Abstract
BackgroundMidwifery plays a vital role in the quality of care as well as rapid and sustained reductions in maternal and newborn mortality. Like most other sub-Saharan African countries, the Democratic Republic of Congo experiences shortages and inequitable distribution of health workers, particularly in rural areas and fragile settings. The aim of this study was to identify strategies that can help to attract, support and retain midwives in the fragile and rural Ituri province.MethodsA qualitative participatory research design, through a workshop methodology, was used in this study. Participatory workshops were held in Bunia, Aru and Adja health districts in Ituri Province with provincial, district and facility managers, midwives and nurses, and non-governmental organisation, church medical coordination and nursing school representatives. In these workshops, data on the availability and distribution of midwives as well as their experiences in providing midwifery services were presented and discussed, followed by the development of strategies to attract, retain and support midwives. The workshops were digitally recorded, transcribed and thematically analysed using NVivo 12.ResultsThe study revealed that participants acknowledged that most of the policies in relation to rural attraction and retention of health workers were not implemented, whilst a few have been partially put in place. Key strategies embedded in the realities of the rural fragile Ituri province were proposed, including organising midwifery training in nursing schools located in rural areas; recruiting students from rural areas; encouraging communities to use health services and thus generate more income; lobbying non-governmental organisations and churches to support the improvement of midwives’ living and working conditions; and integrating traditional birth attendants in health facilities. Contextual solutions were proposed to overcome challenges.ConclusionMidwives are key skilled birth attendants managing maternal and newborn healthcare in rural areas. Ensuring their availability through effective attraction and retention strategies is essential in fragile and rural settings. This participatory approach through a workshop methodology that engages different stakeholders and builds on available data, can promote learning health systems and develop pragmatic strategies for the attraction and retention of health workers in fragile remote and rural settings.
Highlights
Midwifery plays a vital role in the quality of care as well as rapid and sustained reductions in maternal and newborn mortality
This study aimed to identify strategies, based on the research presented, that can help to attract, support and retain midwives in the fragile and rural Ituri province
Using the WHO framework on retention of health workers in remote and rural areas, workshop participants were able to reflect on the midwifery situation in their districts and province and develop strategies that were based on their local context, identifying and solving implementation challenges
Summary
Midwifery plays a vital role in the quality of care as well as rapid and sustained reductions in maternal and newborn mortality. Like most other sub-Saharan African countries, the Democratic Republic of Congo experiences shortages and inequitable distribution of health workers, in rural areas and fragile settings. Nurses and midwives make up the majority of the health workforce and play key roles in maternal and newborn healthcare [3, 4]. Midwives are a critical skilled birth attendant (SBA) cadre associated with improved quality care and rapid and sustained reductions in maternal and newborn mortality [5]. The UN report on the progress of the SDGs shows that many countries are still facing the challenge of shortages of qualified health workers, i.e. fewer than 1 doctor per 1000 population and fewer than 4 nurses and midwives per 1000 population [7]. Most sub-Saharan countries are amongst those countries [8, 9] and, within countries, there are serious distribution inequities between urban and rural areas [10]
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