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. 2018 Jan 3;18(1):99.
doi: 10.1186/s12889-017-5020-2.

The potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar: a mixed-method study

Kyu Kyu Than  1   2 , Khaing Nwe Tin  3 , Thazin La  4 , Kyaw Soe Thant  4 , Theingi Myint  3 , James G Beeson  4   5   6 , Stanley Luchters  4   6   7 , Alison Morgan  8
Affiliations

The potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar: a mixed-method study

Kyu Kyu Than et al. BMC Public Health. .

Abstract

Background: An estimated 282 women die for every 100,000 live births in Myanmar, most due to preventable causes. Auxiliary Midwives (AMWs) in Myanmar are responsible for providing a package of care during pregnancy and childbirth to women in rural hard to reach areas where skilled birth attendants (Midwives) are not accessible. This study aims to examine the role of AMWs in Myanmar and to assess the current practices of three proposed essential maternal interventions (oral supplement distribution to pregnant women; administration of misoprostol to prevent postpartum haemorrhage; management of puerperal sepsis with oral antibiotics) in order to facilitate a formal integration of these tasks to AMWs in Myanmar.

Methods: A mixed methods study was conducted in Magwe Region, Myanmar involving a survey of 262 AMWs, complemented by 15 focus group discussions with midwives (MWs), AMWs, mothers and community members, and 10 key informant interviews with health care providers at different levels within the health care system.

Results: According to current government policy, AMWs are responsible for identifying pregnant women, screening for danger signs and facilitating early referral, provision of counselling on nutrition and birth preparedness for women in hard-to-reach areas. AMWs also assist at normal deliveries and help MWs provide immunization services. In practice, they also provide oral supplements to pregnant women (84%), provide antibiotics to mothers during the puerperium (43%), and provide misoprostol to prevent postpartum haemorrhage (41%). The current practices of AMWs demonstrate the potential for task shifting on selected essential maternal interventions. However, to integrate these interventions into formal practice they must be complemented with appropriate training, clear guidelines on drug use, systematic recording and reporting, supportive monitoring and supervision and a clear political commitment towards task shifting.

Conclusion: With the current national government's commitment towards one AMW in one village, this study highlights the potential for shifting specific maternal lifesaving tasks to AMWs.

Keywords: Auxiliary midwives; Maternal health; Mixed methods study; Myanmar; Task shifting.

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Conflict of interest statement

Authors’ information

Dr. Kyu Kyu Than: Kyu Kyu Than: kyukyu.than@burnet.edu.au

Dr. Khaing Nwe Tin: Khaing Nwe Tin: khaingnwetin@gmail.com

Dr. Thazin La: Thazin La: thazinla@burnetmyanmar.org

Dr. Kyaw Soe Thant: Kyaw Soe Thant: soethantkyaw@gmail.com

Dr. Theingi Myint: Theingi Myint: theingimyint5@gmail.com

Dr. James Beeson: James Beeson: james.beeson@burnet.edu.au

Dr. Stanley Luchters: Stanley Luchters: stanley.luchters@burnet.edu.au

Dr. Alison Morgan: Alison Morgan: apmorgan@unimelb.edu.au

Ethics approval and consent to participate

Ethical approval for the study was obtained from the Proposal and Ethical Review Committee of the Department of Medical Research, Ministry of Health Myanmar (approval number 42A/ethics/DMR/ 2015) and from The Alfred Hospital Ethics Committee in Australia (approval number Project 150/15). Approval to conduct the study was also obtained from the Ministry of Health after obtaining the ethical approval from the Department of Medical Research. Written information was provided to all participants in Myanmar language and written consent to participate in the study was obtained. Consent forms were stored in a secure location at Burnet Institute.

Consent for publication

Written permission was taken and granted from all participants in the study that after de-identification of the transcripts quotations will be used for publications.

Competing interests

We have read and understood BMC policy on declaration of interests and declare that all authors have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. World Health Organization: WHO recommendations: Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting OPTIMINIZEMNH. In. Geneva: World Health Organization; 2012. - PubMed
    1. Department of Population-Ministry of Labour Immigration and Population-The Republic of the Union of Myanmar: Thematic report on Maternal Mortality, Census Report Volume 4-C. In., vol. Census Report Volume 4-C. Nay Pyi Daw: Department of Population-Ministry of Labour Immigration and Population; 2016.
    1. Ministry of Health Myanmar: Health Workforce Strategic Plan 2012-2017. In.; 2012.
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    1. World Health Organization: Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: World Health Organization; 2007.

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