Investing in Midwives
In April 2008, ICM and the United Nations Population Fund (UNFPA) launched a joint programme, “Investing in Midwives and others with Midwifery Skills,” to accelerate progress towards achieving MDG 4 and 5. The programme ended in December 2013. It took place in about 30 countries, mainly in sub-Saharan Africa and a few in Asia and Latin America. ICM had a significant role in the programme and midwife advisers who provided technical assistance to the CMAs including an international midwife adviser and three regional midwife advisers representing Africa and Asia.
The Programme's overall goal was to improve skilled attendance at birth in low resource settings by developing a sustainable midwifery workforce. Work was focussed on creating a “critical mass” of Country Midwifery Advisors (CMAs) who were identifying gaps in midwifery education, regulation and professional associations. The CMAs were working with Governments at national and regional levels to develop policies and programmes to address these gaps in order to elevate the availability and quality of care provided by midwives.
Some of the key activities for 2013 included capacity building of Associations; review of draft technical and policy documents from countries such as consultant’s terms of references and strategic plans; technical assistance to countries including development of harmonised curricula for Diploma and Bachelor’s programmes, and contribution towards the development of scope of work for CMAs and their job descriptions for recruitment; as well as provision of support for regulatory strengthening.
The publication of the ICM Standard List for Competency-based Skills Training after a final review was a significant achievment in education.
HIghlights from the team's work
Support for regulatory strengthening included the hosting of the 2012 CMA capacity building workshop in Ethiopia focusing on processes for establishing regulatory councils, development of regulatory guidelines for reference, as well as development of strategy plans for 2013. Skills development at the meeting was covered through a demonstration of Skills improvement in "Helping Babies Breathe.” In terms of strengthening Midwives Associations, support included participation and conference presentation at Asia-Pacific Regional Conference, dissemination of the MACAT in many countries as well as conference representation of ICM to present papers and advocate for better MNCH services, and Technical Assistance in the planning and celebration of the International Day of the Midwife in various countries.
The “Investing in Midwives Programme” (IMP) team met in The Hague in November 2012, (Photograph) to address the need for harmonised regional curricula for midwifery training at Diploma, Bachelor’s and Master’s levels, given the many different curricula currently available. This set the stage for harmonisation as curricula are adapted or adopted to suit local needs, thereby ensuring strong midwifery education and provision of quality midwifery services.
Photograph: Gap Analysis work in LIberia 2012
Photograph: MACAT-meeting with MAs in Juba, SouthSudan
Photograph: Mothers at a post-delivery clinic
Until recently, Bangladesh had only community midwives. A cadre of certified midwives did not exist. UNFPA and ICM supported Bangladesh to establish its first three midwifery training institutions, and the first-ever midwifery class graduated in 2011. Bangladesh also has begun implementing a three-year, direct-entry midwifery programme, a two-year community midwifery education programme and post-basic midwifery training for nurses. Bangladesh has committed to double the percentage of births attended by a skilled health professional by 2015 and seeks to train an additional 3,000 midwives in total.
Midwifery Association Strengthening:
ICM and UNFPA are working together to assess and address the capacities of midwifery assocations and to advocate for their creation where none exist. A new midwife association has been launched in Bangladesh and a country midwifery adviser posted. In Guyana, the first midwives association was launched in May 2009. In Ethiopia the Programme has supported the establishment of the Tigray and Amhara Regional Midwifery Associations. With these, Ethiopia now has one national and three regional midwifery associations. And in Djibouti, an extremely resource poor country, efforts are underway to form the country’s first midwifery association.
Regulation of Midwifery:
Support is being provided for capacity building, institutional development and strategic planning. The Ministry of Health in Djibouti has adopted a law that equates a midwifery certificate with equivalent of first level university degree. Cambodia now has a Midwifery Council and is drafting new guidelines for midwifery education, services and regulations. In Ghana, after a review of the falling standards of service provision by midwives and nurses, a code of ethics for midwives has been developed with support from Ghana’s Nursing and Midwifery Council.