Nurse-midwifery in St. Vincent and the Grenadines.

Namita Nayyar (WF Team)

12 years ago

Nurse-midwifery in St. Vincent and the Grenadines.

– Reported, March 30, 2012

Brain drain, the exodus of highly trained professionals from developing countries to better paying jobs in the developed world, threatens the structure of community health care in those developing countries. In the Caribbean Basin, as in many developing countries, midwives are the primary health care providers for mothers and their children. This paper describes the maternal and child health (MCH) system in the Caribbean island community of St. Vincent and the Grenadines (SVG); compares MCH indicators in SVG with those in developed and developing nations; describes the role of the nurse-midwife in the delivery of MCH services; and examines the growing problem of recruitment and retention (brain drain) of nurse-midwives. Suggestions made by the nurse-midwives of SVG will be used to explore some solutions to this major human resource problem threatening the MCH system and to identify the major obstacles to their implementation.

The background, history, sociodemographic characteristics, and health services in St. Vincent and the Grenadines are described. In the discussion of the status of maternal and child health (MCH) and the role of nurse-midwife, information is provided on how midwives view their role, the benefits and rewards, drawbacks, and problems of recruitment and retention. 6 strategies for change are presented to address the concerns of nurse-midwives, and the constraints to implementation are noted. Interviews were conducted in August 1990 and validated. Statistical documents and records were consulted and hospital delivery observed. The current health personnel situation is one of shortages of trained physicians and nurses and a burgeoning population creating additional demand for health services. 9 health districts with 36 clinics and 5 rural hospitals and 1 general hospital in Kingston provide services for the 113,570 population. There are 2 privately owned hospitals in Kingston and private practice physicians. The district health center is the primary care facility with a nurse-to-patient ratio of 2/10,000 in 1987 and 4 trained obstetricians for the island. Of these 36 clinics, 16 are without a district nurse. MCH statistics are impressive with no maternal deaths since 1982 and rates comparable to developed countries. Nurse-midwives provide almost all prenatal and postnatal care and delivery. Midwives felt their roles were important and rewarding and are viewed as professional, knowledgeable, compassionate and trustworthy. Benefits were independence, personal satisfaction, career opportunities, and the rewards of contributing to the health of the Islands. Drawbacks were understaffing, lack of modern equipment, inadequate supervision, insufficient orientation to community health principles, lack of career mobility or financial incentives or improvement opportunities, and falling status. To halt the brain drain (exodus of trained professionals from developing countries to higher paying jobs in developed countries) a bond contract making those fiscally liable for their education has been implemented. Recruitment needs to be made from within the community being served. Greater financial incentives are needed. The role and image of the district nurse needs to be upgraded. Decentralized training and greater emphasis on community health must be given during nursing education. The age limit for nursing students needs to be increased and job sharing allowed. The constraints to implementation are lack of funding and resistance to change by those in power.

Credits: Miller S

More Information at: http://www.ncbi.nlm.nih.gov/pubmed/1538269

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