery training A3 midwives: Since the colonial period until late 1980s, midwifery training began at a secondary-school level (Institut de Techniques Médicales: ITM) [ 67 ] - Entry requirements: 10 years of education (6 years of primary and 4 years of secondary) - 2 years of midwifery in nursing schools training A3 level birth attendants (accoucheuses A3) - The A3 midwifery programme was abolished and replaced by a four-year midwifery education programme (A2). 1.…”

mentioning

confidence: 99%

Developing strategies to attract, retain and support midwives in rural fragile settings: participatory workshops with health system stakeholders in Ituri Province, Democratic Republic of Congo

Baba¹,

Martineau

Theobald

et al. 2020

Health Res Policy Sys

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Background Midwifery plays a vital role in the quality of care as well as rapid and sustained reductions in maternal and newborn mortality. Like most other sub-Saharan African countries, the Democratic Republic of Congo experiences shortages and inequitable distribution of health workers, particularly in rural areas and fragile settings. The aim of this study was to identify strategies that can help to attract, support and retain midwives in the fragile and rural Ituri province. Methods A qualitative participatory research design, through a workshop methodology, was used in this study. Participatory workshops were held in Bunia, Aru and Adja health districts in Ituri Province with provincial, district and facility managers, midwives and nurses, and non-governmental organisation, church medical coordination and nursing school representatives. In these workshops, data on the availability and distribution of midwives as well as their experiences in providing midwifery services were presented and discussed, followed by the development of strategies to attract, retain and support midwives. The workshops were digitally recorded, transcribed and thematically analysed using NVivo 12. Results The study revealed that participants acknowledged that most of the policies in relation to rural attraction and retention of health workers were not implemented, whilst a few have been partially put in place. Key strategies embedded in the realities of the rural fragile Ituri province were proposed, including organising midwifery training in nursing schools located in rural areas; recruiting students from rural areas; encouraging communities to use health services and thus generate more income; lobbying non-governmental organisations and churches to support the improvement of midwives’ living and working conditions; and integrating traditional birth attendants in health facilities. Contextual solutions were proposed to overcome challenges. Conclusion Midwives are key skilled birth attendants managing maternal and newborn healthcare in rural areas. Ensuring their availability through effective attraction and retention strategies is essential in fragile and rural settings. This participatory approach through a workshop methodology that engages different stakeholders and builds on available data, can promote learning health systems and develop pragmatic strategies for the attraction and retention of health workers in fragile remote and rural settings.

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A gap analysis of midwifery competency, pre- and in-service education for reproductive, maternal, newborn, child and, adolescent health in Lao People's Democratic Republic

Kubota,

Ando,

Khambounheuang

et al. 2024

The Lancet Regional Health - Western Pacific

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Midwifery education, regulation and association in the Democratic Republic of Congo (DRC) – current state and challenges

Cited by 29 publications

References 24 publications

Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo – An interview study

Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo – An interview study

Developing strategies to attract, retain and support midwives in rural fragile settings: participatory workshops with health system stakeholders in Ituri Province, Democratic Republic of Congo

A gap analysis of midwifery competency, pre- and in-service education for reproductive, maternal, newborn, child and, adolescent health in Lao People's Democratic Republic

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