Nurse Midwife Strengthens the Health System and Saves Mothers’ Lives
A 47% reduction in maternal mortality at Seed Global Health supported Mbale Regional Referral Hospital is a powerful sign that when skilled health workers are trained, supported, and connected across the system, more lives are saved. The hospital saw its institutional maternal mortality ratio drop from 1,117 deaths in 2024 to 594 in 2025 per 100,000 live births.
This progress reflects a deliberate effort across the Elgon region of Eastern Uganda, led by the Ministry of Health with support from Seed and partners, to strengthen both care at lower-level facilities and the referral chain that connects them to the regional referral hospital. But at the center of this transformation are nurse midwives like Sister Annette Nabushuwu.
As an assistant nursing officer and midwife in-charge for maternal and newborn health at Busiu Health Centre IV, located about 25 km from Mbale Regional Referral Hospital, Sister Annette leads care at the closest and first point of care for many women in Busiu and surrounding areas.
By strengthening the quality of care at the primary level and ensuring that women are treated appropriately or referred early when complications arise, Annette is a key driver of a stronger referral chain. Her work helps ensure that women arrive at the regional referral hospital in time, and in better condition, when advanced care is needed. It is this system-wide coordination, starting at facilities like Busiu, that is contributing to the significant reduction in maternal deaths at Mbale.
Sister Annette is not just a nurse midwife; she is also a “trainer of trainers,” selected for this role because of her strong clinical skills and leadership. As a trainer of trainers, she has received advanced training and has a set of skills which, combined with her wealth of experience, enables her to train other trainers who then pass on their learning to others.
“Besides my midwifery work, I have a passion for teaching,” she said. “Through working with organizations like Seed Global Health, I can reach and teach more midwives and health workers across Uganda. I feel I am a good teacher, and it is good to share knowledge with others.”
The importance of continuous learning
Each week at Busiu Health Centre IV, Sister Annette leads her colleagues through hands-on learning, reviewing real cases, and strengthening how they respond in emergencies. “It improves our knowledge, and you feel proud when you know what you are doing,” Sister Annette says. That preparation matters in a facility where up to ten babies are born each day and as many as 50 women come for antenatal care.
This continuous learning strengthens clinical decision-making, helping teams manage complications early and make faster, more appropriate referrals when needed, where delays can turn fatal.
Sister Annette’s leadership in maternal and newborn health was recognized by district health leaders and the Elgon Learning Network for Maternal and Newborn Health. She was selected and trained as a trainer of trainers, an acknowledgment of both her clinical excellence and her ability to mentor others during routine care. With further support from the Uganda Ministry of Health, she advanced into a master trainer role, contributing to national efforts to strengthen maternal and newborn care.
Today, through her work with Seed Global Health, Sister Annette extends that impact far beyond Busiu. She leads simulation-based trainings and continuous medical education sessions across the Elgon region, reaching more than 20 lower-level facilities. By strengthening skills, reinforcing teamwork, and improving how health workers respond to complications, she is helping ensure that more women receive quality care close to home – and are referred in time when higher-level care is needed.
While Mbale Regional Referral Hospital remains the main referral hub for complex cases, referrals are now more timely, coordinated, and appropriate. Communication between facilities is faster and more responsive, supported by ongoing collaboration. This stronger system, anchored in skilled care at the primary level, is helping drive the reduction in maternal deaths at the referral hospital.
Journey to midwifery
Sister Annette’s journey into midwifery was shaped by a deeply personal experience in her childhood. Her younger sister had been born at home without a skilled health worker present. During the delivery, the baby fell and hit her head and, because of that trauma, developed epilepsy.
“I was young but felt helpless,” she recalled. “I wished I knew what to do so I could help my mother.” Her resolve was made then. She told herself that one day she would help deliver babies and encourage women to seek care in health facilities. Luckily for the family, her sister’s condition was eventually managed. Today, she is healthy, happy, and has a family of her own, with three children.
With now over ten years in midwifery practice, Sister Annette believes in the instrumental role midwives play in sustaining the future, not just at the moment of delivery, but across the continuum of care.
Midwives extend services such as immunizations right to the community, bringing care closer to where mothers live. “We teach mothers, provide preventive care, and screen them for diseases,” she said. “When we identify a high-risk case, the mother is referred to a medical officer, but a midwife has already begun her care. If a midwife has done well, lives are saved.”
By addressing delays in seeking and reaching care, nurse midwives like Annette help ensure more women arrive in time, strengthening the link between communities, primary care, and referral hospitals like Mbale.
The ripple effect across the system
The ripple effect of a highly skilled midwife like Annette is far-reaching not only through frontline care she provides, but through the more than 20 facilities she has supported through training and mentorship. Each midwife she trains is better equipped to manage timely referrals and provide care. When midwives are trained, supported, and connected across the system, care improves at every level, delays are minimized, and more mothers survive. At the core of all our partnerships, is a deep-rooted belief that
The world needs more midwives like Sister Annette.
The International Confederation of Midwives (ICM) has launched a global petition for one million more midwives. It calls on governments and global health leaders to grow, support, and sustain the global midwifery workforce, so mothers can access safe, respectful, high-quality care.
Because investing in midwives is investing in women’s health.
