A lifesaving mission
Australia may boast world-class maternity facilities, but the situation for many South Pacific countries is very different. The outlook is gradually improving thanks to the vital work of UTS to improve maternal-child health in the region.
In achieving World Health Organization Collaborating Centre (WHO CC) status in January 2008, the Faculty of Nursing, Midwifery and Health at UTS became one of seven nursing and midwifery collaborating centres in the Western-Pacific region.
As an institute designated by the WHO Director-General to form part of an international collaborative network, a CC’s primary role is to implement WHO’s mandated work and program objectives, and develop and strengthen institutional capacity in countries and regions.
“The Faculty’s extensive history of regional work in human resources for health, education, regulation, policy and capacitybuilding means we’re well-placed to carry out activities in support of WHO programs,” says Michele Rumsey, Director of Operations and Development at the Faculty, which is headed by Professor John Daly, Dean, Faculty of Nursing, Midwifery and Health.
An application to become a CC can only be submitted following a two-year working relationship with the WHO, while the designation process takes at least two more years. Each institute is assessed on areas such as scientific and technical standing, and development of working relationships at country, regional and global levels.
Designation is given for a maximum of four years, after which the institute must apply to be redesignated. After going through “a massive global process” – as Rumsey describes it – the WHO CC achieved redesignation at the beginning of 2012. The process involves supplying a work plan and terms of reference, which are:
- Improving health systems and building capacity
- Strengthening cross-sectoral relationships, including supporting regulatory systems, research-based education, and faculty development
- Promoting and supporting national, regional and international development of nursing and midwifery health systems, which includes human resources for health
- Strengthening maternal and child health care.
“It was very exciting for us to be redesignated as it validates that we are doing good work in line with WHO’s broader aims,” says Rumsey.
The WHO CC’s key strength areas are around improving health policy and service delivery in nursing and midwifery across the Asia-Pacific, through technical advice; research; policy analysis; consultation; advocacy; training; and skills development. “All of our work takes into consideration the UN Millennium Development Goals (MDGs) for 2015, which are now a priority across the region,” says Rumsey.
“Specifically, we work on goals four and five, which encompass maternal and child health. However, others such as gender equality underpin our work.”
WHO CC is currently involved in a large AusAI D-funded Papua New Guinea (PNG ) Maternal Child Health Initiative, which saw it recently employ eight clinical midwifery facilitators and two obstetricians into regions in PNG to help rebuild midwifery, and support four universities to assist with educational standards for maternal health.
“The PNG government aims to rapidly increase the number of skilled obstetric health workers,” Rumsey says. “We’re working with them to make an impact on the educational and practice standards of existing and incoming healthcare workers. This way we can sustainably address the dire situation of mothers and babies who are dying through childbirth.”
PNG has one of the highest maternal mortality rates in the region: today, five women will die in childbirth.
“The vast majority of maternal deaths – 88 to 90 per cent – are preventable, yet only 39 per cent of births in PNG are reported as being attended by a skilled birth attendant. It should be 80 per cent. Moreover, only around half of pregnant women receive the minimum internationally recommended number of four antenatal visits.”
“What has happened in many countries like PNG ,” says Professor Caroline Homer, Associate Dean (International & Development) and Director of the Centre for Midwifery, Child and Family Health in the Faculty of Nursing, Midwifery and Health at UTS, “is that midwives haven’t been well supported. Some of this relates to the fact it’s a women’s issue and not particularly valued. Some of it’s because resources have not been put into nursing and midwifery education. Resources haven’t been put into education in lots of areas, but particularly nursing and midwifery. Additionally, some issues have existed around regulation of midwives: not regulating or even registering them quickly enough because of resource issues. So midwifery largely died off.”
Eighty student midwives will go through the PNG program this year. Next year it will be 100, and the year after 120, which is exceptional for a country that currently has around 200 midwives.
“The students have been really well supported by AusAI D, which is fantastic,” says Homer. “Their fees are paid and they receive a living allowance. Many come from rural areas – often from quite a distance – into Port Moresby or Madang or Goroka to do their training. So it’s very exciting to be rebuilding the profession, and there’s a real sense of pride. I think we will see benefit in the next two or three years around people feeling part of what they do, and wanting to make a difference for women.”
Two midwives at the University of Goroka work alongside midwifery students and clinicians in the hospitals, doing on-theground teaching and learning activities, and going out into rural areas with their students to run antenatal clinics, attend women in labour; and role model good practice and good teaching.
“It’s pretty hard work,” says Homer with clear admiration. “Security in PNG continues to be an issue, and even though a range of security protocols are in place, this puts huge restrictions on people’s lives, particularly in Port Moresby.”
Staff undergo security training with the UN Security Services. Numerous security protocols are in place around travel: they have radios in their cars, they don’t travel alone at night and if they need to go into rural areas where there’s trouble, they always travel with security support – sometimes armed security. Houses are protected, with UN security clearance to ensure they meet security requirements.
“For the most part, if people just are sensible and keep their head down, it’s fine,” says Homer. “But there’s no question it’s a difficult environment. Still, despite this, they’re totally committed and really enthusiastic.” In fact, two women have moved their families to PNG . “One is there at the moment with two small children, while another is about to give birth to her child,” says Homer. “The kids live in a very protected environment and are having a great time as far as I can see.”
Improving population health
Across the region the WHO CC is working with the WHO and other organisations such as AusAI D, NZAI D, World Bank, and the Asian Development Bank to improve population health by strengthening nursing and midwifery. “One area where we’ve done this is working with our partners, the South Pacific Chief Nursing and Midwifery Officers Alliance,” says Rumsey.
“These are the nursing and midwifery leaders in education, regulation and the Ministries of Health in the 14 countries of the South Pacific.” A program to come out of this work is the annual AusAI D Australian Leadership Award Fellowships program, which commenced in 2009.
“This work is very innovative, with the chief nursing and midwifery officers of the region selecting ‘Fellows’ to participate in the program, which focuses on developing leadership skills and capabilities,” says Rumsey. “They basically identify future leaders in specific sectors and put them forward. As this program is based on mentoring, the chief nursing officer becomes a mentor for these participants.”
The Fellows choose their own projects to address local issues. These have ranged from focusing on strengthening midwifery care, to infection control measures, to setting standards of care. “While some may be quite simple in concept, all can have huge impacts on patient care,” says Rumsey.
Quality improvement in education for nursing and midwifery is a global project on which the WHO CC is working with the WHO Western Pacific Regional Office. “Our project is around faculty development,” says Rumsey. “Many schools or universities in the Asia-Pacific region suffer from inadequate numbers of skilled educators in nursing and midwifery. So we’re working to identify the issues for nursing and midwifery schools through a facultydevelopment survey, with the ultimate aim to create faculty-development programs to strengthen nursing and midwifery education in the region.”
A meeting last December with colleagues from Vietnam, Samoa, PNG , Lao, China, the Philippines, and Hong Kong provided the opportunity to hold a focus working group on this survey to ensure the language is accurate for all the Asia-Pacific regions it will go to. “For us, it was amazing to know we’re at that next stage,” says Rumsey.
She continues: “We looked at a variety of issues, including educational standards and competencies. It’s about ensuring we have adequately trained midwives in the region, and this is something we’re continuing to work on with the WHO, AusAID and other bodies.
“Some of our rural and remote case studies and mapping work reveals that our nursing colleagues are the primary caregivers, so it’s really important there are sufficient professionals in the region.”
Story by Rosemary Ann Ogilvie
Photography by Anthony Geernaert