midwifery education rapid assessment tool -...

Midwifery Education

RAPID ASSESSMENT TOOL

Version March 7, 2015

Endorsed by

ACKNOWLEDGMENTS

Internal Respondents Sheena Currie (US) Edwin Wambari (Kenya) Rosemary Kamunya (Kenya) Chantelle Allen (Ghana) Gaudiosa Tibaijuka and Tanzania MNH team Endris Mekonnen (Ethiopia) Osborn Koech Kiptoo (Kenya) Ali Abdelmegeid (US) Ouattara Kiyali (Cote d’Ivoire) Patricia Gomez (US) Tegbar Yigzaw (Ethiopia) Marion Subah (Liberia) Nabukeera Josephine (Uganda) Ukende William Shalla (Tanzania) Peter Johnson (US) Catherine Carr (US) Nancy Kiplinger (US)

Jean Pierre Rakotovao (Madagascar) Jeffrey Smith (US) Anonymous Phelelo Marole (Botswana) Nerrej Agrawal (India) Anne Hyre (Indonesia) Cherry (Myanmar)

External Respondents Anna af Ugglas, Technical Specialist Skilled Birth Attendant,

UNFPA Laos Malin Bogren, Technical Specialist – Midwifery, UNFPA

Afghanistan Gillian Butts-Garnett, Midwifery Specialist, UNFPA South Sudan Tamar Khomasuridze, SRH Advisor, UNFPA EECA Regional Office Michaela Michel-Schuldt, Technical Officer Midwifery, UNFPA

Geneva Sharifa Mir, Midwifery Advisor, UNFPA Pakistan Affoue Nguessan, Midwife Country Adviser, UNFPA Cote D'Ivoire


1 Midwifery Education Rapid Assessment Tool

MIDWIFERY EDUCATION RAPID ASSESSMENT TOOL A Users’s Guide and Handbook accompanies this tool, proving direction for its use and scoring.

Components ICM Education Standard WHO Core Competency

Additional Resources Assessment Criteria Score

INFRASTRUCTURE AND MANAGEMENT 1.1. The country has sufficient schools needed to produce the number of fully competent midwives needed in the workforce

ICM: I.6, V.2 UNFPA: State of the World’s Midwifery, 2014 WHO: Global Toolkit for Evaluating Health Workforce Education

OPTION 1: Step 1. Determine the number of students enrolled in the school being assessed Step 2. Determine the number of unfilled slots (U) Step 3. Determine whether school being assessed anticipates increasing enrollment in any of the future 5 years





OPTION 2: Assessor takes the following action. Step 1. Review data from State of the World’s Midwifery, 2014 What If scenario #2

OPTION 3: Assessor takes the following action. Step 1: Inquire whether the Ministry has engaged in the WHO Health Workforce Education assessment. If YES, request information on Preliminary assessment: country level indicators

SCORING

OPTION #1 IF number obtained in Step 2 = 0, score = Yes Yes IF number obtained in Step 2 = 0 and answer to Step 3 = Yes, score = Yes Yes IF number obtained in Step 2 = ≥ 1; score = No No IF number obtain in Step 2 ≥1, and answer to Step 3 = No; score = No No OPTION #2 IF estimate = 100%; score = Yes Yes IF estimate < 100%; score = No No OPTION #3 IF: Preliminary indicator #1 (quantity) = GREEN light; score = Yes Yes IF: Preliminary indicator #1 (quantity) = YELLOW OR RED light, score = No No





1.2. The midwifery program or school being assessed is led by a midwife with appropriate clinical, administrative, academic and leadership experience

ICM: I.5 Assessor asks 5 questions. Q1. Is leader currently qualified as a midwife in the country? Q2. Does leader have at least two years of teaching experience in a school of nursing or midwifery? Q3. Does leader have at least two years of clinical experience in midwifery practice? Q4. Does leader have prior experience in administration of an education or clinical unit within an institution equivalent to at least small college or district hospital size? Q5. Has leader held any prior role as designated “in charge” for the work of 5 or more individuals?

SCORING IF answer to Q 1,2,3 is yes; score = Yes Yes IF answer to Q 1 is no; score = No

No IF answers to 1 or more of Q 2, 3, 4 or 5 is no; score = No

1.3. The school being assessed has sufficient space needed to facilitate theoretical (classroom) learning needs of students

ICM: V.2 Assessor conducts direct observation of at least one (preferably 2 or 3) classroom(s) in which class is in session. a) each student has an individual desk/workspace b) there is a subjective feeling of “elbow room” for each student c) there is adequate light and ventilation d) seating arrangements allow each student and teacher an unobstructed

view e) the classroom is appropriately equipped for teaching purposes f) maximum number of students in the room = 30. NOTE: If country-specific standards exist; substitute the country-based number





SCORING

IF all six criteria are yes, score = Yes Yes IF one or more of the criteria = no, score = No No Note: If more than one classroom is assessed; EACH classroom must meet all criteria in order to achieve a YES score.

1.4. The school has the textbooks and journals or library internet access to journals, and other library resources needed for existing students

ICM: V.2 Assessor takes four actions. 1. Assessor should conduct a site review of the institution and midwifery

program (if they differ) library(ies); looking specifically for: a) midwifery textbooks < 10 years old b) at least 1 copy for each 5 students of standard (major) textbooks that

are listed as required reading for classes in the specialty and/or c) internet access to electronic texts and resources

2. Assessor should make a reasonable judgment that there is sufficient space (including tables and chairs) where students may sit for use of library resources

3. Assessor should determine the presence of a designated head of the library ; who serves the post at least the equivalent of a full-work-week

4. Assessor should ask designated head of the library whether/not there is an annual budget for purchase of new resources

SCORING

IF each of the four criteria (including sub-criteria (1a, and either of 1.b and 1.c) are met; score = Yes Yes

IF one or more of the criteria or sub-criteria (1 a, and either of 1.b and 1.c) are not met; score = No No

1.5 The school has a functional clinical skills lab needed for practice and simulation

ICM: V.2 ICM Standard Equipment List

Assessor takes four actions. 1. Assessor should view the skills lab; testing any (at least one) randomly

selected model(s) and/or piece(s) of electronic or computer-controlled equipment to ensure that it/they are in working order.

2. Assessor asks academic teachers to complete a checklist, excerpted from ICM Standard Equipment List for Competency-Based Skills Training in





Midwifery Schools, to determine presence and functional status of essential equipment.

3. Assessor should render an informed opinion about whether the lab is sufficiently organized/arranged/accessible to accommodate student learning (See criteria in handbook).

4. Assessor determines whether there is an individual who has been designated as “in charge” of the laboratory; including responsibility for scheduling of students and inventory of supplies.

SCORING IF the response to criteria 1,2,3, and 4 are all = yes, score = Yes Yes IF any equipment tested or supplies inventoried are not in working order or are missing, or if response to step 3 or step 4 is no, score = No No

1.6 The school has a computer lab with sufficient functional computers, and appropriately skilled teaching/support staff

ICM: V.2 Assessor should view the computer lab. 1. 1. Each computer should have, at minimum

a) a Microsoft Office (or similar) productivity package b) DVD player or USB flash drive port (for video viewing)

2. There should be sufficient working computers to meet a 1:10 computer/enrolled midwifery student ratio. Non-functional computers should not be counted

3. The lab should be staffed by a support person, sufficiently skilled to assist student learners (judged by his self-description of learned expertise)

4. Electricity must be functional

SCORING IF all four criteria and sub-criteria are met, score = Yes Yes IF any one or more of the criteria or sub-criteria are not met, score = No No





TEACHERS TUTORS AND PRECEPTORS 2.1. The school has sufficient midwives and appropriate non-midwives that are needed to educate existing students in the academic/theory components of the curriculum (1:30 teacher: student ratio)

ICM: II.1, II.4 ICM: II.7; V.3 WHO: Basic requirement

Assessor conducts four assessment steps. 1. Assessor should select at least three midwifery specialty courses; confirm

the number of academic teachers and students assigned to/enrolled in those academic/theory courses; then compute the teacher/student ratio.

2. Assessor should confirm (by query of administrator or course teacher) whether the teacher of the midwifery course is qualified as a midwife in the country

3. Assessor should query administrator concerning a) the number of midwife teachers who teach courses that are included

in the midwifery program of study (the full curriculum) b) the number of non-midwife teachers who teach courses that are

included in the midwifery program of study (the full curriculum) c) whether there are courses (both general and specialty) for which there

is no assigned teacher in the current academic year 4. Assessor should confirm (by query of administrator) whether each general

course (outside of the midwifery specialty) is taught by an individual prepared in the relevant art or science.

SCORING

IF criterion #1 is yes, (ratio ≤1 teacher:30 midwifery students) for each of the midwifery courses ; AND IF criterion #2 is yes, for each of the midwifery courses, AND IF criterion #3c is no, score = Yes

Yes

IF criterion #1 exceeds 1:30 for any of the three classes, OR if criterion #2 = no for any of the three courses; OR if Q3c = yes; score = No No

Note: criterion 3a, 3b and 4 are for informational purposes





2.2. Teachers have completed a course preparing them for their teaching role

ICM: II.2.d, II.3.e WHO: Basic requirement

Assessor takes the following step: 1. Assessor should ask/confirm whether each academic teacher assigned to

courses in the midwifery program of study (both midwives and other professionals) has completed a pedagogical/instructional skills (a.k.a. teacher preparation) course.

SCORING

IF answer= yes for all teachers of all courses, score = Yes

Yes IF answer = no, for one or more teachers of general curriculum courses; BUT answer = yes for each teacher of a major course in the midwifery specialty; score = Yes IF one or more courses in the midwifery specialty are taught by academic teachers who have not completed a teacher preparation course, score = No

No

2.3. Teachers have acquired and maintain their clinical competency

ICM: II.2.b, II.3.b WHO: 3, 4

Assessor asks four questions of a minimum of 2, maximum of 4 academic teachers: Q1. Assessor asks each teacher of a midwifery specialty course the number of years of clinical practice acquired prior to transferring to the role of academic teacher (should be at least one full year) Q2. Assessor asks each academic midwifery teacher when s/he last practiced in a clinical setting (either public or private); (should be within the past year) and Q3. whether that practice includes:

a) antepartum and b) intrapartum and c) postpartum, and d) reproductive health (including family planning)

Q4. Assessor asks when that individual last attended a “clinical update” course (name of topic and date)





SCORING

IF answer to Q1 = > 1year, and answer to Q2 = < 1 year, and answer to Q3 includes each of sub-criteria a, b, c, and d, and answer to Q4 includes a midwifery relevant topic and was attended less than 18 months prior to assessment, score = Yes

Yes IF answer to Q1 = > 1 year, and answer to Q2 = < 1 year, and answer to Q3

includes one or more of sub-criteria a, b, c, or d among all academic teachers interviewed, and answer to Q4 includes at least one midwifery relevant topic and was attended less than 18 months prior to assessment for each academic teachers interviewed, score = Yes IF answer to Q1 <1 year OR answer to Q2 >1 year for ANY member interviewed, and each of sub-criteria a, b, c, d are not included among all academic teachers interviewed, score = No

No

2.4. Teachers have the resources that they need to be effective

ICM: V.2 Assessor conducts site visit of at least two midwifery teacher offices; completing a checklist that covers the following criteria: a) office (shared office must have an individual desk for each teacher) b) located in the accessible vicinity of classrooms and skills labs c) functional computer (with Microsoft office or equivalent; and DVD or USB

port) shared with no more than 1 other teacher d) internet access e) electricity – functions majority of working day f) access to toilet and running water g) office supplies h) textbooks (<10 years old) relevant to the courses to which the teacher is

assigned

SCORING IF answer= yes for all criteria in each office, score = Yes Yes IF answer = no, for any of the criteria in any office, score = No No

2.5. Teachers receive salary equal to or greater than midwives in clinical practice

Assessor takes 2 steps. Step 1. Assessor requests salary scales for full-time academic teachers and clinical staff (Possible sources: Central government office; Midwifery Program Administrator; Human Resource Department; Individual or preceptor)





Step 2. Assessor asks at least two academic teachers and two clinical preceptors – one of whom should be at the “in charge” level - if their salary is consistent with the full-time salary figure cited on that scale

SCORING IF salaries are consistent (equal or above) scale figures; score = Yes Yes IF teachers are paid at lower salary scale than “in-charge” clinicians, score = No No

2.6. The education system has clinicians prepared for the role of clinical preceptor (clinical teacher)

ICM: II.3; V.3 WHO: Basic requirement

Assessor takes 4 steps. Step 1. Assessor visits 2 clinical settings (hospital and health center); identifies the number of midwives designated as preceptors on the particular unit/shift, and compares that number to the number of students assigned in the setting (1:4 ratio). Step 2. Assessor approaches a minimum of 2 preceptors in each of at least 2 settings (hospital and health center), and asks them to describe the way in which they were prepared and authorized for the role; completing a checklist of acceptable ways/means of preparation Step 3. Assessor approaches a minimum of 2 preceptors in each of at least 2 settings (hospital and health center), and asks them to identify any academic or facility-based criteria for service in the role of preceptor Step 4. Assessor asks these same preceptors whether they receive any academic or facility-based recognition for service in the role of preceptor

SCORING

IF Q 1 is ≤ 1:4; AND answers to any of checklist sub-criteria 2 a, b, c, or d = yes, score = Yes Yes

IF Q1 is ≥ 5; AND/OR if at least one of checklist sub-criteria 2 a, b, c, or d ≠ yes, score = No No

Note that Criteria #3 and #4 are for informational purposes only.





2.7. The education system has clinicians supported in the role of clinical preceptor (clinical teacher)

Assessor visits 2 sites. At academic teaching site: Assessor asks the midwifery academic teachers whether the preceptor receives any support from the program for service in the role of preceptor, and to describe what is meant by the response At clinical preceptorship site: Assessor asks the unit “in-charge” whether the preceptor receives any adjustment in the expected workload when a student is present; and to describe what is meant by the response.

SCORING

IF each preceptor has received at least one means of support for the role (Q1), AND IF each preceptor has received at least one type of workload adjustment when a student is present (Q2), score = Yes

Yes

IF either Q1 or Q2 = no; score = No No Note: sub-criteria (see assessor handbook) are for information only





STUDENTS 3.1. The country (and this school) have sufficient qualified applicants to midwifery education programs (2:1 qualified applicant/enrollment)

ICM: III.1 Assessor takes the following steps. Step 1. Check available data to ensure that 12th grade education is minimum educational requirement for admission Step 2. Confirm with school administrator that all available slots were filled for current academic year. Step 3. Confirm with school administrator number of students admitted for current academic year Step 4. Retrieve information from school administrator or central government office about N of qualified applicants on wait list (if one exists) Step 5. Compute the ratio of qualified applicants: students admitted Note that if admissions are handled centrally (e.g., MoH or MoE) information needed for scoring of this standard may be difficult to obtain.

SCORING

IF ratio of qualified applicants to admitted students ≥ 2:1; score = Yes Yes IF answer to step 2 is no; score = No

No IF answer to step 1 is no; score = No IF ratio of qualified applicants to admitted students < 2:1; score = No





3.2. The school is located in communities accessible to targeted students (commutable from residence to school on a daily basis)

Assessor asks 3 questions. Q1. Assessor asks Administrator whether the majority of students live within the catchment area (same or adjacent region); accessible by public or private transportation Q2. Assessor asks Administrator if residence facilities are available for students who live at a distance Q3. Assessor asks Administrator whether undue tardiness and absences occur; with “transportation difficulty” (including seasonal challenges) cited as the reason.

SCORING

IF answer to Q1 = yes, score = Yes Yes IF answer to Q1 = no AND answer to Q2 = yes, AND answer to Q3 = no; score

= Yes IF answer to Q1 = no AND answer to Q2 = no, AND answer to Q3 = yes; score = No No

3.3. The majority of students enrolled are enthusiastic about entering the midwifery profession

Assessor assembles a group (8—10 students) and asks three questions of each student. Q1. Did you choose midwifery as a profession, or did someone else choose or assign midwifery to you as your profession? Q2. Do you anticipate that midwifery will be your profession for most of your working life? Q3. Is there a profession you would prefer over midwifery?





SCORING

IF answer to Q1 = self, score = Yes

Yes

IF answer to Q1 = other, AND answer to Q2 = yes, and answer to Q3 = no; score = Yes IF answer to Q1 = other AND answer to Q2 = either yes or no; AND answer to Q3 =no, score = Yes Compute the percentage score (Sum of individual YES scores /N of interviews) IF percentage = ≥ 70%; score = Yes IF answer to Q1 = other AND answer to Q2 – either yes or no AND answer to Q3 = yes; score = No No

3.4. The country and/or school has student selection criteria that account for anticipated deployment and retention

ICM: III.1; III.3 Assessor asks 3 questions of Central government office representative, Academic Administrator/and or representative of Admissions Committee: Q1. Are students given extra consideration for admission based on their urban or rural region of residence? Q2. Are students given extra consideration for admission based on their status as a member of an underserved or minority population group? Q3. Are students given extra consideration for admission based on their stated intention to practice in an underserved area following graduation?

SCORING IF answer to ANY of Q1, 2 or 3 = yes; score = Yes Yes IF answer to EACH of Q1,2 and 3 = no; score = No No





CLINICAL PRACTICE SITES 4.1. The school has sufficient clinical sites needed to prepare students to competency in accord with ICM guidelines

ICM: III.6 Assessor asks 2 questions of academic teachers. Q1. Are there sufficient clinical sites in which to place students for practical experience? Q2. What is the average number of clinical practice experiences that students conduct on their own with supervision? (Criteria noted in Assessors Handbook)

SCORING

IF answer to Q1 = yes, and answer to each of 2 a, b, c, d, e (see Handbook for minimum numbers) meets or exceeds ICM guidelines; score = Yes Yes

IF answer to Q1 = yes, but answer to one or more of 2 a, b, c, d, e are less than ICM guidelines; score = No No IF answer to Q1 = no; score = No

4.2. The school has clinical practice sites that are accessible to students and teachers (commutable from school to clinical facility in accord with the schedule of clinical experiences)

ICM: III.6 Assessor asks the following questions of academic teachers. Q1. Does the school use any clinical practice sites that are NOT located on the same campus where the school is located? Q2. (If answer to Q1 is yes): Does the school provide transportation to those clinical sites for students and teachers? Q3. (If answer to Q2 is no): Do students or teachers report difficulties in making their way to these clinical sites that result in absence or tardiness?

SCORING

IF answer to Q1 = no, score = Yes

Yes IF answer to Q1 = yes AND answer to Q2 = yes; score = Yes IF answer to Q1 = yes ANC answer to Q2 = no, AND answer to Q3 = no, score = Yes IF answer to Q1 = yes, AND answer to Q2 = no, AND answer to Q3 = yes, score = No No





4.3. The clinical practice site has sufficient medical supplies and other resources needed to train students to competency

ICM: V.4 WHO: SARA clinical practice site assessment tool

Assessor takes the following actions in each health facility that is observed. In antenatal care settings: 1. Conduct an inventory of supplies/equipment present on the unit,

according to guidelines (Assessors Handbook) In intrapartum settings: 1. Conduct an inventory of supplies/equipment present on the unit,

according to guidelines (Assessors Handbook) 2. Count the number of women in labor beds; plus the number awaiting

admission to labor 3. Compute the ratio of supplies/equipment: women in need, according to

the guidelines given on the checklist NOTE that the WHO SARA observational tool can be used if a more exhaustive clinical site review is warranted.

SCORING

IF supplies/equipment are present at designated or computed ratios; score = Yes Yes

IF supplies/equipment are not present in designated or computed ratios; score = No No

4.4. The clinical practice site models practice that is consistent with evidence-based best practices

ICM: IV.5 WHO: 8

Assessor takes three actions. 1. Request to see a copy of clinical practice guidelines (national, regional or

local) 2. Ask at least 3 midwives when they last attended a “clinical update”

course (topic and date). (Standard: within the last 18 months) 3. Ask midwife “in charge” (or lead preceptor) whether a qualified

preceptor is available on the unit on each shift to which a midwifery student is assigned (24 hour)





SCORING

IF guidelines are present on the unit (accessible – not locked away) AND if, each midwife said YES, they had attended a course within the previous 18 months, AND if, in the judgment of the assessor, the topic was appropriate, AND if answer to Q3 is yes, score = Yes

Yes

IF guidelines are accessible BUT if 1 or more of midwives had not attended a clinical update course on an appropriate topic within the last 18 months, AND/OR answer to Q3 is no, score = No

No IF guidelines are not accessible; score = No IF a qualified preceptor is not present when students are assigned to the unit, score = No

CURRICULUM 5.1. The curriculum is aligned with national health priorities, and has been endorsed by the ministry of health and the relevant regulatory and professional bodies

ICM: I.6 Assessor conducts a brief review of most recent curriculum document noting: 1. reference citations; which should include

a) national health plan (or equivalent document) b) at least one document relevant to country burden of disease/health

statistics c) educational resource documents including ICM Essential

Competencies 2. names/titles of those who participated in

development/review/endorsement of the curriculum; which should include a) relevant ministries b) administration and/or academic teachers of the program c) relevant professional body

SCORING IF each of the 6 criteria/sub-criteria is present, score = Yes Yes IF any one of the 6 criteria/sub-criteria are not present, score = No No





5.2. The curriculum is competency-based (contains varied teaching approaches, simulation, clinical practice opportunity, assessment of measurable clinical behaviors)

ICM: IV.2.a; IV.3 WHO: 5,6, 7, 9, 10, 11

Assessor conducts a review of at least two randomly selected courses, in the midwifery specialty, noting that course materials indicate the following: 1. Course methods include more than one measure of teaching/learning 2. Course grade is computed on more than one method of assessment (NOTE that examples of CBE methods are offered in the Assessor Handbook)

SCORING IF both measure 1 and measure 2 are accommodated; score = Yes Yes IF either measure 1 OR measure 2 are accommodated; but the other measure is not accommodated; score = No No

5.3. The curricular content is current and evidence-based

ICM: IV.5 WHO: 1, 2

Option #1: Academic teachers conducts a full curriculum review using ICM’s curriculum mapping tool Option #2: Assessor conducts a review of two randomly selected courses in the midwifery specialty, using ICM’s curriculum mapping tool (NOTE that ICM Essential competencies for basic midwifery practice are congruent with all current best practice guidelines and topics issued by global partner agencies.)

SCORING

IF full curriculum review indicates substantial compliance with ICM Essential Competencies, score = Yes

Yes IF review of two courses indicates substantial compliance with content indicated for the relevant domain, score = Yes IF, in opinion of Academic teachers (full review) or Assessor (course review) any domain is underdeveloped in the curriculum, score = No No





5.4. The curriculum has been reviewed and updated within the past five years

ICM: VI.3; VI.5 Assessor identifies date of last curriculum review. Acceptable sources of evidence include, but are not limited to:: a) date on document b) attestation of Administrator IF Administrator has been in office for at least 5

years prior to the date of assessment c) attestation of 1 or more academic teachers IF academic teacher(s)

has/have been in service for at least 5 years prior to the date of assessment

SCORING

IF date of document is within 5 years of date of review, OR attestation of administrator or academic teacher(s) = yes, score = Yes Yes

IF date of document is more than 5 years of date of review, OR if administrator or academic teacher(s) cannot attest to the date of most recent review, score = No

No

5.5. Teachers have an active role in updating and revising the curriculum

ICM: I.4; VI.3 WHO: 12, 13

Assessor speaks with each academic teacher who has been in service for at least 5 years. 1. Academic teacher(s) is/are asked for attestation that they had an active

role in the curriculum review process 2. Academic teacher(s) is/are asked to describe that role

SCORING

IF answer to Q1 is yes, AND if answer to Q2, in the opinion of the assessor, suggests active participation in course revisions/updates, score = Yes Yes

IF answer to Q1 is no for any academic teacher who has 5 years of service, OR if, in opinion of assessor, no active role can be identified, score = No No





INFLUENCING FACTORS 6.1. The Country has quality standards for midwifery education that address, at minimum, the domains of this framework and ICM Educational standards

ICM: I.6 Assessor asks the following questions. Q1. Is there a government Ministry, Department or organization (e.g., Council) that has been delegated the responsibility for the regulation of midwifery practice? Q2. (IF the answer to Q1 is yes), Is the regulatory agency responsible for setting standards for midwifery education? Q3. Do midwives have a mechanism for providing direct input into these standards? Q4. Has the midwifery education program established a Quality Improvement team/process that conducts an internal review (using ICM standards) at least annually?

SCORING

IF answer to each of Q1, Q2, Q3 and Q4 are yes, score = Yes Yes IF answer to Q1 is no, BUT answer to Q4 is yes, score = Yes (Q3 would be Not

Applicable) IF answer to each of Q1, Q2, and Q4 are no, score = No (Q3 would be Not Applicable) No

6.2. A midwifery education accreditation system is operative in the country that reviews and documents educational quality at least every five years addressing, at minimum, the domains of this framework and ICM Educational standards

ICM: VI.5 Assessor asks the following questions. Q1. Is there a government Ministry, Department or organization (e.g., Council) that has been delegated the responsibility for the regulation of midwifery practice? Q2. (IF the answer to Q1 is yes). Does that department or organization have responsibility for accreditation of education programs? Q3. (IF the answer to Q2 is no). Is there an external/private organization that offers an accreditation mechanism for education programs?





Q4. (If the answer to either Q2 or Q3 is yes). Does this government or private entity take responsibility for reviewing compliance with standards and quality of midwifery education programs in the country at least every 5 years?

SCORING

IF answer to Q1 is yes, AND answer to either Q2 or Q3 are yes, AND answer to Q4 is maximum of 5 years, score = Yes Yes

IF answer to Q1 and Q3 are no; score = No (Q2 and Q4 are not applicable) No IF answer to Q1 is yes, AND answer to either Q2 or Q3 is no, OR if answer to

Q4 is greater than 5 years; score = No

6.3. The Country has a mechanism for independently assessing the competency of graduates prior to deployment within the health system (licensing exam)

ICM: IV.2.b Assessor asks the following questions. Q1. Is there a system of licensing for midwives/nurse midwives before they start practicing? Q2. (If answer to Q1 is yes). Does this system include some measure of assessment of theoretical knowledge and/or clinical competence as a condition of licensure? Q3. (If answer to Q2 is yes). Who is responsible for developing these testing methods?) Q4. What are the minimum pass criteria for this assessment? Q5. Is the license to practice given for life, or is there a criterion for reassessment at a later time, including evidence of clinical practice (such as number of births) and/or for accumulation of continuing education (CE) credits prior to re-licensure? (Note that Q 3, 4, 5 are for information only)

SCORING

IF answer to Q1 and Q2 are yes, score = Yes Yes IF answer to Q1 is no, score = No

No IF answer to Q1 is yes, and answer to Q2 is no, score = No





6.4. The government (country or administrative district) has a committed budget for sustaining midwifery education to meet current and anticipated workforce needs (not dependent on external support)

ICM: I.2 Assessor takes the following steps. Step 1. Assessor requests to review the government (country or administrative district) midwifery budget Step 2. Assessor identifies a line item for midwifery education Step 3. Assessor queries Program Administration about budget sufficiency for year-to-year operational quality and status (Assessors Handbook)

SCORING

IF a midwifery-specific line item is identified in Step 2; and response to each item in Step 3 = no, score = Yes Yes

IF a midwifery-specific line item is identified in Step 2; and response to any item in Step 3 = yes, score = No

No IF the budget is not in the public domain and/or a midwifery-specific line item cannot be identified in the publically available budget, score = No



Relevant Global Documents: International Confederation of Midwives. Midwifery Services Framework. Guidelines for developing SRMNAH services by midwives. http://www.internationalmidwives.org/assets/uploads/documents/Manuals%20and%20Guidelines /MSF%20for%20field-testing,%2017Mar15.pdf International Confederation of Midwives. Essential competencies for basic midwifery practice. 2010, amended 2013. Available at: http://www.internationalmidwives.org/ International Confederation of Midwives. ICM Standard equipment list for competency-based skills training in midwifery schools. 2012. Available at: http://www.internationalmidwives.org/ UNFPA/ICM/WHO. The state of the world’s midwifery. 2014. Available at: http://unfpa.org/public/home/publications/pid/17601 World Health Organization. Midwifery educator core competencies. 2013 Available at: http://www.who.int/hrh/nursing_midwifery/educator_competencies/en/ World Health Organization. Service Availability and Readiness Assessment (undated) Available at: www.who.int/healthinfo/systems/sara_methods/en/ Example of a country-specific guideline document (criteria may exceed the minimum standards cited in this Rapid Assessment Tool) Government of India. Strengthening pre-service education for the nursing and midwifery cadre in India. 2013. Available at: http://www.unicef.org/india/StrengtheningPreServiceEducation%281%29.pdf