That was a cordial morning of the day when I was in the Pearl Continental Hotel, Karachi. My presence was, as an observer, in a training based program. People who have come to take training, were associated with a program pertains to mother and child health in Sindh. They had come from the different districts of Sindh to participate as “Trainees”.

“Strengthening the quality of maternal, newborn and child health services by the community midwives in the underserved areas of Sindh” was the core objective of the step. Organizers held the event with the passion to support the government and its Maternal, Newborn and Child Health (MNCH) program in order to make strengthen to basic healthcare infrastructure and medical workforce.

Thousands of women and children in Pakistan die each year as a result of preventable complications of diseases. Pakistan’s high maternal mortality rate has always been a major concern. Similarly, mortality rate; neonatal (per 1;000 live births) in Pakistan was reported at 45.5 in 2015, according to the World Bank collection of development indicators. A major reason for maternal deaths during pregnancy and childbirth has been the use of unskilled and nonprofessional birth attendants. These births have usually take places in unhygienic environments. Birth attendants are often not equipped to handle the normal course of pregnancy, let alone any sort of complication that may develop during pregnancy or childbirth.

Village life is all about the traditional rural life of the people of Pakistan. There is no doubt about the fact that Pakistan is the land of villages. Rural life of the marginalised people looks like a portrait of misery. Lack of desired budgets, human resources, infrastructure, equipment and supplies, competencies, entrepreneurial skills, absent or poor referral linkages and acceptance from community are the major challenges. Maternal and childhood diseases have been a primary concern throughout the Pakistan. Approximately 61% of Pakistan’s population lives in rural areas with minimal access to healthcare. Almost 50% of women still deliver at home in condition of poor hygiene. To address the issues of availability and accessibility the government’s National Maternal Newborn and Child Health Program (NMNCHP) introduced a new cadre of skilled birth attendants called “Community Midwives” (CMWs) meeting the international definition of skilled birth attendants in terms of practical skills and the required knowledge. These were rural women from the same community as their clients. Training of community midwives began in 2007-08 according to a curriculum designed by the Pakistan Nursing Council (PNC). CMWs were given 18 month of training in antenatal, intra- partum, postnatal and newborn care. The program aimed to train and deploy around 12,000 CMWs nationwide to increase coverage of MNCH services by skilled providers. However, due to deficiencies in strategic planning and proper training the program could not progress as expected. Consequently, most of the graduates did not continue their practice and those who were practicing could not capture sufficient clientele.

Most of the maternal and neonatal deaths can be prevented if there were enough properly organised and well stablished healthcare institutes and trained, competent and supported workforce working in the communities. A functional medical system with skilled, authorised and supported doctors, nurses, midwives, lady health workers and other stakeholders are the front line life saving entities in protecting mothers and children from avoidable deaths due to extreme complications of the diseases. Especially in the underserved areas of Pakistan, an effective and enhanced role of midwives in simple cases of childbirth could be an important contributing factor to bring about a significant and sustained reduction in maternal and infant mortality. According to the National Maternal and Neonatal Child Health Programme “the community midwives are specially trained and equipped to conduct a normal home delivery under safe and clean conditions, they provide individualized care to the pregnant women throughout the maternity cycle and the newborn, in her own environment and helping her in self-care. They also provide guidance and counseling to the community for healthy habits, and involving the family in preparation for childbirth and for unforeseen emergencies. CMWs identify the actual or anticipated conditions requiring medical attention and making timely referrals.”

Such training events surely play an imperative role for every Pakistani as they give a real feeling about how we can contribute, in the best of our capacity, to the noble cause of saving lives of mothers, newborns and children in Pakistan. Undoubtedly, a strengthened healthcare system and skilled workforce is mandatory to reduce maternal and neonatal mortality. Focusing on human and institutional capacity building through pre-service and in-service can be helpful to save lives of rural mothers. A competent and productive workforce is a cornerstone of any healthcare system therefore, there is utmost need for proper coordination between ministry of health and maternal and child health programs, provincial health departments and Pakistan Nursing Council for the uplift of midwifery services in the country. Similarly, the initiation of midwifery education can be a step forward to overcoming the existing gaps and making coordinated effort for the well-planned activities relating to the enhancement of midwifery and referral services in the country. CMWs can be considered the backbone of the health profession as the importance of these midwives to the far-flung areas of our country cannot be underestimated. But without the training, capacity building and skills enhancement, we would not be able to reduce the infant and maternal mortality rates. Globally many countries had been successful in reducing maternal mortality rate with the active support of trained midwives.

At the last day of the event, “speeches” from the chief guests were tremendously motivational. They tried to convince the trainees to implement effectively and sincerely, what they had learned in the training program. “Trainers” had also played their role very effectively. I really felt guests’ and trainers’ persuasion quite essential and factual because mother and child health shall indeed be an indispensible element for a prosperous Pakistan.