Career mobility of maternal care providers in Mali: a mixed method study on midwives and obstetric nurses

Cheick Sidya Sidibé, Ousmane Touré, Laurence Codjia, Assa Sidibé Keïta, Jacqueline E W Broerse, Marjolein Dieleman

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: An important strategy to reduce maternal and child mortality in Mali is to increase the number of deliveries assisted by qualified personnel in primary care facilities, especially in rural areas. However, placements and retention of healthcare professionals in rural areas are a major problem, not only in Mali but worldwide, and are a challenge to the health sector. The purpose of this study was to map the mobility of midwives and obstetric nurses during their work lives, in order to better understand their career paths and the role that working in rural areas plays. This article contributes to the understanding of career mobility as a determinant of the retention of rural health professionals.

METHODS: A mixed method study was conducted on 2005, 2010, and 2015 cohorts of midwives and obstetric nurses. The cohorts have been defined by their year of graduation. Quantitative data were collected from 268 midwives and obstetric nurses through questionnaires. Qualitative data had been gathered through semi-structured interviews from 25 midwives and stakeholders. A content analysis was conducted for the qualitative data.

RESULTS: Unemployment rate was high among the respondents: 39.4% for midwives and 59.4% for obstetric nurses. Most of these unemployed nurses and midwives are working, but unpaid. About 80% of the employed midwives were working in urban facilities compared to 64.52% for obstetric nurses. Midwives were employed in community health centers (CSCom) (43%), referral health centers (CSRef) (20%), and private clinics and non-governmental organizations (NGO) (15%). The majority of midwives and obstetric nurses were working in the public sector (75.35%) and as civil servants (65.5%). The employment status of midwives and obstetric nurses evolved from private to public sector, from rural to urban areas, and from volunteer/unpaid to civil servants through recruitment competitions. Qualitative data supported the finding that midwives and obstetric nurses prefer to work as civil servant and preferably in urban areas and CSRef.

CONCLUSION: The current mobility pattern of midwives and obstetric nurses that brings them from rural to urban areas and towards a civil servant status in CSRef shows that it is not likely to increase their numbers in the short term in places where qualified midwives are most needed.

Original languageEnglish
Article number94
Pages (from-to)94
JournalHuman Resources for Health
Issue number1
Publication statusPublished - 5 Dec 2019


Ethical approval for this study was sought and obtained from the Ethics Committee of the National Institute of Research in Public Health (N°23/2017/ CE-INRSP). Participation was voluntary. Consent to participate was obtained from each respondent at the time of enrollment prior to any data collection. Authors received financial support from Nuffic for the data collection for the study.

FundersFunder number
National Health Research Institutes23/2017/ CE-INRSP


    Dive into the research topics of 'Career mobility of maternal care providers in Mali: a mixed method study on midwives and obstetric nurses'. Together they form a unique fingerprint.

    Cite this