Abstract

In 2015, the International Confederation of Midwives (ICM) launched the Midwifery Services Framework (MSF): an evidence-based tool to guide countries through the process of improving their sexual, reproductive, maternal and newborn health services through strengthening and developing the midwifery workforce. The MSF is aligned with key global architecture for sexual, reproductive, maternal and newborn health and human resources for health. This third in a series of three papers describes the experience of starting to implement the MSF in the first six countries that requested ICM support to adopt the tool, and the lessons learned during these early stages of implementation. The early adopting countries selected a variety of priority work areas, but nearly all highlighted the importance of improving the attractiveness of midwifery as a career so as to improve attraction and retention, and several saw the need for improvements to midwifery regulation, pre-service education, availability and/or accessibility of midwives. Key lessons from the early stages of implementation include the need to ensure a broad range of stakeholder involvement from the outset and the need for an in-country lead organisation to maintain the momentum of implementation even when there are changes in political leadership, security concerns or other barriers to progress.

Highlights

  • In 2015, the International Confederation of Midwives (ICM) launched the Midwifery Services Framework (MSF): a tool to assist countries to operationalise the process of strengthening the midwifery profession (ICM, 2015a)

  • It is anticipated that successful implementation of the MSF will lead to a number of outcomes at multiple levels of the health system, such as a broader sense of ownership of and responsibility for the delivery and quality of SRMNH services, and services being shaped around the needs of women and their families

  • This paper focuses on six Abbreviations: ICM, International Confederation of Midwives; M&E, monitoring and evaluation; MoH, ministry of health; MSF, Midwifery Services Framework; SRMNH, sexual, reproductive, maternal and newborn health; ToR, terms of reference; TWG, technical working group

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Summary

Introduction

In 2015, the International Confederation of Midwives (ICM) launched the Midwifery Services Framework (MSF): a tool to assist countries to operationalise the process of strengthening the midwifery profession (ICM, 2015a). The content of the MSF is based on compelling evidence that investment in midwifery is a cost-effective way to improve sexual, reproductive, maternal and newborn health (SRMNH) outcomes (The Lancet, 2014; UNFPA et al, 2014). Of the eight early adopting countries: Uganda and Zimbabwe are not included because they are at a very early stage of implementation, having so far only held some introductory meetings This is the third in a series of three papers about the MSF; it aims to document the early outcomes of the process and describe the lessons learned so far in the six remaining countries. The information was analysed using an inductive process, and all contributors were invited to comment on an early draft of this manuscript to check that they were in agreement with the content

Country contexts
SRMNH outcomes and health system indicators
Strength of the midwifery profession
No c
Stage of MSF implementation reached in each country
Lead organisation
Lessons learned and challenges encountered
Recommendations for the future
Findings
Conclusion
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