This proposal seeks to address the challenge of connecting women in a specific rural province of Zambia with midwifery services to improve reproductive health outcomes. The proposal takes a two pronged approach to addressing this issue by both increasing visibility and access to midwifery services and by strengthening the services midwives provide. The proposed actions will be implementation in the North West Province of Zambia through the coordinated efforts of the Midwifery Association of Zambia (MAZ). The North West Province of Zambia represents a rural region of the country where community engagement and professional development of midwives is challenging due to the vast landscape. This project will serve as a model that can be replicated and scaled-up in other rural provinces of Zambia. ************************************************************************* Problem One: There is a lack of community knowledge in the North West Province of Zambia of who midwives are, where midwifery services are offered and why those services are of value and worth actively seeking. ************************************************************************* The landscape and distribution of communities in rural Zambia poses a particular challenge to addressing issue of educating the community about midwifery services. There are 10 provinces in Zambia with Lusaka, Copperbelt and southern provinces housing the major cities and therefore accounting for a large portion of the total population. According to the 2011 -2015 Ministry of Health National Health Strategic plan, Zambia has 1882 health facilities with core health service delivery facilities falling into five categories: 275 health posts and1060 health centres at the community level; 84 first level hospitals at the district level; 21 second level general hospitals at provincial level; and 6 third level tertiary hospitals at national level serving the Zambia population. ______________________________________________________ These facilities are widely dispersed and often without adequate numbers of skilled health care providers. The demographic distribution in Zambia makes it difficult for women to discover their reproductive health care options and access midwifery services. It also creates challenges for midwives to educate the community about the services they offer or provide health promotion activities. For this reason we propose to reach out to community members thereby improving access to midwives that reside in these rural areas. ______________________________________________________ The North Western province where this proposal will be implemented is one of the smaller provinces in Zambia with most of the population living in rural districts. The area is served by 2 general hospitals, 10 first level hospitals, 18 urban health centres, 120 rural health centres and 17 health posts. ______________________________________________________ In Zambia where maternal mortality is 591 per 100,000 live births and the infant mortality rate is 70 per 1,000 live births, there is a tremendous need for midwifery services and development of human resources in support of services provided by midwives. In rural areas of Zambia there has been such a shortage of midwives that almost everyone has tried to fill the gap. Due to the shortage of midwives in the rural areas of Zambia the category of skilled health provider has been broadened and other health professionals without appropriate education and training are placed in the health facilities to provide health services including midwifery services. ______________________________________________________ The most startling examples of this are in the rural, remote areas where people choose to settle because there is fertile soil for cultivation or a source of water. This increases the distance they must travel to a health facility making it difficult to access even the meagerly trained staff. Many women won’t make it to a facility and may be attended to by anyone who feels they have the skills to conduct a delivery, though without the education that qualifies them as a skilled attendant. Women are placed in the precarious situation of thinking they are birthing at home with a qualified birth attendant though they have no way of really knowing what to ask about qualifications and outcomes. _____________________________________________________ When women do make it to a facility, midwives are not easily distinguished from other providers and there is a lack of awareness about the particular and unique services that midwives offer. Most midwives in Zambia today are qualified and licensed nurses with additional training in midwifery which includes care of the neonate. However, midwives wear the same uniform as general nurses making them difficult to identify as specialist in childbirth and neonatal care. Differentiation and enhancement of the image and education of the public about the services midwives provide has the potential to save lives in Zambia. ************************************************************************* Problem Two: There is a need to increase opportunities for professional development and midwife led continuing education for midwives in the North West Province of Zambia ************************************************************************* Enhancing midwifery care entails building a strong and organized midwifery workforce that is aware of what is needed to improve access and delivery of maternity care. To aid in building a midwifery workforce that is skilled and strong enough to attempt to meet the demand for maternity services, MAZ has been working to recruit members into the organization. One of the principal goals of MAZ is to strengthen the knowledge and skills of its midwife members. While this work is challenging enough in cities, it is far more difficult in rural areas where few persons have the resources for advanced communication technologies such as internet. _____________________________________________________ For midwives in the rural provinces of Zambia, while there are some cellphone towers and sometimes access to electricity, the principal means of communication is still face-to-face meetings. MAZ has a number of small, yet energetic chapter affiliates (groups of midwives) in the provinces that are committed to addressing recruitment of each area’s midwives. A key component of the recruitment plan is organizing gatherings of midwives where their professional development can be addressed with activities such as continuing education sessions with evidence-based updates on the management of pre-eclampsia, family planning options and postpartum hemorrhage amongst many others. _____________________________________________________ Gatherings of midwives in rural regions however are rare as they require advance planning, organization, and a small amount of funding. As such, there are few opportunities at present for rural midwives to learn, to network, to meet prospective clients, and to inform the public about the services they offer. _____________________________________________________ Moreover, Zambian midwives are not alone in facing challenges with regard to respectful care. Programs exist to teach and reward regeneration of respectful care but they are not universally available to nurses and midwives and especially difficult to find in rural areas. It is known that dissemination of information on provision of respectful care enhances the image of nurses and midwives. ____________________________________________________ _ Hence, MAZ also understands that it needs to promote learning and change behaviors such that midwives are truly providing respectful care and doing conscientious work to improve the image of midwives. Enhancing the quality, image and approachability of midwives starts by nurturing their professional capacity. _____________________________________________________ This can be done through organized gatherings that facilitate the implementation of collaborative efforts to address their professional needs. Such gatherings have tremendous potential to improve the quality and reputation of midwifery care.

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