Quality of pre-service midwifery education in public and private midwifery schools in Afghanistan: a cross sectional survey

Abstract

Background Midwives are the key skilled birth attendants in Afghanistan. Rapid assessment of public and private midwifery education schools was conducted in 2017 to examine compliance with national educational standards. The aim was to assess midwifery education to inform Afghanistan Nurses and Midwives Council and other stakeholders on priorities for improving quality of midwifery education. Methods A cross-sectional assessment of midwifery schools was conducted from September 12–December 17, 2017. The Midwifery Education Rapid Assessment Tool was used to assess 29 midwifery programs related to infrastructure, management, teachers, preceptors, clinical practice sites, curriculum and students. A purposive sample of six Institute of Health Sciences schools, seven Community Midwifery Education schools and 16 private midwifery schools was used. Participants were midwifery school staff, students and clinical preceptors. Results Libraries were available in 28/29 (97%) schools, active skills labs in 20/29 (69%), childbirth simulators in 17/29 (59%) and newborn resuscitation models in 28/29 (97%). School managers were midwives in 21/29 (72%) schools. Median numbers of students per teacher and students per preceptor were 8 (range 2–50) and 6 (range 2–20). There were insufficient numbers of teachers practicing midwifery (132/163; 81%), trained in teaching skills (113/163; 69%) and trained in emergency obstetric and newborn care (88/163; 54%). There was an average of 13 students at clinical sites in each shift. Students managed an average of 15 births independently during their training, while 40 births are required. Twenty-four percent (7/29) of schools used the national 2015 curriculum alone or combined with an older one. Ninety-one percent (633/697) of students reported access to clinical sites and skills labs. Students mentioned, however, insufficient clinical practice due to low case-loads in clinical sites, lack of education materials, transport facilities and disrespect from school teachers, preceptors and clinical site providers as challenges. Conclusions Positive findings included availability of required infrastructure, amenities, approved curricula in 7 of the 29 midwifery schools, appropriate clinical sites and students’ commitment to work as midwives upon graduation. Gaps identified were use of different often outdated curricula, inadequate clinical practice, underqualified teachers and preceptors and failure to graduate all students with sufficient skills such as independently having supported 40 births.

Rapid assessment of pre-service midwifery education in conflict settings: Findings from a cross-sectional study in Nigeria and Somalia

“…Differences in ndings across assessment sites in Nigeria and Somalia are not surprising considering the differences in the maturity of midwifery education and workforce development initiatives and regulation in the two countries. Initial eld testing of the Rapid Assessment Tool in Myanmar in 2015, and subsequent use in Afghanistan in 2017, also revealed notable variation in the quali cations of teachers and preceptors, availability of recommended resources, and lack of adequate clinical practice opportunities (21,22). Gaps identi ed in both countries were also consistent with those highlighted in a recent scoping review examining evidence related to pre-service midwifery education in sub-Saharan Africa, suggesting that challenges are not unique to contexts affected by con ict and humanitarian crises (23).…”

Understanding care seeking behavior for reproductive tract infections among Afghan women: A cross-sectional study

“…Health system barriers were cited as reasons for delayed care-seeking by one third of the respondents, also an expected result. Afghanistan, as a developing country with an ongoing humanitarian crisis, has a limited number of healthcare facilities: there are only 0.3 physicians and 0.4 nurses and midwives per 1,000 people, lower than the threshold determined by the WHO (4.45 doctors, nurses and midwives per 1,000 people) [32,33]. Since the 2021 government takeover, many healthcare professionals have left the country, and the healthcare system is paralyzed in many areas, particularly in the villages [34], where about 20% of our respondents lived in.…”

An evaluation of the effectiveness of an updated pre-service midwifery curriculum integrated with emergency obstetrics and newborn care in Kenya: a cluster randomised controlled trial

“…For quality and competent midwives, investments are urgently needed to improve the quality of midwifery education, and in particularly the knowledge and skills required for management of obstetric and newborn emergencies (12)(13)(14)(15)(18)(19)(20). The ICM recommend that at least 50 percent of midwifery education should be practice-based and provide experience in clinical and community settings (16).…”

“…The purpose of this study was to assess whether educator speci c skills training and additional mentoring support improves the midwifery educators' quality of teaching of an EmONC-enhanced curriculum and students' knowledge and skills. The study is important as it (i) addresses a major gap in pre-service curriculum content against ICM standards for midwives (12,14,15,19,67) (ii) addresses a major gap in faculty development for effective quality teaching and practice (15, 18, 31, 32, 68) (iii) integration of EmONC within the pre-service midwifery curriculum to equip nursing and midwifery graduates with essential EmONC competencies as skilled health personnel as recommended by ICM and WHO at graduation (15, 19, 21, 69) (iv) potentially reduces the need for longer duration and resource-intensive in-service EmONC trainings after graduation required for optimal skilled care at birth (18, 35, 70) and (v) provide a strong foundation for targeted regular, short and structured mentoring to strengthen midwifery educators' capacity to deliver a competency-based midwifery education curriculum (71).…”