I like to start my presentation on my discussion, giving a background to Africa. And by so, I would say that Africa is a continent with 1.2 billion people with 54 states. And according to WHO, we need 4.2 million more health workers with 1.5 million of those needed in African continent alone. That is looking at it globally. And if we look at the state of the world's media share reports 2011, it indicates that there is a global shortage of an estimated 350,000 midwives and a third of these are required to be within the poorest countries in Africa and we tend to have some of these actually in in Africa. According to WHO globally as of 2013, there were 20.7 million necessary midwives globally. But by 2030, we need to increase it to 32.3 million. In Africa, as of 2013, we had 1 million necessary midwives. And again, Africa has a huge bedroom of maternal and newborn death. And by 2030, we need 1.5 million necessary midwives to be able to address the productive or challenges on the continent. If we take Sierra Leone, for instance, as of 2019, we had only 949 midwives. And by 2030, we need to raise 3,000 midwives to be able to meet their maternal newborn health needs of the of the country. And I had the opportunity to work with the ICM over five-year period providing technical backstopping to about ten countries in Africa looking at the going to see alone, South Sudan, Sudan, Zambia and then Uganda to mention a few. And therefore, I would like to say some of the initiatives that we introduce number four of these countries and how this has impacted on me graffiti. So if we check the garner story through the ICM, your nephew partnership. It started with conducting a nice assessment to know what exactly was the problem based on which strategy plans were developped and then we began to look at Regulatory Act to revise the Regulatory Act. Human resource policies were introduced that sought to look at direct entry midwifery and to increase intake intimately free programs. So across the country, there midwifery institutions that were introduced in every region of the country. So you didn't need to travel very far to be able to access me to free education. We also had a introduction of invested level programs that will help to develop faculty, so that they become qualified in order to teach in the midwifery schools. And then we had direct entry diploma and degree programs or undergraduate program that we're introduced to the investing in partnership with the Ministry of Health where the Minister of Health gave me invested or sort of. They entered into a memorandum of understanding, which invested to begin to train midwives at levels where they can begin to grow their careers and also to be able to sit at the policy table. And then also we had a presentation training to be able to prepare clinical presenters who supports and the training of midwives without international partners, and bilaterals who were interested in me briefly also coming on. But I mean, country organizations like if I go have done a lot of work in Africa developing nation immediate resistance and then also trying to build associations to be able to be good advocates for them in different profession. And then of course, beginning to push midwives to the community level in order to increase investor coverage for a maternal newborn health services. If you look at Ethiopia, for instance, and then the UNFPA, I see a partnership and also with support of the Swedish government. They also went on a similar pathway looking at strengthening regulation as a collective and human resource. They looked at upgrading the direct entry Programs rise up to the master's level. When are you going to do PR? You can do need to see at masters level. They did a lot of continuing professional education programs for SEPTA. Ship is trending. They association to become an independent income. Did Britain organization where it can actually built for projects and and implement, so they became self sufficient and you could actually wait for four projects and then also they also began to look at. Media access web, midwives could be posted to the community level to be able to help communities or woman who cannot travel right into the city centre to access it. Now, let's look at the story of South Sudan. We all know the soil, South Sudan, a war ravaged country that has suffered so many human rights abuses and with very very high maternal mortality rate. There was actually very limited or less in new infrastructure in South Sudan to begin to look at. How do we do a competent mean? If you work force in order to make a case for an newborn health improvements? And again, I must say that with the support of the Canadian government working with ICMA and UNFPA there there was a lot of partnership this assessment done. And there was a book as he right at presidential level and parliamentary level, in order to draw attention to the role of the nature of the midwife. And they were advocacy and some of which I had your privileged to participate to make a case for me to free, and when sound, so that realize that midwives could rise to the level of having doctorate degrees. It was like wow, we never thought that midwives could could rise to that level. And therefore, I remember at that time, it was a vice president who came to give the keynote and he said that if other countries have made wise with doctorate degrees. We need to begin to train midwives who will be qualified in the future too also. Expand the challenges of our country and that meant that. They that's meant that we could look at begin to pave a way for the country to put systems in place. And therefore, through continual advocacy with the school. That was how to change qualified midwives to be able to begin to gradually fill the gap. And therefore, we began to change people at the level of diploma to meet the needs of the people of South Sudan. I wouldn't say that it is perfect yet, we have midwives who have been trained and they have not been able to be absorbed by government. The private sector absorbed them, those who already in, but those who is with you know that you have qualified midwives who can easily find what you do. Whether in the private sector or in the public sector to begin to impact. So it has been a slow process. But at least, we're happy that we have qualified midwives who can be available within the clinical facilities to wake. Now, let us look at Sierra Leone. Sierra Leone also has a similar history like South Sudan do. It is not as severe and we've been able to walk through a walkthrough infection with Ebola virus announcer. Sierra Leone is picking up and doing an is best and currently also needs assessment. They have just rejected plans with the support of UNFPA and other organizations. Midwives are giving scholarship to undertake either an 18-month or two-year different training program where you can qualify as midwives and therefore be posted to a two communities. And also to the clinical setting and the district, regional and national level to be able to practice meet briefly that a lot of investment into training in basic emergency. Newborn care, in order that we can enhance their competences. We are doing a lot around Preceptorship Development, so the student midwives can have access to competent midwives o train them. And of course, there's a lot of work being done around gender issues and cultural sensitivities, that tend to also affect the work of the midwives and also maternal and child health. As we know, we have a lot of high incidence of fetal mutal cotton and then also, incidence of rape, that tend to affect maternal and girl child and therefore, there's definitely the work of the midwife, that needs to be addressed. So, I will say that these are some of the encouraging progress and initiatives that have gone on in a few of the countries that I've talked about. And these are promising. I will say that currently in Ghana, we have actually over produced midwives. And now, the government is trying to look at how they can actually do invest in medical tourism, where midwives, countries which need midwives and nurses and actually come and have a government to government bilateral relationship, to be able to support the health care needs. As Africa, we will need over 500,000 midwives to be trained by 2030, if we are to be able to achieve the call for investor access to help. And we cannot just achieve this, unless we adopt and continue to apply a multifaceted approach to Health Systems strengthening. Where, apart from training them, we make sure that they are well motivated and placed within their right enabling environment. Where midwives are recognized as equal professionals to other professions. Where the skills of the midwife is respected, because the midwife is able to provide over 80% of the core interventions that are needed to save the mother. And therefore, midwife-led models of care should be promoted for save vaginal delivery, and it is only when complications arise, then the obstetrician gynecologist must come there for midwives. The whole of Africa must be allowed to practice independence, effective, competent, maybe free care.
