Barriers of Midwives, as Primary Health Care Frontiers, in Providing Primary Health Care Services to Community in Bogale Township, Myanmar

Abstract Background: Human resources for health (HRH) is an important pillar among six building blocks of health system strengthening in achieving Universal Health Coverage, where midwives also play a critical role in provision of primary health care services, especially maternal and child health, in geographically remote rural areas in developing countries including Myanmar. There is global crisis in human resources for health and insufficient health workforce due to different underlying barriers. Aim and objectives: The aim of the study is to identify the barriers of midwives as basic health care front line workers in provision of primary health care services in one delta township in Myanmar. Specific objectives are to identify the coverage of midwives for their catchment population; to determine the knowledge and trainings received by midwives; to assess task prioritisation of midwives at respective health facilities; and to explore the barriers and factors influencing motivation of midwives. Methodology: A cross-sectional study design was applied to explore the barriers around midwives’ day-to-day activities through individual depth interviews with qualitative research method. Non-probability purposive sampling method was chosen to purposively collect information of midwives assigned at health facilities. Fifteen midwives were interviewed through semi-structured interview guide, which was developed and prior tested before data collection process. Ethical approvals were received from Institutional Review Board, Defence Service Medical Research Committee and Institute for Health Research Ethics Committee, University of Bedfordshire in advance of the study. Ethical practices, such as informed written consent and confidentiality, were exercised throughout the study. Results: The density of health workforce particularly midwives are far less than WHO recommended threshold as well as regional average density in the population. Most participants see themselves overburden with their responsibilities. Geographic, financial, social and security barriers are common among the interviewees. Conclusion: This study provides evidences that midwives are facing different barriers in their working environment. Government of Myanmar and health policy makers need to take insight review of current HRH policies, prioritise HRH issues in general health policies and strategically plan to improve HRH component in future. Keywords: primary health care providers, midwives, health workforce, barriers and human resources for health (HRH)