Strengthening Clinical and Business Skills of Community Midwives to Help Establish their Private Practice: A Study from Sindh, Pakistan

Presenter: Shaista Rahim, USAID’s Maternal and Newborn Health Integration Program, Jhpiego

Background: In Pakistan, the maternal mortality rate is high. The government has introduced a new cadre of health care workers – Community Midwives (CMW) in 2007. The aim was that these trained CMWs will improve access to Maternal Newborn Child Health (MNCH) services in harder-to-reach areas by establishing their private setup.  However data showed that program failed to achieve desired results. The Maternal and Newborn and Child Health (MNCH) Services Project, a component of USAID/MCH Program in focused districts of Sindh approached deployed CMWs to upgrade their clinical and business skills.

Methods:  A total of 112 CMWs were traced in five districts: 43 (38%) were practicing after deployment and only 24 (22%) of CMWs had the physical space (or “birthing station“) to provide MNCH services.  Skills assessments showed that even practicing CMWs lacked basic skills, such as infection prevention etc. A six day competency based-clinical skills update training and a five day business skills training was imparted. Through a private partnership, almost 33 health facilities have also been constructed.  These health facilities also received essential infection prevention and MNCH supplies. All CMWs also received supportive supervisory coaching and mentioning visits by a technical project staff.

Results: Before the trainings, the CMW were performing on an average 8 deliveries per month. The clinical practice improved drastically after business skills training which was focused on sales, record keeping, customer management, and interpersonal skills. The results of post training follow up assessment showed that after six months of business skills training, 88% of CMW increased the total number of clients, 59% increased the number of deliveries and 79% increased overall income level.

Conclusion:  Capacity building which included supportive supervision for both clinical and business skills improved performance built confidence and helped establish private practices of CMWs in Sindh, Pakistan.