The number of professional midwives in the country is still low, creating a gap in the provision of better services for safe motherhood.

This was pointed out as Rwanda joined the rest of the world to mark the International Day of the Midwife. A national event was held at Kabgayi Hospital in Muhanga District on Tuesday.

According to Demographic and Health Surveys (DHS) 2010, maternal mortality dropped from 1,071 in 2000 to 476 in 2010, while the UN figures for 2012 put the rate at 320 out of every 100,000 live births. The target under the global Millennium Development Goals is 268, while the country’s Vision 2020 blueprint seeks to slash maternal mortality rate to 200 out of 100,000 live births.

For neonatal mortality, DHS statistics show that 37 babies out of 1000 live births died. This figure reduced to 27 in 2010 and 20 in 2013, according to UN estimates. Here, the MDGs target is 12 (by end 2015) with at the national level, the Second Economic Development and Poverty Reduction Strategy (EDPRS II) target 10 out of 1,000 live births.

Josephine Murekezi, president of Rwanda Midwives Association, said the number of midwives in the country is not enough vis-à-vis the number of women in need of maternal care.

"Those accepted to work as midwives by the Rwanda Nursing Council are only 1,100 yet there is need for at least 3,664”, she said. She also said there is need for a comprehensive policy to ensure competency among midwives.

"When students graduate and get employed, the Ministry of Health should carry out continuous professional development, supervision, monitoring and evaluation as well as in-service training,” she said.

Insufficiency of midwives attracts unqualified individuals in midwifery, she added.

"For the problem to be addressed there is need for enough midwives at each health centre and referral hospital in the country. Secondly, there is need for continuous training of midwives. Our aim is no woman or child should die while giving birth,” she added.

Dr Felix Sayinzoga, head of maternal health at the Ministry of Health, said Rwanda had made impressive progress in improving access and quality of health services in general, specifically by providing quality services to expectant mothers, child birth, post natal, and under five children.

He said the ministry was focusing on increasing access to equitable and high quality Maternal, Neonatal and Child Health (MNCH) services

"The ministry’s mission is to provide leadership of the health sector to ensure universal access to affordable preventive, curative, and rehabilitative health services of the highest attainable quality. Therefore, the provision of quality and accessible health care services is ensured through continuous improvement of health care providers capacity and availability and accessibility of required infrastructure, medical supplies and drugs,” he said.

He, however, said there are some challenges still facing maternal health care provision, including geographic accessibility, traditional practices, access to clean water and appropriate latrine, behavioral change, cultural beliefs, and lack of enough equipment.

"There is need for capacity building as there is insufficient number of obstetricians, midwife, medical doctor and nurses. ‘‘MNCH services need to be continuously monitored and evaluated for evidence based planning by decisions makers at all levels”.

"This will be achieved by organising joint monitoring with stakeholders, documenting and disseminating lessons learnt and ensuring MNCH interventions are included in district plans and district team involved in monitoring of key MNCH programmes,” he added.

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