In Southern Sudan, this programme is launched under the distinct pleasure of the Vice President.
Training Nurses and Midwives is a Priority
Southern Sudan National Health Facility Mapping Estimates
The situation is slowly improving, but estimates indicate that deployed within the healthcare system, there are only:
83 registered nurses
1,110 certified nurses
19 Registered Midwives
132 Community Certified Midwives (CMW)
Absence of regulations and a Nurses and Midwives Act
Contributes to the lack of knowledge regarding their scope of practice.
Inability to guarantee quality nursing and midwifery care to the general population.
No formal mechanism in place for the continuous professional development of midwives and nurses.
No association to support regulation.
Some nurses are called up to be midwives.
Deployment of international midwifery specialists
As a result of the many gaps and low status of midwifery in the country and the high maternal mortality ratio, UNFPA, as part of the global programme on investing in midwifery, deploys two international midwifery specialists in Southern Sudan.
18 nursing and 12 midwife trainees are registered — of these, 10 are male and 20 are female.
Trainees come from Eastern Equatoria, Central Equatoria, Upper Nile and Western Equatoria states. The school is supposed to take students from all states, but it is difficult to get candidates with all entry requirements.
The highly motivated and enthusiastic students start by taking foundation courses in mathematics, biology and English.
The school helps contribute towards the achievement of the Millennium Development Goal 5 (reduction of maternal mortality), as well as improving access to family planning, and basic and comprehensive emergency and obstetric care.
When they have finished training in 2013, the qualified nurses and midwives will repatriate to their respective states to offer professional support to the health facilities.
Petronella Wawa is identified as the principal of JCONAM.
Some of us have been working as nurses in various state hospitals. We are very happy to be here. The courses will help us upgrade our knowledge and skills.
— Midwifery student
First Diploma College of Midwifery and Nursing
The first college of this kind in the country is established with support from the UNFPA, Real Medicine Foundation, St. Mary’s Juba, and St. Mary’s Isle of Wight.
National Association of Nurses and Midwives of Southern Sudan (NAMASS) is Born
International Day of the Midwife March
On May 5, International Day of the Midwife, there is a major march through the streets of Juba celebrating nursing and midwifery, and ending with a rally for maternal health at Juba College of Nursing and Midwifery.
NAMASS is launched by the Under Secretary, and at the first meeting an interim executive is elected:
Jemelia Beda, President
Polly Grace, Vice President
Repent Khamis, Secretary
Michael Malish, Treasurer
Petronella Wawa, Midwifery Chapter Chairperson & Vice President
four Committee members
A draft of the Midwifery and Nursing Association Constitution is created.
Team from UNFPA and MOH, and NAMASSexecutives visit all ten states in South Sudan to hold meetings, to discuss and educate about the importance of the association, and to establish State Chapters (branches).
A State Chapter Handbook is created. It serves as a guide for midwives and nurses to better understand the benefits of an association and their role.
The successful outcome of the referendum results in Southern Sudan celebrating its independence in July 2011, becoming the Republic of South Sudan.
Steps towards regulation and strengthening the professions
The first national workshop to finalize the diploma in midwifery curriculum is held with participants from ICM and representatives from training institutes in neighbouring countries. The midwifery curriculum is validated and approved for use.
UNFPA first procures and distributes midwifery education equipment and simulators to four health training centres in states across the country, and establishes a modern state of the art library and skills lab at the Juba College of Nursing and Midwifery.
The Nursing and Midwifery Technical Working Group is established as an advisory committee to the Director General for Nursing and Midwifery.
The first stakeholders workshop on nursing and midwifery regulations is held with midwives and nurses from across South Sudan, including representatives from ICM, ECSACON, and councils from Uganda and Kenya. A road map is developed for establishing nursing and midwifery regulations in the country, and a task force is established to review the draft Bill developed by a UNFPA midwifery specialist.
23 students are granted scholarships to pursue studies for a certificate in midwifery in Uganda, as a collaborative effort between the Ministries of Health of South Sudan and Uganda. Interviewers from training institutes in Uganda arrive in South Sudan with support from UNFPA, and 44 students are selected out of 128 interviewed for scholarships.
17 additional international United Nations Volunteer (UNV) midwives are deployed across all the ten states of the country. These midwives work to support midwifery service delivery, strengthen state associations, and provide mentoring to students on the clinical areas.
There is a Ministerial Order to stop all training of traditional birth attendants, community midwives, village midwives, and maternal and child health workers. Only enrolled Certificate (2.5 years) and Diploma (3 years) Midwives will be trained.
Strengthening Midwifery Services in South Sudan, Phase 1
UNFPA receives support from Canada for funding of the Strengthening Midwifery Services project for 4 years, starting April 2012. The project focuses on strengthening all pillars of midwifery — Education, Regulation and Association Strengthening — as well as task shifting initiatives and training of other health workers, such as obstetricians.
Midwifery curriculum is finalized, and UNFPA supports training midwives at the certificate level (2.5 years) at Kajo Keji and Wau. The Wau Midwifery School is established, and the midwifery training programme at Kajo Keji includes upgrading community midwives to enrolled midwives. Another diploma midwifery course is started at Maridi HIS.
UNFPA offers scholarships for midwives at the Catholic Health Training Institute in Wau (a faith‑based training institute). Eighteen students receive scholarships.
UNFPA supports 12 nurses, midwives, and clinical officers to be trained in Tanzania as tutors. They are deployed to health sciences institutes on their return.
International Day of the Midwife (IDM) is celebrated with a march and rally, with main events in Juba and Torit.
First SSNAMA conference is held with over 500 participants from across the country, including representatives from all state branches. In attendance are the Vice President of the International Confederation of Nurses (ICN), board members from the ICM, the president of ECSACON, and presidents from associations in Kenya, Uganda and Ethiopia. Key presentations from neighbouring associations focus on how to strengthen advocacy, and include profiles of nursing and midwifery.
SSNAMA holds its first communications workshop for public relations officers from all state branches, and drafts an advocacy and communications strategy.
UNFPA supports a workshop for journalists on promoting nursing and midwifery through the media.
First national examinations for nursing and midwifery commence, after the revitalization of the National Examinations Board.
First group of students in Midwifery and Nursing graduate from JCONAM and receive their diplomas.
Regulation and association strengthening
Canada begins funding the deploying midwives project through UNFPA. 30 international United Nations Volunteer (UNV) midwives are deployed throughout the country in all 10 states, to strengthen midwifery service delivery and mentor students at training institutes.
UNFPA supports a consultant to develop the first Nursing and Midwifery Strategic Plan for South Sudan. The draft Strategic Plan focuses on nursing and midwifery regulations, education, association, and leadership.
UNFPA supports a gender assessment of the midwifery programme. The assessment reveals that there is a need for integration of gender issues in all pillars of midwifery, including midwifery education, midwifery policy, association, and regulatory documentation.
First Emergency Obstetric and Newborn Care (EmONC) Needs Assessment is conducted in South Sudan with support from Canada. This is a joint programme with UNICEF and WHO. This EmONC Needs Assessment is widely supported by SSNAMA’s state chapters across the country. Many of the association members are engaged in data collection and analysis.
WHO commences deploying international and national midwives at health facilities, as part of their sexual and reproductive health project.
As the conflict escalates, United Nations Volunteer (UNV) midwives are deployed into humanitarian settings, including at Protection of Civilians Sites (POCs) managed by the UN for Internally Displaced Persons (IDPs). The UNV Midwives provide midwifery services, ensuring access to skilled birth attendants for IDPs. Training is also provided for midwives to work in humanitarian settings.
SSNAMA develops the first Code of Conduct for Nurses and Midwives.
Nurses and midwives in South Sudan participate in the Africa Regulatory Consortium, working on strengthening nursing and midwifery regulations in the country.
The Minister of Health issues a decree for the upgrading of all Health Sciences Institutes (HSI), requiring only diploma programmes be implemented at HSIs. The Ministry of Health (MOH) will therefore no longer train enrolled midwives and nurses in the country. All HSIs will offer diploma programmes for nursing and midwifery.
Nurses and midwives from the MOH and SSNAMA participate in a twinning programme with the Zimbabwe Midwives Association, supported by UNFPA and ICM.
UNFPA supports 6 nurses and midwives to travel to Tanzania to be trained in health personnel education as tutors.
The MOH, with support from the World Bank, supports 11 nurses to be trained as nurse anesthetists in Kenya. After initial challenges, they graduate successfully and return to South Sudan.
14 midwives complete their studies in Uganda and are deployed in health facilities across South Sudan.
Over 100 midwives and nurses are estimated to graduate from Juba College of Nursing and Midwifery (JOCNAM).
Nurses and midwives join other healthcare workers to participate in the Sweden course on sexual and reproductive health.
40 nurses, midwives and clinical officers are sent to study health personnel education in Tanzania to become tutors, with support from the European Union (EU).
Two midwives successfully complete their studies in Uganda, receiving a diploma in midwifery from Jinja, and are deployed in South Sudan.
International Day of the Midwife (May 5) and International Nurses Day (May 12) celebrations take place in over 10 locations across the country, with nurses and midwives marching, holding education sessions, and having speaking events.
The deploying midwives project concludes as a separate project and is integrated into the Strengthening Midwifery Services in South Sudan, Phase 2 (SMS II) project. As such, 16 of the international United Nations Volunteer (UNV) midwives conclude their assignments and 2 additional UNV midwives join the programme.
Full implementation of the SMS II project commences, including the Peer‑to‑Peer program, a twinning‑based mentorship model that matches in‑service midwives from SSNAMA with their counterparts from CAM.
South Sudan experiences another internal conflict, causing displacement of persons and evacuation of international staff.
A team from SSNAMA, a UNV midwife, and the UNFPA participate in the ICM Conference and the IDM celebrations in Canada.
Lowering Maternal Mortality
Maternal mortality drops from over 2,000 to 789 per 100,000, with most maternal deaths occurring during labour, delivery and the immediate postpartum period. It is still the highest in the world, but the efforts of midwives and nurses in reducing maternal deaths has been astonishing.
SSNAMA executive and members conduct a study tour with the Uganda Nurses and Midwives Association, and also participate in their conference.
Infection Prevention and Control (IPAC)
A 3‑day workshop in Juba outlining the importance, steps and actions to be taken by midwives, nurses and other healthcare providers to reduce the risk of infection among patients turns into an unforgettable experience for all involved.
My big dreams for the next couple of years are that things are going to change — because we have already seen great changes happening. Our country is still young. There are a lot of things that need to be done at once. Health is a priority, everything is a priority … in my position, I am able to see clearly what are the priorities.
9 nurses and midwives receive a Bachelors Degree in Midwifery and Nursing from Great Lakes University of Kisumu.
20 midwives and nurses commence the first Bachelor’s Degree programme in midwifery at the St. Mary’s Help College in Wau.
The first local training of nurses and midwives as tutors begins at the College of Physicians and Surgeons of South Sudan (CPS).
Over 24 Health Sciences Institutes (HSI) are established across the country, training nurses and midwives at diploma level.
SSNAMA increases its branches to 15 across the country.
SSNAMA engages in business ventures at the state level with support from Canadian midwives (almost $5,000 CAD), with the goal of becoming financially independent from international donors. Through innovative business trainings delivered by Vocational Skill Development Organization (VOSDO), each SSNAMA chapter plans to open businesses designed to financially support the chapter.
SSNAMA is confirmed as a full, unconditional member of ICM.
SSNAMA and the Canadian Association of Midwives (CAM), as part of the SMS II project, launch the first instalment of Labour Pains, a projected three‑part series of comic books based on the real‑life experiences of midwives and student midwives in South Sudan.
SSNAMA members create workshops on adolescent health and sexuality. The young women in the class are all given “Dignity Kits” (menstrual hygiene kits), consisting of washable pads, a washcloth and soap. With it, girls can continue to go to school, even during their periods, instead of spending time sitting on ash, isolated from the public and missing valuable education time.
All educational facilities are interrupted for long stretches due to COVID‑19. The replenishment of new midwives and nurses is delayed. Some classes move online, but in areas where only 20% have internet access, virtual teaching is not really a viable option.
To us, as an association, it is a big turn and we will use it for advocacy in a bigger way. Now we can proudly feel that we are members of the international nursing community. For the nurses, it will lift the profile of the nursing profession in the country, and we are so happy that this will provide us an opportunity to participate fully in the activities of ICN.
The Integrated Reproductive and Maternal Health Services in South Sudan Research Report is created, along with a series of Health Facility Specific Quantitative Reports for 12 hospitals in South Sudan.
SSNAMA Firmly on the International Stage
SSNAMA holds its third national conference, both physically and virtually.
SSNAMA holds its Annual General Meeting and elections. The National Chairperson is returned to serve another term of office.
Despite the setbacks caused by COVID‑19, SSNAMA continues to disseminate innovative recruitment materials to high school and college students. The materials promote the professions of midwifery and nursing as viable and valuable career paths.
Nurses and Midwives Council of South Sudan (NAMCOSS) creates a website and builds a Continuing Professional Development (CPD) Portal. It features links to learning resources to help midwives keep themselves up‑to‑date with the changes in research and clinical practice guidelines.