Midwifery program in the Nursing Department of the Liberia Dujar Technical College

Midwifery is the health science and health profession that deals with pregnancy, childbirth and the postpartum period including care of the unborn.

Background of the project (Midwifery Education)

The Midwifery Education is part of the Liberia Dujar Nursing School Department which started in 2011 while the Midwifery Program started in 2016 as a pilot project. Nearly all of the students who graduated from the Department of Nursing are in the employment of the Liberian Government or companies. Some of the graduates are supervisors in governmental clinics in rural areas or with other private hospitals such as Redemption Hospital which is run by Doctors without Borders (Läkare Utan Gränser). Information received from graduate students of the Nursing Department of Liberia Dujar Technical College shows that many women in the rural areas die in childbirth because of the lack of trained midwiferies in those areas. The students have several times appealed to the management of the college to make the Midwifery Division under the Nursing Department a genuine program to train more women and young girls in the area of Midwifery Education. They would like to help save lives and cut down the death rate in the rural area and in Liberia as a whole.

Liberia is currently one of the countries with the highest maternal mortality in the world (Ministry of Health 2016). The Ministry of Health of Liberia attributes this to low emergency obstetrics, high home deliveries by unskilled personnel and shortage of midwives (Liberia Demographic Health Survey, 2000). This trend has steadily been deteriorating from 578 per 100,000 live births by 2005(LDHS 2008) to 990 per 100,000 live births in 2011 (Human Development Report 2011). Following the Ebola outbreak, maternal mortality in Liberia is approximated at around 1072 per 100,000 live births as of 2015. According to United Nation Children Fund UNICEF Liberia 2012-2017 country programme document, the trends has worsened in spite of the improvement in antenatal care (UNICEF 2017).

Improving the well-being of pregnant women, mothers and newborns is an important pillar of the 2011-2021 National Health Policy and Plan goal for Liberia (MOH 2011). However, despite several interventions, gaps still exist. These gaps range from infrastructure, access to services, out of pocket expenses, shortages of midwives tool kits (obstetric kits for midwives) and human resource needs for skilled attendants’ at the primary level of care.

Even before the Ebola outbreak, the number of obstetrician-gynaecologists in Liberia was very low. According to the Liberian Minister of Health, Bernice Dahn, today there may be fewer than five. One major problem is that unfortunately, specialized midwives are not accessible to all expecting mothers. There are currently only 400 trained midwives in the Liberian healthcare system, a number too small to meet the needs of over four million people, and the majority of midwives reside in urbanized sectors.

The Liberia Dujar Midwifery Program

The key problem that LDA wants to address by operating the Midwifery Program under the Nursing Department of the Technical College (TC) is that in Liberia, 44 percent of women give birth with no medical attendant because they live in rural areas where care is too far away to obtain. One in every 138 live births results in a mother’s death due to preventable complications requiring basic medical care. Today there are only six midwifery schools in Liberia.

Liberia Dujar Association intends to join hands with the Ministry of Health by educating and training young girls and women in order to have an additional number of midwives who will be willing to help future mothers in Liberia. Liberia Dujar Association is prepared to elevate this program to a 5-year level Higher Degree program, but students can also graduate with a Bachelor’s Degree in a 3-year program. LDA has been given permission by the Ministry of Health and Social Welfare to carry out the new programs. LDA intends to approach the Danish Midwives Association for cooperation to give program instructors current and advanced training in order to ensure the program’s success and sustainability.

Overall Goal

The Liberia Dujar Technical College operates as a three-year tertiary school which offers an Associate Degree programme. The college will start to offer Bachelor Degree beginning with the next term for 2018/2019 to encourage students who are interested in earning a degree on this level before seeking employment. The overall goal is to educate and strengthen young girls and women to contribute to the reduction of maternal, newborn and child morbidity and mortality in Liberia. Here are some long-term goals the Liberia Dujar Nursing Department would like to achieve:

• To invest in the midwifery workforce for an effective strategy for improving outcomes.
• More midwives for increased maternal and newborn survival.
• Midwives are seen as a pillar of reproductive health programmes, and the Ministry of Health gives priority to educate and support them.

All courses will be based on the Liberian national curriculum of the Midwifery program. In addition, the Liberia Dujar Association model used in our Technical College will be combining theoretical and practical education. This will prepare students for the job market and establish contacts with potential future employers. The Nursing Department at the Technical College has the capacity to enrol 50 students as a starter, and the number will be increased successively on a yearly basis depending on its popularity.

Target group

The target group for this project is females the Townships of Gardnersville, Barnesville, Johnsonville, Dixville and Caldwell others from the age of 20-45 years, who have so far not had the opportunity to access job qualifying professional education.

Throughout the planning process, LDA-Liberia and LDA-Sweden have reflected on the risk that the entry requirement may cause for the disadvantaged and less fortunate young girls and women. To reach this group, a scholarship program plan is being discussed with a focus on talented but poor students who might, otherwise, will not get the opportunity to be trained.

Top foto av: Lois Hemgren