BACKGROUND

In September 2000, leaders of 189 countries met at the United Nations in New York and endorsed the Millennium Declaration, a commitment to work together to build a safer, more prosperous and equitable world. The Declaration was translated into a roadmap setting out eight time-bound and measurable goals to be reached by 2015, known as the Millennium Development Goals (MDGs).

For the Malawi Project, Goal 5 is of most relevance:

Millennium Development Goal 5: Improve maternal health

Reduce maternal mortality by three quarters and achieve universal access to reproductive health

Health systems across Africa, severely weakened by a profound lack of human resources, are limited in their capacity to uphold the right to health and provide quality care to the neediest populations. One innovative and affordable solution, which has been pioneered by several sub-Saharan African countries, is the use of ‘mid-level providers’, including assistance medical officers, clinical officers and surgical technicians.

PURPOSE OF THE MALAWI PROJECT: ADVOCACY

In Malawi, 93% of all Caesarean sections at the district hospital level are carried out by mid-level providers; for Mozambique, that figure is 92% and in Tanzania, it’s 84%. With the right training and an appropriate enabling environment, mid-level providers have been shown to have similar outcomes to doctors when providing life-saving emergency obstetric surgical care. Importantly, their retention rates are excellent, especially in districts and rural areas. 

Despite this, little research has been done on the potential of mid-level providers and they are virtually invisible in policy discussions. This project aims to assist in highlighting their crucial role in health care delivery

WHY FIONA BASILE?

Australian Writer and Photographer Fiona Basile met Columbia University’s (New York)  Dr Helen de Pinho and Professor Staffan Bergstrom (International Health and Senior Consultant / Obstetrics and Gynaecology, Karolinska Institute, Stockholm) in Sweden in 2008. Along with Dr Pinho and other leading health officials, Dr Bergstrom, were working with 35 clinicians from various developing nations who were receiving further training for their emergency obstetric work.

During this time, an invitation was extended to Fiona to visit the countries that are part of their work so that she could document with both photos and words the important work being done by mid-level providers in these developing nations. Having worked with not-for-profit organisations in the past, and wanting to increase her experience in international aid and humanitarian work, Fiona spent three weeks in Malawi working with mid-level providers to document their work.

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