When Saidath Gato was about to finish secondary, she selected medicine and midwifery as the faculty she would join at the University of Rwanda. She was inspired by the desire to save lives after attending the funeral of a neighbor who died while giving birth, leaving behind four children and the newborn. ALSO READ: Rwanda’s midwifery workforce grows to 2,400 amid high targets Gato later heard several claims that the death might have been caused by negligence and lack of quality antenatal care. From there, she decided she wanted to be part of those who save lives at birth. A 40-year-old midwife now with 15 years of experience, Gato currently works for Partners In Health Rwanda, an organisation that supports the delivery of quality healthcare through multiple hospitals. She works with Kirehe, Rwinkwavu and Butaro hospitals as programme lead for maternal child health. Her day usually starts with physical exercise and reading for about an hour. After that, she checks morning reports from three hospitals to stay updated on any incidents or issues that need her attention. Gato reads emails and responds, then does clinical rounds with other midwives and nurses in the hospital, where she also does mentorship and coaching. She handles other work matters that need attention and usually ends her day with family time from around 7 p.m. Gato's most challenging experience The health professional recalls a period when she was working at Muhima Hospital, which was the most intense time she has ever experienced, and even now she wonders how she managed it. At the time, there were often 40 to 60 newborns in the neonatal unit, with only two or three midwives on duty during day or night shifts to care for them. “In the maternity ward, we used to have a team of four midwives who were supposed to care for almost 20 to 30 women in the labour room, conduct 10 to 15 deliveries per shift, manage emergencies, and also handle logistics to make sure bills were paid and supplies were replenished,” she said. Gato added that teamwork among passionate midwives helped them manage the pressure. She said she's motivated by the call to save lives. She explained that knowing her work contributes to someone’s life, family, and the country gives her a strong sense of purpose. It is enough for her to feel she has a responsibility to advocate for and provide quality care for mothers, unborn babies, and their families. The need for more midwives Rwanda has more than five million people of reproductive age, while health facilities register about 300,000 births each year, creating a heavy workload for a limited number of trained midwives. There are about 2,400 midwives, according to the nurses and midwives union. According to the Ministry of Health, in many health facilities, a single midwife may be responsible for up to 20 women in labour at the same time. They move from one patient to another, responding where the need is most urgent, but it becomes impossible to give each woman the attention she needs. Gato noted that as the Rwandan health system continues to evolve, midwives still face challenges, including heavy workloads due to few staff, salaries that do not match the living standards, and a lack of clear career progression. She raised concerns about the recognition of midwifery degrees when upgrading studies, saying they are not always recognised by the Ministry of Health in the same way as medical doctors or other health professionals. “Hearing these complaints from my team and knowing that these issues have already been raised to the ministerial level is not healthy,” she said. The midwife hopes the 4x4 reform, the government's initiative to increase health workers by four times, will help address some of these challenges, including high staff turnover, which affects the quality of care, especially in underserved areas. From 2027, Rwanda is expected to graduate more than 1,000 midwives every year, a shift that is expected to gradually ease shortages in hospitals and health centres, according to the Ministry of Health.
