RESUMO
@#Midwives are primarily considered as professionals with expertise in assisting women before, during, and after childbirth. Thus, the competencies for midwifery as defined by the International Confederation of Midwives revolve principally around assessment and provision of care to women and the fetus/newborn/infant during the pre-pregnancy and antenatal periods, labor and birth, postnatal/postpartum periods.1 The availability of skilled midwives in communities has allowed women, especially those who belong to lower income groups, to access professional services around childbirth, as reflected in responses from the National Demographic and Household Survey.2 For instance, while 50% of all women surveyed received antenatal care from a midwife, it is notable that 70% of those who belonged to the lowest wealth quintile were seen by a midwife during the antenatal period. Furthermore, midwives assisted 30% of deliveries reported by respondents, while roughly a little over a third of deliveries for each of the three lowest quintiles were attended by a midwife. Furthermore, in the Philippine setting, midwives are recognized as the first professional point of contact for most members of a community, especially in rural and remote places, as midwives are the ones deployed to manage Barangay Health Stations. Elaborating the scope of the practice of midwifery in relation to the provision of “primary health care services in the community” as stipulated in Republic Act No. 73923, the Board of Midwifery of the Professional Regulation Commission, in a primer for the profession, stated that midwives are expected to, among others, (a) implement government health programs in accordance with policies and guidelines of the Department of Health; (b) supervise barangay health workers; and (c) manage a Barangay Health Station.4 Stated differently, midwives, given the scope of work that they do and the areas where they are deployed, serve as the face and touchpoint of the health sector in our communities. They are the embodiment of the different health policies and programs enacted at the national and local levels through which Filipinos experience, individually and collectively, the drive for better health (or lack thereof ) advanced by different agencies, personalities, and stakeholders. However, as pointed out by Felipe-Dimog et al.5 in this issue of Acta Medica Philippina, midwives, especially those working in the public health sector, may take on roles beyond that contemplated by law. For instance, in the course of my professional practice during which I was deployed briefly in a rural health unit, and worked with an urban health department, I have encountered midwives who were tasked to work as program coordinators (or assistant coordinators), sanitation inspectors, field epidemiologists, and supply managers, among others, because of scarcity in the overall staff complement of health departments. Given their close ties with their areas of assignments, midwives are also expected to be community coordinators, if not organizers. The extent to which midwives are assigned these additional tasks depend on their professional relationship with their immediate supervisor; the level of trust and confidence reposed on them by their superiors; in some instances, their attendance to specific training workshops; as well as the availability of more qualified personnel (or lack thereof ) in the locality. Yet despite all these – placement in remote, if not hardship posts; additional assignments beyond their job description – midwives receive salaries that may not be commensurate after consideration of the job context. Staff midwife positions (i.e., Midwife I to III) in government institutions are remunerated at Salary Grades 9 to 13 (i.e., approximate gross pay of PHP 21,000 to PHP 31,000, based on the fourth tranche of the Salary Standardization Law, but may be lower depending on the income classification of the local government unit6). Additional compensation and benefits under special laws may not always be provided as this will depend on the paying capacity of the employing agency. Furthermore, midwives – especially those who completed the two-year program under the previous policy – also must contend with issues concerning their professional status. I have personally encountered community members who do not consider midwives as professionals in the same league as nurses or physicians, or who view midwives as “assistants” or “subordinates” of nurses and physicians, forgetting that a certain degree of independent practice is allowed each professional licensed by the Republic of the Philippines. Midwives play a crucial role in caring for Filipinos not only around childbirth – this is their primary professional duty – but throughout the lifespan – especially for midwives working in local health departments. Stakeholders must not forget to give due recognition to the value and worth contributed by midwives in shaping the health and well-being of each generation of Filipinos.
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TocologiaRESUMO
Introdução: A contribuição das obstetrizes e enfermeiras obstétricas é fundamental para a melhora na assistência à saúde da mulher, especialmente em relação às taxas de mortalidade materna, qualidade, disponibilidade e acessibilidade dos serviços de saúde e redução na quantidade de cesarianas. Daí a importância de conhecer como ocorre a formação desses profissionais. Objetivos: 1. Caracterizar os cursos de Obstetrícia de entrada direta e as instituições de ensino superior que os oferecem, nos países da América do Sul; 2. Analisar o projeto pedagógico dos cursos, especialmente sua estrutura curricular. Método: Estudo documental, descritivo-exploratório. Teve como referencial teórico o ensino por competências, apoiado pelos documentos sobre a educação e a prática profissional de obstetrizes publicados pela Confederação Internacional de Obstetrizes (ICM). Foram incluídos cursos de Obstetrícia de nível superior, de entrada direta, dos países da América do Sul, filiados à ICM em 2017. Cinco estruturas curriculares foram analisadas de acordo com uma matriz de conteúdos baseada no modelo de currículo da ICM. Para cada um deles, foi construída uma ficha com as características básicas do curso. Foi realizada análise quantitativa e qualitativa dos dados. Resultados: Foram localizados 75 cursos, distribuídos em sete países: Argentina (n=9), Brasil (n=1), Chile (n=20), Equador (n=1), Paraguai (n=6), Peru (n=36), Uruguai (n=1) e binacional Argentina e Uruguai (n=1). Entre outros dados, foi apurado que todos os cursos são oferecidos em universidades e exigem uma prova ou curso preparatório para ingresso. A carga horária dos cursos varia de 3.322 a 9.000 horas e a duração é de 8 a 12 semestres, sendo 10 semestres a mais frequente. Majoritariamente, denominam-se Curso de Obstetricia e outorgam o grau de licenciado e o título de Licenciado em Obstetrícia, Matrona/Matrón ou Obstetriz/Obstetra. É grande a heterogeneidade em relação à visão, missão e perfil do egresso. A análise das estruturas curriculares dos cursos mostrou que os conteúdos correspondem às recomendações da ICM, exceto para os módulos relacionados a habilidades básicas em saúde para parteiras, assuntos profissionais da Obstetrícia e atendimento obstétrico para mulheres que precisam se submeter a um aborto. Isto pode refletir um compromisso da educação de obstetrizes para a aquisição das competências essenciais estabelecidas pela ICM. Conclusões: São oferecidos 75 cursos nos sete países estudados e existem muitas diferenças em suas características, em particular, quanto à quantidade e distribuição geográfica dos cursos, duração, carga horária e perfil do egresso. Nas estruturas curriculares analisadas, identificou-se a quase totalidade dos conteúdos curriculares recomendado pela ICM. A principal lacuna nas ementas dos cursos se refere à competência para atenção às mulheres em situação de abortamento.
Introduction: The contribution of midwives and nurse-midwives is essential to achieve an improvement in women's health care, especially regarding quality, availability and accessibility of health services, reduction in the number of caesarean sections and maternal mortality rates. Hence the importance of knowing how the training of these professionals is currently taking place. Aim: 1. Characterise the direct entry Midwifery programmes and the higher education institutions that offer them, in South American countries; 2. Analyse the pedagogical project of the programmes, particularly its curricular structure. Method: Descriptive-exploratory, documentary study. The theoretical reference was based on competency education, supported by the documents of the International Confederation of Midwives (ICM) on education and professional practice of midwives. Were included undergraduate direct entry Midwifery programmes from the South American countries affiliated to the ICM in 2017. Five curricular structures were analysed according to a content matrix based on the ICM curriculum model. Quantitative and qualitative data analysis were performed. Results: 75 programmes were found, distributed in seven countries: Argentina (n = 9), Brazil (n = 1), Chile (n = 20), Ecuador (n = 1), Paraguay = 36), Uruguay (n = 1) and binational Argentina and Uruguay (n = 1). Among other data, it was found that all programmes are offered in universities and require a test or preparatory course for admission. The total number of hours of the programmes varies from 3,322 to 9,000 hours and the duration is 8 to 12 semesters, 10 semesters being the most frequent. They are mainly denominated Curso de Obstetricia and the majority grants the degree of licensee and title of Licenciado em Obstetricia, Matrona/Matrón or Obstetriz/Obstetra. There is great heterogeneity regarding the vision, mission and graduates profile. The analysis of the programmes curricular structures showed a correspondence between the programmes contents and the recommendations of the ICM, except for the modules related to basic health skills for midwives, professional midwifery subjects and obstetric care for women who need to undergo abortion. This may compromise midwifery education for the acquisition of the core competencies established by the ICM. Conclusions: 75 programmes are offered in the seven countries studied and there are many differences in their characteristics, in particular, the quantity and geographical distribution of the programmes, duration, number of hours and graduate profile. Almost all of the curricular contents recommended by the ICM were identified within the analysed curricular structures. The main gap in the programmes syllabuses refers to the competence to provide abortion-related care.