Nepal: Partnership with MOHP, UNFPA, WHO and GIZ to foster Midwifery Education

Students Conduct Successful Breastfeeding Exhibit: Q1 2019

April 01, 2019

Pragya Gautam

Former RMF nurse Pushpa (5th from the left), now a student of the Bachelor of Midwifery Sciences program, with her class at NAMS

Former RMF nurse Pushpa (5th from the left), now a student of the Bachelor of Midwifery Sciences program, with her class at NAMS

Program Update

RMF’s Presence

To further address the problem of maternal and neonatal mortality, Nepal’s Ministry of Health is also planning to implement a Proficiency Certificate Level (PCL) midwifery program to replace the preexisting Skilled Birth Attendant (SBA) program. RMF has been involved in the curriculum development for this program in collaboration with other external development partners and organizations, including GIZ, UNFPA, the Midwifery Society of Nepal (MIDSON), and the Council for Technical Education and Vocational Training (CTEVT), as well as implementing universities, midwifery nurses from various hospitals and nursing colleges, and other experts in the field.

During this Quarter:

  • RMF participated in the Orientation Workshop on Simulation-Based Education, organized by the Nursing and Social Security Division
  • RMF participated in the external development partners (EDP) meeting
  • NAMS students conducted an exhibition on breastfeeding
Representatives from Laerdal demonstrating a simulation scenario

Representatives from Laerdal demonstrating a simulation scenario

Workshop on Simulation-Based Education

Promoting Midwifery Education

A workshop was held to orient the stakeholders to the significance of simulation in clinical practice for midwifery education. It was organized by the Nursing and Social Security Division under the Department of Health Services, Ministry of Health and Population. Dr. Pushpa Chaudhary, Secretary of the MoHP, was the chief guest of the program. Director General of the Department of Health Services Dr. Guna Raj Lohani, Chief of Quality Standards and Regulation Dr. Dipendra Raman Singh, and President of the Nepal Nursing Council Prof. Goma Devi Niraula were the distinguished guests of the program.

After the distinguished guests were seated, a welcome speech and an overview of the program were delivered by Roshani Laxmi Tuitui, Director of Nursing and Social Security Division. During her presentation, she explained the present status of nursing education and practice as well as advances in the midwifery education program. She also described the benefits of simulation-based education and how it would be integrated into nursing and midwifery education. She took a strong stand for the integration of simulation-based education because of its evidencebased potential to enhance the skills of the students, teachers, and even practicing staff as well as improve the quality of health services provided.

Margaret Walsh, a representative from GIZ, who is also serving as a consultant and mentor for the midwifery students, also spoke in favor of the introduction of simulation-based education, as it could be beneficial for students to practice rare clinical scenarios, and the difficulty levels can be set according to the level of the student. Thus, they would be equipped to handle such rare cases in later stages of their careers. She also stressed the importance of simulation labs in educational and clinical settings for developing the confidence of students and practicing personnel.

In her remark speech, Prof. Goma Devi Shrestha informed the participants that the quality of nursing education and practice has always been an issue of highest priority in the council. In the near future, when newly graduated midwives are placed at different stations throughout the country, their ability to handle the cases independently as well as confidently relies on theoretical knowledge and clinical practice. As the midwifery model of care is entirely a novel subject, the groundwork of practice is yet to be firmly established. This process requires much advocacy and ongoing dialogues with the concerned stakeholders. Hence, a simulation-based technique and environment has been proposed as an ideal solution for covering topics which are not generally possible to teach in clinical settings.

In her remark speech, Secretary of MoHP Dr. Pushpa Chaudhary firstly congratulated the Nursing and Social Security Division for making a huge leap in the field of midwifery education. She heartily appreciated the efforts of everyone working for the development of nursing and midwifery education. She was elated that the education of the health professionals is not solely based on traditional textbook study, but has now expanded enough to generate evidence, and the practice has continued to develop on the basis of that evidence. The idea that simulation-based education would be helpful to practice clinical situations repeatedly and at different levels at the same time amazed her. She thanked Laerdal Foundation and GIZ for the initiative and committed that the ministry would support the plan of establishing high-end simulation labs in all seven provinces and investigate ways to implement them successfully.

In his concluding remarks, Dr. Guna Raj Lohani, Director General of Department of Health Services (DoHS), thanked the organizers, participants, EDPs, and other stakeholders on behalf of DoHS for gathering and working towards the goal of minimizing maternal and neonatal mortalities through multifaceted efforts. He added that the Nursing and Social Service Division’s enthusiasm for maintaining the quality of health services through improvements in planning, restructuring, and integrating different approaches is exemplary. Furthermore, he stated that it is worth introducing simulation-based education in nursing and midwifery education and practice as one of these efforts. He encouraged the nurses to take further steps in upgrading the standard of services and assured them that the DoHS would fully cooperate.

After the formal session, representatives of Laerdal Foundation presented on the theme of simulation-based education, covering topics including the cycle of learning, areas in which simulation would prove to be the most useful, such as OSCE, and decision-making and critical thinking. They also demonstrated different learning scenarios for simulation.

Midwifery students of NAMS explaining about breastfeeding during the exhibition

Midwifery students of NAMS explaining about breastfeeding during the exhibition

Successful Exhibition

Midwifery Students Conduct an Exhibition on Breastfeeding

As a part of their curriculum, the Bachelor of Midwifery Sciences students conducted a health exhibition on breastfeeding at Paropakar Maternity and Women’s Hospital. The students made various informational and educational materials for the exhibition independently. They managed stalls on different themes related to breastfeeding, informed visitors about their topics, and answered their queries. The clients of the hospital and those accompanying them also viewed the exhibition and found it very informative. The students’ mentors appreciated their efforts and congratulated them on the success of the exhibition. Altogether, 157 people attended.

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)

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.