1.0 Introduction
1.1 Background of Study
Historically, Midwives Service Scheme in Nigeria is closely connected to the country's efforts to reduce maternal and infant mortality rates and improve access to maternal healthcare services, especially in rural communities. Before the introduction of the scheme, many rural healthcare facilities in Nigeria suffered from a shortage of skilled healthcare workers, inadequate infrastructure, and poor maternal healthcare services. These conditions contributed significantly to the high number of deaths among pregnant women and newborns during childbirth. According to the World Health Organization (2019), Nigeria accounted for a significant percentage of global maternal deaths due to complications related to pregnancy and childbirth. Many women in remote communities lacked access to skilled birth attendants, leading to increased dependence on traditional birth attendants and home deliveries. The shortage of trained midwives in primary healthcare centres became a major concern for the Nigerian government and international health organizations.
Maternal health remains one of the major public health concerns globally, especially in developing countries where access to quality healthcare services is still limited. Maternal health refers to the health condition of women during pregnancy, childbirth, and the postnatal period. Nigeria has continued to experience high rates of maternal and neonatal mortality despite several interventions introduced by government and international organizations. According to the United Nations Children's Fund, many maternal deaths in Nigeria occur due to preventable complications associated with poor healthcare access, shortage of skilled birth attendants, poverty, ignorance, and inadequate healthcare infrastructure. Rural communities are particularly affected because many healthcare facilities in such areas lack trained personnel, equipment, and essential medical supplies needed for effective maternal healthcare delivery.
The shortage of skilled healthcare workers, especially midwives, has remained a major challenge affecting maternal healthcare services in Nigeria. Midwives are healthcare professionals trained to care for women during pregnancy, labour, delivery, and after childbirth. Their role is important in reducing complications during childbirth and ensuring the survival of both mother and child. According to the United Nations Population Fund, access to skilled midwives is one of the most effective strategies for reducing maternal mortality and improving reproductive healthcare services in developing countries.
The Midwives Service Scheme was also designed to improve antenatal attendance, promote hospital delivery, encourage immunization, and reduce maternal and neonatal deaths in communities with poor health indices. According to National Primary Health Care Development Agency (2010), the scheme was introduced as part of the government's commitment toward achieving improved maternal health outcomes and addressing inequalities in healthcare access between urban and rural populations. Through the deployment of midwives to primary healthcare centres, the programme sought to improve healthcare utilization and increase community confidence in government healthcare facilities.
Although the scheme was introduced with positive intentions, several challenges have continued to affect its implementation and effectiveness. Abimbola et al. (2012) reported that issues such as poor staff motivation, inadequate supervision, shortage of medical equipment, and weak healthcare infrastructure have negatively affected the performance of the programme in many communities. In some healthcare centres, midwives work under difficult conditions without adequate accommodation, electricity, water supply, or transportation facilities. Furthermore, the attitudes and perceptions of mothers toward healthcare services have continued to influence the utilization of the Midwives Service Scheme. Many women in rural communities still prefer traditional birth attendants or home delivery due to cultural beliefs, fear of surgical procedures, financial constraints, and previous negative experiences with healthcare workers.
Okonofua et al. (2014) asserted that poor communication between healthcare workers and patients, long waiting time, and negative attitudes of some healthcare providers contribute to low utilization of maternal healthcare facilities in some communities. This study is therefore aimed at examining the Midwive's and Mother's Perception of Midwives Service Scheme in order to understand the extent to which the programme has influenced maternal healthcare delivery and the challenges affecting its effectiveness in healthcare facilities and communities. This study is set against the backdrop of persistent maternal and neonatal health challenges, shortage of skilled birth attendants, poor healthcare utilization, and the need to strengthen maternal healthcare services in Nigeria.
1.2 Statement of Problems
Investigation revealed that the Midwives Service Scheme was introduced to improve access to quality maternal and child healthcare services, especially in rural and underserved communities where the shortage of skilled birth attendants has continued to contribute to high rates of maternal and infant mortality. Despite the establishment of the scheme in many parts of Nigeria, maternal health challenges such as complications during pregnancy, unsafe delivery practices, poor antenatal attendance, and preventable deaths among mothers and newborns are still common in many healthcare facilities and communities.
Additionally, midwives working under the scheme often experience challenges such as inadequate medical equipment, shortage of personnel, poor motivation, insufficient accommodation, insecurity, and irregular payment of salaries and incentives, which may affect their level of commitment and service delivery (Okonofua et al., 2014).
Furthermore, although the government and other health agencies have invested resources toward improving maternal healthcare through the scheme, there is still uncertainty about how both mothers and midwives perceive its effectiveness, accessibility, and sustainability. In some areas, healthcare centres operating under the scheme are underutilized despite the presence of trained midwives, while in other cases, the quality of interaction between mothers and healthcare providers has affected the confidence of women in seeking maternal healthcare services (Adewuyi & Auta, 2013). It is against this backdrop that this study seeks to examine the Midwive's and Mother's Perception of Midwives Service Scheme.
1.3 Aim and Objectives of Study
The aim of this study is to examine the perceptions of midwives and mothers on the midwives service scheme in selected primary healthcare centres in Nigeria.
The specific objectives of the study are to:
- Determine the perception of mothers toward the Midwives Service Scheme in selected healthcare facilities.
- Examine the perception of midwives regarding the implementation of the Midwives Service Scheme.
- Identify the factors affecting the utilization of maternal healthcare services under the Midwives Service Scheme.
- Assess the challenges faced by midwives in the delivery of maternal healthcare services.
- Examine the relationship between the attitudes of healthcare workers and the utilization of maternal healthcare services by mothers.
1.4 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What are the perceptions of mothers toward the Midwives Service Scheme in selected healthcare facilities?
- What are the perceptions of midwives regarding the implementation of the Midwives Service Scheme?
- What factors affect the utilization of maternal healthcare services under the Midwives Service Scheme?
- What challenges are faced by midwives in the delivery of maternal healthcare services?
- What relationship exists between the attitudes of healthcare workers and the utilization of maternal healthcare services by mothers?
1.5 Research Hypotheses
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant relationship between the attitudes of healthcare workers and the utilization of maternal healthcare services by mothers under the Midwives Service Scheme.
- H1: There is a significant relationship between the attitudes of healthcare workers and the utilization of maternal healthcare services by mothers under the Midwives Service Scheme.
Hypothesis Two
- H0: There is no significant difference in the perceptions of mothers and midwives toward the Midwives Service Scheme.
- H1: There is a significant difference in the perceptions of mothers and midwives toward the Midwives Service Scheme.
Hypothesis Three
- H0: Factors affecting the utilization of maternal healthcare services do not significantly influence the effectiveness of the Midwives Service Scheme.
- H1: Factors affecting the utilization of maternal healthcare services significantly influence the effectiveness of the Midwives Service Scheme.
Hypothesis Four
- H0: The challenges faced by midwives do not significantly affect maternal healthcare service delivery under the Midwives Service Scheme.
- H1: The challenges faced by midwives significantly affect maternal healthcare service delivery under the Midwives Service Scheme.
Hypothesis Five
- H0: The implementation of the Midwives Service Scheme does not significantly improve maternal healthcare utilization in selected healthcare facilities.
- H1: The implementation of the Midwives Service Scheme significantly improves maternal healthcare utilization in selected healthcare facilities.
1.6 Significance of Study
It is believed that at the completion of the study the findings will provide factual information on the perceptions of mothers and midwives toward the Midwives Service Scheme in selected healthcare facilities. Also, the research will assist healthcare administrators in identifying operational challenges affecting maternal healthcare delivery under the Midwives Service Scheme.
Furthermore, the outcome will support government agencies in improving policies relating to staffing, supervision, and healthcare infrastructure in rural communities. In addition, the study will contribute relevant academic materials for future researchers and students in maternal and child healthcare studies.
Lastly, the findings will encourage improved relationships between healthcare workers and mothers receiving maternal healthcare services.
1.7 Scope of Study
This study focuses on the Midwive's and Mother's Perception of Midwives Service Scheme in selected primary healthcare centres under the supervision of the Lagos State Primary Health Care Board in Lagos State.
The study covers issues relating to the perception of mothers, perception of midwives, utilization of maternal healthcare services, challenges affecting the implementation of the scheme, and the relationship between healthcare workers' attitudes and maternal healthcare utilization.
1.8 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations are listed as follows:
- The study was affected by insufficient data because some healthcare facilities did not provide complete information relating to maternal healthcare services and the Midwives Service Scheme.
- Delay from respondents also limited this research because some mothers and healthcare workers were not readily available during the period of questionnaire administration and interview sessions.
- The research was affected by financial constraints due to the high cost of transportation, printing of questionnaires, and other research materials required for data collection.
- Finally, time constraints also hindered this study because the researcher combined academic activities with fieldwork during the period of the study.
1.9 Definition of Terms
Perception:
Perception refers to the way individuals understand, interpret, and form opinions about a programme, situation, or experience based on their knowledge, attitude, and interaction with it. In this study, perception refers to the opinions and feelings of mothers and midwives toward the Midwives Service Scheme. According to Robbins and Judge (2017), perception involves the process through which individuals organize and interpret information to give meaning to their environment.
Midwife:
A midwife is a trained healthcare professional who provides care and support to women during pregnancy, labour, childbirth, and the postnatal period. Midwives also educate women on maternal and child health practices and identify complications that require medical attention. According to the World Health Organization (2023), midwives are essential healthcare providers involved in reducing maternal and neonatal mortality.
Mother:
A mother refers to a woman who is pregnant, has given birth, or receives maternal healthcare services in a healthcare facility. In this study, mothers include women attending antenatal clinics, delivery services, and postnatal care under the Midwives Service Scheme.
Midwives Service Scheme:
The Midwives Service Scheme refers to a maternal healthcare programme introduced by the Federal Government of Nigeria in 2009 through the National Primary Health Care Development Agency to deploy trained midwives to rural primary healthcare centres for the purpose of improving maternal and child healthcare services (NPHCDA, 2010).
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