Factors Affecting The Learning Implementation Of Midwife In-Service Training In South Sudan

Miki Hirata,Yumiko Endo,Yoko Tamashiro,Keiko Kawamitsu,Fujiko Omine

doi:10.15344/2394-4978/2016/167

Abstract

Background: In South Sudan where both maternal mortality rate and infant mortality rate are among the worst in the world, we conducted a qualitative study in the area of midwife in-service training outcomes with an aim to contribute to the in-service training development that fits the local context and serves the needs of midwives in dire environment. Methods: We conducted semi-structured interviews with five graduates of a midwife in-service training program. The interview guide was developed to determine the progress, the facilitators and the bottleneck in the transfer of knowledge from the training program to practicum. The interviews were conducted in Juba, South Sudan, and transcribed verbatim followed by content analysis of data using the Modified- Grounded Theory Approach. Results: The content analysis of data produced 24 concepts, 5 subcategories and 3 categories. Those categories were “Development of motivation for application,” “Building up midwife skills,” and “Midwife care improvement in the facility.” We found that the midwife leaders’ skills building processes were influenced by environmental factors such as community members' perception which impedes safe delivery, lack of pregnancy and birth related knowledge among women in the community, and low level of language skills of colleagues. There were also intrinsic factors including having successful experiences, recognition from others, and confidence in new skills. Conclusion: Overall, the study indicated the incorporation of participant-centered learning methodology and strategies to effectively work through environmental issues and midwives’ level of self-efficacy will increase successful application of learning.

Highlights

The analysis focused person was a midwife in a leadership role at the PHCC or hospital in South Sudan who had attended midwife inservice training (Table 2)
Our study investigated the factors affecting the learning implementation of midwife in-service training in South Sudan
To the best of our knowledge, this study represents the first attempt to document the process of skills building after in-service training among the midwife leaders in South Sudan

Summary

Introduction

According to the World Health Organization (WHO), 2004, a skilled birth attendant is defined as “an accredited health professional such as a midwife, doctor or nurse who has been educated and trained to proficiency in the skills needed to manage normal pregnancies, childbirth and the immediate postnatal period, and in identification, management and referral of complications in women and newborns [1].”Robinson and Wharrad (2001) reported that “...maternal deaths are substantially reduced when a high proportion of births are attended by health professionals, including primary health care workers trained in midwifery skills, with the maintenance of an aseptic environment, the identification of maternal and fetal complications, and the opportunity when necessary to transfer parturient mothers to centers with higher level skills and facilities [2].” In the initiative launched in 2008 by the United Nations Population Fund and International Confederation of Midwives, it was stated that “Up to 90 per cent of maternal deaths can be prevented when midwives and personnel with midwifery skills are authorized and supported by the health system to practice their full set of competencies, including basic emergency obstetric and newborn care [3].” This message underscores the importance of skilled birth attendants.In South Sudan, the maternal mortality is 2,054 per 100,000 live births (sub-Saharan Africa average is 740 per 100,000) which is the worst in the world [4]. In the initiative launched in 2008 by the United Nations Population Fund and International Confederation of Midwives, it was stated that “Up to 90 per cent of maternal deaths can be prevented when midwives and personnel with midwifery skills are authorized and supported by the health system to practice their full set of competencies, including basic emergency obstetric and newborn care [3].”. This message underscores the importance of skilled birth attendants.

Objectives

Discussion

Conclusion