title: Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality.
abstract: This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
authors: WHO Regional Office for Europe, Athens, Greece. Electronic address: wvl@euro.who.int.
authors: Wim
authors: W
authors: Van Lerberghe
authors: Evidence for Action, University of Southampton, Southampton UK.
authors: Zoe
authors: Z
authors: Matthews
authors: Center for Family Welfare, Faculty of Public Health University of Indonesia, Depok, West Java, Indonesia.
authors: Endang
authors: E
authors: Achadi
authors: Brussels, Belgium.
authors: Chiara
authors: C
authors: Ancona
authors: Instituto de Cooperación Social Integrare, Barcelona, Spain.
authors: James
authors: J
authors: Campbell
authors: Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
authors: Amos
authors: A
authors: Channon
authors: UN Population Fund, Geneva, Switzerland.
authors: Luc
authors: L
authors: de Bernis
authors: Woman & Child Health Research Centre, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Vincent
authors: V
authors: De Brouwere
authors: Holistic Santé, Montpellier, France.
authors: Vincent
authors: V
authors: Fauveau
authors: Norad Oslo, Norway.
authors: Helga
authors: H
authors: Fogstad
authors: US Agency for International Development, Washington DC, USA.
authors: Marge
authors: M
authors: Koblinsky
authors: Lund University, Sweden.
authors: Jerker
authors: J
authors: Liljestrand
authors: Rabat, Morocco.
authors: Abdelhay
authors: A
authors: Mechbal
authors: International Development Institute, King's College London, London, UK.
authors: Susan F
authors: SF
authors: Murray
authors: National Reproductive Health Program, Phnom Penh, Cambodia.
authors: Tung
authors: T
authors: Rathavay
authors: Evidence for Action, London, UK.
authors: Helen
authors: H
authors: Rehr
authors: Institute of Tropical Medicine, Antwerp, Belgium.
authors: Fabienne
authors: F
authors: Richard
authors: Instituto de Cooperación Social Integrare, Barcelona, Spain.
authors: Petra
authors: P
authors: ten Hoope-Bender
authors: Afghan Midwives Association, Jhpiego, Kabul, Afghanistan.
authors: Sabera
authors: S
authors: Turkmani
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D003906:Developing Countries; D005260:Female; D006268:Health Facilities / Q000600:supply & distribution; D006291:Health Policy; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration* / Q000592:standards / Q000600:supply & distribution; D008428:Maternal Mortality; D008880:Midwifery / Q000458:organization & administration* / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards; D011787:Quality of Health Care