Nepal: Partnership with MOHP, UNFPA, WHO and GIZ to foster Midwifery Education
Assessing Needs to Develop University Programs: July – December 2016
January 21, 2017
Summary of Activities
The program to foster midwifery education in Nepal directly correlates to the Nepal government’s initiative to reduce maternal and neonatal mortality and morbidity by placing professional midwives in birthing centers throughout the country to ensure availability, access to, and utilization of skilled care at every birth.
The program entails assisting the selected universities to pioneer midwifery education in Nepal by meeting the international curriculum standards of the World Health Organization (WHO) and International Confederation of Midwives (ICM) under the supervision and mentorship of foreign, professional midwives. The curriculum will be assessed by the Nepal Nursing Council (NNC) to ensure it meets the benchmarks set by the program. The program aims to establish midwifery as a profession that is independent and separate from nursing.
With the aim to produce more professional midwives, a consortium of development partners was established, which includes these well-respected organizations:
- United Nations Population Fund (UNFPA)
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)
- World Health Organization (WHO)
- Real Medicine Foundation (RMF)
- Royal College of Midwives (RCM)
The need for this program is urgent, as the population of Nepal is projected to reach a total of 32.9 million by the year 2030, and the country will face even more shortages of professional midwives, especially in rural areas. This need is also confirmed by the Nepal government’s Midwifery Education and Management Guidelines published in 2016.
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The program was proposed to the Ministry of Health and Population (MOHP) , which asked for a detailed list of support that would be provided by each of the external development partners (EDP). UNFPA representatives of the midwifery program have been in constant communication with the ministry and have submitted the details of support of each EDP, which were mutually agreed upon during the meeting held on July 8th, 2016.
- Update on MoU with Universities
- Guidelines on the management of midwifery education and cadre in Nepal
- Reviving of Task Force committee
- Feasibility study
- Signing of Collaborative Partnership arrangement for midwifery education and cadre document by all parties
External Development Partner
In response, RMF offered the following means of support:
- Development and strengthening of faculty in 4 universities: BP Koirala Institute of Health Sciences (BPKIHS), Kathmandu University (KU), National Academy of Medical Sciences (NAMS), and Patan Academy of Health Sciences (PAHS).
- Supporting the universities in recruiting faculty members.
- Sponsoring training and capacity building/skills development programs for faculty members.
- Contributing to the remuneration of technical staff.
- Supporting students from economically and socially disadvantaged and marginalized backgrounds in all 4 universities.
- Providing scholarships to needy students
- Covering accommodation costs and potentially providing stipends to selected students.
- Covering the cost of necessary physical infrastructure and equipment for training labs and other infrastructure as requested by one of the universities, Patan Academy of Health Sciences (PAHS).
During August and September 2016, the NNC carried out preliminary visits to assess 3 universities:
- BP Koirala Institute of Health Sciences (BPKIHS)
- Kathmandu University (KU)
- National Academy of Medical Sciences (NAMS)
Main objectives of NNC/UNFPA university visits:
- To carry out preliminary assessment of clinical sites for initiating a Bachelor of Midwifery education program
- To assess faculty preparation, skills labs, and any support needed
- To conduct meetings with VC (Vice Chancellor), dean, campus chief, hospital matron, and midwifery faculty members
It was concluded by the NNC, along with the UNFPA team, that the universities met the minimum benchmarks set by the program to provide quality Bachelor of Midwifery education programs and were fully equipped to offer the course with exceptions.
Learning From Others
Since this program is the first of its kind in Nepal, the teams and EDPs felt that it was necessary to see the successful implementation of a similar program in another country and learn from their experience first-hand. A request to visit Bangladesh was presented to the UNFPA by the NNC and other stakeholders, in order to study the midwifery education and midwife-led centers in Bangladesh that meet the standards set by the ICM/WHO. Bangladesh was chosen for the visit, because it implements the ICM standard midwifery education program and has a similar country context to Nepal.
This request was accepted by the UNPFA, and a team of 8 delegates participated in the visit from September 24th, 2016 to October 2nd, 2016.
Because some of the initial external development partners (EDPs) decided not to be a part of the program or to play a limited role, and because of the 4 initially selected universities, PAHS had not taken any steps to initiate midwifery education at their university, RMF’s support to the program (outlined in early meetings and proposals) had to be revised. Also, support that had not been discussed in the first meeting was brought to the attention of the Technical Working Committee during the meeting on November 25th, 2016. To address these changing developments and needs, RMF’s current support includes:
- Database for Nepal Nursing Council (NNC)
- International mentor for NAMS
- Skills lab for NAMS
- Skills development materials
Visit to NAMS
Assessment and Funding
During the second week of December 2016, RMF Nepal’s team visited NAMS and met with its faculty, who gave us a tour of the existing facilities. The team noticed that most buildings were severely damaged because of the April 2015 earthquake and the school was in the process of moving to another location. RMF’s team closely examined the existing skills lab and assessed the institution’s need for equipment and books to have a fully equipped and functional skills lab.
The skills lab will be funded by RMF in partnership with UNFPA. UNFPA has already provided come equipment to the school, and the rest will be provided by RMF once NAMS moves to its new location, which is estimated to be by March 2017.
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)
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Kathmandu University has already started the course with 6 students.
The National Academy of Medical Sciences will start in January 2017 with 10 students.
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