The Millennium Development Goals 4 and 5 focus on improving maternal and child health. In Malawi, Shortage and poor retention of midwives is a challenge for achieving these MDGs. This also contributes to a shortfall in skilled birth attendants.
One mechanism developed by Malawi government to try to increase skilled attendance at birth, particularly in rural areas, was the introduction of CMA training (18-month training programme).
CMA training started as a pilot program in 2011 25 female students enrolled at St. Joseph’s College of Nursing and Midwifery 23 at St. Lukes College of Nursing and Midwifery All deployed now Currently enrolled at St. Joseph, MCHS, Ekwendeni, st.Johns, Mulanje, Phalombe, St.Lukes, Nkhoma.
To reduce MMR currently 675/ live birth and neonatal mortality rate 33 per 1000 live births To increase skilled birth attendants in the rural areas.
80% of population live in rural areas Challenges to access health services due geographical and infrastructure problems
Many midwives refuse to work in rural settings CMA understands community cultural background. CMAs stay in communities
CMAs are adding to number of skilled attendants in the communities. Curriculum revised to incorporate care of emergencies
Mentorship training for NMTs to mentor CMAs Support from local organisations.
No grass root level infrastructures for CMAs to practice close to their communities. Retention of CMAs poses a challenge as most of them are young and will get married or want to continue with education.
Mentors not always available to give the necessary support Recruitment done at a district level and not at local level. Curriculum still in draft form.
Provision of infrastructures for CMAs to practice in their communities after six months of working with a mentor- this will improve access to skilled attendance at grass root level.