Gap Analysis to Strengthen Midwifery
The objective of the Gap Analysis workshop in Tanzania from 8-12 September is to develop action plans for the next years to strengthen midwifery services and contribute to developing a strong midwifery workforce that is well educated, regulated, and well represented by a strong association in each country. The workshop was initially scheduled to take place in Yemen and funded by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, on behalf of the Federal Ministry for Economic Cooperation and Development (BMZ), however due to security issues, the location had to be changed and the Tanzanian Midwives Association (TAMA) agreed to host the workshop. Participants attending the workshop came from Rwanda, Swaziland, Tanzania and Yemen.
The workshop was officially opened with speeches from Guests of Honor such as the president of the Tanzania Midwives Association, Ministry of Health, representative of GIZ and representative of the Yemeni Embassy in Tanzania. The Ambassador of Yemen said admitted in his speech that he did not know much about midwifery but was keen to learn more and ended saying “let’s catch lots of happy babies”.
Then the countries presented the status of midwifery in their country. In Rwanda midwifery training school at diploma level started in 1997. There are 850 midwives in the country and 300 are members of the association. In Tanzania midwives have a negative image as resources are lacking and the number of midwives is insufficient. However, TAMA benefitted from the previous Twinning project with the Canadian Midwives Association and has professionalised its services. The Yemen Midwives Association was established in 2004 and has a diverse educational programme and workforce in midwifery.
The day started with the explanation of the GAP Analysis Tool, the results of the Member Capacity Association Tool (MACAT) that were completed before the workshop, were reviewed. In the presentations and based on the input from day 1 many of the associations had to admit that their MACAT results as "homework" were different than during the workshop. The participants from Swaziland said: "we thought we had a mission and a vision, but we realised we are only operationalizing and do not really have a vision and mission". Out of this a fruitful and long debate ensued around the inclusion of midwives in a nurse association and the benefits of having their own midwives association. Tanzania shared their experience, where originally the midwives were members of the nurses' association but were able to establish their own midwives association. In the discussion with the government, they used the fact that there is an ICN and an ICM, the basic competencies and education is so different that they are recognised at international level to be two different professions.
In the second session, groups were divided in association, regulation and education groups. The groups then came up with different suggestions:
Suggestions to Strengthen the Associations:
- Develop income generating activities,
- Have a clear vision and mission oriented to all members – sustainable membership income fee, communication effectively with members and they miss all the most
- “SMART strategic plans”, more involvement of the media.
- Establish a centre of excellence to improve midwifery skills.
Suggestion to Improve Education:
- Educate the midwifery students about the role of the association.
- Lecturers should be role models by becoming members of the association.
- Work with the association to set the admission criteria to the profession in an attempt to produce a quality graduate.
Suggestion to Improve Regulation:
- Register the midwives and accredit the midwifery institute
The hosting Tanzanian Midwives Association had issued a press release and the workshop is featured on All Africa. You can read the article here
On day 3 the participants presented the results of their SWOT (Strength, Weaknesses, Opportunities, Threats) Analysis. Rwanda identified weaknesses in regards to midwives not being aware of the association and the association not having a communication strategy nor a website. A threat is also the lack of resources and the non-existent recognition by the government. However, the interest of the media was identified as a huge opportunity that would help change the weaknesses into strengths. Swaziland identified the need to be more involved in the system in order to be recognized and heard by the government. The second part of the day was used for strategic planning.
On day four the participants discussed the results of the Gap Analysis. The Yemeni midwives recounted their efforts to establish an 18 months education programme according to the ICM Global Standards for Education, but the Ministry of Education only allowed a 12 month programme. The participants from Rwanda discovered during the workshop that their education adheres to international standards but the demands for their national workforce were not taken into account.
The results of the Regulation Assessment Tool were also discussed and the importance of regulation explained. While Swaziland emphasized the importance of having a regulatory body, the Yemeni explained that they do not have a regulatory authority but there are still midwives in Yemen while the countries around them do not have midwives, only nurses.
The participants examined the three pillars Eduacation, Regulation, Association, which are the foundation of a strong midwifery profession. Education should facilitate the registration of midwifery in the regulatory body and ensure that midwifery standards are adhered to clinical practise. Regulation should have a provision for midwifery representation. Association: has to advocate for good midwifery education environment. Advocate for rights of clients and midwives.