Earthquake Adds to Urgent Women's Health Issues
After the earthquake, up to 90% of health facilities in many rural areas are known to be damaged or destroyed. For example, in Rasuwa district, up to 78% of district health facilities are reported to be completely demolished, and only two health posts remain functional. Hospitals in district capitals, including Kathmandu, have been overwhelmed, medical supplies severely depleted and capacities overstretched. Out of a total of 352 birthing centers, 115 were totally damaged and 137 partially damaged. Overall, the April 25 earthquake affected some 8 million people, including 2 million women of reproductive age and over 126,000 pregnant women.
Even before the earthquake, out of an estimated total population of 27.5 million, 23 million (84%) were living in rural areas and 7.4 million (27%) were women of reproductive age in 2012; the total fertility rate was 2.3. By 2030, the population is projected to increase by 20% to 32.9 million.
To achieve universal access to sexual, reproductive, maternal and newborn care, midwifery services must respond to 0.9 million pregnancies per annum by 2030, 85% of these in rural settings. The health system implications include how best to configure and equitably deploy the sexual, reproductive, maternal and newborn health (SRMNH) workforce to cover at least 70.2 million antenatal visits, 10.9 million births and 43.7 million post-partum/postnatal visits between 2012 and 2030 (UNFPA, 2014). There is a dearth of professional midwives to cater to the current and growing need; their roles will be instrumental in improving maternal and child health in rural areas.
In this context, an MOU has been signed between 4 universities by UNFPA and MOHP, which includes introducing midwifery education as a different faculty in their universities as a professionally accredited course. Likewise, a draft bachelor's degree curriculum on midwifery has been drafted and will be tailored by the universities to suit their interests and this curriculum will be approved by the NNC (Nepal Nursing Council).
Building Midwifery Education
We have finalized the components of the agreement and have taken up the elements as per our objectives and expertise, especially addressing human resources and infrastructural needs. The following represents our components of support in the "Collaborative Partnership Agreement for Supporting Midwifery Education and Care in Nepal":
Real Medicine Foundation (RMF) has been working around the globe in close collaboration with governments, ministries, donor agencies, international development partners and local stakeholders to improve the quality of and access to professional health care services and intends to contribute for the same in Nepal too. We have co-founded and established the first ever accredited College of Nursing and Midwifery in South Sudan, the Juba College of Nursing and Midwifery (JCONAM); the college offers a 3-year diploma for Registered Nursing and Midwifery. Through the provision of trained and qualified nurses and midwives, it is aimed to fill the gap of professional skilled healthcare services in the country. In particular, we are supporting through sponsorships of students, provision of skills and laboratory equipment, clinical training equipment, IT equipment, capacity enhancement of the faculty and investments in infrastructure as required.
We are committed to long-term sustainable solutions towards addressing high maternal mortality and infant mortality by increasing access to and quality of human resources for health. In this context, we welcome the initiation to foster midwifery education in Nepal.
We intend to contribute in the following areas, which will be finalized in the very near future following discussions with the government of Nepal, partner organizations, concerned universities and other stakeholders:
Development and strengthening of faculty in the chosen universities and educational institutions in close collaboration with the:
We intend to accomplish this by:
Supporting the universities in recruiting faculty members
Contributing to the remuneration of the technical staffs
Sponsoring trainings, capacity building/skills development programs for the faculty members.
Supporting students from economically and socially disadvantaged and marginalized backgrounds through scholarships and covering accomodation costs and stipends to selected students.
Making investments into necessary physical buildings and equipment support for one selected university.
In 2006, Nepal’s Ministry of Health and Population (MOHP) introduced the National Policy of Skilled Birth Attendants with an aim to bring about sustainable development and reduce the mother and child mortality rates. In 2009, MOHP finalized its selection of 4 universities to pioneer midwifery education as a professionally accredited degree in Nepal. These universities are:
- B.P. Koirala Institute of Health Sciences (BPKIHS),
- Kathmandu University (KU),
- National Academy of Medical Sciences (NAMS), and
- Patan Academy of Health Sciences (PAHS).
It was agreed that the universities would establish professional midwifery education as a separate faculty within the university and offer a bachelor’s degree in midwifery as a professionally accredited course. The curriculum would be proposed by each university to the Nepal Nursing Council (NNC) for review and finalization. The NNC would offer accreditation to the proposed curriculum only if it was confirmed to be consistent with ICM/WHO international standards.
1. Address gaps in human resources, including faculty development
2. Provide scholarships for students from underserved communities
3. Support infrastructure development: i.e. classrooms, hostel facility
4. Acquire Skills Lab/Equipment (dummy/ anatomical models)