Mentorship Program Improves Access to Emergency Obstetric Care

{Photo credit: Rejoice Phiri/MSH}Midwife Chirford Semu stands in the labor and delivery room at Bowe Health Center, in Dowa district, Malawi.Photo credit: Rejoice Phiri/MSH

Chirford Semu knows that time is of the essence when complications arise during labor and delivery.

He is a midwife at Bowe Health Center in Dowa district, one of the most remote areas in Malawi. This single health center serves an estimated 42,445 people. Of these, 9,762 are women of childbearing age, and there are approximately 2,100 expected births per year in the district.

Women who develop birth complications at this facility have to travel 96 kilometers on unpaved roads to reach Dowa District Hospital, the district’s referral facility.

Despite being designated as a Basic Emergency Obstetric Newborn Care (BEmONC) facility, Bowe does not have an ambulance to use during an emergency and must rely on a midwife’s personal vehicle or public transport to make a referral to a higher level facility. As a result, Semu and other clinic staff often feel reluctant to perform certain procedures, including assisted vaginal deliveries that require vacuum extraction, for fear of added complexity if the procedure fails.

An obstetric care mentorship program, implemented by the District Health Office with support from the USAID-funded Organized Network of Services for Everyone’s Health (ONSE) Activity, aims to give staff the tools and skills to ensure quality care for all women during labor and delivery. Specifically, ONSE is helping district-based mentors in 11 districts to support obstetric care providers, such as Semu, to better manage obstetric and newborn complications. With ONSE support, mentors visit these health facilities at least every quarter to demonstrate best clinical practices and to coach providers. Thanks to the mentorship he received and the provision of user-friendly vacuum extractors, Semu is providing better quality care for women during labor and delivery. “Mentorship has really helped me. I am now confident; I am able to screen patients for complications, and I know how to use a vacuum extractor. I have not had failed during an extraction,” he explained.

As a result of the mentorship program, staff at Bowe Health Center are now better managing complications during delivery, performing up to five cases of vacuum extraction per month.

“I saved a life of a mother with eclampsia because I used the protocols which ONSE supplied for managing obstetric complications,” Semu recalls proudly. “I have seen the woman and her baby at our family planning clinic, and they are both doing well.” As confidence in the facility’s maternal and newborn care services improve, facility-based deliveries have also increased from 28 to 72 between September 2018 and January 2019. Better quality care at Bowe Health Center means that women can access the life-saving health services closer to home without traveling to the referral hospital, a huge benefit to mothers and families in this community.