Training Midwives to Improve
Postabortion Care: A Study Tour in Ghana
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A study tour was conducted in Ghana to provide an opportunity for health
managers and providers from ESA to learn from recent efforts in Ghana to expand and
improve PAC services. The MOH, Ghana Registered Midwives Association (GRMA) and Ipas had
just completed a year-long operations research study to assess the feasibility of
expanding PAC services to lower levels of the health system through the training of
midwives. The research, titled, "Training Non-Physician Providers to Improve
Postabortion Care," was conducted through the USAID-funded MotherCare Project. The
research results indicate that training midwives in PAC is a feasible and acceptable
strategy for decentralizing PAC services. As a result of the operations research, access
to emergency services has increased, postabortion FP is more common, client followup
occurs more frequently and midwives are providing information on broader RH issues to
clients and communities.
Ghana Study Tour
- Research to assess the feasibility of expanding PAC services to lower levels of
the health system through training nurse midwives
- Dissemination meeting
- Eight delegates, four countries, right mix
- Site visits, stakeholder meetings
- Synergy, commitment
- Country action plans
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The MOH in Ghana was hosting a national dissemination meeting and the
study tour was designed, in conjunction with this meeting, to offer an opportunity for
representatives from throughout Africa to learn firsthand from the Ghana experience. Eight
delegates from South Africa, Tanzania, Uganda and Zambia participated in the study tour,
which was organized and hosted by the MOH, the GRMA and Ipas with USAID funding support
via the POLICY and BASICS projects. In addition to attending the dissemination meetings,
delegates visited 12 of the operations research sites, meeting with more than 24
policymakers, stakeholders, service providers and researchers who were involved in the
project. Hosts at each site provided background information on their organizations or
facilities, described their participation in the project, discussed what effects the
training of midwives had on their facility or practice, and talked about future plans.
Delegates met as a group daily throughout the week to share experiences from their
countries, synthesize the lessons they were learning from their Ghanaian colleagues and
prepare action plans for strengthening PAC services in their own countries.
The success of the study tour, in large part, was due to the participants. Each
delegate came from a country that is currently attempting to implement PAC services at the
primary level of the healthcare system. All are committed to improving PAC services and
have the initiative and the authority to follow through and implement in their respective
countries the lessons learned in Ghana. Ghanaian colleagues who participated in the
operations research project and hosted the study tour were exemplary role models. They
demonstrated that through empowerment of service providers, and through hard work and
dedication, significant changes could be made to the healthcare system to increase access
to PAC services for women in need.
The study tour created a time and place for people with shared vision to come together
to explore new ideas, meet others who face similar challenges and find ways to support one
another. The result was a tremendous synergy and commitment to continue collaboration
across borders. |
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Quality of Care Workshop on Standards
and Guidelines
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In June of 1998, the Quality of Care component of Health Networks hosted
an invitational seminar in Harare, Zimbabwe, to review standards and guidelines for
priority RH inventions such as dual protection, management of STDs, emergency
contraception, PAC and screening for cervical cancer. An extra day, supported by POLICY
Project, was added to the meeting and Ipas was able to vet a draft version of their Regional
Standards and Guidelines for Postabortion Care with 110 stakeholders from 10 ESA
countries. Participants had the opportunity not only to comment on the technical content
but to spend time in their country teams discussing ways that the Standards and Guidelines
could be utilized/adapted/ adopted in their respective countries. In addition, workshop
participants were treated to a performance by Amakhosi Theatre Group of a play about
adolescent pregnancy, unsafe abortion and PAC, titled, "Don’t B Ungaqali."
Almost all of the countries included PAC on their followup activity lists and action
plans. The final document, published by Ipas, will be available later this year and
disseminated for use throughout the region. |
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Expanding Opportunities For PAC in
Communities Through Private Nurse/Midwives in Kenya
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The PRIME Project has initiated a project to demonstrate the feasibility
and safety of decentralizing quality PAC to the nurse/midwife provider level and the
primary care service delivery level in Kenya. PRIME will train 40 teams of private
nurse/midwives and their assistants from seven districts to provide PAC services. PRIME
will provide technical training in PAC to private nurse midwives, and monitoring and
public sector supervisory support in the pilot districts. REDSO is interested in the
private sector focus because 70 percent of all health services in Kenya are provided this
way. This study will complement the work completed in Ghana and ongoing in Uganda with
nurse/midwives in the public sector.
Private Nurse Midwives in Kenya
- Role of the private sector to improve PAC services
- Parallel projects
- PRIME: training and supervision
- POLICY: building support
- Advocacy component added to service delivery should strengthen Kenyan commitment
to the expanded role of nurse midwives
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The POLICY Project will implement a set of activities to complement the
ongoing study conducted by PRIME. POLICY Project’s focus will be to build support for
this service delivery strategy among the Kenyan nursing community and stakeholder groups
in the districts where the PRIME study is being conducted. POLICY will be collaborating
with the Nurses Council of Kenya and the Nurses Association of Kenya, strengthening their
capacity to advocate for PAC and other RH issues, and to improve their capacity to conduct
qualitative research at the community level on the problems of unsafe abortion and the
expanded role of the nurse/midwife. POLICY Project will also be responsible for
documenting lessons learned so that other countries can benefit from this experience.
The addition of an advocacy component to service delivery training should strengthen
Kenyan commitment to this new expanded role of the nurse/midwife, which in turn will
increase access to PAC services at the community level in a more sustainable way. It is
our belief that this is an important model that should be considered for all training
activities and we should see some concrete results in the next year. |
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Conclusion
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These examples illustrate how networking and collaboration can add
significant value to improving and increasing PAC services. The problem of unsafe abortion
in the region is huge and there is much to done in social mobilization, training, policy,
service delivery, IEC and systems research. It is critical for each of these disciplines
to work together so that we can effectively scale-up our efforts and reduce the numbers
and consequences of unsafe abortion in the region. |
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References
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Billings DL, S Settergren and M Folsom. 1997. Training Midwives to
Improve Postabortion Care: A Study Tour in Ghana. POLICY Project, The Futures Group
International in collaboration with Research Triangle Institute and the Centre for
Development and Population Activities: Washington D.C. Billings DL et al. 1997. Training
midwives to improve postabortion care in Ghana. MotherCare Matters, Special Issue
6(4).
Brazier E, R Rizzuto and M Wolf. 1998. Prevention and Management of Unsafe Abortion:
A Guide for Action. Family Care International: New York.
Camlin C et al. 1998. The Situation of Postabortion Care in Zambia. POLICY
Project, The Futures Group International in collaboration with Research Triangle Institute
and the Centre for Development and Population Activities: Washington D.C.
Folsom M. 1997. The Situation of Postabortion Care in Kenya. USAID/ REDSO/ESA:
Nairobi, Kenya.
Huntington D (ed). 1998. Summary Report of a Global Meeting: Advances and Challenges
in Postabortion Care Operations Research. Population Council: New York.
Kinoti SN et al. 1995. Monograph on Complications of Unsafe Abortion in Africa.
Reproductive Health Research Programme of Commonwealth Regional Health Community
Secretariat (CRHCS) for East, Central and Southern Africa, JHPIEGO Corporation and IPAS:
Baltimore, Maryland.
Settergren S et al. 1997. The Situation of Postabortion Care in Uganda. POLICY
Project, The Futures Group International in collaboration with Research Triangle Institute
and the Centre for Development and Population Activities: Washington D.C. |
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