The School of Nursing and Midwifery (SONAM) brought together policymakers from the Sindh government and private sector experts at a seminar to highlight how a competency-based midwifery programme at the undergraduate level could equip midwives with the clinical skills needed to reduce Pakistan’s alarming maternal mortality ratio (MMR).
Pakistan’s MMR stands at
170 deaths per 100,000 live births – a figure that is nearly 2.5 times the global target of 70 deaths per 100,000 live births set under
SONAM Dean Dr David Arthur sharing his thoughts at the seminar
the Sustainable Development Goals (SDGs).
“Pakistan's maternal mortality rate remains one of the highest in the region,” said Dr Muhammad Akhlaque Khan, Director General Health Services, Sindh. He noted that a shortage of skilled community-based midwives alongside challenges in retaining trained midwives meant that mothers living in remote areas lacked access to basic reproductive healthcare and resources.
Dr Khan called on SONAM to develop an action plan to ensure that competent and trained midwives are ready to practice in remote areas of the province.
Since 2013, the School has had in place a two-year Post RM Bachelor of Science in Midwifery (Post-RM BScM) programme which has been bridging the gap between midwifery education and practice by emphasising the need for hands-on skills development for midwives.
Speaking at the event, SONAM Dean Dr David Arthur highlighted how SONAM aims to graduate leaders in midwifery who are well-prepared to go out in the field and contribute to the SDGs.
He mentioned that the School is now in the phase of developing a four-year undergraduate degree programme in midwifery. This would not merely provide a structured career path to aspiring midwives but would also allow them to have the necessary clinical exposure along with theoretical knowledge required in community services.
Government and private sector stakeholders present at the event unanimously agreed to the idea of launching an undergraduate programme in midwifery and called on the University to take the lead in this initiative. Representatives of the Midwifery Association of Pakistan (MAP) and Pakistan Nursing Council (PNC) also agreed on working towards improving the scope of practice of the midwives while funding agencies expressed financial support towards such initiatives.
Speaking at the seminar, Dr Rubina Barolia, assistant dean for clinical practice at SONAM, explained how the School’s Midwifery-Led Model (MLM) of care complements the vision shared by the School’s Dean. She noted that the MLM consists of a rigorous, credentialed programme that empowers skilled midwives to take the lead in meeting the antenatal, intrapartum and postpartum needs of low-risk pregnant women including newborn care.
The model has already been successfully implemented at AKU’s campus in Tanzania and a pilot MLM for Pakistan has been developed by SONAM faculty which is in line with local needs and regulatory requirements, Dr Barolia added.
“This MLM concept is designed keeping in view global best practices with a vision of improving maternal and newborn health in Pakistan through low-cost, effective evidence-based midwifery care,” Dr Barolia said. “It will not only improve the status of the profession but will also facilitate efforts to scale up the availability of quality midwifery services that will guarantee women their right to quality sexual and reproductive health.”
The MLM’s shared care concept has been developed by SONAM faculty in collaboration with AKU’s Department of Obstetrics and Gynecology as a strategic intervention and will be introduced at AKU’s secondary hospitals in Pakistan.
Dr Minhaj Qidwai, CEO Sindh Healthcare Commission, said: “Sindh Healthcare Commission strongly supports interventions and strategies that allow only those skilled midwives with strong competence to undertake delivery cases”. He also suggested that cases taken up by each midwife in the communities should be periodically assessed for improvements in the practice.
The seminar was also attended by Mr Habibullah Soomro, Director Nursing, Sindh; Dr Sarah Ashraf, Registrar, PNC; Ms Arusa Lakhani, President, MAP; Dr Syed Khalid, Director, Maternal, Newborn and Child Health programme; Dr Suleman Otho, Director, Monitoring and Evaluation, Sindh Healthcare Commission; Dr Adeela Khan, Reproductive Health Analyst, United Nations Population Fund; Dr Farhana Shahid, Senior Technical and Program Adviser, Johns Hopkins Program for International Education in Gynecolgy and Obstetrics; faculty leadership at AKU-SONAM and nurse leaders from AKU’s teaching hospital alongside other officials from the participating organizations.
