Musarrat Rani
Midwifery Association of Pakistan, IndiaTitle: Facilitators and barriers influencing utilization of services provided by community midwives in district Thatta, Pakistan: a qualitative exploratory study
Abstract
Background: To address the issue of high maternal mortality, the Government of Pakistan initiated a community midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. Despite a large investment in the community midwifery program, research evidence from rural districts of Pakistan suggests that the utilization of maternal and newborn services through community midwives is very low. This exploratory study aimed to understand the facilitators and barriers influencing community midwives’ services utilization in district Thatta.
Methods: A qualitative study was conducted in the rural district Thatta, Pakistan. Key-informant interviews (KIIs) were conducted with health officials. In depth interviews were conducted with midwifery students; trained community midwives providing services in district Thatta; and community women to explore their views about the factors influencing the utilization of community midwives’ services in district Thatta, Pakistan. Data were analyzed using qualitative thematic analysis.
Results: A total of 25 interviews (KIIs = 5; IDIs = 20) were conducted. Two overarching themes were identified: (I) community midwives’ skills and competencies; and (II) ownership and supportive supervision. The major hindering factors for community midwives’ service utilization included deficiencies in community midwives’ training particularly in clinical hands-on training, lack of ownership of community midwifery program, and lack of service structure by the CMWs regulatory body.
Conclusion: The study has identified serious gaps in the CMWs program at the level of training and supervision of midwives in Pakistan. The study has also identified factors related to the training of CMWs that could facilitate the program in the context of Pakistan and similar settings.
Biography
Musarrat Rani is RMNCAH Specialist, Vice President- Midwifery Association of Pakistan and Educator in the Eastern Mediterranean Regional Professional Committee, ICM. She is dynamic professional with more 28 years of extensive experience in midwifery and nursing in institutional development, programs development and management, all in academia clinical and in community. She is member of National Newborn Survival and Health Technical Working Group cum Steering Committee Meeting Islamabad, RMNCH Committee and People’s Health Movement. PHM Pakistan Chapter. She was former Manager Health program in HANDS Pakistan and looked after health projects of health dealing with Midwives, MNCH, FP, nutrition, adolescent health and rights based project, etc She worked as a midwifery educator for past many years, she was enthusiastically involved in teaching midwifery students in the classroom, clinical, and in community settings. She introduce new mobile application for midwives- working in 10 rural areas of Pakistan, also pioneer and actively participated in initiating midwifery-led birthing stations in different places in Pakistan.At present, she is involved in the development of the midwifery Curriculum with Pakistan Nursing Council as per ICM guidelines.
She is a registered Nurse Midwife and completedMSN from Ziaudding University. Karachi.
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