Midwives’ And Mothers’ Perception Of Midwives Service Scheme

Project and Seminar Material for Nursing (Science)

Midwives’ And Mothers’ Perception Of Midwives Service Scheme


Abstract


The purpose of the study was to find out how mothers and midwives in selected Area Councils in Abuja metropolis perceive the Midwives Service Scheme (MSS). A total of 134 respondents were selected from the population figure out of which the sample size was determined. The primary source of data collected was mainly the use of a structured questionnaire which was designed to elicit information on mothers’ and mothers’ perception of the MSS. Data collected will be analyzed using frequency table, percentage and mean score analysis while the nonparametric statistical test (Chi-square) was used to test the formulated hypothesis using SPSS (statistical package for social sciences). The study revealed that the mothers’ parity significantly influences their perception of MSS, there is a significant difference in the midwifery qualification and their perception, there are significant differences in the years of service in the scheme and their perceived reason for MSS and there is significant difference between the midwive’s qualification and midwife’s perception. The study also revealed that different levels of political support and prioritization, alongside financial barriers occasioned by relatively high user fees, contributed substantially to affect the uptake of maternal and child health services. These findings therefore will serve as useful guide for policy makers in decisions toward improving or making progressive changes or adjustments in the programme if necessary.


Chapter One


Introduction

1.1 Background to the Study

Pregnancy and childbirth are normal physiological processes that bring joyful experiences to individuals and families. However, in many parts of the world, pregnancy constitutes a perilous journey, a risky and potentially fatal experience for millions of women especially in developing countries. Over 289,000 women die annually from complications during pregnancy, childbirth, or postpartum period (World Fact book, 2014 and WHO, UNICEF, UNFPA & The World Bank 2014). About 70% of these deaths are largely treatable or at least preventable (UNICEF, 2010) and nearly all these deaths (over 90%) occur in developing countries where fertility rates are higher and a woman’s life time risk of dying during pregnancy and childbirth is over 400 times higher than in developed countries (Audu, Takai, & Bukar, 2010). The situation in Nigeria is especially grave as maternal mortality rate as high as630 per 100,000 live births is still recorded (World Health Organization, UNICEF & The World Bank, 2014), thus including Nigeria among the nations with the highest number of maternal deaths (WHO, 2010, National Primary Healthcare Development Agency (NPHCDA) 2009). Nigeria makes up only 1% of the total world population but accounts for about 10% of the global estimate for maternal mortality (FMOH & NPHCDA, 2010). The new-born and under-five mortality rates follow the same trend with an estimated infant mortality rate of 74/1,000 (Index Mundi, 2014). This ugly trend has been traced to deliveries being attended to by unskilled birth attendants (N&MCN Newsletter 2011 & NPHCDA, 2009). It is against this backdrop that the Midwives Service Scheme [MSS] was initiated in 2003 by the Nursing and Midwifery Council of Nigeria (N&MCN) though originally as a mandatory service.


1.2 Statement of Problem

Deliveries by skilled birth attendants (SBAs) serve as indicators of progress toward reducing maternal mortality worldwide – (MDG 5). Based on this, midwives were posted to primary health care facilities in Nigeria under the midwives’ service scheme to ensure that pregnant women are attended to by skilled health care providers. The various communities were duly informed of the presence of the skilled health care providers at the PHC facilities and the need for them to access care from them. The expectation is that the mothers will comply by using the services of the midwives. However, evidence at the health care facilities show poor patronage of the services of these skilled healthcare providers – MSS midwives. For instance, the total deliveries in Gwako PHC facility in Gwagwalada Area Council in 2012 was 54 and that of Kuchibuyi in Bwari Area Council was 23, (i.e., the monthly average of approximately 5 and 2 respectively).In addition to the above, Nigerian Health Watch (2011) reported that mothers still patronize the traditional birth attendants (TBAs) even with the presence of the midwives in their midst. The implication is that the women are not getting the care they need and therefore maternal mortality will continue to increase. Having once been part of the MSS, the researcher also observed that some of the midwives that were posted to the primary health care facilities were not always there when they were expected to be. The researcher wondered how these key players in MSS (providers and consumers) perceive the scheme and therefore was motivated to undertake the study.


1.3 Purpose of Study

The purpose of the study was to find out how mothers and midwives in selected Area Councils in Abuja perceive the midwives service scheme. Based on this purpose, the following specific objectives were set:

Specific Objectives

The specific objectives to the study are to:

  1. Assess midwives’ perception of the implementation of the MSS.
  2. Determine the midwives’ view of their role in the MSS.
  3. Ascertain the midwives’ perception of their remuneration in the MSS.
  4. Ascertain the mothers’ perception of the services of the midwives in the MSS.
  5. Determine if there is an association between the mothers’ demographics and their perceived reasons for the MSS.
  6. To determine the factors perceived by midwives as negatively influencing provision of services MSS.

1.4 Research Hypotheses

The following null hypotheses to be tested at 0.05 level of significance were established to guide the study.

  • H01: The mothers’ parity will not significantly influence their perception of the MSS.
  • H02: There will be no significant difference in the midwives’ qualification and their perception of the MSS.
  • H03: There will be no significant difference in the midwives’ years of service in the MSS and their perception of the scheme.

1.5 Significance of Study

It is expected that findings of the study will help to ascertain the perception of mothers and midwives about MSS. Since the midwives are the principal actors in the scheme and the mothers are the users of the services provided, the opinion of these two groups of people will go a long way in buttressing the strengths and weaknesses of the programme (in terms of its formation and operation) and factors enhancing and/or militating against its efficacy. These findings therefore will serve as useful guide for policy makers in decisions toward improving or making progressive changes or adjustments in the programme if necessary. The findings from the study will also add to the existing body of knowledge as well as serve as a useful reference for other researchers who will be carrying out studies in related areas. These findings will also be of importance to the Federal Government of Nigeria in achieving the Millennium Development Goals 4&5. Other Non-Governmental Organizations or agencies that have interest in women’s health will also make use of these findings.


1.6 Scope of Study

This study was delimited to only midwives recruited into MSS who are working in MSS PHC facilities in Bwari and Gwagwalada Area Councils as well as mothers of child bearing age pregnant at the time of the study and/or those who have had at least one previous pregnancy and childbirth since the inception of the scheme in the communities where the midwives are working. The study was also delimited to eliciting midwives view on the implementation of the MSS, their role in the scheme and the remuneration of midwives in the scheme. It was also delimited to eliciting mothers’ views of the services provided by the midwives and if there is an association between the mothers’ demographics and their perceived reasons for MSS.


1.7 Operational Definition of Terms

Perception of the midwives’ service scheme: the midwives’ opinion about the implementation of the scheme, their role in the scheme, and the remuneration of midwives in the scheme. Perception of role in the midwives’ service scheme: what the midwives view as their functions in the PHC facility and whether the stipulated work in MSS is appropriate or too much for them. Perception of remuneration in midwives service scheme: this is the view of the midwives about their salaries in MSS. Perception of mothers for midwives’ service scheme: this implies the view of the mothers regarding the ability of midwives in taking care of mothers during pregnancy and child birth.


Chapter Five


Summary, Conclusion and Recommendations

5.1 Summary of Findings

The objectives of the study were to;

  1. Assess midwives’ perception of the implementation of the MSS.
  2. Determine the midwives’ view of their role in the MSS.
  3. Ascertain the midwives’ perception of their remuneration in the MSS.
  4. Ascertain the mothers’ perception of the services of the midwives in the MSS.
  5. Determine if there is an association between the mothers’ demographics and their perceived reasons for the MSS.
  6. To determine the factors perceived by midwives as negatively influencing provision of services MSS.

5.2 Conclusion and Recommendation

This study is on midwives’ and mothers’ perception of midwives service scheme and this study revealed that the mothers’ parity significantly influence their perception of the MSS, there is a significant difference in the midwives’ qualification and their perception of the MSS, there is a significant difference in the midwives’ years of service in the MSS and their perception of the scheme. In a constitutional federal democracy, where the federating units determine their health care priorities, subnational governments can substantially enhance or undermine the outcome of a national health care human resource strategy with serious consequences for the target populations. Nigeria’s Midwives Service Scheme represents a good model for improving availability of highly skilled health workers in previously underserved communities. Its impact has, however, been markedly limited by suboptimal commitment by some participating subnational governments as demonstrated in this study by contrasting outcomes in Benue and Kogi states; two Nigerian states with similar socioeconomic characteristics. Differential levels of political support and prioritization, alongside financial barriers occasioned by relatively high user fees, contributed substantially to affect the uptake of maternal and child health services. Consequently, for strategies aimed at improving PHC and addressing inequities to be successful in this setting, it must be accompanied by a total and unwavering commitment by subnational governments. It should, to the same degree, be able to address demand side constraints especially those relating to user fees. While the MSS was designed as strategy to achieve the health-related MDGs, insights on why Nigeria failed to achieve the goals should inform efforts to achieve the new Sustainable Development Goals. Notably, it is important to prioritize engagement with sub-national stakeholders, and to include subnational indicators of progress towards the new goals as a way to potentially encourage competition among sub-national jurisdictions.


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