Motivating Ugandan midwives and attracting students

 Rose Aciro and her colleagues outside Lira Regional Referral Hospital after receiving the midwives4all award, May 2015.jpg

Rose Aciro and her colleagues outside Lira Regional Referral Hospital after receiving the midwives4all award, May 2015

In May 2015, the Swedish Ministry for Foreign Affairs launched a global campaign, Midwives4All, to highlight the important role midwives play in maternal and child health. As part of the campaign, a midwives4all award was presented to a Ugandan midwife to recognize her contribution to maternal health in the country.
The winner was Rose Aciro, who works as a midwife at Lira Regional Referral Hospital in Northern Uganda. In their decision to award Rose Aciro, the award committee emphasized Rose’s dedication to train students and pass on her knowledge and experience to new generations of midwives.

One year later, the Embassy of Sweden in Uganda is keen to find out what the last year has been like for Rose, and what has happened after she received the award.

It’s been a very busy year. The number of deliveries is increasing, and so far we have delivered more than 2 400 babies in 2016. We are 10 midwives at the hospital, so we have a lot to do,” Rose Aciro explains.

This number should be compared against the recommended WHO standard of 15 deliveries per midwife per month. In Lira, the 10 midwives working at the Regional Referral Hospital have each delivered an average of 80 babies per month during the first quarter of 2016.

When asked how she explains the increased number of deliveries, Rose does not hesitate:

“Our health centers are not always fully functional; for example some health centers do not have a functioning theatre. Mothers do not want to risk having a complicated delivery where emergency obstetric care is not available so instead they come straight to the hospital to deliver.

Many mothers come here without a referral and I suspect that the award plays a role. They have heard about it and know that the service and care we provide at the Regional Referral Hospital is good.”

According to Rose Aciro, another development in the past year is that the number of students who come to the Regional Referral Hospital for their practical training has increased.

“More and more students come to the hospital for their applied training. I think that the interest in the midwifery profession in general is increasing – and I believe that the midwives4all campaign can take a big part of the credit. Last year, the midwives4all campaign put a lot of focus on midwifery and the role midwives play in maternal and newborn health, and I think this has motivated more young people to join the profession.”

Rose laughs and continues:

But we are still waiting to see more young men take on their role… Some students tell me that they want to do midwifery because it’s such a happy profession – where else do you get to bring new life in to the world every single day?


New born baby boy, Lira Regional Referral Hospital, May 2015

New born baby boy, Lira Regional Referral Hospital, May 2015

These past years, more and more private training institutions are opening, and because of our good reputation here at the Regional Referral Hospital, more students wish to do their practicum here. This past year I’ve really been able to scale up the number of students that I mentor – and I am enjoying it!”

When the Embassy of Sweden in Uganda asks Rose, what other trends she sees in maternal and child health in Lira, she tells us that the maternal and newborn deaths have remained more or less constant. So far this year, they have lost three mothers at the hospital.

“The biggest challenge to reduce the numbers is to ensure timely referral from the health centers to the Regional Referral Hospital, where we provide emergency obstetric care including cesarean and blood transfusion – which can save a mother’s life,” Rose explains.

Rose also tells us that the number of teenage pregnancies has remained the same, and that most of the women who come in with post-abortion complications are young.

The high number of deliveries makes it challenging for Rose and her colleagues to find time for the other services that they provide; including ante-natal and post-natal care and family planning services. To make up for the lack of time, they actively use students to provide these services.

According to Rose, antenatal attendance at Lira Regional Referral Hospital is good, though many mothers do not start antenatal care until the 2nd or 3rd trimester. A main reason for this is that Ugandan women traditionally disclose their pregnancy late which makes it difficult for a mother to attend all four antenatal visits.

With regards to family planning Rose explains;

“It is difficult to motivate mothers to opt for post-partum contraception. I do however see more and more of our very young mothers asking for a family planning method after delivery.”

Providing post-partum contraception is important as it is one of the most effective ways to increase family planning uptake and reduce the number of unplanned pregnancies.

Mother waiting in the maternity ward, Lira Regional Referral Hospital, May 2015

Mother waiting in the maternity ward, Lira Regional Referral Hospital, May 2015

The midwives4all award sets out to recognize the tremendous effort made by thousands of midwives everyday across Uganda – often under very challenging circumstances – and to acknowledge an outstanding individual contribution. When asked whether winning the midwives4all award has changed anything for Rose, she promptly explains:

“The award hangs in my home, and everyday it motivates me to make an extra effort. When times are challenging at the hospital, it helps me stay motivated.

More importantly, it has enabled me to reach many more facilities and midwives. After I won the award, I have been asked to mentor and coach midwifes in other hospitals in the Acholi sub-region. I love this part of my job – this is where I can really make a change.”

Rose also believes that the midwives4all award inspires midwives and makes them feel more appreciated, and she encourages the embassy to continue with the award.

Rose was the first midwife to receive the Midwives4All award, but she will not be the last. In 2016, a total of 12 midwives will be recognized globally, including in Afghanistan, Bangladesh, Zimbabwe, Ethiopia and Kosovo. When asked if she has a piece of advice for this year’s winners, Rose does not hesitate:

“In general, my advice to all midwives is to do their best, love their profession and handle the mothers with care. Nothing beats meeting a mother and her healthy baby in the community after a good delivery. To the winners I would say: Use the award to create more awareness about midwifery and be a good example for other midwives.”

Lastly, we ask Rose if she has any feedback to the Embassy.

“I would love to see the Embassy expand its training program; so that we can have more qualified midwives in Uganda and close the gap especially in rural, hard to reach areas where midwives are still few. After all, that’s how we save lives.”

Text and pictures by Ane-Kirstine Bagger Birnbaum,

National Programme Officer, Embassy of Sweden in Uganda