The Potential of Private Sector Midwives in Reaching Millennium Development Goals

Government health sectors in many countries face an uphill battle to reach the Millennium Development Goals (MDGs) set for 2015. In the last six years, Ministries of Health (MOHs) in many less developed countries (LDCs) have been unable to invest sufficiently in their health systems. To achieve the MDGs despite inadequate resources, new approaches for delivering critical clinical services must be considered.

This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in LDCs’ ability to reach MDGs. This paper examines factors that support or constrain private practice midwives’ (PPMWs’) ability to offer expanded services in order to inform the policy and donor communities about PPMWs’ potential.

Data was collected through literature reviews, stakeholder interviews, and field-based, semi-structured interviews in Ghana, Indonesia, Peru, Uganda, and Zambia.

Ghana, Indonesia, and Uganda were chosen because they are countries where PPMWs provide expanded services. Peru and Zambia were selected as examples where midwives have struggled to develop private practices or they provide expanded services despite issues about midwives’ roles and legal sanctions for private practices.

Four major factors influence PPMWs’ ability to expand beyond traditional services: the nature of the country’s colonial legacy, the PPMW’s motivation to enter and expand private practices, the legal and regulatory requirements to enter and expand private practices, and the access to capital and supplies to open and expand private practices. The data also illustrated opportunities and challenges for midwives in or interested in entering private practice. Challenges include insufficient access to capital and financial sustainability, a lack of training in additional services, inadequate supervision by and weak interaction with the national health system, scant business skills, and competition from physicians. Opportunities included the professional association’s advocacy potential and the communities’ trust of midwifery services.

PPMWs are often the only professional providers in poor and remote areas that offer a range of primary health services. They often are the first contact for health care in settings where the public sector does not provide services. In countries where PPMWs have flourished, they provide a substantial amount of essential clinical services nationally.

Separation of the formal health sector from the private sector can weaken the former’s ability to mobilize personnel and resources, measure health statistics, and assess expenditures and manpower needs. In addition, the quality of clinical services in the private sector can suffer without a link to the formal sector and national standards of care. Start-up capital is beyond the reach of many midwives, especially in African countries, and traditional commercial-sector loans are difficult for most midwives to obtain and repay as interest rates are high. x

The authors of this paper recommend that donors, governments and implementing agencies:

• further support PPMWs to acquire business, continuing clinical and monitoring and evaluation skills and help them adapt approaches and tools for quality improvement

• further support PPMWs’ ability to access financial capital and business-skills training

• explore alternative financing mechanisms, including contracting out, vouchers, and community-based insurance by which PPMWs can sustain their practices while still serving vulnerable populations

• identify and strengthen links between PPMWs and formal governmental and nongovernmental sectors so that the MOH and PPMWs have stronger connections through regulatory agencies, professional associations, and policy support to remove barriers that prevent the success of PPMWs

Source: USAID
Year: 2006