Restoring trust through community midwifery care
Brenda is a third-year midwifery student at Lira University who recently learned how to provide home-based, or domiciliary, midwifery care to clients, a service that’s not only expanding access but also restoring trust in the public health system across communities in Uganda.
This community-centered approach is part of a broader effort by Seed Global Health to improve maternal and newborn health in Uganda by ensuring midwifery education translates into real-world impact. At the heart of this effort is Seed’s educator model. Educators are experienced midwives, nurses, and doctors – many from across Africa – who are embedded in partner institutions like Lira University, where they help integrate classroom learning with clinical practice. By teaching, mentoring, and modelling evidence-based, respectful care alongside local faculty, Seed educators prepare students to deliver high-quality care in both health facilities and the communities they serve.
Every year, Seed supports Bachelor of Midwifery students like Brenda to take part in domiciliary care, a training requirement of the Uganda Nurses and Midwives Council. Provided in clients’ homes and communities, this care includes prenatal visits, labor support, postnatal follow-up, and newborn assessments.
To ensure students can reach clients in even the most remote areas, Seed provides logistical support, including transportation, and clinical mentorship from educators like Dr. Winifred Ukoha. “This level of care is not typically offered in public hospitals,” Dr. Ukoha says. “But through this model, students are learning how to deliver truly individualized, respectful, and evidence-based care in the communities they will one day serve.”
Brenda participated in a community outreach in Adyel, a small community in Lira district, where she met Susan, who was pregnant with her second child. Initially hesitant, Susan agreed to receive home-based care after Brenda explained it was both free and her right as a pregnant woman. Like many women in low- and middle-income households, Susan had longed for personalized maternity care but lacked access – until now.
Brenda supported Susan throughout her pregnancy, assisted her during delivery, and even accompanied her home afterward. These visits are vital. Students assess environmental risks to newborns, educate families, and reinforce healthy behaviours. For example, a classmate of Brenda’s once intervened when a client’s family planned to plaster their home’s interior with cow dung, a traditional practice that could expose newborns to serious infections. In another case, students observed women cooking indoors with poor ventilation and educated families about the risks of carbon monoxide poisoning.
Susan’s positive experience quickly spread through the neighborhood. Her neighbor Sharon, pregnant with her third child, had been seeking care at a private clinic due to past mistreatment at the public hospital. When she heard about Susan’s care, she cautiously returned to the public system, on the condition she’d receive the same level of compassionate support. Brenda and her peers promised to be there for her. Sharon delivered safely and received emergency treatment for postpartum hemorrhage, a potentially fatal condition had she delivered elsewhere.
“Skilled, respectful care not only improves outcomes, it builds trust,” Brenda says. “We’re proud to see our work making a difference in people’s lives and perceptions.”
Seed’s investment in midwifery education and practice is grounded in the belief that midwives save lives and are central to achieving universal health coverage. By embedding experienced educators in institutions like Lira University, Seed helps ensure that students are not only competent clinicians but also champions of respectful, person-centered care.
According to the Midwifery Accelerator Report, universal coverage of midwife-delivered care could avert two-thirds of maternal and newborn deaths, including stillbirths. That vision is what Seed and our partners are working toward – one midwife, one mother, and one community at a time.
