Enhancement of knowledge and skills of community midwives in Sindh, Pakistan

With a maternal mortality rate of 276 deaths per 100,000 live births, Pakistan is one of the countries with a large share in the percentage of world’s maternal mortality. As an intervention for the Millennium Development Goals (MDG) 4 and 5, the World Health Organization (WHO) strongly suggests that skilled care before, during, and after childbirth can save the lives of women and newborn babies. One of the interventions to ensure care to mothers and babies by skilled care providers is the capacity building training of Community Midwives (CMWs) aiming to improve their midwifery competency. One such training intervention was organized in Hyderabad, in the Sindh Province of Pakistan. Forty two CMWs who had graduated from ten districts across Sindh participated in the training; they were divided into 3 cohorts. The training aimed to review the midwifery knowledge and skills of CMWs; introduce them to evidence-based midwifery practices and the concept of respectful maternity care; strengthen their financial management skills, to enable them establish and sustain their birth centers independently; and, most importantly to provide hands on practice under the mentorship of clinicians. The training started with a pre-training assessment, to assess the participants’ previous knowledge and skills along with a learning needs assessment to facilitate self -directed learning. At the end of 5 weeks, a post training assessment was conducted to analyze the outcomes of this training. The post-assessment showed an increase in CMWs’ knowledge and skills, and they shared that the training had made them more competent and confident. This training was a significant effort to enhance CMWs’ development, as it was the first of its kind in the country. Through this training, the CMWs were able to review the important midwifery concepts and skills. Moreover, the CMWs recommended internship in the community with a mentor, after their graduation, and inclusion of management of birthing centers through coverage of entrepreneurial skills in the curriculum