Based on RMF South Sudan’s highly successful Juba College of Nursing and Midwifery, RMF Nepal was invited by UNFPA to enter into a partnership to support professional Midwifery education in Nepal. A "Collaborative Partnership Agreement for supporting Midwifery Education and Cadre in Nepal" is to be signed shortly with the Ministry of Health and Population.
After the earthquake, up to 90% of health facilities in some rural areas are known to be damaged or destroyed. For example, in Rasuwa district, up to 78% of district health facilities are reported to be completely demolished, and only two health posts remain functional. Hospitals in district capitals, including Kathmandu, have been overwhelmed, medical supplies severely depleted and capacities overstretched. Out of a total of 352 birthing centers, 115 were totally damaged and 137 partially damaged. Overall, the April 25 earthquake affected some 8 million people, including 2 million women of reproductive age and over 126,000 pregnant women.
Even before the earthquake, out of an estimated total population of 27.5 million, 23 million (84%) were living in rural areas and 7.4 million (27%) were women of reproductive age in 2012; the total fertility rate was 2.3. By 2030, the population is projected to increase by 20% to 32.9 million.
To achieve universal access to sexual, reproductive, maternal and newborn care, midwifery services must respond to 0.9 million pregnancies per annum by 2030, 85% of these in rural settings. The health system implications include how best to configure and equitably deploy the sexual, reproductive, maternal and newborn health (SRMNH) workforce to cover at least 70.2 million antenatal visits, 10.9 million births and 43.7 million post-partum/postnatal visits between 2012 and 2030 (UNFPA, 2014). There is a dearth of professional midwives to cater to the current and growing need; their roles can be instrumental in improving maternal and child health in rural areas.
In this context, a MOU has been signed between 4 universities by UNFPA and MOHP, which includes introducing Midwifery education as a different faculty in their universities as a professionally accredited course. Likewise, a draft Bachelor's degree curriculum on Midwifery has been prepared and will be tailored by the universities to suit their interests and this curriculum will be approved by the NNC (Nepal Nursing Council). Some of the pressing needs of the universities are as listed below and the areas where RMF would be supporting are also under discussion, i.e.:
- Human resources, including faculty development (lack of quality due to limited human resources)
- Scholarships for students from underserved communities
- Infrastructure development: i.e. classrooms, hostel facility
- Skills Lab/Equipment (dummy/ anatomical models)
In 2006, Nepal’s Ministry of Health and Population (MOHP) introduced the National Policy of Skilled Birth Attendants with an aim to bring about sustainable development and reduce the mother and child mortality rates. In 2009, MOHP finalized its selection of 4 universities to pioneer midwifery education as a professionally accredited degree in Nepal. These universities are:
- B.P. Koirala Institute of Health Sciences (BPKIHS),
- Kathmandu University (KU),
- National Academy of Medical Sciences (NAMS), and
- Patan Academy of Health Sciences (PAHS).
It was agreed that the universities would establish professional midwifery education as a separate faculty within the university and offer a bachelor’s degree in midwifery as a professionally accredited course. The curriculum would be proposed by each university to the Nepal Nursing Council (NNC) for review and finalization. The NNC would offer accreditation to the proposed curriculum only if it was confirmed to be consistent with ICM/WHO international standards.
1. Address gaps in human resources, including faculty development
2. Provide scholarships for students from underserved communities
3. Support infrastructure development: i.e. classrooms, hostel facility
4. Acquire Skills Lab/Equipment (dummy/ anatomical models)