Bill & Melinda Gates Foundation

How Much Training Should Health Workers Have?

October 24, 2013

“The World Needs Midwives Now More than Ever” is the International Confederation of Midwives’ (ICM) theme. It’s part of our ongoing campaign to highlight the world’s critical need for midwives. This reflects the WHO call for midwives and the need to accelerate progress towards MDGs 4 and 5. We have been joined in our quest by organizations, policy makers and world leaders across the globe demanding an increase in health workers. As governments from all corners of the world are desperately trying to improve their health systems and achieve the MDGs by 2015, they promise to increase the workforce of health workers manifold.

 The question is, do we want to cover the tip of the iceberg and train health workers in emergency skills, or do we want to do our job right and educate a cadre of health workers – including midwives – who all have the essential competencies to do every part of the job instead of only a few quick interventions.The example of Ethiopia has made the rounds in the halls of the United Nations General Assembly, where maternal and child mortality have been reduced by 28 percent and 67 percent, respectively, due to the deployment of over 30,000 health extension workers. Other countries are eager to replicate the success. For example the President of Malawi, Joyce Banda, who pledged to increase the number of health workers in her country from 10,000 to 27,000 by 2015. Such promises are inspiring and visionary. But are they feasible? Are they fair? Do they take quality of care into account? Or are they just cosmetic changes to allow impressive number crunching?

To properly educate a midwife, also a health worker, it takes three years. During those years, midwives develop the essential competencies and skills necessary to practice safely and properly. They learn emergency skills such as preventing and managing bleeding after birth, resuscitating babies who do not breathe at birth along with ways to prevent and manage diseases such as meningitis and pneumonia. Even if these skills can be taught in a short workshop, they do not cover the breadth and depth, the scope, of midwifery practice. The question therefore is: do we want to cover the tip of the iceberg and train health workers in emergency skills, or do we want to do our job right and educate a cadre of health workers – including midwives – who all have the essential competencies to do every part of the job instead of only a few quick interventions.

Photo © Liba Taylor

Training health workers only in emergency interventions will not adequately address the problem of dying mothers and babies. Emergency care does not cover family planning. Emergency care does not address care during pregnancy. Emergency care does not include postnatal care for mother and baby. True, addressing emergencies will save lives. But will this approach see mothers and their babies as a whole? Shouldn’t we focus on the root causes of poor health such as overpopulation, poverty, illiteracy, and lack of sanitation?

 Saving the lives of mothers and children can’t be done using a quick-fix. It is time to address all the issues properly and let the midwives and other health workers develop all of the skills that people need so desperately.A properly educated and well equipped midwife counsels young couples in family planning matters and contributes to the issue of overpopulation. A midwife who is educated will know how to work effectively with non-existent sanitation. A midwife has had education and can be a role model for girls and young women to go to school and contribute to their families’ livelihoods.

Saving the lives of mothers and children can’t be done using a quick-fix. It is time to address all the issues properly and let the midwives and other health workers develop all of the skills that people need so desperately. 

 
blog comments powered by Disqus