Midwifery Education: Building Global Consensus The ICM Global Standards for Midwifery Education

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Midwifery Education Building Global
ConsensusThe ICM Global Standards for Midwifery
Education

• Joyce Beebe Thompson, DrPH, CNM, FAAN, FACNM
• Professor Emerita
• Co-Chair ICM Task Force on Standards

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Overview of Presentation

• Role of education in preparing fully qualified
  midwives to meet MDGs
• Need for global midwifery standards background
  review challenges
• ICM Collaborative Process for reaching global
  consensus modified Delphi survey process
• Draft ICM/WHO midwifery standards
• Reflections for the future

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Healthy Women Children
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Healthy Women Midwives

• A natural, mutually beneficial partnership
• Midwifery model of care teach women how to be
  healthy
• Midwives are the skilled attendant needed to keep
  women safe and healthy
• A fully qualified midwife formal education
  based on ICM Essential Competencies

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Value of Education Standards

• Program graduates held to established standards
  of proficiency
• Knowledge
• Professional behaviors
• Specific skills
• Program meets defined country needs for health
• Program faculty students demonstrate critical
  thinking informed judgment
• Promotes best practice by adapting to changing
  evidence
• Enhances legal recognition for midwifery practice

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UN Millennium Development Goals (MDGs) 2000

• 3. Promote gender equality empower women
  essence of midwifery care
• 4. Reduce child mortality healthy informed
  mothers needed
• 5. Improve maternal health entire midwifery
  model of care

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World Health Report 2005

• Women risk death to give life.for optimum
  safety, every woman needs professional skilled
  care .. in an appropriate environment that is
  close to where she lives and respects her
  birthing culture.
• Such care can best be provided by a registered
  midwife or health worker with midwifery skills in
  decentralized, first-level facilities
• Dr. Lee, WHO Director-General, p. xv

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Lancet Maternal Survival 2006

• where an option still exists for a professional
  attendant midwife or doctor, the evidence is
  strongly in favor of midwives as the main
  providers.
• Campbell Graham, p.32

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Linking Midwives to Healthy Women

• Countries understand need for skilled midwives
• Some countries willing to invest in fully
  qualified midwives
• Some countries want cheaper solutions through
  various other cadres of health workers most
  without midwifery competencies e.g.TBAs, CHWs
• Many countries asking for help in scaling up
  health workforce
• Need consensus on how one educates a fully
  qualified midwife adapted to country needs

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ICM Council Deliberations 2008

• Many individuals using title midwife
• Education processes vary
• Scope of practice varies
• Practice competencies vary
• Many countries needing skilled attendants do not
  have a midwifery education program
• Great confusion disagreement about how to
  prepare fully qualified midwives

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ICM Council Considerations 2008

• ICM the voice of fully qualified midwives
  globally (Definition of the Midwife)
• ICM Essential Competencies2002 - the building
  blocks for education regulation
• ICM position statements - qualifications of
  midwifery teachers, ongoing education, ethics
• ICMs role responsibility to establish
  standards of midwifery education
• in keeping with core ICM documents
• in collaboration with WHO
• in synergy with other global partners

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ICM Council Decisions - 2008

• Update and expand Essential Competencies..
• Establish Global Standards for Midwifery
  Education
• Establish global regulatory standards
• Strengthen midwifery associations to meet needs
  for healthy women and newborns

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ICM Study Process 2009-2010

• Established global task force representing all
  ICM regions, language groups, Board, WHO
• Appointed J. Thompson A. Sawyer as co-Chairs
• Study leader for standards - J. Thompson
• Coordinator Guidelines A. Sawyer
• Consultant J. Fullerton

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The First Step for Task Force

• Task Force critiqued existing midwifery standards
  
• WHO Midwifery toolkit, Chapters 5 6
• Accreditation Commission for Midwifery Education
  (US) - 2008
• East, Central, Southern African College of
  Nursing midwifery standards
• WHO Initial Nursing Midwifery Standards - 2009

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Definition Used by TF

• Definition of standard
• a norm/uniform reference point that describes a
  required level of achievement for quality
  midwifery education.

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Research Question

• What are the elements of quality that should be
  reflected in any type of midwifery educational
  program that prepares a person to meet the ICM
  International Definition of the Midwife?

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ICM Methodology

• Modified Delphi survey process
• Internal external global rounds
• Consensus at .80 level or above retain
• Two-phase process over two years
• Phase 1 development of survey instruments,
  human subjects research approval
• Phase 2 validation of standards, revising as
  needed after each round

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Preliminary Responses

• Total number of completed surveys N 162
• Total number respondents N 190
• Total number ICM MA countries N 46/88
• Language groups
• English N 138
• French N 28
• Spanish N 23
• As of May 28, 2010 includes two external rounds

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Responses by ICM Region

• Africa 10/19 countries 53
• Americas 10/14 countries 71
• (plus 3 non-ICM member countries)
• Asia Pacific 8/19 countries 42
• target Southeast Asia
• Europe 18/36 countries 50
• target southern Europe
• Overall response rate to electronic survey 52
  (46/88)

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Glossary of Terms Preface

• 32 glossary terms agreed
• 11 components of Preface, with 9 agreed including
  post-secondary level of education to begin
  program
• Areas that currently lack of .80 level of
  consensus
• Minimum length of direct entry program
• Minimum length of post-nursing program
• Minimum years clinical practice of midwife
  teachers

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ICM Organization of Standards

• Organization and administration (6)
• Midwifery faculty (8 plus 8 subparts)
• Student body (6 plus 8 subparts)
• Curriculum (6 plus 4 subparts)
• Resources, facilities services (5 plus 5
  subparts)
• Assessment strategies (5 plus 5 subparts)

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Key Details Addressed

• Midwifery leadership of program
• Entry level of students other qualifications
• Qualifications of midwifery classroom clinical
  teachers
• Content of curriculum beginning with ICM
  Essential Competencies
• Resources and practice facilities
• Length of program
• Ongoing evaluation processes students, teachers,
  curriculum, program

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ICM Lessons Thus Far

• Resource poor nations need support for educating
  fully qualified midwives
• All agencies need to work together to avoid
  quick fixes as alternative to midwife
• Multiple languages and country needs require
  clarity in Standards and Guidelines
• Preparation of fully qualified midwife requires
  support of regulatory body midwifery
  association
• Standards can provide benchmarks for measuring
  quality

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Joint Statement

• We will work together with governments and civil
  society to strengthen national capacity to
• Address the urgent need for skilled health
  workers, particularly midwives..
• WHO, UNFPA, UNICEF, World Bank (2008)
• Joint Statement on Maternal and Newborn Health
• Accelerating efforts to save the lives of women
  and newborns.

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Reflections on Future

• Need further evidence of
• Effective curriculum models tailored to country
  needs
• Effective teaching methods for competency-based
  education
• Effective clinical learning (practice) settings
• Need
• Appropriate skill mix of health professionals and
  community workers
• Effective midwifery regulation to allow fully
  qualified midwife to practice to full scope of
  abilities
• Strong midwifery associations to support global
  standards for education, regulation, and practice