The University of Southampton
University of Southampton Institutional Repository

Diverse pre-service midwifery education pathways in Cambodia and Malawi: a qualitative study utilising a midwifery education pathway conceptual framework

Diverse pre-service midwifery education pathways in Cambodia and Malawi: a qualitative study utilising a midwifery education pathway conceptual framework
Diverse pre-service midwifery education pathways in Cambodia and Malawi: a qualitative study utilising a midwifery education pathway conceptual framework
Objectives: Educated and skilled midwives are required to improve maternal and newborn health and reduce stillbirths. There are three main approaches to the pre-service education of midwives: direct entry, post-nursing and integrated programmes combining nursing and midwifery. Within these, there can be multiple programmes of differing lengths and qualifications, with many countries offering numerous pathways. This study explores the history, rationale, benefits and disadvantages of multiple pre-service midwifery education in Malawi and Cambodia. The objectives are to investigate the differences in education, roles and deployment as well as how key informants perceive that the various pathways influence workforce, health care, and wider health systems outcomes in each country.

Design: Qualitative data were collected during semi-structured interviews and analysed using a pre-developed conceptual framework for understanding the development and outcomes of midwifery education programmes. The framework was created before data collection.

Setting: The setting is one Asian and one African country: Cambodia and Malawi.

Participants: Twenty-one key informants with knowledge of maternal health care at the national level from different Government and non-governmental backgrounds.

Results: Approaches to midwifery education have historical origins. Different pathways have developed iteratively and are influenced by a need to fill vacancies, raise standards and professionalise midwifery. Cambodia has mostly focused on direct-entry midwifery while Malawi has a strong emphasis on dual-qualified nurse-midwives. Informants reported that associate midwifery cadres were often trained in a more limited set of competencies, but in reality were often required to carry out similar roles to professional midwives, often without supervision. While some respondents welcomed the flexibility offered by multiple cadres, a lack of coordination and harmonisation was reported in both countries.

Key conclusions: The development of midwifery education in Cambodia and Malawi is complex and somewhat fragmented. While some midwifery cadres have been trained to fulfil a more limited role with fewer competencies, in practice they often have to perform a more comprehensive range of competencies.

Implications for practice: Education of midwives in the full range of globally established competencies, and leadership and coordination between Ministries of Health, midwife educators and professional bodies are all needed to ensure midwives can have the greatest impact on maternal and newborn health and wellbeing.
Cambodia, Human resources for health, Malawi, Maternal and newborn health, Midwife education
0266-6138
Neal, Sarah
2b63ebf7-1cf9-423d-80a2-bd99a759f784
Bokosi, Martha
c48f31da-85ca-437b-abab-e978da635cd1
Lazaro, Dorothy
24220dac-761a-42e3-87ba-86cb0a23de28
Vong, Sreytouch
0a91886a-bbd5-42db-88cc-9bd8f1c745ca
Nove, Andrea
4910da76-1414-495e-928b-9f5014003c33
Bar-Zeev, Sarah
f1ac5ba0-6a96-4ca7-83cc-f798caf1d476
Pairman, Sally
12ec6260-e9df-4573-8d07-94a750e69ab4
Ryan, Erin
89ad5519-4c81-40ef-bf40-e859ab5fab24
ten Hoppe-Bender, Petra
37bf0cc9-d228-4d22-b4b6-790149979804
Homer, Caroline S.E.
8662fc89-2cc6-4c00-b4ed-469ded2131d6
Neal, Sarah
2b63ebf7-1cf9-423d-80a2-bd99a759f784
Bokosi, Martha
c48f31da-85ca-437b-abab-e978da635cd1
Lazaro, Dorothy
24220dac-761a-42e3-87ba-86cb0a23de28
Vong, Sreytouch
0a91886a-bbd5-42db-88cc-9bd8f1c745ca
Nove, Andrea
4910da76-1414-495e-928b-9f5014003c33
Bar-Zeev, Sarah
f1ac5ba0-6a96-4ca7-83cc-f798caf1d476
Pairman, Sally
12ec6260-e9df-4573-8d07-94a750e69ab4
Ryan, Erin
89ad5519-4c81-40ef-bf40-e859ab5fab24
ten Hoppe-Bender, Petra
37bf0cc9-d228-4d22-b4b6-790149979804
Homer, Caroline S.E.
8662fc89-2cc6-4c00-b4ed-469ded2131d6

Neal, Sarah, Bokosi, Martha, Lazaro, Dorothy, Vong, Sreytouch, Nove, Andrea, Bar-Zeev, Sarah, Pairman, Sally, Ryan, Erin, ten Hoppe-Bender, Petra and Homer, Caroline S.E. (2023) Diverse pre-service midwifery education pathways in Cambodia and Malawi: a qualitative study utilising a midwifery education pathway conceptual framework. Midwifery, 116, [103547]. (doi:10.1016/j.midw.2022.103547).

Record type: Article

Abstract

Objectives: Educated and skilled midwives are required to improve maternal and newborn health and reduce stillbirths. There are three main approaches to the pre-service education of midwives: direct entry, post-nursing and integrated programmes combining nursing and midwifery. Within these, there can be multiple programmes of differing lengths and qualifications, with many countries offering numerous pathways. This study explores the history, rationale, benefits and disadvantages of multiple pre-service midwifery education in Malawi and Cambodia. The objectives are to investigate the differences in education, roles and deployment as well as how key informants perceive that the various pathways influence workforce, health care, and wider health systems outcomes in each country.

Design: Qualitative data were collected during semi-structured interviews and analysed using a pre-developed conceptual framework for understanding the development and outcomes of midwifery education programmes. The framework was created before data collection.

Setting: The setting is one Asian and one African country: Cambodia and Malawi.

Participants: Twenty-one key informants with knowledge of maternal health care at the national level from different Government and non-governmental backgrounds.

Results: Approaches to midwifery education have historical origins. Different pathways have developed iteratively and are influenced by a need to fill vacancies, raise standards and professionalise midwifery. Cambodia has mostly focused on direct-entry midwifery while Malawi has a strong emphasis on dual-qualified nurse-midwives. Informants reported that associate midwifery cadres were often trained in a more limited set of competencies, but in reality were often required to carry out similar roles to professional midwives, often without supervision. While some respondents welcomed the flexibility offered by multiple cadres, a lack of coordination and harmonisation was reported in both countries.

Key conclusions: The development of midwifery education in Cambodia and Malawi is complex and somewhat fragmented. While some midwifery cadres have been trained to fulfil a more limited role with fewer competencies, in practice they often have to perform a more comprehensive range of competencies.

Implications for practice: Education of midwives in the full range of globally established competencies, and leadership and coordination between Ministries of Health, midwife educators and professional bodies are all needed to ensure midwives can have the greatest impact on maternal and newborn health and wellbeing.

Text
1-s2.0-S0266613822002959-main - Version of Record
Available under License Creative Commons Attribution.
Download (964kB)

More information

Accepted/In Press date: 7 November 2022
e-pub ahead of print date: 9 November 2022
Published date: 1 January 2023
Additional Information: Funding Information: This work was funded by a grant from the New Venture Fund (reference NVF-NGDF-NOV10_Subgrant-014,350–2021–05–01). Publisher Copyright: © 2022
Keywords: Cambodia, Human resources for health, Malawi, Maternal and newborn health, Midwife education

Identifiers

Local EPrints ID: 473351
URI: http://eprints.soton.ac.uk/id/eprint/473351
ISSN: 0266-6138
PURE UUID: 7f22b7b7-69d8-4f36-9e6d-1fcdc173c057
ORCID for Sarah Neal: ORCID iD orcid.org/0000-0003-1812-7221

Catalogue record

Date deposited: 16 Jan 2023 17:48
Last modified: 17 Mar 2024 03:19

Export record

Altmetrics

Contributors

Author: Sarah Neal ORCID iD
Author: Martha Bokosi
Author: Dorothy Lazaro
Author: Sreytouch Vong
Author: Andrea Nove
Author: Sarah Bar-Zeev
Author: Sally Pairman
Author: Erin Ryan
Author: Petra ten Hoppe-Bender
Author: Caroline S.E. Homer

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×