Advocating for Change: Empowering the Maternal Health Workforce We Need to Save Lives

By Lilia Carasciuc, White Ribbon Alliance

In Western Tanzania, Elvina Makongolo is the only midwife on staff at the Mtowisa Health Centre’s maternity ward. She works around the clock to give pregnant women the care they need. She knows all too well the risks these women face in giving birth so far away from the lifesaving equipment required in emergencies.

“We are too few midwives…so being understaffed, this leaves me to do everything: cleaning, preparing the instruments, preparing delivery kits, and still when a pregnant woman comes, I deliver her, keep her safe, record her information. If we were many, we would help each other to relief the burden,” Elvina said.

White Ribbon Alliance (WRA) is making sure the world knows how crucial midwives like Elvina Makongolo are in saving the lives of mothers and newborns. Yet all too often, midwives work in substandard conditions, for small salaries, and are trapped in a vicious circle of low public regard and poor performance. We are supporting midwives around the world to advocate for their profession, changing the public’s perception of their work and pushing for improvements in midwives’ pay and working conditions so that their vital role is recognized and justly rewarded.

Sadly, chronic health workforce shortages in Tanzania pose enormous barriers to women’s access to safe and reliable maternal and child health services. Women the Rukwa region must walk all day to see a skilled midwife at Mtowisa Health Centre, and must walk an even further 200 km to the nearest hospital in the event of an obstetric complication or emergency.

Time and time again, we have seen how powerful health workforce advocates can be in urging governments to recognize the indispensable role of health workers in achieving national maternal and child health goals. As a result of our campaign in Malawi, the Minister of Health committed to develop a strategy for increasing the number of professional midwives; to work with Malawi’s directorate of human resources to develop a career path for midwives; and to include in the next national budget funding for research to determine the number of midwives in the country.

Following our campaign in Tanzania, Prime Minister Pinda directed all district councils to allocate an adequate budget for human resources to support comprehensive emergency obstetric and newborn care. Because of citizen advocacy in Uganda, the government provided an 18% salary increase for enrolled midwives and nurses, as well as a 13% salary increase for registered midwives.

In many other countries, midwives still face extraordinary staffing shortages, inadequate medical supplies, and public scrutiny. To address these challenges, we are sharing our lessons learned in citizen empowerment and advocacy, hoping to help others spark change. Only then can we recruit, train, employ and retain the skilled frontline maternal health workforce so urgently needed to prevent deaths in childbirth.

White Ribbon Alliance formed over a decade ago to give a voice to the women at risk of dying in childbirth. Our mission is to inspire and convene advocates who campaign to uphold the right of all women to be safe and healthy before, during and after childbirth. We help citizens recognize their rights and hold their governments to account for commitments made to maternal and newborn health.