Private Midwives Serve the Hard-to-Reach in Yemen

Private Midwives Serve the Hard-to-Reach in Yemen

With sometimes impenetrable terrain and limited infrastructure, Yemen presents a very challenging environment for delivering health services to rural areas. Basic health services do not reach most women; rural areas lack health facilities; and Yemen’s conservative cultures do not allow women to receive health services from men, or to freely come and go from their home.

In Yemen, through a pilot program, the Extending Service Delivery (ESD) Project supported the Basic Health Services (BHS) Project to assist midwives with setting up private practices in rural communities where facilities did not exist or were too far away. Midwives are generally respected in Yemen communities and, most husbands allow their wives to visit the midwives in their homes.

The ESD Project is funded by USAID’s Global Health Bureau and is designed to address an unmet need for family planning and to increase the use of reproductive health and family planning services at the community level.

ESD adopted a new practice model in Yemen – a national health professional association became the vehicle to reach isolated populations with reproductive and family planning services. ESD chose to support the National Yemen Midwives Association (YMA) for this intervention because midwives play a unique role in maternal, neonatal, and child health in conservative environments. The YMA supports private midwives with the tools and resources they need to be successful in proving quality reproductive health care to underserved populations.

ESD partnered with the YMA in 2006 and conducted a rapid organizational needs assessment using MSH’s Management and Organizational Sustainability Tool (MOST). As a result, the YMA identified immediate challenges that needed attention such as updating a strategic plan, developing an organizational plan, improving financial management, and developing board member skills in proposal development for external funding.

From this exercise, a study visit was organized for YMA members in 2007 to visit and learn lessons from the Uganda Private Midwives Organization and how this association maintains itself and supports members who are private midwives.  Immediately upon returning from Uganda, the YMA implemented a number of lessons learned, including: the development of Ministry of Public Health (MoPHP) approved job descriptions for midwives; development of a code of ethics for paramedical practitioners with local training institutes; the revitalization of the MoPHP’s registration and licensing process for all practicing paraprofessional health staff such as midwives ; and, the revision of eligibility requirements for selecting midwives to establish a private practice.

Midwives are well-positioned to fill the deficit of female clinicians. They are able to provide basic maternal, newborn, and child health (MNCH) services in hard-to-reach settings. Midwives help educate and counsel women on family planning for healthy timing and spacing of pregnancy (HTSP). Private midwives are particularly valuable because they can serve a smaller clientele and provide more personalized services.

The initial small group of 12 trained private midwives is already having a distinct impact on service delivery. They have extended their reach in 2009, providing a total of 5,734 services. They provided: family planning services, skilled deliveries, antenatal care visits, postnatal care visits, newborn care visits, home visits, health education visits, immunizations, and other services.

Given the conservative setting in which the midwives work, there are many successes and lessons learned to be shared with other culturally conservative environments.

Through the ESD program, we learned that training tools need to be adapted to the local context and language when partnering with a local institution.  Government support needs to be fostered from the beginning – the Ministry of Health or MoPHP should be continually informed and supported as it strengthens its own systems.

ESD and BHS will focus on continuing education in upgrading the midwives technical skills in maternal, newborn, and child health. A capacity building toolkit is being created and finalized to help train other interested midwives.  In Yemen, the status of the midwife needs to be advanced to be a more respected member of the health team within a clinical setting. Institutionalizing the training program is the first step in the right direction.

Jeanette Kesselman is a Senior Advisor, Capacity Building and Sustainability on the Extending Service Delivery Project (ESD).