Providing Equitable, High Quality Maternity Care in the Context of a Limited Health Workforce: Lessons From Nigeria
Shortages in the availability of well-trained health workers have been well documented in developing countries, particularly in sub-Saharan Africa. Even in cases where there are relatively large numbers of health care providers, inadequate pre-service and in-service training, suboptimal proportions of different clinical specialties and a lack of strong health system support remain major challenges to providing high quality maternity care.
The question therefore arises: How do developing countries facing severe shortages in well-trained, equitably distributed health workers ensure access to high quality maternal health care for all women?
Perhaps the most logical long-term solution is to invest more resources into the expansion of training capacity to meet the health needs of the population. However, amid widespread poverty and competing needs for scarce resources, as well as migration of health workers across geographic boundaries, this may not be attainable for most developing countries. There are several other potential solutions that may be feasible in the short-term, which are currently being tested in Nigeria.
The Midwives Service Scheme
The National Primary Healthcare Development Agency launched the Midwives Service Scheme in 2009 to expand skilled birth attendance to reduce maternal, infant and child mortality, especially in rural communities. Since 2010, more than 2,600 midwives have been recruited and deployed to over 650 rural primary health centers across Nigeria. The program incorporates training of midwives and medical officers to improve the quality of maternity care while strategically adding to the health workforce.
West African College of Surgeons training program and curricula
Lessons learned from the Midwives Service Scheme partly stimulated the development of other innovative strategies involving redistribution of the health workforce to rural areas. For example, the Faculty of Surgery, West African College of Surgeons revised its training program and curricula in 2016 to include a mandatory six-month “rural posting” for senior trainees before their exit fellowship exams. It is expected that this will make senior health workforce team members available in underserved communities to work with and mentor non-specialist physicians in the provision of maternal health services.
The Volunteer Obstetrician Scheme
Similarly, the Volunteer Obstetrician Scheme (VOS) was launched in Nigeria in July 2016 as an initiative of the Society of Obstetricians and Gynecologists and the Primary Health Care Development Agency. Under VOS, experts in obstetrics and gynecology who work in referral hospitals volunteer to commit some of their regular work hours in designated lower level health facilities where they treat patients and provide in-service training. This program gives experts in obstetrics the opportunity to share their knowledge and skills with caregivers working at community-based and primary health care centers.
What is next?
Nigeria, like many other developing countries in Africa, is confronted with severe health workforce shortages, but the resources needed to expand training capacity for health workers to meet the needs of the population are not readily available. Therefore, it is necessary to explore innovative solutions that maximize efficient use of the available health workforce, including redistribution to vulnerable communities. Programs like these could help to ensure equitable access to maternal health services with skilled providers. Rigorous research is needed to evaluate the effects of these interventions.
Have you tried these strategies in your country? If so, tell us about it!
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