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

Abstract

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 the mother and newborn. Scaling up the midwifery workforce in relation to number, quality of healthcare, and retention in service is 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.

A scoping review of the impact of organisational factors on providers and related interventions in LMICs: Implications for respectful maternity care

“…Meanwhile it was reported that too many interns crowded around women delivering [70]. In the DRC, midwives reported being placed at departments where their midwifery skills were not utilised, such as surgery/internal medicine wards, the pharmacy, or the administration office [74]. They also noted being shifted across departments according to their supervisor's preferences rather than their professional competence.…”

“…For midwives across settings, not being allowed to practise their profession, not receiving recognition for their work, being unable to influence decisions made by more senior staff or management and experiencing professional disrespect and inferiority within multi-cadre teams, in combination with resource constraints, led to stress, frustration, feeling undervalued, demotivated, demoralised to the point of making it challenging to continue their job [73,74,78]. Being unable to independently take actions that are in the best interest of patients was also argued to contribute to moral distress among nurses in Egypt [79] and Malawi [62].…”

“…In the Democratic Republic of Congo (DRC), not having an equitable remuneration system, reflected in low pay and irregular payment, made midwives feel underappreciated. It also prompted midwives to take up second jobs which increased their work stress [74]. Not being compensated for working overtime was also reported by midwives in Tanzania, which contributed to feeling devalued in their work [49].…”

Optimizing the contributions of nursing and midwifery workforces: #Protect, #Invest, #Together

“…The second main area of action was to create new nursing jobs by 2030, primarily in low- and middle-income countries, to off-set the projected shortages, and to redress the inequitable distribution of nurses across the world. Papers that we have published in the Call include an examination of factors that motivate midwives to remain in their workplace in the Democratic Republic of Congo [ 8 ]; a report on evidence-based health workforce planning and unemployed nurses and midwives in Ghana [ 9 ]; an analysis of the risks of the precarization (casualization) of the Mexican nursing labour market [ 10 ], a study on preferred employment settings of final-year nursing students in Israel [ 11 ], and an international review on burnout in nursing, which takes on even greater prominence with the impact of the pandemic [ 12 ].…”

Contextual factors influencing a training intervention aimed at improved maternal and newborn healthcare in a health zone of the Democratic Republic of Congo

“…Only the master trainers were reimbursed, and they judged the compensation level to be too low. This may be explained by the fact, found in another study in the DRC, that healthcare professionals in the DRC, especially nurses and midwives, often lack regular payment or compensation for their employment [ 24 ].…”