The salt between the beans : a qualitative study of the role of auxiliary midwives in a hard-to-reach area of Myanmar

Abstract

AbstractBackground:Auxiliary Midwives (AMWs) are unpaid volunteer health workers assisting qualified paid midwives inmaternal and child health care mainly in hard-to-reach areas of Myanmar. This paper describes the relationshipbetween AMWs and the health system in providing maternal and child services as perceived by the community,AMWs themselves and health care providers in one remote township of Myanmar.Method:A qualitative study was conducted in Ngape Township, Myanmar. A total of 15 focus group discussionswith midwives, AMWs, community members and mothers were conducted. Ten key informant interviews wereperformed with national, district and township level health planners and implementers of maternal and child healthservices. Thematic analysis was done using the ATLAS.ti software.Results:AMWs occupy a unique position between the community and the health sector in the study township. Therelationship and trust with the community is built upon prolonged presence providing health care, skill building andfulfilling community expectations. Health care providers’expectations to provide only preventive care, healthpromotion and education and childbirth care are often exceeded in reality when emergencies occur in hard-to-reachareas. This challenge to handle emergency situations with no support and limited skills and training is considered asmost difficult by the AMWs. This mismatch of service provision expectations by both the community and other healthcare providers has put AMWs in a position which they describe as being the“salt between the beans”an essentialingredient but often invisible between the beans.Conclusion:The trust and relationship developed by AMWs over four decades of community practice serving as themediator role is an untapped resource that can facilitate future community-based maternal and child healthinterventions in Myanmar.