ArticleBMC health services research2025
Midwives workload in the context of free maternal healthcare: a cross-sectional study based on the Workload Indicators of Staffing Needs (WISN) method in primary healthcare facilities in Kananga, Democratic Republic of the Congo.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
backgroundThe Democratic Republic of the Congo has introduced free maternal halthcare to reduce direct payments made by households. This initiative may lead to an increase in the demand for maternal services, which could put significant pressure on healthcare providers. This study aimed to assess the workload of midwives and to estimate the pressure it exerts on these providers in this context.
methodsWe conducted a cross-sectional study of 13 primary healthcare facilities in four health zones in the city of Kananga, including six first-level healthcare facilities and seven second-level healthcare facilities. The workload of midwives was assessed via the Workload Indicators of Staffing Need approach.
resultsThe basic services provided by midwives included childbirth, antenatal care, postnatal care and family planning. The results show that, in the seven first-level healthcare facilities, the number of midwives available was 20, whereas the actual need was 42, a shortfall of 22 agents. In the six second-tier healthcare facilities, 28 midwives were in post, whereas the calculated requirement was 35, a difference of 7 agents. Although some hospitals had a relatively balanced workforce, high average pressure (WISN ratio of 0.62) was reported for all hospitals studied. This pressure is moderately high in second-tier healthcare facilities (WISN ratio of 0.80) and very high in first-level healthcare facilities (WISN ratio of 0.48). All the primary healthcare facilities studied had only 44.8% of the midwives needed to provide free maternity services.
conclusionsThe results of this study reveal a marked shortage of midwives in eight healthcare facilities. Five healthcare facilities currently have sufficient staffing levels, which highlights the relevance of extending the analysis to other facilities to assess the potential for a redistribution of human resources. Such an adjustment would help balance the workload and enhance the effectiveness of free maternal healthcare.
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