James Cook University ISSN 1445-6354
Introduction: Home birth remains a strong preference and village midwives are the only option for maternal and neonatal care for many rural women in Sudan. This study assessed whether interventions such as strengthening linkages among health facility/staff, skilled birth attendants and village midwives; strengthening the supervision system; and strengthening the governance capacity of local health departments improved their service delivery and examined factors linked with improved performance of village midwives in their communities.
Methods: This descriptive study comprised a cross-sectional baseline survey, two intervention years, and an endline survey. Data collection involved in-depth, semi-structured questionnaire interviews. Fifty-seven village midwives and 151 community women are targeted for the study in Sinnar, a south-eastern state of Sudan.Participants were interviewed about demographic information, perceptions of operational barriers, training provided, function in the community, supervision and referral for emergency cases.
Results: Results showed the monthly average number of village midwife-assisted home births increased from 1.4 to 3.3. The annual average number of emergency cases referred by village midwives rose from 1.6 to 3.5, and the percentage of village midwives using official monthly reports rose from 33% to 80%. Village midwives reported improved bonds with their supervisors and relationships in the community.
Conclusion: Improved service provision may be associated with development of supervision systems for village midwives, active provision of community activities, strengthened linkages between health facilities and village midwives and enhanced community trust of village midwives. Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in particular settings, international communities should focus on strengthening capacity of community midwives for home births as a realistic measure.