Why midwives alone are not enough

Talking to midwives from across Ethiopia and Kenya about the challenges and triumphs of being a clinician, the conversation often turned to where to go next (Box 1). Although there have been considerable steps taken over the recent decades to reduce maternal, neonatal and child mortality and morbidity (Alkema et al, 2016), there is still some way to go. Across eastern Africa, many programmes of risk and harm reduction have centred on the training of healthcare professionals, both increasing the skills of those already practising and introducing new positions, such as the community health extension workers (Say et al, 2014). There are proven benefits to such approaches, with research demonstrating a general raised awareness of common health problems, vaccinations, and the importance of public health education (regarding, for example, access to clean water, improved hygiene practices, and adherence to medicine schedules) in the prevention of certain disease outbreaks (Perry et al, 2014). In addition, research has also shown a decreased burden on larger medical facilities, with basic treatment outsourced to community-based health posts (Perry et al, 2014). These are commendable improvements that work. But in the realm of maternal health, the problems run deeper (Say et al, 2014). As midwives have said: