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ICM assists at a 'rebirth': the Midwives Association of Sierra Leone: Nester T Moyo, ICM Senior Midwifery Adviser, describes the step-by-step process of bringing a midwifery association back to life after the damage of a civil war.


The mission to Sierra Leone was carried out in a collaboration between the International Confederation of Midwives (ICM) and Cordaid--an international development organisation with a network of partners in 36 countries--in a move to reduce maternal, newborn and child morbidity and mortality. ICM is grateful to Cordaid for making this mission possible as strengthening midwives associations is a core activity of the Confederation.

This trip formed the foundation for a number of activities with the Sierra Leone Midwives Association (SLMA) in strengthening the contribution of midwives and midwifery to the reduction of maternal, newborn and child morbidity and mortality in Sierra Leone and the general improvement of maternal newborn and child health in that country. Currently, Sierra Leone has one of the highest rates of maternal and neonatal deaths in the world.


The objectives of the visit included:

* to make acquaintance with the association, and to meet other stakeholders

* to make an assessment of SLMA and, if appropriate, of other organisations of midwives in Sierra Leone;

* to elaborate an action plan to strengthening SLMA

* to support SLMA in reformulating an action plan with a budget for the first year.

The objective of getting in touch with stakeholders was achieved by meetings with the Ministry of Health and Reproductive Health Unit, the Medical Research Council and the Christian Hospitals Association of Sierra Leone (CHASL). Visits were scheduled to two government facilities and two privately owned facilities.

With the help of Piet van Gils, Cordaid Programme Officer, I met the Director General of Health Services, the Directors of Primary Health Care Services, NGO Liaison, Reproductive Health, Hospital Services, and Human Resources. The ICM aims were shared with the Director General, who pledged support for the midwives: all are anxious to do what will contribute to reducing maternal newborn and child mortality and morbidity. I was able to gain insights into areas where midwives can contribute under the auspices of these organisations. All agreed that midwives are the lynchpin of maternal, newborn and child health care provision.

Visits to the Reproductive Health Unit, the government hospitals and clinics and the private hospital and clinics showed conditions which emphasise the need for a strong association to develop standards of care and monitoring and supervision mechanisms. The head of UNFPA country office, UNICEF and head of the fistula hospital in Sierra Leone all spared time for meetings and to share their conviction that this was an opportune moment to strengthen the midwives association. There is conviction that if this can be done, the care of women and children will improve and the mortality rates will drop. People are therefore looking forward to a rebirth of the profession following this visit.

The Midwives Association

On day one of the mission, Sister Elisabeth Decker, the President of the Association; the Director of the School of Midwifery (who serves as the Public Relations Officer of the Association); the secretary of the association; the Director of Nursing Services in the Ministry of Health; her deputy; and the Registrar for nurses and midwives joined in a meeting. The group was guided into determining whether the association was still viable, and if not what should be done. A conclusion was reached that the association is largely inactive and ineffective. It was agreed that more people were needed to increase momentum and provide a democratic base for decisions.

On day two, senior midwives in and around Free Town were invited to the meeting: 20 midwives came, and the objectives were shared. Everyone present wanted a rebirth to take place and they were keen to work as hard as it took to ensure that by the end of the mission, the association was reborn. The participants pledged to give all the support, effort and commitment they can to ensure that midwifery services and the interests of midwives and women get back onto the health agenda with midwives contributing their share as chief advocates for women and newborns.


The Visioning Process

Capturing the momentum, the midwives worked to: develop a vision where the association is working perfectly, agree on a mission and devise a strategic plan. The process was facilitated by having the participants answering the questions:

* What do we see in the future of midwifery and of Sierra Leone and its women? (vision)

* How do we get there? (strategies)

* Where do we start and when? (objectives)

* What do we need? (resources)

* From whom? (support systems and partners)

Main issues

Morale is low. Midwives do not feel valued. Both the practice environment and the care environment for women are very poor. In some instances there is no running water or electricity in a maternity hospital. Staffing levels are low, though some midwives are qualified but not employed. In hard-to-reach areas there is no accommodation for midwives, no schools for their children, no roads for transport back into town or for referral of patients.

The rebirth of the association is strongly believed to be the first step towards revitalising the midwifery workforce, as the association will provide a forum for discussion and sharing; give a sense of identity to midwives; and have a long lasting positive influence on the delivery system for maternal newborn and child health in Sierra Leone.


Once all the thoughts and emotions about the above frustrations were openly expressed and discussed to the full, the midwives agreed a vision and a mission:

They also drafted a strategy to include the following areas:

* Establish the association's secretariat.

* Spread the association to cover the whole country

* Advocacy

* Quality improvement and management

* Strengthen the education of midwives

* Continuing education

* Research

* Collaboration and partnerships

* Publicity and communication

* Sustainability

The Midwives Association of Sierra Leone

The Midwives' Association of Sierra Leone (MASL) is an organisation with a new name born following the support received from ICM and Cordaid to strengthen the Sierra Leone Midwives Association, which collapsed during the war. The rebirth will provide an opportunity for the association to establish strong relationships with all concerned with maternal and newborn health including men and women in the community. Grass-roots women's organisations, such as the Market Women Association, were identified as stakeholders with whom the association should work closely in charting the way forward. When these people, the recipients of care, feel that they are receiving the care they need, then midwives will know that the care they offer is of appropriate and of good quality.

Action plan and conclusion

Action included the planning of events for the International Day of the Midwife, and 'Mother-night', to coincide with the celebration of Mother-night in the Netherlands. The possibility of twinning of the association with the Dutch Midwives was also accepted very eagerly.

This mission was successful. All the objectives were met and more. The relationship between ICM and the association in the making will be maintained as ICM will be offering desk support for the implementation of the action plan and will have a further support and monitoring visit towards the end of the year.


The Vision

The midwives' vision is a Sierra Leone where all women of childbearing age, newborns and children are receiving quality midwifery care wherever they live, from happy, committed providers. There is a very low rate of maternal, newborn and child mortality. The midwives function as the lynchpin in the provision of maternal, newborn and child health services and they work in partnership with women.

The Mission

The association is set out to unify midwives, give them a sense of belonging and identity, and maximise their contribution to the provision of maternal newborn and child health within the context of the Ministry of Health's strategic plan for reproductive and sexual health.
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Article Details
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Title Annotation:International Confederation of Midwives
Author:Moyo, Nester T.
Publication:International Midwifery
Geographic Code:60AFR
Date:Mar 1, 2008
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