Everyday mothers and babies die from complications during childbirth that could have been prevented. In 2020, sub-Saharan Africa accounted for about 70 percent of maternal deaths globally; many of these deaths were from bleeding after childbirth, infections or high blood pressure during pregnancy.
Yet for many nurses and midwives in low-income countries, opportunities for advanced training and bedside mentorship are often few and far between. There are limited opportunities for career advancement, and without a path to advancement, many nurses and midwives leave clinical practice and pursue different educational paths or leave the health sector altogether. This, in turn, adds to the shortage of providers.
One solution, according to UCSF’s Global Action in Nursing (GAIN), is increasing the number of nurses and midwives who are supported with trainings and long-term mentorship. GAIN aims to prevent maternal mortality by investing in nursing and midwifery in four countries in sub-Saharan Africa. Since its inception in Malawi in 2017, GAIN has expanded to three additional countries. Now, with a $2.7 million gift of continued support from the Wyss Medical Foundation, GAIN will continue to improve maternal and neonatal health outcomes in these countries while expanding to Lesotho.
“We’re grateful for the continued support of the Wyss Medical Foundation, which has been supporting GAIN for six years,” said Kimberly Baltzell, RN, PhD, MS, director of GAIN and professor at the UCSF School of Nursing. “This funding will allow us to deeply analyze the impact of what we’ve already been doing in other countries and continue to bring more nurses and midwives into the work.”
The GAIN model has three pillars: scholarship, fellowship and mentorship. GAIN partners with local educational institutions to provide scholarships and curriculum support. The program also developed a novel fellowship program for newly graduated nurses and midwives to have intensive support at the bedside during the first 12 months of their careers. In addition, they provide training for in-service providers which is followed by at least 12 months of bedside mentorship to strengthen clinical skills and competence. “Our core philosophy is ‘no training without mentorship,’” said Baltzell.
Daniel Maweu, the co-director of GAIN and a registered nurse-midwife, said that GAIN provides tailored research support to meet each country’s unique need. And while GAIN primarily provides research support, in some circumstances the program also helps to purchase updated textbooks, provide scholarships to complete specialized training, support mentorship on the use of ultrasound and bridge staffing gaps with part-time faculty.
Maweu has seen GAIN’s impact first-hand. In the district hospital in Sierra Leone where GAIN works, approximately 20 mothers died out of every 2,000 giving birth each year, he said. Last year, he said, that has dropped to 13 deaths — a significant decrease. He attributed the improvement to increased supply availability and a higher skill level of the midwives – both made possible by GAIN. “We now see that they are able to identify emergencies, call for a response, and get the ambulance all in time and provide that initial care,” he said. Maweu and Baltzell hope these improvements will be realized in Lesotho, where transportation and road infrastructure are poor. Women often have to seek care via horseback, leading to longer travel times to health care facilities. In Lesotho, GAIN will continue to work closely with long-time collaborator Partners In Health, the organization that initially invited GAIN to collaborate in the country.