Harare, Zimbabwe (May 14 2007)
The shortage of nurses and midwives is threatening Zimbabwe and Africa's capacity to improve midwifery practice and attain the goal of reducing maternal and infant morbidity and mortality.

As Africa joined the rest of the world in marking the International Day of the Midwife (on May 5), the World Health Organisation reports that every single minute of every day, a woman dies from complications of pregnancy and childbirth somewhere in the world.

The UN agency also estimates that annually four million newborn babies die and another four million babies are stillborn while 10 million more women suffer debilitating injuries.

  "There is strong evidence to show that midwives play a critical role in reducing the prevailing high levels of maternal and child mortality in developing countries such as Zimbabwe," UNFPA, Unicef and WHO said in a joint statement released recently.

"However studies here show that at least 30 percent of pregnant women still lack access to skilled care at delivery. The consequences are devastating."

The UN agencies said skilled assistance is very critical to lowering the number of women and new born babies who die or are injured during child birth.

Health experts estimate that ensuring skilled attendance at delivery, supported by emergency obstetric and newborn care could reduce maternal and neonatal deaths by 75 percent.

Midwives are at the core of Zimbabwe and Africa's health care system.
However the flight of skilled health personnel including nurses and midwives is eroding Zimbabwe and Africa's capacity to attain goals to reduce child mortality rates.

More than 400 highly skilled Zimbabweans have settled in the United Kingdom over the past five years under a special scheme allowing highly skilled professionals to stay in Britain, the home office reported early this year.

Over the same period, the British home office said Nigeria lost 3 058 workers followed by South Africa with 2 527 and Egypt with 444.

The high staff turnover in most African countries are due to an unaffordable cost of living and daunting working environment characterised by poor housing, inadequate equipment and drugs and red tape.

Poorly defined career structures and unaffordable medical care were also some of the reason for the outflow of highly skilled medical professionals.

This situation plays out across the entire African continent with a massive exodus of nurses and doctors to Europe and North America being the norm.

As a result of the brain drain, the majority of Africa's women face numerous challenges when it comes to giving birth safely.

Lack of access to clinics and hospitals closer to their homes, the flight of nurses, midwives, obstetricians and lack of equipment needed to make the process of giving birth safe have all compounded the crisis in Africa.

At the 54th World Health Assembly in 2001 delegates acknowledged that nurses and midwives play a crucial and cost effective role in reducing excess mortality, morbidity and disability.

It was noted that nurses and midwives have a role in promoting healthy life styles and are  at the core of any health system.

Delegates to the assembly expressed concern about the global shortages of nurses and midwives. They passed a resolution, WHA 54.12 which called upon Member States to:

· involve nurses and midwives in the framing, planning and    implementation of health policy.
· review and develop models of education, legislation, regulation and  practice.
· develop human resource plans that support training, recruitment and retention.
· ensure healthy workplaces.
· continuously assess nursing and midwifery plans.
· enhance the development of nursing and midwifery services based on   evidence.

As follow up to the resolutions, the WHO secretariat in Geneva produced "Strategic Directions for Strengthening Nursing and Midwifery Services 2002-2008" document which was endorsed by nine international organisations including the International Council of Nurses and the International Confederation of Midwives.

Five key result areas were identified as being crucial to the process of strengthening nursing and midwifery services:

· Health planning, advocacy and political commitment.
· Management of Health personnel for nursing and midwifery services
· Practice and health system improvement
· Education of health personnel for nursing and midwifery services
· Stewardship and governance

Apart from the accredited health workers, strengthening support and training of traditional birth attendants is also crucial since TBAs are more accessible to many women across many African communities.

In East Africa, about a quarter of all births are overseen by TBAs and health experts say many women feel more comfortable giving birth with traditional attendants.

According to Unicef, although sub-Saharan Africa has only 11 per cent of the global population, the region is the source of one half of the world's victims of mortality for children under five years old.

Pneumonia is the number one killer of children and claims the lives of over 1 million children in sub-Saharan every year followed by malaria and diarrhea.

The vast majority of child deaths - more than nine in 10 - occur in just 60 developing countries, according to a 2007 report by Save the Children.

The child agency says of the approximately 10 million children under age 5 who die every year, most could be saved with cheap solutions, like nets to protect against mosquito-borne malaria or antibiotics to treat pneumonia.

These aren't intractable problems. It is simply wrong for only the few to have access to all of the tools for survival because of where they live. Dr William Foege, Emory University School of Public Health, wrote in a foreword to the report.

About 4 million children die of complications in the first month after birth every year, according to Save the Children. Maternal mortality continues to be a major challenge in Africa with many women dying due to pregnancy related complications.

African countries need to mobilise resources and development assistance to ensure the availability of skilled health personnel, essential drugs and equipment necessary for the provision of high quality obstetric care.

"The World Health Assembly has in the past three years passed several resolutions on health financing and health worker shortages  - yet there has been an overall increase in annual African deaths resulting from lack of sustainable health finance and health worker shortages," said the African Public Health Alliance (APHRA) coordinator Rotimi Sankore ahead of the World Health Assembly (May 14-23) in Geneva, Switzerland.

"The worlds Health Ministers must now move from passing resolutions to effecting resolutions and emergency action to end the deaths of over 8 million Africans a year to preventable, treatable and manageable diseases, caused mainly by maternal mortality, child mortality, HIV/AIDS, TB and malaria."