Research, Monitoring & Evaluation
Research, Monitoring & Evaluation focuses on generating information for the best practice intervention and policy recommendations, activities include;
Community Consultation Workshops: A Best Practise Approach
As a country with such low institutional delivery rates, the Ethiopian Midwives Association (EMwA) designed and delivered a holistic Community Consultation (CC) program aimed at addressing the lack of uptake of maternal health services.
The CC workshops are designed to address barriers that restrict access to the midwifery services provided at the local Health Post (HP) and Health Centre (HC), as well as educate communities about the benefits in accessing quality midwifery services. The workshops are aimed at increasing the number of institutional deliveries and ultimately contribute to a reduction in maternal mortality rates.
In collaboration with both the Ethiopian Government MOH and UNFPA (United Nations Population Fund), EMwA’s chapter offices delivered these workshops in selected woreda’s/catchment areas throughout the country. The community centered approach of the workshop aligns with the MOH’s strategy of working at the grass roots level of the community and delivering a community-based health-care system. As such, the CC workshops involve participants from all parts of society, from government departments to local community leaders and members.
EMwA piloted a number of CC workshops where a sizeable increase in the utilization of maternal health services occurred in the period following the workshops. As such, EmwA has developed a best practise publication and film highlighting the success of 2 selected woreda/catchment areas that partook in the CC workshops.
The State of Ethiopia's Midwifery 2012 Report
In 2012 EMwA undertook a major investigation into midwifery services in Ethiopia, which provided the first comprehensive baseline study of the availability, distribution, education levels, challenges and opportunities of Ethiopian midwives and midwifery students.
The survey demonstrated that the number of trained midwives has increased from 1275 in 2008 to 4725 in 2012. Of these, 95% are providing direct midwifery services. Oromia has the largest number of registered midwives and Afar, which has a high case fatality rate, has the least number of registered midwives.
The survey showed that there are more females (3662) midwives than male (1063) with more male midwives holding bachelor degrees than female midwives who tend to be trained at the diploma level.
There has been significant increase in the number of midwifery training institutions from five in 2000 to 46 in 2012. Eighteen universities currently offer bachelor degrees in midwifery. Overall, 91% of practicing midwives are qualified at the diploma level, 8.8% hold bachelor degrees and 0.2% have attained masters degrees.
The investigation further revealed the during the 2012 academic year there were 7767 midwifery students in public and private training centers. Among them, 5739 were enrolled in the diploma program, 1840 in degree programs and 188 in the post-graduate (masters) program.
As with the overall number of midwives, Oromia has the highest number of midwifery students with 2241 currently studying in the region. 93.4% of students are enrolled in government institutions, with the remaining 6.6% studying at private institutions.
The survey also explored the positive and negative aspects of working as a midwife. 70% of those surveyed were satisfied with the type of work they were doing, citing relationships as being particularly rewarding. Sources of dissatisfaction included limited access to further education, poor working conditions, low salaries and lack of opportunities for career development.
Systemic issues were also reported by practicing midwives and students including the lack of a comprehensive licensing regime (currently only 68% of practicing midwives are formally licensed) and the shortage and quality of midwifery tutors.
The study also included a section on the contribution of the Accelerated Midwifery Training Program to increasing midwife availability. The Accelerated Midwifery Training Program allows practicing diploma-level nurses to undertake a one-year midwifery qualification. The study indicates that 1558 nurses graduated from the program in 2011 and were deployed to different health facilities across the country. 1756 nurses were enrolled in the same program in 2012.
National Midwife Licensing Examination
Through the National Health Sector Development Plan, Ethiopia has identified 'increasing the number of midwives and medical doctors', as its top priority for improving the health workforce. Training and retaining high quality midwives and medical doctors, and making them accessible to the Ethiopian people is a critical component of Ethiopia’s national development strategy.
EMwA therefore developed a proposal that looks at the need for a national midwives licensing examination in Ethiopia. The current low quality of education in the higher education institutions, the high production of health professionals and increased public complaints towards health professionals, initiated the need to consider a licensure examination for health professionals. EMwA also reviewed the factors affecting the implementation such a system, along with the strengths and limitation of such an examination.
A review of a standardized national exam will ensure that any midwife graduate or practicing midwives in Ethiopia has achieved at least a common standard of medical knowledge and clinical skills competencies. The proposal was submitted to the MOH and we look forward to working with them on this important initiative in the coming year.
Leadership and Management Manual for Nurses and Midwives at Health Facilities in Ethiopia
EMwA contributed to the MOH's development of the Leadership and Management Manual or Nurses and Midwives. The need for the manual stemmed from a comprehensive baseline assessment of nursing and midwifery service conducted in 2011 that highlighted the nursing service provided across the country was declining. This was largely due to lack of nursing and midwifery management structure, and nursing and midwifery processes in care delivery, lack of representation of nurses and midwives on senior management teams, and lack of continuous professional development (CPD) on leadership and management.
Nurses and midwives should be supported and expected to meaningfully engage in a range of leadership activities in their daily routine professional work. Effective leadership is critical in delivering high-quality care, ensuring patient safety and facilitating positive staff development. Therefore, creating the structure, building the capacity of nurse and midwife leaders, and involving nurses and midwives in the leadership and Management of health facilities is crucial to improve the quality of health service delivery at all levels. In order to fill the gaps, FMOH developed the Nurses and Midwives Leadership and Management Manual for nurses and midwives to use in practical management and leadership skills.