Table 3 Strategies to increase attraction and retention of midwives in remote and rural areas
Categories of intervention | Proposed strategies | Challenges | Possible solutions | |
|---|---|---|---|---|
National | Local/district | |||
Education | Promotion of nursing schools organising midwifery in rural areas | Recruiting and training rural background students | Poverty Community ignorance Lack of children to be recruited Conflict generated from selection candidates | Community-based education sponsorship scheme for recruited students |
Regulatory | Registration of rural-based midwives | Recruiting and integrating TBAs in facilities | No salary for TBAs Continuation of providing home delivery | Salary from user fees Local authority involvement to ban home delivery |
Financial incentives | Salary of health workers from the central government Implementation of rural placement allowances | Increased salary from income generated from user fees | Lack of funding from the government Flat rates imposed by NGOs Poverty of the rural population | Difficult to overcome Increased local income generated from user fees |
Professional and personal support | Better living conditions Safe and supportive working environment | Good relationship at the facility and with the community Good leadership at different levels (communities, facilities, DHMTs) | Lack of funding from the central government Unrest or insecurity | Community/church mobilisation to improve building conditions and houses for health workers District initiative on fund raising Lobbying to NGOs Difficult to overcome insecurity Strengthening supportive supervision and in-service training by church medical coordination and NGOs in the area |
Other local interventions | Â | Promoting interactions and contacts with students at nursing schools and colleges Promoting local marriage Recruiting and integrating TBAs in facilities | Church regulations Socio-cultural-related challenges No salary for TBAs Continuation of providing home deliveries by TBAs | Community mobilisation on the importance of education and midwifery TBAs salary from user fees Local authority involvement to ban home delivery |