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Bukenya J, Kebede D, Mwambi H, Pate M, Adongo P, Berhane Y, Canavan CR, Chirwa T, Fawole OI, Guwatudde D, Jackson E, Madzorera I, Moshabela M, Oduola AMJ, Sunguya B, Sall A, Raji T, Fawzi W. The future of public health doctoral education in Africa: transforming higher education institutions to enhance research and practice. Lancet Public Health 2024:S2468-2667(24)00056-2. [PMID: 38735302 DOI: 10.1016/s2468-2667(24)00056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 05/14/2024]
Abstract
The African Union and the Africa Centers for Disease Control and Prevention issued a Call to Action in 2022 for Africa's New Public Health Order that underscored the need for increased capacity in the public health workforce. Additional domestic and global investments in public health workforce development are central to achieving the aspirations of Agenda 2063 of the African Union, which aims to build and accelerate the implementation of continental frameworks for equitable, people-centred growth and development. Recognising the crucial role of higher education and research, we assessed the capabilities of public health doctoral training in schools and programmes of public health in Africa across three conceptual components: instructional, institutional, and external. Six inter-related and actionable recommendations were derived to advance doctoral training, research, and practice capacity within and between universities. These can be achieved through equitable partnerships between universities, research centres, and national, regional, and global public health institutions.
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Affiliation(s)
- Justine Bukenya
- School of Public Health, Makerere University, Kampala, Uganda.
| | - Derege Kebede
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Henry Mwambi
- School of Mathematics, Statistics, and Computer Science, Durban, South Africa
| | - Muhammed Pate
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Philip Adongo
- School of Public Health, University of Ghana, Accra, Ghana; Association of Schools of Public Health in Africa, Accra, Ghana
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Chelsey R Canavan
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olufunmilayo I Fawole
- Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - David Guwatudde
- School of Public Health, Makerere University, Kampala, Uganda
| | - Elizabeth Jackson
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Isabel Madzorera
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mosa Moshabela
- Vice Chancellor's Office, University of KwaZulu-Natal, Durban, South Africa
| | - Ayoade M J Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Tajudeen Raji
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Wafaie Fawzi
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
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Rosenberg J, Juvonen M, Ng MZ, Arinzeh N, Adanu TSA, Ninsiima H, Temesgen R, Ajuwon G, Abiodun-Asanre OA, Pellegrom S, Weintraub R, Hailu T. Medical schools in Africa: seeing momentum. BMJ Glob Health 2024; 9:e014468. [PMID: 38388165 PMCID: PMC10884242 DOI: 10.1136/bmjgh-2023-014468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
| | - Miina Juvonen
- Better Evidence, Ariadne Labs, Boston, Massachusetts, USA
| | - Melanie Z Ng
- Better Evidence, Ariadne Labs, Boston, Massachusetts, USA
| | - Nneka Arinzeh
- Better Evidence, Ariadne Labs, Boston, Massachusetts, USA
| | | | | | - Rodas Temesgen
- Arba Minch University, Arba Minch, Southern Nations, Ethiopia
| | - Grace Ajuwon
- University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | | | - Sara Pellegrom
- Better Evidence, Ariadne Labs, Boston, Massachusetts, USA
| | | | - Tadiwos Hailu
- Internal Medicine, Arba Minch University, Arba Minch, Southern Nations, Ethiopia
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McGivern G, Wafula F, Seruwagi G, Kiefer T, Musiega A, Nakidde C, Ogira D, Gill M, English M. Deconcentrating regulation in low- and middle-income country health systems: a proposed ambidextrous solution to problems with professional regulation for doctors and nurses in Kenya and Uganda. HUMAN RESOURCES FOR HEALTH 2024; 22:13. [PMID: 38308369 PMCID: PMC10835984 DOI: 10.1186/s12960-024-00891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Regulation can improve professional practice and patient care, but is often weakly implemented and enforced in health systems in low- and middle-income countries (LMICs). Taking a de-centred and frontline perspective, we examine national regulatory actors' and health professionals' views and experiences of health professional regulation in Kenya and Uganda and discuss how it might be improved in LMICs more generally. METHODS We conducted large-scale research on professional regulation for doctors and nurses (including midwives) in Uganda and Kenya during 2019-2021. We interviewed 29 national regulatory stakeholders and 47 subnational regulatory actors, doctors, and nurses. We then ran a national survey of Kenyan and Ugandan doctors and nurses, which received 3466 responses. We thematically analysed qualitative data, conducted an exploratory factor analysis of survey data, and validated findings in four focus group discussions. RESULTS Kenyan and Ugandan regulators were generally perceived as resource-constrained, remote, and out of touch with health professionals. This resulted in weak regulation that did little to prevent malpractice and inadequate professional education and training. However, interviewees were positive about online licencing and regulation where they had relationships with accessible regulators. Building on these positive findings, we propose an ambidextrous approach to improving regulation in LMIC health systems, which we term deconcentrating regulation. This involves developing online licencing and streamlining regulatory administration to make efficiency savings, freeing regulatory resources. These resources should then be used to develop connected subnational regulatory offices, enhance relations between regulators and health professionals, and address problems at local level. CONCLUSION Professional regulation for doctors and nurses in Kenya and Uganda is generally perceived as weak. Yet these professionals are more positive about online licencing and regulation where they have relationships with regulators. Building on these positive findings, we propose deconcentrating regulation as a solution to regulatory problems in LMICs. However, we note resource, cultural and political barriers to its effective implementation.
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Affiliation(s)
| | | | | | - Tina Kiefer
- University of Warwick, Coventry, United Kingdom
| | | | | | | | - Mike Gill
- University of Oxford, Oxford, United Kingdom
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Ghofrani M, Valizadeh L, Zamanzadeh V, Ghahramanian A, Janati A, Taleghani F. Baccalaureate nursing education institutions' key performance indicators: a review of the existing indicators and qualitative analysis of expert interviews. BMC Nurs 2023; 22:357. [PMID: 37798710 PMCID: PMC10552274 DOI: 10.1186/s12912-023-01484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Improvements in nurses' and midwives' education will increase workforce quantity and quality. Continual improvement of organization performance is based on continual measuring; Appropriate indicators must be selected to measure and appraise the performances. This study aimed to recognize and categorize key performance indicators (KPIs) for baccalaureate nursing education institutions' performance measurement. METHODS This study had two phases: (1) Interview: Seven semi-structured interviews were conducted with faculty members and nurses. (2) Narrative Literature review: schools' and universities' reports and web pages were assessed to recognize KPIs. The data analysis method was directed content analysis. The Donabedian Model components were used to guide the data analysis. RESULTS The total number of indicators retrieved was 468; 75 were from interviews with faculty members and nurses and 393 were from the literature review. Indicators were categorized into: Structure (staff; equipment, resources, and facilities; guidelines), Process (education; communication and collaboration; evaluation), and Outcome (survey and accreditation; national and international recognition; satisfaction; sustainability and financial efficiency; students; alumni; knowledge related to the field). CONCLUSIONS A number of indicators were identified that were categorized into various groups related to the performance of nursing schools. Further investigations are needed with different groups of stakeholders including students, professional associations, healthcare institutions, alumni, and clients. As well in some areas, new or composite indicators may need to be developed. Also, each institution needs to select appropriate indicators based on its context, policy goals, and infrastructure.
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Affiliation(s)
- Marjan Ghofrani
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, South Shariati Street, Tabriz, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, South Shariati Street, Tabriz, Iran.
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Ghahramanian
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Department of Health Service Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Taleghani
- Nursing & Midwifery Care Research Center, Faculty of Nursing & Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Reis-Oliveira J, Costa BDSF, Borges-Oliveira AC, de Abreu MHNG. Association between management, human resources, and care provided to patients with special healthcare needs in dental specialty centers in Brazil: A cross-sectional study. SPECIAL CARE IN DENTISTRY 2023; 43:611-618. [PMID: 36522843 DOI: 10.1111/scd.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/04/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
AIMS This study aimed to identify the association between management and human resource factors with the performance of dental care provided to patients with special health care needs (SHCN) in secondary care in Brazil in the second cycle of the Program for Quality Improvement and Access to Dental Specialty Centers (PMAQ-CEO). METHODS AND RESULTS This study is a secondary data analysis from the second cycle from PMAQ-CEO, which evaluated 1097 Dental Specialty Centers (DSCs), conducted in 2018. Seventeen independent variables taken from dentists' training, and dental team management characteristics were analyzed to assess their influence on the reported "Performance of care for SHCN patients". An estimated score was generated from their performance on 23 questions related to the physical and human structure and work processes in the oral health care of SHCN patients in the DSCs. Negative binomial regression model with values p ≤ 0.05 were considered significant. Data analysis included residual deviation to the degree of freedom and the chi-square test. The patient care performance score with SHCN increases significantly when the DSC has a manager (RR = 1.019; CI = 1.011-1.026) and goal monitoring and analysis (RR = 1.012; CI = 1.007-1.005). By contrast, the DSCs in which the dentist is a statutory public servant (RR = 0.998; CI = 0.997-1.000) and performs additional unhealthy or hazardous duties (RR = 0.998; CI = 0.996-0.999) are less likely to provide a higher quality care. CONCLUSION The heterogeneity and low-performance scores for dental care provided to SHCN was identified in Brazilian health services. It was possible to verify that management and human resource factors of the DSCs were associated with the performance of dental care provided to SHCN patients.
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Affiliation(s)
- Jennifer Reis-Oliveira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo horizonte, MG, Brazil
| | - Brune de Sousa Faria Costa
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo horizonte, MG, Brazil
| | - Ana Cristina Borges-Oliveira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo horizonte, MG, Brazil
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Agostini L, Onofrio R, Piccolo C, Stefanini A. A management perspective on resilience in healthcare: a framework and avenues for future research. BMC Health Serv Res 2023; 23:774. [PMID: 37468875 DOI: 10.1186/s12913-023-09701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/14/2023] [Indexed: 07/21/2023] Open
Abstract
Recent major health shocks, such as the 2014-16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.To fill this gap, this systematic literature review aims to provide a clear state of the art of the literature dealing with resilience in healthcare. Specifically, from the analysis of the theoretical articles and reviews, the key dimensions of resilience are identified, and a novel classification framework is proposed. The classification framework is then used to systematize extant empirical contributions. Two main dimensions of resilience are identified: the approach to resilience (reactive vs. proactive) and the type of crisis to deal with (acute shocks vs. chronic stressors). Four main streams of research are thus identified: (i) proactive approaches to acute shocks; (ii) proactive approaches to chronic stressors; (iii) reactive approaches to acute shocks; and (iv) reactive approaches to chronic stressors. These are scrutinised considering three additional dimensions: the level of analysis, the resources to nurture resilience, and the country context. The classification framework and the associated mapping contribute to systematising the fragmented literature on resilience in healthcare, providing a clear picture of the state of the art in this field and drawing a research agenda that opens interesting paths for future research.
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Affiliation(s)
- L Agostini
- Department of Management and Engineering, University of Padova, Stradella San Nicola 3, Padua, Italy.
| | - R Onofrio
- Department of Management, Economics and Industrial Engineering, Politecnico Di Milano, Piazza Leonardo da Vinci, 32, Milano, Italy
| | - C Piccolo
- Department of Industrial Engineering, University of Naples Federico II, C.So Umberto I, 40, Naples, Italy
| | - A Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Lungarno Antonio Pacinotti, 43, Pisa, Italy
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Nawagi F, Kneafsey R, Modber M, Mukeshimana M, Ndungu C, Bayliss-Pratt L. An overview of nursing and midwifery leadership, governance structures, and instruments in Africa. BMC Nurs 2023; 22:168. [PMID: 37198570 DOI: 10.1186/s12912-023-01336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Investment in nursing and midwifery leadership and governance are key suggested approaches by the World Health Organization (WHO) Africa Regional Office to address the shortages in the nursing health workforce. However, there are few if any studies that have investigated the existence and operationalization of the nursing and midwifery leadership and governance structures in Africa. This paper fills this gap by, providing an overview of nursing and midwifery leadership, governance structures, and instruments in Africa. METHODS We conducted a descriptive cross-sectional study of the nursing and midwifery leadership, structures, and instruments in 16 African countries using quantitative methodology. Data was analyzed using SPSS IBM 21 statistical software. Data was summarized in frequencies and percentages and presented as tables and charts. RESULTS Only (9,56.25%) of the 16 countries included had retrievable evidence of all expected governance structures while (7, 43.75%) lacked one or more of the structures. A quarter (4, 25%) of the countries did not have a department of nursing and midwifery or chief nursing and midwifery officer at their Ministry of Health (MOH). The dominant gender representation across all the governance structures was female. Only Lesotho (1, 6.25%) had all expected nursing and midwifery governance instruments while the remaining (15, 93.75%) had either one or four of these instruments missing. CONCLUSIONS The lack of complete nursing and midwifery governance structures and instruments in various African countries is a matter of concern. Without these structures and instruments, the strategic direction and input of the nursing and midwifery profession cannot be maximized for the public good in relation to health outcomes. Addressing the existing gaps requires a multipronged approach with the need to strengthen regional collaboration, and advocacy, creating awareness, and advancing nursing and midwifery leadership training to enable nursing and midwifery governance capacity development in Africa.
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Affiliation(s)
- Faith Nawagi
- College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Rosie Kneafsey
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | | | | | - Cecilia Ndungu
- The National Nurses Association of Kenya, Nairobi, Kenya
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Evashwick CJ. Building the workforce to care for the aged: Can accreditation contribute? Front Public Health 2022; 10:1062469. [PMID: 36438263 PMCID: PMC9685986 DOI: 10.3389/fpubh.2022.1062469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
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Okoroafor SC, Kwesiga B, Ogato J, Gura Z, Gondi J, Jumba N, Ogumbo T, Monyoncho M, Wamae A, Wanyee M, Angir M, Almudhwahi MA, Evalyne C, Nabyonga-Orem J, Ahmat A, Zurn P, Asamani JA. Investing in the health workforce in Kenya: trends in size, composition and distribution from a descriptive health labour market analysis. BMJ Glob Health 2022; 7:bmjgh-2022-009748. [PMID: 36008084 PMCID: PMC9422806 DOI: 10.1136/bmjgh-2022-009748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/13/2022] [Indexed: 11/15/2022] Open
Abstract
Investing in the health workforce to ensure universal access to qualified, skilled and motivated health workers is pertinent in achieving the Sustainable Development Goals (SDGs). The policy thrust in Kenya is to improve the quality of life of the population by investing to improve health service provision and achieving universal health coverage. To realise this, the Ministry of Health undertook a Health Labour Market Analysis with to generate evidence on the relationship between supply, demand and need of the health labour force. In the context of supply, Kenya has a total of 189 932 health workers in 2020 with 66% being in the public sector and 58%, 13% and 7% being nurses, clinical officers and doctors, respectively. The density of doctors, nurses and clinical officers per 10 000 in Kenya in 2020 was 30.14, which represents about 68% of the SDG index threshold of 44.5 doctors, nurses and midwives per 10 000 population. Findings indicates that Kenya needs to align future production in terms of cadre and quantity to the population health needs. Achieving this requires a multisectoral approach to ensure apposite quantity and mix of intakes into training institutions based on the health needs and ability to employ health workers produced.
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Affiliation(s)
- Sunny C Okoroafor
- Health Workforce Unit, Universal Health Coverage Life - Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Brendan Kwesiga
- World Health Organization, Country Office for Kenya, Nairobi, Kenya
| | | | | | | | | | | | | | - Annah Wamae
- Kenya Health Human Resource Advisory Council, Nairobi, Kenya
| | - Mutile Wanyee
- Kenya Health Human Resource Advisory Council, Nairobi, Kenya
| | | | | | - Chagina Evalyne
- World Health Organization, Country Office for Kenya, Nairobi, Kenya
| | - Juliet Nabyonga-Orem
- Health Financing and Investment Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo.,Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101,11 Hoffman St., Potchefstroom 2520, South Africa
| | - Adam Ahmat
- Health Workforce Unit, Universal Health Coverage Life - Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Pascal Zurn
- Health Workforce Department, World Health Organization Headquarters, Geneva, Switzerland
| | - James Avoka Asamani
- Health Workforce Unit, Universal Health Coverage Life - Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Moller AB, Welsh J, Ayebare E, Chipeta E, Gross MM, Houngbo G, Hounkpatin H, Kandeya B, Mwilike B, Nalwadda G, Petzold M, Sognonvi A, Hanson C. Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries-Benin, Malawi, Tanzania, and Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000605. [PMID: 36962507 PMCID: PMC10021168 DOI: 10.1371/journal.pgph.0000605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
This research sought to map midwifery pre-service training curricula as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity in sub-Saharan Africa (ALERT) project conducted in Benin, Malawi, Tanzania, and Uganda. We conducted the review in two phases. In the first phase, online interviews were performed with the lead project midwives in all four study countries to get an overview of midwifery care providers' pre-service training courses, registration, and licensing requirements. We performed a mapping review of midwifery care providers' pre-service training curricula from different training institutions in the four study countries during the second phase. Curricula were reviewed and mapped against the International Confederation of Midwives (ICM) Essential Competencies framework to assess whether these curricula included the minimum essential training components described in the ICM framework. We identified 10 different professional titles for midwifery care providers. The number of years spent in pre-service training varied from one and a half to four years. Ten pre-service curricula were obtained and the assessment revealed that none of the curricula included all ICM competencies. Main gaps identified in all curricula related to women-centred care, inclusion of women in decision making, provision of care to women with unintended or mistimed pregnancy, fundamental human rights of individuals and evidence-based learning. This review suggests that there are skills, knowledge and behaviour gaps in pre-service training curricula for midwifery care providers when mapped to the ICM Essential Competencies framework. These gaps are similar among the different training courses in participating countries. The review also draws attention to the plethora of professional titles and different pre-service training curricula within countries. Trial registration: PACTR202006793783148-June 17th, 2020.
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Affiliation(s)
- Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joanne Welsh
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | | | - Effie Chipeta
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Gisele Houngbo
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Bianca Kandeya
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Beatrice Mwilike
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Antoinette Sognonvi
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Claudia Hanson
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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