Maternal healthcare is improving in rural Nigeria thanks to a program to expand the use of midwives. The program could serve as a model for other developing countries.

It’s called the Midwife Service Scheme and it’s a year old. National Coordinator Dr. Ugo Okoli said the program takes advantage of a large pool of skilled women.

“Nigeria actually has a lot of midwives on its register. So when you go to the Nursing and Midwifery Council - where the midwives register, get their licensing and all that – they actually do have quite a number of midwives registered there. But the issue we have is where are they working?”

Most were not working in rural areas.

“A lot of them actually work in the city centers, in general hospitals, in teaching hospitals. While not a lot of them are working in the rural areas – the primary healthcare centers where we actually need them,” she said.

Dr. Okoli said the concentration of midwives in urban areas meant rural pregnant women were not receiving the best care.

“The problem is we end up having a cadre of workers that we call community health workers, community health practitioners, who are not as well trained as midwives in terms of providing antenatal care and delivery. So you end up seeing quite a high number of risky births in most of these rural areas and actually having a high maternal mortality rate as well in the rural areas,” she said.

The midwives taking rural jobs are not leaving midwifery jobs in cities vacant.

Okoli said, “These midwives are midwives that are unemployed and then also midwives that are retired, but still able to provide services. And also midwives that have done a basic midwifery course for 3 years, but they actually need to do a one year compulsory service to get their license.”

She said a year after the start of the pilot project, the program is bigger than ever. Millions of dollars in funding comes from the federal government’s oil subsidy reinvestment fund.

“We’ve actually signed a memorandum of understanding with each state government that they contribute to the pay of these, and then to contribute to finding accommodation for these midwives. And basically, generally, looking after them. And also begin to think of expanding beyond where we are now in their state,” she said.

She added that midwives in the program are happy they’re contributing to Nigeria’s development. As for the pregnant women in their care, Dr. Okoli said they are much more likely to have a safe delivery for themselves and their babies.

More on the Midwife Service Scheme can be found in PloS Medicine.