A model for direct entry midwifery education and deployment in Ethiopia : transforming rural communities and health care to save lives

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Background: In Ethiopia, a landlocked country in the horn of Africa, only 10% of women give birth with a skilled attendant and the health workforce meets an estimated maternal and reproductive need of only 32%. Midwives save lives, however most midwives live in cities, while 83% of the Ethiopian population live in rural areas. There is therefore an urgent need to scale up the number of midwives and deploy them where they are needed. The aim of this study was to examine the outcomes of a new midwifery educational and rural deployment model which was implemented at the Hamlin College of Midwives in Ethiopia. Methods: A mixed methods design was used to investigate stakeholder experiences and associated health service and outcome data. A thematic analysis of qualitative semi structured interviews with students, new graduates and staff members of the College was undertaken. A descriptive analysis of selected health service data was also undertaken before and after the deployment of Hamlin midwives. Results: Three major themes emerged from the analysis. These are: the journey to midwifery; becoming a midwife; and innovation and transformation These themes revealed the challenges in accessing and pursuing education for rural girls, the transition academically, culturally and socially for midwifery students from rural areas, the passage of ‘novice to professional’ midwife as well as the emergence of professional midwives who are innovative and passionate advocates for women’s health within their own communities. Conclusion: Midwives who are recruited from rural areas, educated to fulfil the international competencies, thoughtfully deployed, supported and enabled with resources and referral networks can provide highly skilled, culturally sensitive woman centred care. Maternal health service usage and community engagement can be enhanced by the employment of local midwives who not only provide an important service but can be an agent of change through their action as a role model for girls, young women and their communities.
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