The nationwide lockdown affected all learning institutions across the country, including the Public Health College located in Xiangkhuang province. All students had to fly back home as part of the protection measures which were imposed in all the districts of the country. Globally, maternal and neonatal mortality as well as stillbirths have increased, and there have been more complications in pregnancies as well as higher rates of maternal depression. In Lao PDR, preliminary estimates are also pointing to an increase in maternal mortality in 2020, as compared to 2019.
“It is very sad that our school is closed, however this time we were ready to continue delivering knowledge, online” said Ms. Souksavanh, midwifery teacher in Xiangkhuang. She added “Students are encouraged to be active online. Assignments and lesson activities with deadlines are given to them. We also filmed some videos demonstrating midwifery practices and posted on Tiktok, which currently has more than 1100 followers.”
XiangKhuang Public Health School is a model to follow in terms of adapting to ensure continuity of learning for the students. This is possible thanks to the engagement of both: midwives, teachers and students. For many, this period also required them to assist at hospitals and clinics to provide maternal and other health care.
Midwifery is a key pillar in reducing maternal and newborn mortality and improving women's and children's health and well-being. Investment in strengthening the quality midwifery care gives rise to a huge return on maternal, adolescent and child health. Recent evidence showed that 83% of all maternal death, stillbirths and newborn deaths could be averted with the full package of midwifery care including family planning. To ensure that all reproductive-aged women receive high-quality midwifery care, it is critical to: i) ensure high educational standards for midwives, ii) produce and deploy sufficient numbers of midwives and iii) ensure a robust regulatory and policy framework as well as clear standards of practice.
The Government of Laos has made a Commitment to the ICPD25 (International Conference on Population and Development) that by 2030, to end Maternal Mortality (MMR) through quality of care and the Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy and policies and ensure the provision of health services that are accessible, affordable, and of high quality. A target was set, to increase the proportion of women delivering with trained Skilled Birth Attendance to 90 %. According to the most recent statistics (LSIS II, 2017), only 65% of women deliver with the assistance of a skilled attendant. Quality midwifery services that earn the population's trust are essential to achieving the ICPD25 goals.
In Lao PDR, UNFPA supports the Ministry of Health through multiple modalities and partnerships to achieve the ICPD25 commitments. This work is supported by partners such as Luxembourg Aid and Development, the Korea Foundation for International Health (KOFIH), and the Korean International Cooperation Agency (KOICA). The partnerships contribute to flagship UNFPA interventions: i) making sexual and reproductive health services universally accessible and available, ii) capacity building for midwives in accordance with international standards, including a focus on inclusion of midwives from ethnic groups iv) Youth-friendly Communication, counselling, and services that are gender-sensitive and facilitate informed choices.
UNFPA also provides technical and financial support to the Ministry of Health to strengthen the capacity of in-service health providers, particularly midwives, through Continuous Professional Development trainings. These training sessions continued to be delivered virtually during the lockdown, including a Family Planning training for health providers in Xiangkhuang that was organised online from 21th -29th July.
Ms. Oravanh, the master trainer said "I am currently residing in Salavanh; prior to the lockdown, I was required to travel to other provinces for training, but that is no longer necessary." The benefit is that the transportation fee is saved, and we can continue to create learning opportunities for health providers across the country”. She continued, "At first, many participants struggled with online learning and training, but we created a Whatsapp group that provided instruction and lessons prior to the actual training days, now, everyone is getting used to it.
Ms. Kinnaly Vangvilaychit, one of Family Planning training participants from Phaxay district hospital added “Online training has some limitations in terms of practice. However, it enables me to continue learning regardless of where I am. The lessons shared during the training and on the Whatsapp group, helped me and I can ask questions in the group chat. The training was extremely beneficial for me, as I gained knowledge about how to respond to the current covid-19 situation and high demand for Family Planning services”.
Lao PDR has the highest maternal and child mortality in ASEAN. Midwives play a significant role in preventing and reducing those mortality rates. Even during COVID-19, we have to ensure the high quality of midwifery education, build the cadre of new skilled midwives and upgrade skills of in-service midwives. Only then can we accelerate reduction of maternal deaths and improve maternal health care.
