Toolkit for strengthening professional midwifery in the Americas
3rd edition
&/$3:56FLHQWL¿F3XEOLFDWLRQ Pan American Health Organization. Latin American Center for Perinatology, Women and Reproductive Health. Toolkit for strengthening professional midwifery in the Americas. 3rd edition. Montevideo: CLAP/WR, 2014. &/$3:56FLHQWL¿FSXEOLFDWLRQ
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Preface ...... 12
Acknowledgments ...... 13
Introduction ......
Executive summary ...... Module 1: Strengthening midwifery services: background paper......
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3XUSRVHRIWKLVWRRONLW ...... 22
7KHFRQFHSWVRIUHSURGXFWLYHKHDOWKDQGVDIHPRWKHUKRRG ...... 23
1.3.1 Reproductive health ...... 23
1.3.2 The status of women ...... 23
1.3.3 The concept of safe motherhood ......
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1.4.1 The early tradition of midwifery: issues of social class and gender ......
1.4.2 The middle tradition of midwifery: issues of technological developments, and the dominance of PDOHSK\VLFLDQVLQWKHSUDFWLFHRIREVWHWULFV ......
1.4.3 The present tradition of midwifery: issues of professional practice ......
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7RRONLWIRUVWUHQJWKHQLQJSURIHVVLRQDOPLGZLIHU\LQWKH$PHULFDV ...... 31
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0RGXOH /HJLVODWLRQDQGUHJXODWLRQ PDNLQJVDIHPRWKHUKRRGSRVVLEOH ...... 32
0RGXOH 'HYHORSLQJVWDQGDUGVWRLPSURYHPLGZLIHU\SUDFWLFH ...... 32
0RGXOH &RPSHWHQFLHVIRUPLGZLIHU\SUDFWLFH ...... 32
0RGXOH 'HYHORSLQJDPLGZLIHU\FXUULFXOXP JXLGHOLQHVIRUPLGZLIHU\HGXFDWLRQSURJUDPV ..... 33
0RGXOH 'HYHORSLQJHIIHFWLYHSURJUDPVIRUSUHSDULQJPLGZLIHWHDFKHUV ...... 33
0RGXOH 6XSHUYLVLRQRIPLGZLYHV ...... 33
0RGXOH 0RQLWRULQJDQGDVVHVVPHQWRIFRQWLQXHGFRPSHWHQF\IRUPLGZLIHU\SUDFWLFH ...... 34
0RGXOH 'HYHORSLQJPLGZLIHU\FDSDFLW\IRUWKHSURPRWLRQRIPDWHUQDODQGQHZERUQKHDOWK .... 34
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Module 2: Legislation and regulation: making safe motherhood possible ...... 43
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2.1.1 The challenge ......
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2.2.1 Developing new regulations ......
2.2.2 Adapting current regulations ......
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2.4.4 Requirements for assessment of continued competency ......
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Module 3: Developing standards to improve midwifery practice ......
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3.2.2 Purpose ......
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8VLQJDQHYLGHQFH±EDVHGDSSURDFKWRHVWDEOLVKDQGGHYHORSVWDQGDUGVIRUPLGZLIHU\HGXFDWLRQ and practice ......
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evidence ......
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Module 4: Competencies for midwifery practice ......
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4.1.1 The midwife as a skilled attendant ......
4.1.2 The scope of midwifery practice ......
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4.2.2 The domains of competence ......
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4.3.1 Key midwifery concepts ......
4.3.2 The midwifery model of care ......
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4.4.2 The evidence that underpins the competencies ......
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'U5LFDUGR+)HVFLQDModule 5: Developing a midwifery curriculum:'UD*LQD7DPELQL guidelines for midwifery *HUHQWH Director de Centro/Coordinador education programs de Proyecto ...... Centro Latinoamericano de Perinatología ÈUHD6DOXGGHOD)DPLOLD\OD&RPXQLGDG Organización Panamericana de la Salud/ y Desarrollo ,QWURGXFWLRQ Humano/ ...... Organización Mundial de la Salud 6DOXGGHOD0XMHU\5HSURGXFWLYD 7KHUROHRIPLGZLYHVLQLPSURYLQJUHSURGXFWLYHKHDOWKVHUYLFHV ...... ÈUHDGH6DOXGGHOD)DPLOLD\OD&RPXQLGDG Organización $SKLORVRSK\RIPLGZLIHU\HGXFDWLRQ Panamericana de la Salud/ ...... Organización Mundial de la Salud 7KHHWKLFVRISURIHVVLRQDOSUDFWLFH ......
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Module 6: Developing effective programs for preparing midwife teachers ......
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3URJUDPVWUXFWXUH ...... 132 6.3.1.1 A stand-alone teacher education program ...... 132 6.3.1.2 Teacher education as an academic focus of study ...... 132 2SWLRQVIRUPLGZLIHWHDFKHUSURJUDPV IXUWKHUH[SORUDWLRQ ...... 132 6.3.2.1 Option 1: Two distinct parts: advanced/post-basic midwifery studies and teacher-education studies .133 6.3.2.2 Option 2: Integrated advanced midwifery theory, education, and practice studies ...... 134 (GXFDWLRQLQVWLWXWLRQUHFRJQLWLRQRIFRPSOHWLRQDQGVWDIIUHTXLUHPHQWVIRUWKH
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Module 7: Supervision of midwives ...... ,QWURGXFWLRQ ...... :KDWLVVXSHUYLVLRQ" ......
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1.4.1 Mentorship ......
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Preface
7KLVWKLUGUHJLRQDOHGLWLRQRIWKH7RRONLWIRUVWUHQJWKHQLQJSURIHVVLRQDOPLGZLIHU\LQWKH$PHULFDVKDVEHHQPDGHSRVVLEOH thanks to the efforts and strong commitment of the technical staff of the Latin American Center for Perinatology/Women DQG5HSURGXFWLYH+HDOWK &/$3:5 RIWKH3DQ$PHULFDQ+HDOWK2UJDQL]DWLRQ 3$+2 DQGWRDWKRURXJKUHYLHZGRQH E\'U-XGLWK)XOOHUWRQ$OOWKLVZRUNZDVFDUULHGRXWLQFROODERUDWLRQZLWKDQHWZRUNRIGHYHORSPHQWSDUWQHUVLQFOXGLQJ WKH8QLWHG1DWLRQV3RSXODWLRQ)XQG 81)3$ WKH8QLWHG6WDWHV$JHQF\IRU,QWHUQDWLRQDO'HYHORSPHQW 86$,' WKH ,QWHUQDWLRQDO&RQIHGHUDWLRQRI0LGZLYHV ,&0 DQGWKH:+2DQG&/$3:5PLGZLIHU\&ROODERUDWLQJ&HQWHUVDWWKH 8QLYHUVLW\RI&KLOHDQGWKH8QLYHUVLW\RI3XHUWR5LFR$OVRYLWDOZDVDWHFKQLFDOUHYLHZFRQGXFWHGE\PLGZLYHVIURP throughout the Region of the Americas.
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Acknowledgments
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Acknowledgments
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0LGZLYHVZKRKDYHEHHQHGXFDWHGDQGOLFHQVHGWRSHUIRUPDQDJUHHGVHWRIFRPSHWHQFLHV nurses who have acquired selected midwifery skills either as part of a nursing curriculum or through special SRVWEDVLFHGXFDWLRQLQPLGZLIHU\ PHGLFDOGRFWRUVZKRKDYHDFTXLUHGWKHVHFRPSHWHQFLHVDWVRPHSRLQWLQWKHLUSUHVHUYLFHRUSRVWEDVLF HGXFDWLRQ REVWHWULFLDQVZKRKDYHVSHFLDOL]HGLQWKHPHGLFDOPDQDJHPHQWDQGFDUHRISUHJQDQF\DQGFKLOGELUWKDQGLQ SUHJQDQF\UHODWHGFRPSOLFDWLRQV
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Strengthening midwifery services: background paper
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Module 1
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1.3.1 - Reproductive health
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Source: ICPD Program of Action, 1994
1.3.2 - The status of women
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Strengthening midwifery services: background paper
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Module 1
strengthening access to and control over income derived from their own employment, and enhancing their LQÀXHQFHRYHUH[SHQGLWXUHVPDGHZLWKKRXVHKROGLQFRPH HJQXWULWLRQSUHYHQWDWLYHDQGFXUDWLYHKHDOWKFDUH VHUYLFHV LQÀXHQFLQJGHYHORSPHQWRISROLFLHVWKDWSURPRWHWKHLUDFFHVVWRHVVHQWLDOREVWHWULFFDUHDQGVLPLODUVHUYLFHVWKDW SURPRWHVDIHPRWKHUKRRGDQGWKDWSURWHFWZRPHQIURPWKHULVNRIYLROHQFHUDSHWUDI¿FNLQJDEXVHDQGFXOWXUDOO\ HPEHGGHGSUDFWLFHVWKDWDUHKDUPIXOWRKHDOWK HJIHPDOHJHQLWDOFXWWLQJ 0HOHLV :+2 &RRNDQG 1JZHQD *ODVLHUHWDO ,\HU6HQDQGgVWOLQ 0EL]YRDQG=DLGL
1.3.3 - The concept of safe motherhood
Safe motherhood is a central component of reproductive health. Many countries have initiated national or local efforts WRLPSURYHDQGH[SDQGPDWHUQDODQGQHZERUQKHDOWKVHUYLFHV6RPHFRXQWULHVKDYHHYHQPDGHHQFRXUDJLQJSURJUHVV LQLPSURYLQJUHSURGXFWLYHKHDOWKDQGSDUWLFXODUO\PDWHUQDODQGQHZERUQKHDOWKRXWFRPHV$OPRVWDOOFRXQWULHVWKDW have achieved such success have done so through strengthening the capacities of those who provide midwifery VHUYLFHV DQG HPHUJHQF\ REVWHWULF FDUH ,PSURYHPHQWV LQ PDWHUQDO DQG QHZERUQ KHDOWK KDYH FRPH DERXW XVXDOO\ ZKHQPLGZLYHVKDYHUHFHLYHGD¿UPHGXFDWLRQDOIRXQGDWLRQIRUSUDFWLFHWKH\KDYHRQJRLQJVXSSRUWIRUWKHLUZRUN VXSSRUWLYH VXSHUYLVLRQ DQG FRQWLQXHG HGXFDWLRQ DQG WKHUH DUH HIIHFWLYH V\VWHPV LQ SODFH WKDW FUHDWH D SRVLWLYH practice environment for midwifery services. These factors create the effective links and mechanism for referral of ZRPHQDQGQHZERUQVZLWKFRPSOLFDWLRQVIRUFRPSUHKHQVLYHHVVHQWLDOREVWHWULFDQGQHRQDWDOFDUH7KHVHOLQNDJHVDUH GHSLFWHGLQ)LJXUHDVDFRQFHSWXDOIUDPHZRUNRITXDOLW\HTXLWDEOHDQGDFFHVVLEOHKHDOWKVHUYLFHV
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Source: WHO, 1994
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A summary of the fundamentals of safe motherhood is offered as follows.
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Source: Thompson, 2005
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Module 1
7KH IROORZLQJ VHFWLRQV EULHÀ\ WUDFH WKH GHYHORSPHQW RI WKH PLGZLIHU\ SURIHVVLRQ7KH\ SURYLGH EULHIFRPPHQWV RQ certain factors that continue to present challenges to the full realization of the potential of the midwife as a key FRQWULEXWRUWRVDIHPRWKHUKRRG
7KH IROORZLQJ VHFWLRQV EULHÀ\ WUDFH WKH GHYHORSPHQW RI WKH PLGZLIHU\ SURIHVVLRQ7KH\ SURYLGH EULHI FRPPHQW RQ certain factors that continue to present challenges to the full realisation of the potential of the midwife as a key FRQWULEXWRUWRVDIHPRWKHUKRRG
1.4.1 - The early tradition of midwifery: issues of social class and gender
0LGZLYHVDUHQDPHGLQHDUO\-HZLVKDQG&KULVWLDQZULWLQJVZKLFKFDOOWKHP³ZLVHZRPHQ´3UHKLVWRULFVFXOSWXUHV DQGDQFLHQW(J\SWLDQGUDZLQJVGHSLFWWKHZRUNRIPLGZLYHV7KHPLGZLYHV¶HIIRUWVZHUHFHQWUDOWRWKHVXUYLYDORIWKH ZRPHQDQGFKLOGUHQRIWKHLUWLPH:RPHQZHUHFDUHWDNHUVDQGKHDOHUV7KH\PL[HGEUHZHGDQGDGPLQLVWHUHGKHUEV DQGSRUWLRQV HDUO\SKDUPDFHXWLFDOV IRUKHDOLQJ7KHNQRZOHGJHDQGVNLOOVRIPLGZLYHVZHUHSDVVHGIURPJHQHUDWLRQ to generation through apprenticeship.
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,Q DQFLHQW WLPHV DQG LQ SULPLWLYH VRFLHWLHV WKH ZRUN RI WKH PLGZLIH KDG ERWK D WHFKQLFDO RU PDQXDO DVSHFWDQGDPDJLFDORUP\VWLFDODVSHFW+HQFHWKHPLGZLIHZDVVRPHWLPHVUHYHUHGVRPHWLPHVIHDUHG VRPHWLPHV DFNQRZOHGJHG DV D OHDGHU RI WKH VRFLHW\ VRPHWLPHV WRUWXUHG DQG NLOOHG 7KH PLGZLIH KDG NQRZOHGJHDQGVNLOOLQDQDUHDRIOLIHWKDWZDVDP\VWHU\WRPRVWSHRSOH6LQFHZRPHQKDGQRDFFHVVWR IRUPDOHGXFDWLRQLWZDVZLGHO\DVVXPHGWKDWWKHPLGZLIH¶VSRZHUPXVWFRPHIURPVXSHUQDWXUDOVRXUFHV VXFKDVDQDOOLDQFHZLWKWKHGHYLO'XULQJWKH0LGGOH$JHVDIUHQ]\RIZLWFKEXUQLQJSURPRWHGE\ERWK FKXUFKDQGFLYLODXWKRULWLHVZDVUHVSRQVLEOHIRUWKHNLOOLQJRIXSWRVHYHUDOPLOOLRQZRPHQPDQ\RIZKRP ZHUHPLGZLYHVDQGKHDOHUV
Source: Sullivan, 2002
Strengthening midwifery services: background paper
1.4.2 - The middle tradition of midwifery: issues of technological developments, and the dominance of male physicians in the practice of obstetrics $VODWHDVWKH¿IWHHQWK FHQWXU\ RQO\ ZRPHQ ELUWK DWWHQGDQWV DUH GHSLFWHG LQ SDLQWLQJV DQG HQJUDYLQJV7KH PDQ PLGZLIHDSSHDUVDURXQGWKHVHYHQWHHQWKFHQWXU\DWDWLPHZKHQWKHPDOHPHGLFDOSURIHVVLRQEHJLQVWRFRQWUROWKH SUDFWLFHRIWKHKHDOLQJDUWV%DUEDUD(KUHQUHLFKDQG'HLUGH(QJOLVKLQWKHLUFODVVLFWUHDWLVHWLWOHGWitches, Midwives and Nurses: A History of Midwifery GRFXPHQWWKHHPHUJHQFHRIWKHPDOHPHGLFDOSURIHVVLRQXQGHU the protection and patronage of the ruling classes.
Medical training was introduced into the arts and sciences taught in medieval universities, from which women were H[FOXGHG7KHJHQHUDOVWDWXVDQGUHSXWDWLRQRIPLGZLIHU\ZDVUHGXFHGHYHQPRUHZLWKLWVXIIHULQJIURPDFRQWLQXHG lack of organization and regulation, and with little or no support for training and development.
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Module 1
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1.4.3 - The present tradition of midwifery: issues of professional practice 0LGZLIHU\DVDSURIHVVLRQKDVLWVRULJLQVLQWKHVHYHQWHHQWKFHQWXU\ZKHQ(XURSHDQFRXQWULHVVXFKDV6ZHGHQ )UDQFH%HOJLXPDQGWKH1HWKHUODQGVEHJDQWRDFNQRZOHGJHWKDWWUDGLWLRQDODWWHQGDQWVDWELUWKUHTXLUHGVSHFLDOLVW HGXFDWLRQDVVLVWDQFHLQVNLOOVGHYHORSPHQWDQGDSSURSULDWHVXSHUYLVLRQ2WKHU(XURSHDQFRXQWULHVVXFKDVWKH 8QLWHG.LQJGRPHYHQWXDOO\IROORZHGVXLWODWHULQWKHQLQHWHHQWKDQGHDUO\WZHQWLHWKFHQWXU\(GXFDWLRQDORSSRUWXQLWLHV RSHQHG IRU ZRPHQ 0LGZLIHU\ LQVWLWXWHV ZHUH HVWDEOLVKHG WKURXJKRXW (XURSH HJ WKH1LJKWLQJDOH :DUG .LQJ¶V &ROOHJH+RVSLWDO/RQGRQ DQGE\H[WHQVLRQLQGHYHORSLQJQDWLRQV 6XPPHUV 0LGZLIHU\UHJXODWLRQ was developed and widely implemented, in the interest of raising the standards of midwifery education and practice 6WHYHQV
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The profession of midwifery at the turn of the century and in the new millennium has emerged in many nations as an autonomous profession, separate from other professions, even though, in many countries, it is linked conceptually DQGSUDFWLFDOO\WRERWKQXUVLQJDQGPHGLFLQH 'DZOH\ ,&0 0LGZLIHU\LQPDQ\RWKHUQDWLRQV WKRVH OHVVHUGHYHORSHGDQGVHYHUDO$VLDQQDWLRQV FRQWLQXHVWRVWUXJJOHWRFKDQJHXQGHUVWDQGLQJVH[SHFWDWLRQVDQG values and to transform traditional cultural paradigms. Midwifery remains an occupation or craft, and it has yet to achieve a professional identity.
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Strengthening midwifery services: background paper
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Scope of Practice
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Source: ICM, 2011
Module 1
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Strengthening midwifery services: background paper
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Module 1
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33 Strengthening midwifery services: background paper
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Strategy to accelerate progress toward the attainment of international development goals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§QPKXNPLGZLIHWLPHOLQHBPLGZLIHWLPHOLQHKWPO>$FFHVVHGRQ2FWREHU@ Strengthening midwifery services: background paper )LJXUH$FRQFHSWXDOIUDPHZRUNRITXDOLW\HTXLWDEOHDQGDFFHVVLEOHKHDOWKVHUYLFHV Quality, equitable and accessible health services Quality and midwifery care COMPETENT AND MOTIVATED NURSING AND MIDWIFERY PERSONNEL 1. Policy and planning 2. Education, training and 3. Deployment and development utilization 1.1 Involvement of nurses and midwives in health 2.1 Coordination between 3.1 Appropiate skill mix policy formulation and education and service and competencies program planning 3.2 Relevant nursing and 2.2 Student recruitment midwifery infraestructure 1.2 Strategic planning for nursing and midwifery 2.3 Competency-based 3.3 Effective leadership and workforce management education management as an integral part of 3.4 Good working conditions human resource 2.4 Multidisciplinary learning and efficiently organized planning and health work system development 2.5 Lifelong learning culture 3.5 Technical supervision systems 1.3 Financing 2.6 Continuing education system 3.6 Career advancement opportunities 3.7 Incentive systems 3.8 Job satisfaction 4. Regulations 5. Evidence-based decision-making Module 1 $QQH[$UDSLGDVVHVVPHQWDSSURDFKWRLGHQWLI\LQJWKH QHHGWRVWUHQJWKHQPLGZLIHU\LQFRXQWU\ &XUUHQW6WDWXV 3 1. Rules/legislation are in No legislation covering Rules are in place but Rules governing Authority for practice SODFHWKDWIUDPHGH¿QH authority to practice not functioning. authority to practice DVGH¿QHGLQWKH the authority to practice midwifery exists. are functioning but are ,&0'H¿QLWLRQRIWKH midwifery. assessed as being Midwife are in place and ineffective. assessed as operating well. 2. A relicensing procedure is No relicensing A relicensing procedure Plans are being A relicensing procedure in place that promotes the procedure is in place. is in place, but is not developed/ is in place and linked to maintenance of continued linked to demonstrating implemented to ensure continued competency competence. competency to relicensing procedures to practice. The practice. that are linked to procedure is operating competent practice. and assessed as being effective. 3. A midwifery education No central standards Central curriculum Curriculum standards Central curriculum curriculum has been have been established standards have been have been revised standards based on developed and is based on for a midwifery established, but no to be in line with ¿WQHVVIRUSXUSRVH particular country needs curriculum. evidence exists that ¿WQHVVIRUSXUSRVH have been established, ³¿WQHVVIRUSXUSRVH´ they meet current however, they are updated, and needs of the country. awaiting approval or implemented. They are implementation. regularly reviewed. (YLGHQFHEDVHG (% EB standards of EB standards are EB standards EB standards are in standards have been comprehensive not developed, or no are currently place and are regularly established for midwifery midwifery care have system is in place for being developed/ DXGLWHG DFWLRQLV SUDFWLFH FRPSHWHQF\EDVHG not been established. regular updating or implemented. taken based on audit auditing. ¿QGLQJV 5. Areas for midwifery and No assessment has Clinical areas do not Clinical areas have Clinical areas provide student clinical practice are been made of clinical provide quality care, or EHHQDVVHVVHG TXDOLW\ quality, comprehensive assessed for the provision of areas. the experiences midwifery care is midwifery care and quality service provision (care required for developing provided. However, the all experiences based on evidence-based competent midwifery areas do not provide required for students of VWDQGDUGV DQGIRUWKHLU¿WQHVV practice. the full experiences midwifery, including to provide appropriate clinical required for developing supportive supervision experience for students to gain competency. of students. competency in midwifery. Strengthening midwifery services: background paper $QQH[ FRQWLQXHG &XUUHQW6WDWXV 3 6. Realistic norms have been 1RVWDI¿QJQRUPV 6WDI¿QJQRUPVDUH A national plan is Norms have been established for the number have been established being established but being developed or established and of midwives needed in each for districts, or norms current numbers of staff revised to establish are being met in all district. for midwives are not in the establishment norms required to meet districts, with only generally known at are below that required current needs. minimal shortfalls of district level. to meet the needs of PLGZLIHU\VWDI¿QJLQ women and newborns some areas. in the district/country. 7. The number of midwives No mapping of The numbers of Mapping of midwives A realistic map of all in clinical posts (both midwives in clinical midwives in clinical in clinical practice is midwives is currently JRYHUQPHQWDQGSULYDWH DUH practice has been practice are known, taking place as part in place and is known known and mapped according undertaken recently. but many vacant posts of a national plan to at national and district to actual place of work. There is no real exist and there is no address needs and level. Special efforts knowledge of the total realistic plan in place to shortfalls. are in place to meet the number of midwives address the shortfall. QHHGVRIKDUGWR¿OO currently working long-term vacant posts. (including in private SUDFWLFH 6XI¿FLHQWPLGZLIHWHDFKHUV No S:TR norms have A realistic S:TR has A plan is currently A realistic S:TR has are in place - based on norms been agreed upon, or been established, but being developed to been established and set for student:teacher ratio the S:TR is unrealistic. is not in place in most address the shortfall is being met in most 6 75 areas. RIPLGZLIHWHDFKHUV places. the plan is based on a realistic S:TR. 9. A program for preparation The numbers of Very few teachers A plan is currently All teachers of of midwife teachers is in midwife teacher of midwifery have being developed/ midwifery have place to ensure that midwife posts required has received training implemented to successfully completed teachers are competent in all not been determined and been assessed ensure all teachers specialist preparation aspects of midwifery practice and/or posting as as competent in all of midwifery are as a midwife teacher. and education, including a midwife teacher aspects of midwifery, competent to be teaching and learning is not determined as well as competency teachers of midwifery. strategies, and have been by successfully to teach. adequately prepared for their completing a specialist post. teacher preparation program/educational course. Module 1 $QQH[ FRQWLQXHG &XUUHQW6WDWXV 3 10. Quality teaching and No or very few TandL Limited TandL Plans are currently 6XI¿FLHQWDQGYDULHG OHDUQLQJ 7DQG/ UHVRXUFHV resources are available resources are available in place to develop TandL materials of are available. at all midwifery at most centers, but in- country appropriate good quality are schools/ educational many are out of date. quality TandL material available and being institutions. to be available at all used in all centers. centers. 11. Job descriptions for 1RVSHFL¿FMRE Job descriptions of Job descriptions Job descriptions midwife at all levels of service description is clinical midwife posts are currently being VSHFL¿FWRPLGZLIHU\ LQFOXGLQJWKHFRPPXQLW\ available for the are too vague, do not reviewed/updated, to SUDFWLFHDUHLQSODFH have been developed, are person who provides specify the particular HQVXUHWKDWVSHFL¿FVRI they are based on regularly updated/revised, PLGZLIHU\FDUHRUMRE needs of midwifery, or midwifery practice are provision of EB and include statements about descriptions are not are out of date. covered, including EB standards of care in the minimum standard of prepared for posts at standards of care and all areas, including the midwifery practice required by all levels of the service. practice. community. the post holder. 12. An in-service/updating There is no provision Limited updating is A plan is being All midwifery program (prescribed by the for updating or in- available to some developed to practitioners participate midwifery association and/or VHUYLFHDQGRQWKHMRE midwifery practitioners implement a regular in a regular updating developed in liaison with the training. in some areas. updating program program. All have PLGZLIHU\UHJXODWRU\ERG\ LV for all midwifery received some in place. practitioners in all updating in the last areas, including rural, three years. hard-to-reach areas. 13. Provision has been made No or limited provision Provision of CEP/ Plans are currently Midwifery practitioners for continuing education has been made for advanced education being developed or at all levels of the SURJUDPV &(3 IRU midwifery practitioners programs for midwifery implemented that service have the strengthening the capacity to participate in CEP/ practitioners to will increase access opportunity to of midwives in country to advanced education increase capacity to CEP/advanced participate fully in provide leadership, and for programs, and/or of midwives to plan education programs, CEP or advanced FDUHHUHQKDQFHPHQW WKH research development, and deliver quality including midwifery education programs, strategy is operating well. management, policy, or midwifery, including management and including specialist leadership programs. research and research. midwifery studies management services, at both Master’s is under consideration. and Ph.D. level and specialist programs for midwifery leadership, management, and research and policy development. 7DEOHOHJHQGVFRULQJUXOH ORZDQG KLJKHVW LGHDOLVWRVFRUHIRUHDFKFULWHULRQ Total score 'DWHDVVHVVPHQWXQGHUWDNHQ Module 2 ,QWURGXFWLRQ 7KH DLP RI WKLV PRGXOH LV WR RXWOLQH WKH ZD\V LQ ZKLFK OHJLVODWLRQ DQG SURIHVVLRQDO UHJXODWLRQ RI PLGZLYHV FDQ EH HPSOR\HGWRHQKDQFHQDWLRQDODQGLQWHUQDWLRQDOHIIRUWVWRUHGXFHPDWHUQDODQGQHZERUQPRUELGLW\DQGPRUWDOLW\DQG LPSURYHUHSURGXFWLYHKHDOWKLQDFFRUGZLWK:+2¶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module of the Toolkit for strengthening professional midwifery in the Americas addresses a range of issues related to WKHVWDWXWRU\RUUHJXODWRU\ OHJDO DXWKRULW\WKDWJRYHUQVWKHSUDFWLFHRIPLGZLIHU\LQDQ\FRXQWU\DQGWKHDXWKRUL]DWLRQRI LQGLYLGXDOVWRHQJDJHLQPLGZLIHU\SUDFWLFH RFFXSDWLRQDORUSURIHVVLRQDOUHJLVWUDWLRQDQGRUOLFHQVLQJ :KLOHWKHHPSKDVLVLQWKLVPRGXOHLVRQOHJLVODWLRQWRVXSSRUWPLGZLIHU\SUDFWLFHOHJLVODWLRQDOVRKDVWREHFRQVLGHUHG IRURWKHUKHDOWKFDUHZRUNHUVZKRIXQFWLRQLQWKHUHSURGXFWLYHKHDOWK¿HOGSDUWLFXODUO\WKRVHZKRSURYLGHSUHJQDQF\ DQGFKLOGELUWKFDUH6LPLODUO\UHSURGXFWLYHKHDOWKOHJLVODWLRQKDVWREHFRQVLGHUHGLQUHODWLRQWRRWKHUODZVWKDWLQÀXHQFH WKHSRVLWLRQRIZRPHQLQVRFLHW\JHQHUDOO\ $QGRUQR *DUFLD0RUHQRDQG6W|FNO &RRNDQG'LFNHQV 2.1.1 - 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The midwife is prepared to provide effective care for women who are XQGHUJRLQJQRUPDOSUHJQDQF\DQGFKLOGELUWKEXWDOVRIRUZRPHQDQGQHZERUQVZKRH[SHULHQFHFRPSOLFDWLRQVPDQ\ RIZKLFKDUHOLIHWKUHDWHQLQJ WKXVWKHQHHGIRUOHDUQLQJOLIHVDYLQJVNLOOV 7KHFRPSHWHQF\EDVHGPRGHOFXUULFXODDUH WREHLQWHUSUHWHGRQO\DVDFRQWHQWJXLGH$Q\SURJUDPRIPLGZLIHU\HGXFDWLRQVKRXOGFRQIRUPWRWKHVWDQGDUGVDQG JXLGHOLQHVDVSURPXOJDWHGE\WKH,&0IRUPLGZLIHU\HGXFDWLRQDURXQGWKHJOREH ,&0 DQGPXVWLQFRUSRUDWH VXI¿FLHQWWLPHIRUVWXGHQWVWRDFTXLUHFOLQLFDOSUR¿FLHQF\ 7KHUHPD\EHGLIIHUHQWOHYHOVRITXDOL¿FDWLRQIRUYDULRXVFDGUHVRISUDFWLWLRQHUV HJDX[LOLDU\QXUVHPLGZLIH ZKRDUH HGXFDWHGLQVRPHSDUWEXWQRWDOORIWKHIXOOVFRSHRIPLGZLIHU\SUDFWLFHLQDVLQJOHFRXQWU\DQGZKRGRQRWPHHWWKH GH¿QLWLRQRIWKHIXOO\TXDOL¿HGSURIHVVLRQDOPLGZLIH ,&0 7KHSURIHVVLRQDOPLGZLIHU\UHJXODWRU\ERG\PD\KDYH DXWKRULW\WRGH¿QHWKHHGXFDWLRQDOSDWWHUQVDQGWKHH[SHFWHGRXWFRPHVRIWKHYDULRXVOHVVTXDOL¿HGFDGUHV2WKHU FRXQWULHVPD\FKRRVHWRHVWDEOLVKVHSDUDWHUHJXODWRU\ERDUGVIRUWKHYDULRXVFDGUHVWRHQVXUHWKDWWKHUHLVVXI¿FLHQW UHSUHVHQWDWLRQ RI WKH SDUWLFXODU FDGUH W\SH RQ WKH ERDUG RU FRXQWU\ HTXLYDOHQW WKDW KDV WKH DXWKRULW\ WR UHJXODWH practice. Module 2 2.4.3 - Entry into practice and initial licensure $SULPDU\SXUSRVHRIOLFHQVLQJERGLHVLVWRSURWHFWWKHSXEOLFIURPXQVDIHSUDFWLFH7KHUHIRUHWKHH[SHFWHGRXWFRPHV RI PLGZLIHU\ HGXFDWLRQ SURJUDPV WKH NQRZOHGJH VNLOOV DQG EHKDYLRUV H[SHFWHG RI VDIH EHJLQQLQJ SUDFWLWLRQHUV DUHDOVRRIWHQH[SOLFLWO\FLWHGDVWKHFRPSRQHQWHOHPHQWVRIHQWU\LQWRSUDFWLFHUHTXLUHPHQWVWKDWDUHHVWDEOLVKHGE\ UHJXODWRU\ERDUGV7KHUHPD\EHDGGLWLRQDOUHTXLUHPHQWVVXFKDVVWDQGDUGL]HGWHVWLQJ HJQDWLRQDOFHUWL¿FDWLRQRU OLFHQVXUHH[DPLQDWLRQV DVDUHTXLUHPHQWIRU¿UVWOLFHQVXUH7KHUHJXODWRU\ERG\VKRXOGDOVRDGGUHVVHTXLYDOHQWVIRU LQWHUQDWLRQDOO\TXDOL¿HGPLGZLYHV HVWDEOLVKLQJPHFKDQLVPVDQGSDWKZD\VIRUUHYLHZLQJWKHLUFUHGHQWLDOVYHULI\LQJ TXDOL¿FDWLRQVDQGGHWHUPLQLQJWKHLQGLYLGXDO¶V¿WQHVVIRUSUDFWLFHXQGHUWKHUHTXLUHPHQWVRIWKHQHZ WKHUHFHLYLQJ FRXQWU\ 0HDG .LQJPD %LHVNL 5HJXODWRU\ERDUGVDUHDOVRWKHJDWHNHHSHUVRIWKHSURIHVVLRQDOUHJLVWHURITXDOL¿HGPLGZLYHVLHWKHOLVWRIWKRVHZKR have complied with all statutory requirements for initial entry into practice, and for relicensure. This information should EHDFFHVVLEOHWRWKRVHVHHNLQJWRHPSOR\PLGZLYHV$UHJLVWHULVDOVRYHU\XVHIXOLQZRUNIRUFHSODQQLQJ 2.4.4 - Requirements for assessment of continued competency 7KHDXWKRULW\WRHQWHULQWRSUDFWLFHPD\EHJLYHQIRUWKHRFFXSDWLRQDOSURIHVVLRQDOOLIHWLPHRULWPD\EHWLPHOLPLWHG &RXQWULHVPD\ DQGDUHVWURQJO\HQFRXUDJHGWR GHYHORSUHJXODWLRQVWKDWUHTXLUHDUHDSSOLFDWLRQIURPWLPHWRWLPH for the authority to practice. These regulations may require evidence that the individual has engaged in a program RIFRQWLQXLQJHGXFDWLRQ IRUHQKDQFHPHQWRINQRZOHGJH DQGRUUHDVVHVVPHQWRISUDFWLFHVNLOOV$QDVVHVVPHQWRI FRQWLQXHGFRPSHWHQF\ZRXOGEHSDUWLFXODUO\LPSRUWDQWIRUWKRVHZLVKLQJWRUHWXUQWRWKHSURIHVVLRQDIWHUDQDEVHQFH IURPWKHZRUNIRUFH WKLVVKRXOGEHDGGUHVVHGLQWKHUHJXODWLRQV 0DLQWDLQLQJFXUUHQWFRPSHWHQF\PD\EHSDUWLFXODUO\FKDOOHQJLQJIRUPLGZLYHVLQFRXQWULHVZKHUHWKHUHLVQRUHJXODU program for the continuing educational development for midwives. 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The consideration of the importance of the continued competency of teachers in EDVLFPLGZLIHU\HGXFDWLRQSURJUDPVLVDGGUHVVHGLQ0RGXOH7KHVHVWUDWHJLHVFRXOGEHUHIHUHQFHGLQWKHUHJXODWLRQV DVRQHDSSURDFKIRUPHHWLQJDQ\FRQWLQXHGFRPSHWHQF\UHTXLUHPHQWWKDWPD\EHHVWDEOLVKHGLQWKHUHJXODWLRQV 2.4.5 - Standards of practice 7KHUHJXODWRU\JXLGHOLQHVVKRXOGLQFRUSRUDWHUHIHUHQFHWRVWDQGDUGVRIKLJKTXDOLW\SUDFWLFH+RZHYHULWLVQHLWKHU QHFHVVDU\QRUHI¿FLHQWIRUWKHUHJXODWRU\ERDUGWRHVWDEOLVKWKHVHVWDQGDUGVEHFDXVHWKHHYLGHQFHWKDWXQGHUSLQV FOLQLFDOSUDFWLFHLVHYHUHYROYLQJ%HVWSUDFWLFHVWDQGDUGVFKDQJHUDSLGO\3UDFWLWLRQHUVVKRXOGEHDEOHWRLQFRUSRUDWH Legislation and regulation: making safe motherhood possible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practitioners or for their removal from the professional register if they are found guilty of misconduct or malpractice. 0LVFRQGXFWPLJKWEHVLPSO\GH¿QHGDV³FRQGXFWXQZRUWK\RIDSURIHVVLRQDO´:KDWFRQVWLWXWHVPLVFRQGXFWZLOOGLIIHU DPRQJFRXQWULHVEXWZRXOGOLNHO\LQFOXGHSXWWLQJWKHSURIHVVLRQLQWRGLVUHSXWHRUVHYHUDOPDWWHUVWKDWDUHDGGUHVVHG LQFLYLOODZ HJDVVDXOWRUWKHIWIURPDFOLHQW 0DOSUDFWLFHPLJKWEHGH¿QHGDV³ODFNRINQRZOHGJHRUH[SHULHQFHRUWKHQHJOLJHQWSHUIRUPDQFHRIGXWLHVWKDWUHVXOW LQSDWLHQWLQMXU\´ *QGR÷PXúh1g]NDUD(0HWH6 WKDWLVWKHIDLOXUHWRSURYLGHDFFHSWDEOHOHYHOVRIKHDOWK FDUH +XJK DQG 'HNNHU 0LROD 0LGZLYHV KDYH EHHQ UHSRUWHG WR EH UHVSRQVLEOH IRU VHYHUDO W\SHV RI malpractice: :URQJIXOGLVFORVXUHRISHUVRQDOLQIRUPDWLRQDERXWFOLHQWV IDLOXUHWRGLVFORVHULVNVRIFKRLFHVDQGRSWLRQVLQFKLOGELUWK %LVPDUNHWDO LQFRPSOHWHPRQLWRULQJRISUHJQDQF\DQGLQDFFXUDWHDVVHVVPHQWRISUHJQDQF\UHODWHGFRQGLWLRQVOHDGLQJWR DGYHUVHFKDQJHVLQWKHFOLHQW¶VKHDOWKVWDWXV QHJOLJHQWFDUH 0R\QLKDQDQG0HQJHUVHQ IDLOXUHWRGHWHFWSUHJQDQF\UHODWHGSUREOHPVDQGWRUHIHUWKHZRPDQWRKLJKHUOHYHOVRIFDUHLQDWLPHO\ PDQQHU IDLOXUHWRSHUIRUPWDVNVLQDVNLOOIXOPDQQHUUHVXOWLQJLQLQMXU\WRWKHFOLHQW HJLQDSSURSULDWHWHFKQLTXHIRU PDQDJHPHQWRIEUHHFKGHOLYHU\RUVKRXOGHUG\VWRFLD $QJHOLQLDQG*UHHQZDOG PHGLFDWLRQHUURUV HJURXWHUHJLRQDQGWHFKQLTXHRIGUXJDGPLQLVWUDWLRQ -RQVVRQ1RUGpQDQG+DQVRQ ,QDQ\FLUFXPVWDQFHXQSURIHVVLRQDOFRQGXFWDQGSURIHVVLRQDOPLVFRQGXFWFDQRIWHQEHYHU\GLI¿FXOWWRGHWHFWDQG HYHQPRUHGLI¿FXOWWR³SURYH´ZLWKVXI¿FLHQWHYLGHQFHWRZDUUDQWDGLVFLSOLQDU\DFWLRQ -RKQVWRQHDQG.DQLWVDNH 7KHSRLQWRILQFOXGLQJUHIHUHQFHWRVWDQGDUGVRISUDFWLFH VXFKDVWKH:+26WDQGDUGVIRU0DWHUQDODQG1HRQDWDO&DUH ZLWKLQDUHJXODWRU\VWDWXWHRUJXLGHOLQHLVWRHVWDEOLVKDQREMHFWLYHH[WHUQDOFULWHULRQRI³EHVWSUDFWLFH´WRZKLFKWKH DFWLRQ V RIDQ\LQGLYLGXDOFDQEHFRPSDUHGDQGWKHQFRQVLGHUHGLQOLJKWRIWKHSDUWLFXODUSUDFWLFHFLUFXPVWDQFHV HJ WKHVLWHRIFDUHRUWKHDYDLODELOLW\RIDOWHUQDWLYHRSWLRQV 7KHVHVWDQGDUGVZLOODXJPHQWWKHH[SHUWZLWQHVVWHVWLPRQ\ WKDWZLOOHVWDEOLVKWKHH[SHFWHGVWDQGDUGRIFDUHXQGHUWKHFLUFXPVWDQFHV Module 2 ,WLVLPSRUWDQWWRQRWHWKDWDQXQGHVLUDEOHRXWFRPHLVQRWQHFHVVDULO\WKHUHVXOWRISURIHVVLRQDOPLVFRQGXFWRUXQVDIH SUDFWLFH6RPHXQGHVLUDEOHRXWFRPHVDUHXQDYRLGDEOH VXFKDVFRQJHQLWDODQRPDOLHVLQFRPSDWLEOHZLWKOLIH 2WKHUV RFFXUGHVSLWHWKHEHVWHIIRUWVRIPLGZLYHVWRLQWHUYHQHDSSURSULDWHO\DQGWRDVVLVWWKHLUFOLHQWVWRJDLQDFFHVVWRKLJKHU levels of care when circumstances warrant such action. 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'H¿QLWLRQRISURIHVVLRQDOPLGZLIHU\DQGRIOHVVHUVNLOOHGFDGUHV Ź &DWHJRULHV FDGUHV RIWKHSURIHVVLRQDOWKDWDUHJRYHUQHGE\WKHUHJXODWLRQV SURWHFWLRQRIWKH WLWOH Ź UHVSRQVLELOLWLHVRIHDFKFDGUH Ź scope of practice of each cadre. 5HTXLUHPHQWVIRUHQWU\LQWRWKHSURIHVVLRQ Ź VWDQGDUGVDQGJXLGHOLQHVIRUSUHVHUYLFHHGXFDWLRQSURJUDPV Ź competencies at entry into practice. 0HFKDQLVPVIRULQLWLDOOLFHQVLQJ Ź WHVWLQJUHTXLUHPHQWV LIVHOHFWHGE\WKHFRXQWU\ DQGPLQLPXPSDVVVWDQGDUG Ź HTXLYDOHQF\OLFHQVLQJPHFKDQLVPVIRUPLGZLYHVHGXFDWHGLQRWKHUFRXQWULHV Ź TXDOL¿FDWLRQYHUL¿FDWLRQ Ź WHUPRIWKHLQLWLDOOLFHQVH Ź LQLWLDOOLFHQVHIHHV LIHVWDEOLVKHGE\WKHFRXQWU\ 0HFKDQLVPVIRUUHOLFHQVLQJDQGRUUHHQWU\LQWRWKHZRUNIRUFH Ź FRQWLQXHGFRPSHWHQF\DVVHVVPHQWUHTXLUHPHQWV LIVHOHFWHGE\WKHFRXQWU\ Ƈ 8SGDWHVIRUNQRZOHGJH Ƈ UHDVVHVVPHQWRIFOLQLFDOVNLOOV Ź UHOLFHQVHIHHV LIHVWDEOLVKHGE\WKHFRXQWU\ 6WDQGDUGVRISURIHVVLRQDOPLGZLIHU\SUDFWLFH 3URWRFROIRUGHDOLQJZLWKPLVFRQGXFWDQGRWKHUXQ¿WIRUSUDFWLFHLVVXHV Ź FULWHULDIRUYROXQWDU\RULQYROXQWDU\UHPRYDOIURPWKHUHJLVWU\ Ź FRQVHTXHQFHVIRUD¿QGLQJRISURIHVVLRQDOPLVFRQGXFW Ź appeal mechanism. 2SWLRQDOFRPSRQHQWV Code of conduct/code of ethics or the general values and principles underpinning the professional practice of midwifery practice of midwifery. Module 2 $QQH[ $FKLHYLQJ FKDQJH LQ PLGZLIHU\ OHJLVODWLRQ DQG UHJXODWLRQIRUVDIHPLGZLIHU\FDUH Stage 4XHVWLRQ Yes No $FWLRQ5HTXLUHG (VWDEOLVKLQJJRDOV Is the purpose of midwifery practice in the national context DQGSULQFLSOHV established? ,VWKHUHFRQVHQVXVRQWKHFDWHJRULHVRIKHDOWKSURYLGHU V permitted to practice the art and science of midwifery in the national context. Is the purpose for regulation and licensing of midwifery and those permitted to practice midwifery explicit and clear? ,VWKHUHDQDWLRQDOGH¿QLWLRQ DJUHHGWRE\DOOVWDNHKROGHUV RIDPLGZLIH",VWKHGH¿QLWLRQFOHDUDQGVXI¿FLHQWWRHQDEOH WLWOHSURWHFWLRQ",VLWFRQVLVWHQWZLWKWKHGH¿QLWLRQRIPLGZLIH and skilled birth attendant promulgated by ICM and WHO? Are the role and responsibilities of a midwife explicit and have they been agreed by all stakeholders? Are the competencies required for safe midwifery practice explicit and do they ensure that the midwives providing FRPSUHKHQVLYHPLGZLIHU\FDUHDUHDEOHWRIXO¿OOWKHLUUROH and responsibilities as agreed upon nationally? 'RWKHFRPSHWHQFLHV¿WWKHICM Essential Competencies for Basic Midwifery Practice and the WHO/ICM/FIGO list of competencies for a skilled attendant for pregnancy and childbirth? Does the scope of practice for this practitioner meet the national priorities for safe midwifery care? /HJDOFRQVWUDLQWV Do the national policies and laws related to drugs and DQGEDUULHUV PHGLFLQHV LQFOXGLQJSUHVFULELQJDGPLQLVWUDWLRQDQGVDIHW\ permit the midwife to administer essential drugs to the women or newborn, including giving life saving drugs for management of a complication in pregnancy, childbirth and/or postnatal period? Legislation and regulation: making safe motherhood possible $QQH[ FRQWLQXHG Stage 4XHVWLRQ Yes No $FWLRQ5HTXLUHG Do the national polices and laws permit midwives (and RWKHUVSUDFWLFLQJPLGZLIHU\ WRFDUU\RXWDOOWKHQHFHVVDU\ FDUHDQGLQWHUYHQWLRQVUHTXLUHGWRIXO¿OOWKHLUUROHDQG responsibilities. Do the national policies and laws permit midwives and others practicing midwifery to carry out all the necessary evidence-based life-saving procedures for safe pregnancy, childbirth and postnatal and neonatal care? 6WUDWHJLHVIRU Is there a national task force/committee or high-level forum GHYHORSLQJHIIHFWLYH established for revising and or drafting regulation and legislation and licensing for midwifery? UHJXODWLRQ Does the national task force/committee ensure representation from all stakeholders, including women, consumers, and the general public? Are there mechanisms to ensure that the voices of women as users or potential users of midwifery services are heard during development of the regulations? Are there national evidence-based standards for midwifery practice and mechanisms for auditing and reviewing these standards? $FKLHYLQJWKH Is there a process for national public consultation FKDQJH and consensus-building on regulation and licensing governing midwifery practice, is this widely known, and are time frames adequate to ensure all stakeholders can participate? Are there clear timelines set and agreed upon for approval of new regulation and licensing for midwifery? Are the roles and responsibilities of all stakeholders clear for achieving the revision/development of new midwifery regulation and licensing, including for implementation of WKHQHZUHJXODWLRQVZKHQ¿QDOO\DSSURYHG" Module 2 $QQH[ FRQWLQXHG Stage 4XHVWLRQ Yes No $FWLRQ5HTXLUHG Have all resources required for achieving the required FKDQJHLQFOXGLQJ¿QDQFLDODQGKXPDQUHVRXUFHVEHHQ FOHDUO\LGHQWL¿HG" 0RQLWRULQJDQG Have clear indicators been established for monitoring HYDOXDWLRQ implementation of the new regulations and licensing mechanisms? Is it clear who is responsible for monitoring compliance with new regulations? 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The WHO has engaged in the process of development of generic standards for maternal and neonatal care that countries FDQ XVH DV D EDVLV IRU HVWDEOLVKLQJ HYLGHQFHEDVHG QDWLRQDO VWDQGDUGV RI FDUH WKH FRPSOHWH VHW RI VWDQGDUGV FDQ EHDFFHVVHGDWWKHOLQNSURYLGHGLQWKHIRRWQRWH1 6WDQGDUGVRIPLGZLIHU\SUDFWLFHVKRXOGUHÀHFWQDWLRQDODQGJOREDO VWDQGDUGVDQGWKHUHIRUHDUHQRWGLVWLQFWIURPWKHVHQRUPVHVWDEOLVKHGIRUDOOVNLOOHGDWWHQGDQWV 7KHEURDGHUFRQWHQWRIPLGZLIHU\VWDQGDUGVLQFOXGHVWKHTXDOLW\RIWKHPLGZLIH¶VSUHSDUDWLRQIRUKHUUROH 0RULQDQG 1KWWS ZZZZKRLQWUHSURGXFWLYHKHDOWKSXEOLFDWLRQVPDWHUQDOBSHULQDWDOBKHDOWKD HQLQGH[KWPOO 27KHXVHRIWKHIHPDOHJHQGHUUHÀHFWVWKDWLQPDQ\FRXQWULHVPLGZLIHU\LVVHHQDVH[FOXVLYHO\RSHQWRZRPHQ+RZHYHULQDQXPEHU RIQDWLRQVPHQQRZHQWHUWKLVSURIHVVLRQ7KH,&0LQWHUQDWLRQDOGH¿QLWLRQKDVEHHQXSGDWHGWRUHÀHFWPRUHJHQGHUQHXWUDOODQJXD JH KRZHYHUWKLVJXLGDQFHXVHVWKHIHPDOHJHQGHUIRUHDVHRIXVH Developing standards to improve midwifery practice AJORVVDU\RIWHUPVUHODWHGWRVWDQGDUGVDQGVWDQGDUGVHWWLQJ Enabling environment: A health care practice setting that provides mechanisms (e.g., policy framework, human UHVRXUFHV HTXLSPHQW DQG VXSSOLHV UHIHUUDO V\VWHPV DQG OLQNDJHV WKDW VXSSRUW TXDOLW\ KHDOWK FDUH VHUYLFH according to standards. 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A VNLOOHG DWWHQGDQW LV DQ DFFUHGLWHG KHDOWK SURIHVVLRQDO ± VXFK DV D PLGZLIH GRFWRU RU QXUVH ± ZKR KDV EHHQ HGXFDWHG DQG WUDLQHG WR SUR¿FLHQF\ LQ WKH VNLOOV QHHGHG WR PDQDJH QRUPDO XQFRPSOLFDWHG SUHJQDQFLHVFKLOGELUWKDQGWKHLPPHGLDWHSRVWQDWDOSHULRGDQGLQWKHLGHQWL¿FDWLRQPDQDJHPHQWDQG UHIHUUDORIFRPSOLFDWLRQVLQZRPHQDQGQHZERUQV Source: WHO / ICM / FIGO, 2004 7KHPLGZLIHDVDVNLOOHGDWWHQGDQW 7KH PLGZLIH ZKR KDV EHHQ HGXFDWHG DQG DXWKRUL]HG WR SUDFWLFH LQ DFFRUG ZLWK WKH LQWHUQDWLRQDO GH¿QLWLRQ RI WKH PLGZLIHLVUHFRJQL]HGDVDVNLOOHGELUWKDWWHQGDQW VHH0RGXOHIRUDGGLWLRQDOGLVFXVVLRQDQGIRUWKHIXOOVWDWHPHQWRI WKHLQWHUQDWLRQDOGH¿QLWLRQRIDPLGZLIHDQGVFRSHRISUDFWLFH 7KLVGH¿QLWLRQUHÀHFWVWKHFRPPLWPHQWRIPLGZLYHVWR EHSUHSDUHGIRUWKHLUUROHDFFRUGLQJWRDFHUWDLQVWDQGDUGRIHGXFDWLRQDQGWRSUDFWLFHZLWKLQDV\VWHPRIUHJXODWLRQ DQGVXSHUYLVLRQWKDWSURPRWHVWKHKLJKHVWVWDQGDUGVRIRFFXSDWLRQDODQGSURIHVVLRQDODFFRXQWDELOLW\ ,QWHUQDWLRQDO'H¿QLWLRQRIWKH0LGZLIH>DEULGJHG@ $ PLGZLIH LV D SHUVRQ ZKR KDYLQJ EHHQ UHJXODUO\ DGPLWWHG WR D PLGZLIHU\ HGXFDWLRQDO SURJUDP WKDW LV GXO\ UHFRJQLVHGLQWKHFRXQWU\ZKHUHLWLVORFDWHGDQGWKDWLVEDVHGRQWKH,&0Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education ZKRKDVDFTXLUHGWKH UHTXLVLWHTXDOL¿FDWLRQVWREHUHJLVWHUHGDQGRUOHJDOO\OLFHQVHGWRSUDFWLFHPLGZLIHU\DQGXVHWKHWLWOH³PLGZLIH´ DQG who demonstrates competency in the practice of midwifery Source: ICM, 2011 Competencies for midwifery practice 4.1.2 - The scope of midwifery practice 7KHVFRSHRIPLGZLIHU\SUDFWLFHXVHGWKURXJKRXWWKLVGRFXPHQWLVEDVHGRQWKH,&0GH¿QLWLRQRIWKHPLGZLIH7KH,&0 recognizes the scope of midwifery practice to include: (GXFDWLRQDQGFRXQVHOLQJRQVH[XDODQGUHSURGXFWLYHKHDOWKDQGSURYLVLRQRIFRQWUDFHSWLYHPHWKRGV SURYLVLRQRIVXSSRUWFDUHDQGDGYLFHGXULQJWKHLQWHUFRQFHSWLRQDOSUHJQDQF\ODERUDQGSRVWSDUWXP SHULRGV WKHFRQGXFWRIELUWKVRQWKHPLGZLIH¶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¿FKHDOWKFRQFHUQVDQGHSLGHPLRORJLFDOFKDOOHQJHV HJ+,9$,'6 6HOHFWHG IXQFWLRQV ZLWKLQ WKH VFRSH RI FRPSUHKHQVLYH PLGZLIHU\ SUDFWLFH PD\ DOVR EH VKDUHG ZLWK RWKHU FDGUHV RI FRPPXQLW\EDVHGKHDOWKSURYLGHUV7KHWLWOHVRIWKHVHLQGLYLGXDOVPD\YDU\ZLGHO\GHSHQGLQJRQWKHVSHFL¿FFRXQWU\ FRQWH[W .REOLQVN\HWDO &HUWDLQIXQFWLRQVPLJKWEHGHOHJDWHGWRKHDOWKZRUNHUVZKRPD\KDYHUHFHLYHGYHU\ VSHFL¿FWUDLQLQJWRFRQGXFWFHUWDLQWDVNVUHODWHGWRWKHSURYLVLRQRISUHJQDQF\DQGELUWKFDUH RIWHQWHUPHG³WDVNVKDULQJ´ RUWDVNVKLIWLQJ´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¿QLWLRQRIFRPSHWHQFH is fundamental to understanding the commitment to safe care. 7KHRUHWLFDODQGRSHUDWLRQDOGH¿QLWLRQV 7KHVHYHUDOGH¿QLWLRQVRIFRPSHWHQFHWKDWKDYHEHHQVHWIRUWKLQWKHOLWHUDWXUHDUHVLPLODULQWKDWWKH\DFNQRZOHGJHWKDW competence is a theoretical concept that includes several underlying concepts and characteristics, each of which makes an LQWHUDFWLYHFRQWULEXWLRQWRVDIHSUDFWLFH 17KHXVHRIWKHIHPDOHJHQGHUUHÀHFWVWKDWLQPDQ\FRXQWULHVPLGZLIHU\LVVHHQDVH[FOXVLYHO\RSHQWRZRPHQ+RZHYHULQDQXPEHU RIQDWLRQVPHQQRZHQWHUWKLVSURIHVVLRQ7KHLQWHUQDWLRQDOGH¿QLWLRQ ,&0 KDVEHHQXSGDWHGWRUHÀHFWDPRUHJHQGHUQHXWUDO ODQJXDJH KRZHYHUWKLVJXLGDQFHXVHVWKHIHPDOHJHQGHUIRUHDVHRIXVH Module 4 A glossary of terms related to professional competence &RQFHSWXDO GH¿QLWLRQ RI FRPSHWHQFH 7KH FRPELQDWLRQ RI NQRZOHGJH VNLOOV DQG DELOLWLHV WKDW HQDEOH DQ LQGLYLGXDOWRSHUIRUPDVSHFL¿FWDVNLQDPDQQHUWKDW\LHOGVGHVLUDEOHRXWFRPHV 2SHUDWLRQDO GH¿QLWLRQ RI FRPSHWHQFH 7KH GRFXPHQWDWLRQ RI DQ DFFHSWDEOH OHYHO RI SHUIRUPDQFH WKURXJK DSURFHVVRIVWUXFWXUHGDVVHVVPHQWXVLQJREMHFWLYHVWDQGDUGVRISURIHVVLRQDOSUDFWLFH NQRZOHGJHVNLOOVDQG DELOLWLHV DVWKHFULWHULDRITXDOLW\ ,&0 GH¿QLWLRQ RI FRPSHWHQFH 7KH FRPELQDWLRQ RI NQRZOHGJH SV\FKRPRWRU FRPPXQLFDWLRQ DQG GHFLVLRQ PDNLQJVNLOOVWKDWHQDEOHDQLQGLYLGXDOWRSHUIRUPDVSHFL¿FWDVNWRDGH¿QHGOHYHORISUR¿FLHQF\ ,&0E ,&0GH¿QLWLRQRIPLGZLIHU\FRPSHWHQF\ $FRPELQDWLRQRINQRZOHGJHSURIHVVLRQDOEHKDYLRUDQGVSHFL¿FVNLOOV WKDWDUHGHPRQVWUDWHGDWDGH¿QHGOHYHORISUR¿FLHQF\LQWKHFRQWH[WRIPLGZLIHU\HGXFDWLRQDQGSUDFWLFH ,&0E 7KLVFRQFHSWXDOGH¿QLWLRQZDVUHÀHFWHGE\:RUWK%XWOHU0XUSK\DQG)UDVHU LQWKHLUVWDWHPHQWRQPRGHOVRI competence in midwifery: ... the most helpful models of competence conceptualise competent professionals as people who have learned an adequate overarching set of skills and knowledge to do their job satisfactorily. A capable professional is then someone who is able to draw on that repertoire of skills and knowledge in different ways in different contexts to perform in a way that is recognized as competent. Source: Worth-Butler, Murphy and Fraser, 1994 4.2.2 - The domains of competence Competence is one of many determinants of performance. The impact of skilled attendants is enhanced when they are properly educated, have the necessary equipment and supplies, and work within a health system and policy IUDPHZRUNWKDWIRVWHUVDQGHQDEOHVFULWLFDOWKLQNLQJDQGFOLQLFDOSUR¿FLHQF\ GH%HUQLVHWDO .DN%XUNKDOWHUDQG &RRSHU )LJXUH )XQGDPHQWDOO\QHYHUWKHOHVVWKHUHDUHVHYHUDOSHUVRQDOFKDUDFWHULVWLFVWKDWDUHJHQHUDOO\ accepted as the individual components of competence. Cognitive knowledge is the understanding of the theoretical principles of safe practice (the understanding of IDFWVDQGSURFHGXUHV .QRZOHGJHLVDFTXLUHGWKURXJKLQGLYLGXDOOHDUQLQJ HJUHDGLQJGLVFXVVLRQGHOLEHUDWLRQ GHEDWH DQGWKURXJKPHQWRULQJ REVHUYDWLRQRIRWKHUVUHFHLYLQJIHHGEDFN 0LGZLIHU\NQRZOHGJHLVDFTXLUHG RYHUWKHSUDFWLFHOLIHWLPHDVLWQHFHVVDULO\LQYROYHVXQGHUVWDQGLQJRIERWKIXQGDPHQWDO EDVLF NQRZOHGJHDQG FRQWLQXHG HYROYLQJ VFLHQWL¿FSULQFLSOHV 6FLHQWL¿FNQRZOHGJHPXVWEHWUDQVODWHGLQWRSUDFWLFDODSSOLFDWLRQ WKLVLVUHÀHFWHGLQWKHSHUIRUPDQFHRIFOLQLFDO VNLOOV WKHFDSDFLW\WRSHUIRUPVSHFL¿FDFWLRQV 0LGZLIHU\VNLOOVDUHDFTXLUHGWKURXJKJXLGHGFOLQLFDOSUDFWLFH DOVRNQRZQDVFOLQLFDOPHQWRUVKLSRUSUHFHSWRUVKLS /LFTXLULVKDQG6HLEROG Competencies for midwifery practice CompetenceDOVRQHFHVVDULO\LQFOXGHVDVHWRISHUVRQDODWWULEXWHVLHpersonal abilities7KHVHDWWULEXWHVDUH UDWKHUPRUHGLI¿FXOWWRGHVFULEHRUWRGH¿QHDVWKH\DUHLQWDQJLEOH7KH\DUHKRZHYHUSHUFHSWLEOHDQGWKH\ DUHUHÀHFWHGLQWKHPDQQHULQZKLFKDQ\LQGLYLGXDODSSOLHVWKHNQRZOHGJHDQGVNLOOVLQWKHFRQWH[WRIUHQGHULQJ FOLQLFDOFDUH7KH\LQFOXGHVXFKWKLQJVDVFRPPXQLFDWLRQVNLOOV VSHDNLQJDQGOLVWHQLQJ WKHDELOLW\WRIRVWHU VXSSRUWLYHLQWHUSHUVRQDOUHODWLRQVKLSVWKHDELOLW\WRUHVSHFWGLYHUVHFXOWXUHVDQGWUDGLWLRQVDQGDZLOOLQJQHVVWR communicate sensitively with communities, families, and individuals. Critical thinkingVNLOOVDUHSDUWLFXODUO\LPSRUWDQWDWWULEXWHV&ULWLFDOWKLQNLQJLVGH¿QHGDVDSXUSRVHIXOSURFHVV RIVHOIUHJXODWRU\MXGJPHQW 7XUQHU 7KLVLQFOXGHVWKHFRJQLWLYHSURFHVVHVWKDWFRQVWLWXWHSURIHVVLRQDO WKLQNLQJ 3URIHWWR0F*UDWK 7KHDSSOLFDWLRQRIFULWLFDOWKLQNLQJLQPLGZLIHU\SUDFWLFHLVDVVRFLDWHGZLWK FOLQLFDOGHFLVLRQPDNLQJ )HVOHU%LUFK GLDJQRVWLFUHDVRQLQJFOLQLFDOMXGJPHQWDQGSUREOHPVROYLQJ,WLV DSURFHVVRIUHÀHFWLYHDQGUHDVRQDEOHWKLQNLQJ &RQ¿GHQFHWKDWLVWKHVHOIDVVHVVHGOHYHORIFRPIRUWLQRQH¶VDELOLW\WRSHUIRUPDSDUWLFXODUVNLOOLVDQHVVHQWLDO FRUROODU\WRFRPSHWHQFH7KHPLGZLIHPD\KDYHDFTXLUHGDQGGHPRQVWUDWHGWKHDELOLW\WRSHUIRUPDWDVNWRD FHUWDLQH[SHFWHGOHYHORIWHFKQLFDODFFXUDF\DWDJLYHQWLPHEXWPD\QRWKDYHDWWDLQHGDQ\GHJUHHRILQWHUQDO assurance that she could do so if called upon to perform the skills, and particularly so in emergency situations RUZKHQRWKHUVNLOOHGDVVLVWDQFHLVQRWLPPHGLDWHO\DYDLODEOH &RRSHUHWDO )DVDQHWDO Competence also involves the demonstration of professional behaviors, such as attitudes and values that are UHÀHFWHG LQ WKH HWKLFDO FRQWH[W ZLWKLQ ZKLFK SURIHVVLRQDO SUDFWLFH LV HQDFWHG 9DQDNL DQG 0HPDULDQ *UDEHUHWDO &HUWDLQDWWULEXWHVPD\EHFRQVLGHUHGWREHFKDUDFWHULVWLFRISURIHVVLRQDOSUDFWLFH HJWKH FRQFHSWVRIFDULQJHPSDWK\RUFRPSDVVLRQ +RZHYHUDQLQGLYLGXDO¶VVRFLDOUHOLJLRXVDQGFXOWXUDOFRQWH[W LQÀXHQFHVWKHZD\LQZKLFKWKHVHDWWULEXWHVPD\EHPDQLIHVWHGRUH[SUHVVHG It is also important to note that, in addition to competencies related to the provision of quality patient care, there DUH PDQ\ DGGLWLRQDO DQG EURDGHU FRPSHWHQFLHV WKDW PD\ EH UHTXLUHG RI DQ LQGLYLGXDO ZLWKLQ D SDUWLFXODU SUDFWLFH FRQWH[W ([DPSOHV LQFOXGH FRPSHWHQFLHV UHODWHG WR PDQDJLQJ DQG RUJDQL]LQJ KHDOWK VHUYLFHV GHOLYHU\ VWLPXODWLQJ active community participation, and serving as a health policy advocate. )LQDOO\WHFKQLFDOFRPSHWHQF\DWWDLQHGIRUDQ\VNLOODQGWKHFRUUHODWHGFRQ¿GHQFHUHODWHGWRWDVNSHUIRUPDQFHDUH UDUHO\VXVWDLQHGDWWKHVDPHOHYHOHYHQIURPGD\WRGD\ 6FRWODQGDQG%XOORXJK *DUGQHUHWDO 7KDWLV EHFDXVHWKHFRQGLWLRQVFLUFXPVWDQFHVDQGXQFRPPRQVLWXDWLRQVWKDWDIIHFWSHDNSHUIRUPDQFHFKDQJHWKXVDOWHULQJ DPLGZLIH¶VFDSDELOLW\IRUFRPSHWHQWSHUIRUPDQFHRIDQ\WDVN Module 4 7KHFRUHFRPSRQHQWVRIPLGZLIHU\SUDFWLFH 4.3.1 - Key midwifery concepts 7KH NH\ FRQFHSWV WKDW GH¿QH WKH XQLTXH UROH RI PLGZLYHV LQ SURPRWLQJ WKH KHDOWK RI ZRPHQ DQG FKLOGEHDULQJ familiesinclude: :RUNLQJZLWKZRPHQWRSURPRWHVHOIFDUHDQGWKHKHDOWKRIZRPHQLQIDQWVDQGIDPLOLHV UHVSHFWIRUKXPDQGLJQLW\DQGWUHDWLQJZRPHQDVSHUVRQVDFFRUGHGIXOOKXPDQULJKWV DGYRFDF\IRUZRPHQZKRVHYRLFHVKDYHEHHQVLOHQFHG HPSRZHUPHQWRIZRPHQZKRZRUNWRREWDLQEHWWHUKHDOWKFDUH cultural sensitivity, as well as working with women and health care providers to overcome cultural practices WKDWKDUPZRPHQ DIRFXVRQKHDOWKSURPRWLRQDQGGLVHDVHSUHYHQWLRQ viewing pregnancy as a normal life event. 0LGZLYHV DUH FRPPLWWHG QRW RQO\ WR SURYLGLQJ FRPSHWHQW PLGZLIHU\ VHUYLFHV EXW DOVR WR WDNLQJ DFWLRQV WR UHGXFH WKHHFRQRPLFDQGVRFLDOYXOQHUDELOLW\RIZRPHQ )LOLSSLHWDO 0LGZLYHVUHFRJQL]HWKDWWKHJUHDWHVWLPSDFWRQ JOREDOPDWHUQDODQGFKLOGKHDOWKEHJLQVZLWKDFKLHYLQJDVWDWXVIRUZRPHQWKDWHQVXUHVHTXLW\DQGDFFHVVWRWKHEDVLF QHFHVVLWLHVIRUKHDOWK\OLYLQJVXFKDVDGHTXDWHQXWULWLRQDQGKRXVLQJFOHDQZDWHUDQGVDQLWDWLRQ :+2 7\HU 9LRODDQG&HVDULR 4.3.2 - The midwifery model of care 7KHPLGZLIHU\PRGHORIFDUHLVEDVHGRQWKHIDFWWKDWSUHJQDQF\DQGELUWKDUHQRUPDOOLIHHYHQWVDOWKRXJKFRPSOLFDWLRQV FDQRFFXUDWDQ\SRLQWLQWKHFKLOGEHDULQJF\FOH7KHPRGHOLQFOXGHV 0RQLWRULQJWKHSK\VLFDOSV\FKRORJLFDOVSLULWXDODQGVRFLDOZHOOEHLQJRIWKHZRPDQDQGKHULPPHGLDWHIDPLO\ WKURXJKRXWWKHFKLOGEHDULQJF\FOH providing the woman with personal, culturally appropriate advice, education, counseling, support, and DQWHQDWDOFDUH FRQWLQXRXVDWWHQGDQFHGXULQJODERUFKLOGELUWKDQGLPPHGLDWHO\SRVWSDUWXPDVZHOODVRQJRLQJVXSSRUWGXULQJ WKHSRVWQDWDOSHULRG HVWDEOLVKLQJUDSSRUWLQRUGHUWRGHYHORSVHOIFRQ¿GHQFHLQWKHZRPDQWRJLYHELUWKDQGDGDSWWRKHUQHZIDPLO\ G\QDPLF PLQLPL]LQJXQQHFHVVDU\WHFKQRORJLFDOLQWHUYHQWLRQVGXULQJFKLOGELUWK LGHQWLI\LQJWKHRQVHWRIFRPSOLFDWLRQVJLYLQJHPHUJHQF\FDUHDQGUHIHUULQJZRPHQDQGRUQHZERUQVZKR UHTXLUHREVWHWULFDORURWKHUVSHFLDOLVWDWWHQWLRQ Competencies for midwifery practice (YLGHQFHEDVHGGHFLVLRQPDNLQJ 7KHPLGZLIH¶VGHFLVLRQPDNLQJSURFHVVLVRUJDQL]HGXVLQJDYDULHW\RIVRXUFHVRINQRZOHGJHLQWXLWLYHSUHFHSWVDQGWKH DELOLW\WRWKLQNFULWLFDOO\DQGPDNHVRXQGFOLQLFDOMXGJPHQWV7KHPLGZLIHU\SURFHVVLVG\QDPLFDVZHOODVV\VWHPDWLF,W UHVSRQGVWRHDFKZRPDQ¶VFKDQJLQJKHDOWKVWDWXVDQGLWDQWLFLSDWHVSRWHQWLDOSUREOHPV0LGZLYHVLQYROYHZRPHQDQG WKHLUIDPLOLHVLQDOOSDUWVRIWKHGHFLVLRQPDNLQJSURFHVVDQGLQGHYHORSLQJDSODQRIFDUHIRUDKHDOWK\SUHJQDQF\DQG VDIHELUWKH[SHULHQFHDQGLQWKHDGMXVWPHQWWRWKHQHZIDPLO\VLWXDWLRQ )LJXUH &RUHFRPSHWHQFLHVIRUPLGZLIHU\SUDFWLFH 7KHNQRZOHGJHVNLOOVDQGDELOLWLHVHVVHQWLDOWRPLGZLIHU\SUDFWLFH ICM took the lead in identifying essential competencies for midwives, as a prerequisite for ensuring good practice. 7KHUH DUH PDQ\ RWKHU VLPLODU FRPSHWHQF\ OLVWV GHYHORSHG E\ D YDULHW\ RI RUJDQL]DWLRQV DV DSSURSULDWH WR WKHLU QHHGDQGSXUSRVH)RUH[DPSOHWKH:+2SUHVHQWVDFRPSHWHQF\OLVWLQRQHRIWKHFOLQLFDOJXLGHVLQWKHIntegrated Management of Pregnancy and Childbirth ,03$& VHULHV :+2 $VHWRI³FRUHVNLOOVDQGDELOLWLHV´IRUVNLOOHG DWWHQGDQWVZDVSXEOLVKHGE\:+2,&0DQG),*2LQVXSSRUWRIWKHLUMRLQWVWDWHPHQWRQWKH0LOOHQQLXP'HYHORSPHQW *RDOV :+2,&0),*2 :+2UHFHQWO\SXEOLVKHGDOLVWRIFRUHFRPSHWHQFLHVIRUYDULRXVKHDOWKRFFXSDWLRQDO DQGSURIHVVLRQDOFDGUHVZKRSURYLGHVH[XDODQGUHSURGXFWLYHKHDOWKVHUYLFHV :+2 0LGZLIHU\PHPEHUVKLSDVVRFLDWLRQVLQYDULRXVFRXQWULHVPD\KDYHDOVRGHYHORSHGFRXQWU\VSHFL¿FGHVFULSWLRQVRI NQRZOHGJHVNLOOVDQGDELOLWLHV .6$V HVVHQWLDOIRUWKHSUDFWLFHRIPLGZLIHU\7KHVH.6$OLVWVPD\PLUURUWKH,&0OLVW WKHLQWHUQDWLRQDOUHIHUHQFHGRFXPHQW RUWKH\PD\KDYHEHHQDPHQGHGWRUHÀHFWVSHFL¿FFRPSHWHQFLHVWKDWDUH HLWKHULQFOXGHGRUH[FOXGHGIURPWKHGRPDLQRIPLGZLIHU\SUDFWLFHLQWKDWFRXQWU\ +RPHUHWDO %XWOHU)UDVHU DQG0XUSK\ )OHPLQJHWDO +RZHYHULQRUGHUWRSURPRWHDFRPPRQJOREDOXQGHUVWDQGLQJRIWKHVFRSHRI SUDFWLFHRIWKHPLGZLIHIXOO\TXDOL¿HGDFFRUGLQJWRWKH,&0GH¿QLWLRQDOORIWKH³EDVLF´FRPSHWHQFLHVFLWHGLQWKH,&0 GRFXPHQWVKRXOGEHUHÀHFWHGLQWKHOLVWVGHYHORSHGDQGHQGRUVHGE\PHPEHUVKLSDVVRFLDWLRQV .6$OLVWVPD\KDYHDOVREHHQGHYHORSHGE\FRXQWU\OHYHOUHJXODWRU\DXWKRULWLHV,WLVNQRZQWKDWWKHNQRZOHGJHDQG VNLOOVH[SHFWHGRIWKRVHZKRDUHFDOOHG³PLGZLYHV´DUHGH¿QHGGLIIHUHQWO\DFURVVFRXQWU\ERXQGDULHV,WLVDOVRWKHFDVH WKDWWKHUHPD\EHVHYHUDOFDWHJRULHVRIPLGZLIHZLWKLQDVLQJOHFRXQWU\)RUH[DPSOHWKHUHPD\EHGLIIHUHQWFDWHJRULHV VXFKDVHQUROOHGRUUHJLVWHUHGPLGZLYHVHDFKKDYLQJDPRUHOLPLWHGRUPRUHH[SDQVLYHGRPDLQRIFOLQLFDOSUDFWLFH DQGWKHUHIRUHUHTXLULQJWKDWDVSHFL¿F.6$OLVWEHGHYHORSHGIRUWKHSXUSRVHRIGH¿QLQJZKDWFDQDQGVKRXOGEH H[SHFWHGRIWKHLUSHUIRUPDQFH7KLVODFNRIFRQVHQVXVLQGH¿QLWLRQDQGVFRSHRISUDFWLFHRIWKH³PLGZLIH´OLPLWVZKDW FDQEHNQRZQDERXWWKHUROHRIPLGZLYHVJOREDOO\DQGWKHLUFRQWULEXWLRQWRWKHVNLOOHGDWWHQGDQWZRUNIRUFH 4.4.2 - The evidence that underpins the competencies 7KH,&0FRPSHWHQF\WDVNOLVWKDVWZRSDUWLFXODUDVVHWVWKDWUHFRPPHQGLWDVDUHVRXUFHGRFXPHQW)LUVWWKHWDVN OLVWZDVJHQHUDWHGE\DQGIRUWKHFRPPXQLW\RI,&0PHPEHUPLGZLIHU\DVVRFLDWLRQVZKRVHSUDFWLFHLWZRXOGDIIHFW 6HFRQGWKHGRFXPHQWLVVXSSRUWHGE\UHIHUHQFHWRWKHHYLGHQFHWKDWXQGHUSLQVWKHWDVNVWDWHPHQWVWKDWDUHLQFOXGHG on the list. Module 4 7KH ,&0 HQJDJHG LQ D IRUPDO UHVHDUFK SURFHVV LQ RUGHU WR JHQHUDWH DQG WKHQ DI¿UP WKH .6$ OLVW WKDW HPHUJHG as The Essential Competencies for Basic Midwifery Practice. Survey research led to the development of the list of .6$V )XOOHUWRQ6HYHULQRDQG%URJDQ )LHOGVWXGLHVFRQGXFWHGLQFRXQWULHVLQDOOUHJLRQVRIWKHZRUOG DI¿UPHGWKHLPSRUWDQFHRIHDFK.6$DVHLWKHUDEDVLFRUDGGLWLRQDOVNLOOIRUPLGZLIHU\SUDFWLFH%DVLFVNLOOVDUHWKRVH WKDWZRXOGEHH[SHFWHGRIDOOPLGZLIHU\SUDFWLWLRQHUVDQGPLJKWEHFKDUDFWHUL]HGDVFRUHVNLOOV$GGLWLRQDO.6$VDUH WKRVHWKDWHQKDQFHWKHVFRSHRISUDFWLFHDQGPLJKWEHSDUWLFXODUO\LPSRUWDQWGHSHQGLQJRQWKHHQYLURQPHQWLQZKLFK WKHLQGLYLGXDOSUDFWLFHV HJPDQXDOYDFXXPDVSLUDWLRQ 7KH,&0XSGDWHGWKHFRPSHWHQF\OLVWDJDLQDI¿UPLQJWKH EDVLFRUDGGLWLRQDOUDWLQJIRUHDFK.6$LWHPWKURXJKDJOREDOVXUYH\RIDOO,&0PHPEHUDVVRFLDWLRQFRXQWULHV7KH FXUUHQWOLVW ,&0E FRQWDLQVDQHZO\DGGHGGRPDLQSHUWDLQLQJWRDERUWLRQUHODWHGFDUHVHUYLFHV ICM took the further step of linking the competency statements with evidence that supported their importance or HIIHFWLYHQHVV )XOOHUWRQ DQG 7KRPSVRQ (YLGHQFH ZDV GUDZQ IURP WKH FOLQLFDO UHVHDUFK OLWHUDWXUH HJ UDQGRPL]HGFOLQLFDOWULDOV 0LOOHUHWDO %DUNKRUGDULDQHWDO DQGDOVRIURPTXDOLWDWLYHVWXGLHVWKDWDGGUHVV LQGLYLGXDOSUHIHUHQFHVYLHZVFRQFHUQVDQGYDOXHV .HQQHG\5RXVVHDXDQG/RZ 7KHUHDUHPDQ\FOLQLFDO LVVXHVIRUZKLFKVFLHQWL¿FVWXGLHVDUHQRW\HWDYDLODEOHWRRIIHUJXLGDQFH([SHUWFOLQLFDOFRQVHQVXVVHUYHGDVWKH HYLGHQFHEDVHLQWKHVHFDVHV %XHWRZ )XOOHUWRQ7KRPSVRQDQG6HYHULQR 7KH,&0FRPSHWHQF\VWDWHPHQWVDVDUHVRXUFH DI¿UPDWLRQVDQGDGDSWDWLRQV 7KH,&0OLVWRIHVVHQWLDOFRPSHWHQFLHVVHUYHVDEURDGSXUSRVHDVDEDVLFUHVRXUFHDQGDUHIHUHQFHGRFXPHQW7KH VSHFL¿F,&0FRPSHWHQFLHVVKRXOGQRWEHDGRSWHGIRUXVHIRUDQ\SXUSRVHZLWKRXW¿UVWUHYLHZLQJDQGDI¿UPLQJWKHLU UHOHYDQFHWRWKHORFDOUHDOLWLHVRIDFRXQWU\RUUHJLRQ,WLVXQGHUVWRRGWKDWWKHFRPSOHWHOLVWRIEDVLFDQGDGGLWLRQDOWDVN VWDWHPHQWVUHSUHVHQWVDUDQJHRISUDFWLFH PLQLPXPWRPD[LPXP 7KRVHZKRZLVKWRXVHWKLVOLVWDVDEDVHOLQHIRU WKHLURZQSXUSRVHVDUHXUJHGWRWDNHWKHVWHSVUHÀHFWHGLQ)LJXUHLQRUGHUWRPDNHWKHVWDWHPHQWVXVHIXOIRUWKHLU own purposes. 7KH,&0WDVNVWDWHPHQWVDQGDQ\VLPLODUOLVWVGHYHORSHGDWWKHFRXQWU\OHYHOQHHGWREHFRQVLGHUHG³OLYLQJGRFXPHQWV´ LH QHYHU VWDWLF DOZD\V FKDQJLQJ$Q\ JLYHQ OLVW PXVW EH UHYLHZHG SHULRGLFDOO\ WR HQVXUH WKDW LW UHPDLQV FXUUHQW FRPSUHKHQVLYH DQG VXLWDEOH IRU LWV SXUSRVH 7KH HYLGHQFH WKDW VXSSRUWV WKH UHOHYDQFH DQG LPSRUWDQFH RI HDFK LQGLYLGXDOWDVNVWDWHPHQWPXVWDOVREHUHYLHZHGSHULRGLFDOO\WRHQVXUHWKDWWKHFXUUHQWVWDWHRIWKHVFLHQFHLVUHÀHFWHG in the statement, as new evidence emerges that either supports current practice or provides a compelling rationale for the need for current practice to change. 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Measuring the competence of health care providers. Operations Research Issue Paper 2(1): Bethesda MD. Published for the U.S. Agency for International Development Quality Assurance Project, 2001. Reprinted with permission.) Social Factors Ŷ&RPPXQLW\H[SHFWDWLRQV Ŷ3HHUSUHVVXUH Provider Ŷ3DWLHQWH[SHFWDWLRQV Motivation Ŷ6RFLDOYDOXHV Ŷ([SHFWDWLRQV Ŷ6HOIHIILFDF\ Ŷ,QGLYLGXDO Organizational Factors JRDOVYDOXHV Provider Ŷ:RUNLQJFRQGLWLRQV Result Ŷ5HDGLQHVVWR Behaviors Ŷ0RQLWRULQJV\VWHP Improvements in FKDQJH Performance Ŷ&ODULW\RIUHVSRQVLELOLWLHV Ŷ+HDOWK according to standards RXWFRPHV DQGRUJDQL]DWLRQDOJRDOV Ŷ&RPSOHWH Ŷ2UJDQL]DWLRQRIVHUYLFHV Ŷ&OLHQW DVVHVVPHQW VDWLVIDFWLRQ ZRUNSURFHVVHV Ŷ&RUUHFWGLDJQRVLV Ŷ7DVNFRPSOH[LW\ Ŷ$SSURSULDWH Ŷ,QFHQWLYHVUHZDUGV UHIHUUDOVFRXQVHOLQJ Ŷ5HVRXUFHDYDLODELOLW\ Provider DQGWUHDWPHQW Ŷ6WDQGDUGVDYDLODELOLW\ Competencies Ŷ7UDLQLQJ Ŷ.QRZOHGJH Ŷ6XSHUYLVLRQ Ŷ6NLOOV Ŷ6HOIDVVHVVPHQW Ŷ$ELOLWLHV Ŷ&RPPXQLFDWLRQPHFKDQLVPV Ŷ7UDLWV Ŷ3HUIRUPDQFHIHHGEDFN Competencies for midwifery practice )LJXUH $IUDPHZRUNIRUGHFLVLRQPDNLQJ 6WHS Collect information in a systematic way from discussion with the woman and her family and from KHDOWKUHFRUGVH[DPLQDWLRQVDQGODERUDWRU\WHVWVLQRUGHUWRPDNHDFRPSOHWHDVVHVVPHQWRI PRWKHUDQGRUEDE\ 6WHS ,GHQWLI\ DFWXDO RU SRWHQWLDO SUREOHPV EDVHG RQ WKH FRUUHFW LQWHUSUHWDWLRQ RI WKH LQIRUPDWLRQ gathered in Step 1. 6WHS 'HYHORSDFRPSUHKHQVLYHSODQRIFDUHZLWKWKHZRPDQDQGKHUIDPLO\EDVHGRQWKHZRPDQ¶V RULQIDQW¶VQHHGVDQGVXSSRUWHGE\WKHGDWDFROOHFWHG 6WHS Implement the care plan, continually updating it within an appropriate time frame. 6WHS ,QFRQMXQFWLRQZLWKWKHZRPDQDQGKHUIDPLO\HYDOXDWHWKHHIIHFWLYHQHVVRIWKHFDUHJLYHQ if outcomes are unsatisfactory, consider alternatives, returning to Step 1 to collect more data and/or develop a new plan. Module 4 )LJXUH 0DNLQJWKH,&0FRPSHWHQFLHVXVHIXODWWKHFRXQWU\OHYHO Steps 3XUSRVHDQGDSSOLFDWLRQ 1. Compare the ICM competency statements to any Policymakers and educators can use this approach to VLPLODU OLVW RI .6$V WKDW PD\ SUHVHQWO\ H[LVW WKDW LGHQWLI\DUHDVRIFRQVLVWHQF\EHWZHHQWKHGRFXPHQWV GHVFULEHV WKH VFRSH RI PLGZLIHU\ SUDFWLFH LQ WKH 7KH\ ZRXOG WKHQ XVH WKLV LQIRUPDWLRQ WR DI¿UP WKH country. VHOHFWLRQRIDVHWRI.6$VDVD³EDVLFFRPSHWHQF\ IRU PLGZLIHU\ SUDFWLFH´ DV GH¿QHG LQ UHJXODWRU\ documents, and to develop a curriculum for the education of midwives. ,GHQWLI\ VSHFL¿F ,&0 .6$V WKDW DUH QRW SUHVHQWO\ 3ROLF\PDNHUVDQGHGXFDWRUVVKRXOGGHOLEHUDWHO\LQFOXGH UHÀHFWHGLQRWKHUUHIHUHQFHGRFXPHQWV WKH ,&0 HYLGHQFHEDVHG ³EDVLF´ .6$V DV D ³EDVLF´ function for midwifery practice in the country. All ICM “basic” KSAs should be included in any country- based document in order that there be a uniform understanding of the scope of practice of midwives globally. 3. Identify KSAs that are relevant to the scope of 6RPHRUDOORIWKHWDVNVWDWHPHQWVLGHQWL¿HGE\WKH midwifery practice in the country, and that are ,&0WREH³EDVLF´PLGZLIHU\VNLOOVPLJKWEHVHOHFWHGIRU essential to safe care. VSHFL¿F GHOLEHUDWLRQ7KH IRFXV VKRXOG DOZD\V EH RQ selecting KSAs that have clear links to evidence that the particular task is a life-saving skill. These KSAs ZRXOG EH LGHQWL¿HG DV WKH SULRULWLHV IRU VXSHUYLVLRQ of midwives and for monitoring and evaluation of the continued competency of midwives in practice. ,GHQWLI\ UHJXODWRU\ EDUULHUV WKDW ZRXOG OLPLW WKH 7KHHYLGHQFHRIDOLQNDJHWRVDIHFDUHVKRXOGEHXVHG midwife from performing a particular function. DVWKHEDVLVIRUDGYRFDF\IRUDGGLQJDSDUWLFXODU.6$ to the scope of midwifery practice in any country or UHJLRQ ZKHUH LW PD\ SUHVHQWO\ QRW EH DQ DSSURYHG practice function. Module 5 Module 5 ,QWURGXFWLRQ This module offers guidance for those seeking to improve reproductive health services to all, through strengthening WKHHGXFDWLRQUHTXLUHGWRGHYHORSWKHNQRZOHGJHVNLOOVDQGDELOLWLHVRIDOOWKRVHZKRSURYLGHWKHVHKHDOWKVHUYLFHV 3DUWLFXODUO\LPSRUWDQWDUHWKRVHVHUYLFHVGHVLJQHGIRUPDNLQJSUHJQDQF\FKLOGELUWKDQGSRVWQDWDOFDUHVDIHU7KH FRQWHQWRIWKLVPRGXOHRIIHUVJXLGDQFHIRUGHYHORSPHQWRIDPLGZLIHU\FXUULFXOXPWKDWLVEDVHGRQDSKLORVRSK\DQG ethical framework of professional midwifery and the overarching principles of sound educational practice. It addresses FRQVLGHUDWLRQVIRUGHYHORSLQJDPLGZLIHU\FXUULFXOXPWKDWLVOLQNHGWRWKHH[SHFWHGRXWFRPHVRIWKHHGXFDWLRQSURFHVV ,WRIIHUVJHQHUDOJXLGDQFHIRUHIIHFWLYHDFDGHPLFDQGFOLQLFDOWHDFKLQJ,WSUHVHQWVEDVLFSULQFLSOHVWKDWXQGHUSLQIDLU DQGYDOLGHYDOXDWLRQRIVWXGHQWVLQWKHWKHRU\DQGFOLQLFDOSKDVHVRIWKHLUHGXFDWLRQ,QDQDQQH[WRWKLV7RRONLWIRU strengthening professional midwifery in the Americas, the essential elements of a midwifery curriculum are offered as DUHVRXUFHIRUWKRVHZKRPD\EHGHYHORSLQJDPLGZLIHU\HGXFDWLRQSURJUDP 7KHUROHRIPLGZLYHVLQLPSURYLQJUHSURGXFWLYHKHDOWKVHUYLFHV 5HSURGXFWLYH KHDOWK LV D FRQFHSW DGRSWHG E\ WKH 8QLWHG 1DWLRQV ,QWHUQDWLRQDO &RQIHUHQFH RQ 3RSXODWLRQ DQG 'HYHORSPHQWKHOGLQ&DLURLQ ,WLVDKROLVWLFFRQFHSWWKDWHPEUDFHVZRPHQ¶VKHDOWKIURPELUWKWRWKHPHQRSDXVH 5HSURGXFWLYHKHDOWKLVDFUXFLDOSDUWRIJHQHUDOKHDOWK,WDIIHFWVDQGLVDIIHFWHGE\WKHEURDGHUFRQWH[WRISHRSOH¶V lives, including economic circumstances, education, employment, living conditions, and family environment. Social DQGJHQGHUUHODWLRQVKLSVDQGWUDGLWLRQDODQGOHJDOVWUXFWXUHVPD\DOVRDIIHFWZRPHQ¶VUHSURGXFWLYHKHDOWK &RWWLQJKDP HWDO 5RVHPDQDQG5HLFKHQEDFK $WWDLQPHQWRIKHDOWKLQFOXGLQJUHSURGXFWLYHKHDOWKLVVHHQDVSDUDPRXQWE\DOOFRQFHUQHGZLWKSXEOLFKHDOWK$FKLHYLQJ WKDWLVDOVRFUXFLDOWRUHDFKLQJWKHDPELWLRXVREMHFWLYHVVHWRXWLQWKH0LOOHQQLXP'HFODUDWLRQ,QRUGHUWRPHHWWKH JRDORIWKH³UHGXFWLRQRIWKHPDWHUQDOPRUWDOLW\UDWLRE\WKUHHTXDUWHUVEHWZHHQ DQG´DQGWKHJRDORIWKH ³UHGXFWLRQE\WZRWKLUGVRIXQGHU¿YHPRUWDOLW\E\´LWLVYLWDOWRKDYHDVXI¿FLHQWVXSSO\RIVXLWDEO\HGXFDWHG KHDOWKZRUNHUV0LGZLYHVDUHDNH\SDUWRIWKLVZRUNIRUFHDVLWLVWKH\ZKRRIWHQSURYLGHWKH¿UVWOHYHORIFDUHIRU ZRPHQDQGIDPLOLHVDQGZKRZRUNZLWKFRPPXQLWLHVWRKHOSSURPRWHKHDOWK7KH\DUHDEOHWRUHFRJQL]HDQGWDNH ¿UVWOLQHDFWLRQZKHQFRPSOLFDWLRQVDULVH,WLVLPSRUWDQWWKDWPLGZLIHU\FXUULFXODDUHUHYLVHGWRHPEUDFHWKHFRQFHSW RI UHSURGXFWLYH KHDOWK LQ RUGHU WR SUHSDUH PLGZLYHV IRU WKHLU UROH DQG UHVSRQVLELOLWLHV LQ SURYLGLQJ PLGZLIHU\ FDUH ZLWKLQWKHEURDGHUFRQFHSWRIUHSURGXFWLYHKHDOWK:LWKRXWDSSUHFLDWLRQRIWKHEURDGHULVVXHVDURXQGUHSURGXFWLRQDQG UHSURGXFWLYHKHDOWKPLGZLYHVZLOOEHKDPSHUHGLQWKHLUDELOLW\WRRIIHUWKHIXOOUDQJHRIVHUYLFHVLQFOXGLQJWKRVHWKDWLQ WKHSDVWZHUHVHHQDVEH\RQGWKHFRQ¿QHVRIPDWHUQDODQGFKLOGKHDOWKDQGIDPLO\SODQQLQJ$QQH[HVDQGRIWKLV PRGXOHKDYHEHHQSUHSDUHGVSHFL¿FDOO\WRKHOSUHYLHZWKHFXUUHQWPLGZLIHU\FXUULFXODLQFRXQWULHVDQGWRSXWVWHSVLQ place to revise them or to develop new ones. 7R PHHW IDPLOLHV¶ QHHGV UHODWHG WR UHSURGXFWLYH KHDOWK DSSURSULDWH VHUYLFHV PXVW EH DFFHVVLEOH DQG DFFHSWDEOH (GXFDWLRQRQIDPLO\KHDOWKLVVXHVLVUHTXLUHGWRKHOSLQWKHSUHYHQWLRQRIIXWXUHSUREOHPVLQWKHUHSURGXFWLYHKHDOWK sphere. These services and education needs include information that is easily understood, skilled counseling, the early GHWHFWLRQDQGPDQDJHPHQWRIKHDOWKSUREOHPVDQGSURYLVLRQRIDSSURSULDWHFDUHDQGUHKDELOLWDWLRQ +LVWRULFDOHYLGHQFHKDVVKRZQWKDWDKHDOWKV\VWHPFRQFHUQHGZLWKUHSURGXFWLYHLVVXHVEDVHGRQPLGZLIHU\FDUH KHOSVLQUHGXFLQJPDWHUQDODQGFKLOGPRUWDOLW\DQGPRUELGLW\LQDKLJKO\FRVWHIIHFWLYHZD\ /RXGRQ ,WLVWKHUHIRUH VXJJHVWHGWKDWZHOOHGXFDWHGPLGZLYHVFRXOGVHUYHDVNH\SURYLGHUVRIUHSURGXFWLYHKHDOWKFDUHLQRUGHUWRLPSURYH Developing a midwifery curriculum for safe motherhood: guidelines for midwifery education programs WKHJHQHUDOKHDOWKVWDWXVRIZRPHQPHQDQGFKLOGUHQWKXVEHQH¿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some of the core set of essential midwifery skills. 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The education of the midwife therefore needs to focus on meeting the holistic needs of the woman in a sensitive and competent manner, acting as her advocate and ZRUNLQJLQSDUWQHUVKLSZLWKKHUKHUSDUWQHUDQGKHUIDPLO\WRSURPRWHDVDIHDQGVDWLVI\LQJH[SHULHQFHRIFKLOGELUWKDQG PRWKHUKRRG7KHSURJUDPPXVWVWULYHWRSUHSDUHLQGLYLGXDOVZKRZLOOEHWKLQNLQJFDULQJPLGZLYHVZLWKDVRXQGNQRZOHGJH EDVHDQGFRPSHWHQWFOLQLFDOVNLOOVE\XVLQJVWXGHQWFHQWHUHGOHDUQLQJPHWKRGVWKDWZLOOGHYHORSFULWLFDOWKLQNLQJDQGDOVR DQDO\WLFDODQGSUREOHPVROYLQJVNLOOV6WXGHQWVZLOOEHHQFRXUDJHGWRUHÀHFWRQWKHLUSUDFWLFHDQGWDNHUHVSRQVLELOLW\IRU WKHLURZQOHDUQLQJVXSSRUWHGE\HGXFDWLRQDODQGFOLQLFDOVWDII6WXGHQWVVKRXOGEHHQFRXUDJHGDQGPRWLYDWHGWRGHYHORS LQWROLIHORQJOHDUQHUVFDSDEOHRIUHFRJQL]LQJWKHLURZQQHHGVIRUFRQWLQXLQJSURIHVVLRQDOHGXFDWLRQDQGRIWDNLQJHYHU\ RSSRUWXQLW\WRPHHWWKHP)LQDOO\WKHFXUULFXOXPPXVWDOVRKDYHDVRXQGSXEOLFKHDOWKEDVLV 7KHHWKLFVRISURIHVVLRQDOSUDFWLFH )XQGDPHQWDOWRWKHSURIHVVLRQDOSUDFWLFHRIPLGZLYHVLVWKHSURIHVVLRQDOHWKLFWKDWXQGHUSLQVDOOWKDWPLGZLYHVGRDQG how they function within society. The relationship the midwife has to women is critical to this ethical view. The general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¿GHQFHLQUHVSHFWIRU DQGWUXVWLQZRPHQDQGWKHLUFDSDELOLWLHVLQFKLOGELUWK ,&0 +LVWRULFDOO\PLGZLYHVKDYHIUHTXHQWO\EHHQLQYROYHG³ZLWKZRPHQ´DVDJHQWVRIVRFLDOFKDQJH0LGZLYHVKDYHDFWHGLQ SDUWQHUVKLSZLWKZRPHQLQPDQ\FRXQWULHVMRLQWO\WRFKDOOHQJHDKLHUDUFKLFDODQGRIWHQSDWHUQDOLVWLFDSSURDFKWRKHDOWK FDUH7KHSULPDU\DLPRIWKLVVRFLDODFWLRQKDVEHHQWRHQVXUHDPRUHHTXLWDEOHEDODQFHRISRZHURYHUZRPHQ¶VERGLHV LQRUGHUWRPDLQWDLQWKHEDVLFSULQFLSOHRIELUWKDVD³QDWXUDOOLIHHYHQW ,QNHHSLQJZLWKWKHFKDUDFWHULVWLFVRIDOOVRFLDOPRYHPHQWVWKHGLVWLQJXLVKLQJIHDWXUHRIWKLVFROOHFWLYHDFWLRQKDVEHHQ WRUHSUHVHQWWKHYRLFHVRIWKRVHZKRKDYHWUDGLWLRQDOO\RUKLVWRULFDOO\EHHQOHVVZHOOUHSUHVHQWHGRUXQGHUUHSUHVHQWHG In this particular case, the voices are those of women who do not wish to receive care for this natural life event designed ZLWKDPHGLFDODQGRIWHQPDOHGRPLQDWHGPHGLFDODSSURDFK7KHEDVLFSUHPLVHWKDWXQGHUSLQVWKHSURIHVVLRQDOHWKLF LVWKDWPLGZLYHVDQGZRPHQWRJHWKHUKDYHVKDUHGEHOLHIVDQGYDOXHVDQGWKDW³HPSRZHUPHQWRIZRPHQ´IRUDQG GXULQJSUHJQDQF\ELUWKDQGWKHWUDQVLWLRQWRWKHQHZIDPLO\G\QDPLFLVDWWKHKHDUWRIDSSURSULDWHPLGZLIHU\FDUH7KLV HPSRZHUPHQWLVIDFLOLWDWHGE\DQGWKURXJKWKHFORVHFRQQHFWLRQVDQGUHODWLRQVKLSEHWZHHQPLGZLYHVDQGZRPHQ 6XFKEHOLHIVPXVWEHDWWKHKHDUWRIDQ\SURJUDPWKDWDLPVWRSUHSDUHVWXGHQWVWRHQWHUWKHPLGZLIHU\SURIHVVLRQDQG EHUHÀHFWHGLQDOORIWKHPHWKRGVDQGVWUDWHJLHVWKDWGH¿QHWKHSURJUDPRIVWXG\ Developing a midwifery curriculum for safe motherhood: guidelines for midwifery education programs 0LGZLYHVVKRXOGEHDEOHWRWDNHRQDPRUHHQDEOHGIRUZRPHQUROH7KLVWKHQKDVLPSOLFDWLRQVIRUUHJXODWLRQ ZKLFKVKRXOGEHVHOIUHJXODWHGWRDSRLQW±EXWVKRXOGDOVRKDYHLQSXWWRWKDWSURFHVVIURPZRPHQWKHPVHOYHV DQGIURPIHOORZSURIHVVLRQDOV ZKRHYHULVDSSURSULDWHLQHDFKFXOWXUH±JHQHUDOSK\VLFLDQVQXUVHVREVWHWULFLDQV 0LGZLYHVVKRXOGEHYHU\LQYROYHGLQWKHSURFHVVDQGVKRXOGSRVVLEO\FRQWUROLWEXWLIWKH\DUHWKHRQO\RQHV LQYROYHGWKHGDQJHULVWKDWDIRUPLGZLIHFXOWXUHGHYHORSVSURWHFWLQJPLGZLYHVDQGSHUSHWXDWLQJSUREOHPV«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¿QGZD\VDURXQGEORFNVDQGEDUULHUVLQWKHVRFLHW\ DQGIROORZ XSRQLWDQGDWDOOWKHWLPHUHVSHFWLQJZRPHQ¶VLQGLYLGXDOLW\DQGWKHFXOWXUHLQZKLFKVKHOLYHV7KLVDOOLPSOLHV HQRXJKHGXFDWLRQWRGRWKLVZHOODQGHQRXJKSRZHUWRLQÀXHQFHWKHV\VWHP7KLVLVZKDW,ZRXOGGHVFULEHDV SURIHVVLRQDO Source: Professor Mary Renfrew, author, professor, and chair of WHO Making Pregnancy Safer Strategic Review Committee 2003 *XLGHOLQHVIRUPLGZLIHU\HGXFDWLRQSURJUDPV 3URJUDPDLPV 0LGZLYHVDUHHVVHQWLDOWRSURPRWLQJUHSURGXFWLYHKHDOWKLQJHQHUDOEXWHVSHFLDOO\ZLWKUHJDUGWRKHOSLQJUHGXFHERWK WKH YHU\ KLJK JOREDO PDWHUQDO PRUELGLW\ DQG PRUWDOLW\ UDWH DQG WKH XQQHFHVVDU\ KLJK WROO RI QHZERUQ GHDWKV7KH PLGZLIHLVUHFRJQL]HGDVDSULQFLSDOSURWDJRQLVWLQDFKLHYLQJWKHVHREMHFWLYHV7KHUHIRUHSULRULW\PXVWEHJLYHQWR HQVXULQJ WKH TXDOLW\ RI HGXFDWLRQ RI PLGZLYHV DV ZHOO DV WR PDNLQJ VXUH WKDW VXI¿FLHQW QXPEHUV RI PLGZLYHV DUH educated to meet the needs of the population. The midwifery curriculum should prepare students to: %HFRPH VDIH FRPSHWHQW SUDFWLWLRQHUV ZKR DUH DEOH WR SUDFWLFH DXWRQRPRXVO\ WR SURPRWH VH[XDO DQG reproductive health. %HFDULQJDQGVHQVLWLYHDQGDEOHWRZRUNDORQJVLGHZRPHQDQGWKHLUIDPLOLHVLQWKHFRPPXQLW\DQGLQKHDOWK facilities, adopting a partnership model to educate, advise, facilitate choice, and respond to individual needs. 'HYHORSWKHDELOLW\WRZRUNZHOOZLWKLQDPXOWLGLVFLSOLQDU\WHDPWRSURPRWHUHSURGXFWLYHKHDOWK Module 5 4. Build up good relationships and liaise with community leaders and other relevant personnel in the community LQRUGHUWRLQFUHDVHWKHXSWDNHRIZRPHQ¶VUHSURGXFWLYHKHDOWKFDUHSURPRWHKHDOWKHGXFDWLRQVWUDWHJLHV DQGRUJDQL]HDUHOLDEOHSODQIRUELUWKFDUHLQWKHHYHQWWKHUHLVQHHGRIWUDQVSRUWRUUHIHUUDOWRRWKHUKHDOWK SUDFWLWLRQHUVRUKLJKHUOHYHOVRIIDFLOLW\EDVHGVHUYLFHV 0DNHDSRVLWLYHFRQWULEXWLRQWRWKHUHGXFWLRQRIPDWHUQDODQGLQIDQWPRUWDOLW\DQGPRUELGLW\E\UHFRJQL]LQJ OLIHWKUHDWHQLQJFRQGLWLRQVHDUO\DQGWDNLQJWLPHO\DQGVNLOOHGDFWLRQ 7DNHUHVSRQVLELOLW\IRUWKHLURZQOHDUQLQJE\SURPRWLQJDFFHVVWRDSSURSULDWHFOLQLFDODQGWKHRUHWLFDOVXSSRUW DQGHQFRXUDJLQJWKHVNLOOVRIUHÀHFWLRQFULWLFDODQDO\VLVDQGHYDOXDWLRQ 5HÀHFWRQWKHLUSUDFWLFHLQRUGHUWRSURPRWHOHDUQLQJIURPWKHLUH[SHULHQFHDQGWKXVHQKDQFHWKHIXWXUHFDUH of women and their families. 5HFRJQL]HWKDWOHDUQLQJLVDOLIHORQJSURFHVVDQGWDNHHYHU\RSSRUWXQLW\WRNHHSXSWRGDWHZLWKQHZNQRZOHGJH DQG UHVHDUFK ¿QGLQJV DQG WR HQKDQFH WKHLU SUDFWLFH ZLWK DOO DYDLODEOH IRUPV RI FRQWLQXLQJ SURIHVVLRQDO education. 'HYHORSLQWRPLGZLYHVZKRYDOXHWKHLURFFXSDWLRQSURIHVVLRQDQGFRQWULEXWHWRWKHGHYHORSPHQWRIPLGZLIHU\ E\DGYRFDWLQJFKDQJHZKHUHQHFHVVDU\DQGE\FRQGXFWLQJUHVHDUFKDLPHGDWLPSURYLQJWKHFDUHJLYHQWR women and their families. 10. Develop into effective managers of a caseload and of health facilities. Developing a midwifery curriculum for safe motherhood: guidelines for midwifery education programs A JORVVDU\RIWHUPVUHODWHGWRPLGZLIHU\HGXFDWLRQ $FFUHGLWHGDFFUHGLWDWLRQ The award of credits for educational achievement. The accumulation of the required QXPEHURIFUHGLWVDWDSSURSULDWHOHYHOVRIDFDGHPLFDFKLHYHPHQWXVXDOO\OHDGVWRDQDZDUG $FFUHGLWHGDFFUHGLWDWLRQ $SURFHVVDQGSURFHGXUHRISHHUUHYLHZE\ZKLFKDQHGXFDWLRQSURJUDPLV acknowledged as meeting quality standards. Advanced midwifery studies: The study of midwifery theory and practice at a level that is higher than that UHTXLUHGIRUEDVLFPLGZLIHU\HGXFDWLRQ Assessment:3ODQQHGPHWKRGVRIDVFHUWDLQLQJWKHVWDQGDUGVRINQRZOHGJHDQGVNLOOVDWWDLQHGE\VWXGHQWV Competency-based education: 7HDFKLQJ OHDUQLQJ DQG DVVHVVPHQW DFWLYLWLHV WKDW DUH VXI¿FLHQW WR HQDEOH students to acquire and demonstrate a predetermined set of competencies as the outcome of learning. Curriculum:$SODQQHGFRXUVHRIVWXGLHV WKHGHVLJQDWHGSURJUDPRIWKHRUHWLFDODQGSUDFWLFDOH[SHULHQFHVWREH acquired over a period of time, leading to intended learning outcomes. Diploma:$FHUWL¿FDWHDZDUGHGLQDFNQRZOHGJHPHQWRIFRPSOHWLRQRIDSURJUDPRIVWXGLHV Degree:$VWDWXVFRQIHUUHGE\DFROOHJHRUXQLYHUVLW\LQDFNQRZOHGJHPHQWRIFRPSOHWLRQRIDSURJUDPRIIRUPDO academic studies. Direct-entry midwifery program: A program of midwifery studies that admits students who have not previously completed a program of prior health professional education. Examination: A formal method of assessment in which the students undertake tests under controlled conditions DQGDFFRUGLQJWRVSHFL¿FUXOHV Intended learning outcomes:6SHFL¿FVWDWHPHQWVLGHQWLI\LQJZKDWWKHVWXGHQWVDUHH[SHFWHGWRDFKLHYH 0RGXOH ,QGLYLGXDOFRXUVHVFRQVLVWLQJRIDQXPEHURIKRXUVRIOHDUQLQJDQGDIRFXVHGXQLWRIFRQWHQWWKDWDVWXGHQW LVH[SHFWHGWRXQGHUWDNH0DQ\SURJUDPVDUHQRZPRGXODUL]HGWKDWLVFRQVWUXFWHGRIDQXPEHURIPRGXOHVWR EHOHDUQHGRYHUDVSHFL¿HGWLPHIUDPH 3ODFHPHQWV &OLQLFDODUHDVZKHUHVWXGHQWVREWDLQSUDFWLFDOH[SHULHQFH 3UHFHSWRU $ KHDOWK FDUH SURYLGHU PLGZLIH RU RWKHU KHDOWK SURIHVVLRQDO ZKR RIIHUV GLUHFW VXSHUYLVLRQ GXULQJ clinical student placements, under the general supervision of the midwife teacher. 3UREOHPEDVHGOHDUQLQJ $PHWKRGRIWHDFKLQJXVLQJSUREOHPVDVDEDVLVIRUVWXGHQWDFWLYLW\ Student-centered teaching and learning methods: Teaching and learning methods that actively involve the students in their own learning. Module 5 0RGHVRIHQWU\LQWRDPLGZLIHU\SURJUDPDQGOHQJWKRISURJUDP &XUUHQWHGXFDWLRQDOEHVWSUDFWLFHHPSKDVL]HVFRPSHWHQF\EDVHGOHDUQLQJLQZKLFKDQLQGLYLGXDOUHFHLYHVVXI¿FLHQW RSSRUWXQLW\WRDFTXLUHDQGWRGHPRQVWUDWHDERG\RINQRZOHGJHDQGDEHJLQQLQJVDIHOHYHORISHUIRUPDQFHLQHDFKRI WKHVNLOOVWKDWKDYHEHHQGHWHUPLQHGWREHHVVHQWLDOWRPLGZLIHU\FOLQLFDOSUDFWLFH &RZDQ1RUPDQDQG&RRPSDPDK D 0DOODEHUDQG7XUQHU 3HKONH0LOGHHWDO .OHLQDQG)RZOHV )XOOHUWRQHWDO 7KHUHIRUH PLGZLIHU\SURJUDPVVKRXOGEHGHVLJQHGWRDFFRPPRGDWHZLWKLQUHDVRQWKHRSSRUWXQLW\IRULQGLYLGXDOVWRUHFHLYHFUHGLW IRUSULRUOHDUQLQJ 6FRWW &XELWDQG/HHVRQ DQGDOVRWRSDFHWKURXJKWKHFXUULFXOXPZLWKDFFRPPRGDWLRQ for acceleration of learning or remediation of individual learning needs. &RXQWULHVPD\RIIHUDYDULHW\RISDWKZD\VIRUHQWU\LQWRWKHPLGZLIHU\SURIHVVLRQ )HDOH\HWDO %RJUHQ:LVHPDQ DQG%HUJ 7KHSURJUDPGHVLJQPD\YDU\EXWWKHFRPSHWHQF\EDVHGRXWFRPHVRIPLGZLIHU\HGXFDWLRQVKRXOG EHHTXLYDOHQW,QRWKHUZRUGVDOWKRXJKWKHUHPD\EHYDULDELOLW\LQWKHTXDOL¿FDWLRQVRIVWXGHQWVDGPLWWHGWRWKRVH SURJUDPV HJEDVLFVWXGHQWVWKRVHZKRKDYHSULRUTXDOL¿FDWLRQVLQVRPHDOOLHGKHDOWK¿HOGRUWKRVHDOUHDG\IXOO\ TXDOL¿HGDVQXUVHV DQGYDULDELOLW\LQWKHOHQJWKRIWKHFRXUVHRIPLGZLIHU\VWXGLHVthe competency- based outcomes of midwifery education should be equivalent,QGLYLGXDOVZKRTXDOLI\WREHWLWOHGDVDPLGZLIHDFFRUGLQJWRWKHLQWHUQDWLRQDO GH¿QLWLRQVKRXOGEHHGXFDWHGWRDFRPPRQVWDQGDUGDQGDFRPPRQVHWRIFRPSHWHQFLHV 0RGXOH 0LGZLIHU\HGXFDWLRQSURJUDPVEDVHGLQXQLYHUVLWLHVIROORZDFDGHPLFFRQYHQWLRQVIRUWKHOHQJWKRISURJUDPVRIVWXG\ OHDGLQJWRWKHDZDUGRIDFDGHPLFGHJUHHV7KLVLVFRPPRQO\XSWRIRXU\HDUVRIVWXG\DWWKHEDFFDODXUHDWHGHJUHHOHYHO DQGDQDGGLWLRQDORQHRUWZR\HDUVIRUWKHSRVWEDFFDODXUHDWHFHUWL¿FDWHRUWKHPDVWHU¶VGHJUHH$IHZFRXQWULHVKDYH LQWURGXFHGWKHFRQFHSWRIGRFWRUDOSUHSDUDWLRQDVWKHHQWU\LQWRSUDFWLFHOHYHO $YHU\DQG+RZH (GZDUGVRQ 5.5.3 - Direct-entry midwifery programs 6WXGHQWVZKRDUHDGPLWWHGWRGLUHFWHQWU\PLGZLIHU\SURJUDPVZLOOQRWKDYHFRPSOHWHGDEDVLFQXUVLQJSURJUDP)RU WKRVHZLWKRXWDJHQHUDOQXUVLQJTXDOL¿FDWLRQWKHHGXFDWLRQSURJUDPVKRXOGH[WHQGRYHUDSHULRGRIWLPHVXI¿FLHQWWR DFFRPPRGDWHWKHDFTXLVLWLRQRIEDVLFKHDOWKVNLOOVSULRUWRWKHIRFXVRQPLGZLIHU\VWXGLHV,&0VWDQGDUGVFDOOIRUD minimum of three years of theoretical and practical study for programs of this type. 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7KRPSVRQ-$KXPDQULJKWVIUDPHZRUNIRUPLGZLIHU\FDUH-0LGZLIHU\:RPHQV+HDOWK 7KRPSVRQ - )XOOHUWRQ - 6DZ\HU$ 7KH ,QWHUQDWLRQDO &RQIHGHUDWLRQ RI 0LGZLYHV JOREDO VWDQGDUGV IRU PLGZLIHU\ HGXFDWLRQ ZLWKFRPSDQLRQJXLGHOLQHV0LGZLIHU\ :LOGLQJ305HÀHFWLYHSUDFWLFH DOHDUQLQJWRROIRUVWXGHQWQXUVHV%U-1XUV :LQWHUV&$(FKHYHUUL57HDFKLQJVWUDWHJLHVWRVXSSRUWHYLGHQFHEDVHGSUDFWLFH&ULW&DUH1XUVH :RUOG+HDOWK2UJDQL]DWLRQ,&0),*20DNLQJSUHJQDQF\VDIHU WKHFULWLFDOUROHRIVNLOOHGDWWHQGDQWV DVWDWHPHQW *HQHYD :+2 :RUOG+HDOWK2UJDQL]DWLRQ0LGZLIHU\0RGXOHVIRU6DIHPRWKHUKRRG HGXFDWLRQPDWHULDOVIRU 0LGZLIH7HDFKHUV*HQHYD :+2 Developing a midwifery curriculum for safe motherhood: guidelines for midwifery education programs )LJXUH 5HÀHFWLYHF\FOH DESCRIPTION What happened? ACTION PLAN FEELINGS If the situation arose again, What were you thinking what would you do? and feeling? Reflection process CONCLUSION EVALUATION What else could you What was good and bad have done? about the experience? ANALYSIS What sense can you make of the situation? Module 5 $QQH[ )UDPHZRUNIRUHYDOXDWLQJWKHFXUULFXOXP 7KLVFKHFNOLVWFDQEHXVHGWRDVVHVVWKHFXUULFXOXPDQGLGHQWLI\ZKHUHWKHFXUULFXOXPQHHGVVWUHQJWKHQLQJ,Q completing the assessment checklist it is important to: &KHFNWKHZULWWHQFXUULFXOXPGRFXPHQWDQGDOODVVHVVPHQWWRROVDQGJXLGHOLQHV REWDLQWKHYLHZRIFXUUHQWDQGUHFHQWO\FRPSOHWLQJVWXGHQWVWHDFKHUVDQGSURJUDPOHDGHUV REWDLQWKHYLHZRIWKHPLGZLYHVLQFOLQLFDOSUDFWLFHZKRVXSHUYLVHVWXGHQWV REWDLQWKHYLHZRIWKHHGXFDWLRQDOLQVWLWXWLRQVXSHUYLVLQJWKHFXUULFXOXP REWDLQWKHYLHZVRIWKHUHJXODWRU\ERG\DQGSURIHVVLRQDODVVRFLDWLRQZKHUHVXFKH[LVWV REVHUYHWHDFKLQJDQGOHDUQLQJEHLQJXQGHUWDNHQ REVHUYHVWXGHQWVLQWKHFOLQLFDODUHDV UHYLHZVWXGHQWUHFRUGV review teaching and learning resources. Yes No Not known 7KHFXUULFXOXPKDVEHHQUHYLHZHGDQGUHYLVHGLQWKHODVW¿YH \HDUV 0LQLPXPHQWU\UHTXLUHPHQWVHVWDEOLVKHGIRUWKHSURJUDPDUHLQSODFHDQGEHLQJ IROORZHG ,QVHUWDSSURSULDWHFULWHULDKHUH $WHDFKHUWRVWXGHQWUDWLRKDVEHHQDJUHHGXSRQDQGLWFRQIRUPVWRQDWLRQDOQRUPV and international standards. 7KHFXUULFXOXPUHTXLUHVDSSURYDOE\WKHPLGZLIHU\UHJXODWRU\DXWKRULW\ WKHERG\ HVWDEOLVKHGE\WKHJRYHUQPHQWWRRYHUVHHPLGZLIHU\DQGJUDQWWKHULJKWWRSUDFWLFH 7KHFXUULFXOXPLVGHOLYHUHGLQRUKDVWKHDSSURYDORIDQDSSURSULDWHHGXFDWLRQDOERG\ institution. The curriculum is at the educational level equivalent to the curriculum of other health care practitioners. 7KHFXUULFXOXPLVEDVHGRQVRXQGHGXFDWLRQDOWKHRULHVRIDGXOWOHDUQLQJWKDWIRVWHUWKH FULWLFDOWKLQNLQJDQGSUREOHPVROYLQJVNLOOVRIVWXGHQWV The curriculum has a clear philosophy of midwifery that values midwives working with ZRPHQLQDSDUWQHUVKLSDQGUHFRJQL]LQJSUHJQDQF\DQGFKLOGELUWKDVDQDWXUDOOLIHHYHQW for most women. 7KHFXUULFXOXPLVRUJDQL]HGWRHQVXUHVWXGHQWVFDQOLQNWKHRU\WRSUDFWLFH SUDFWLFH SODFHPHQWVDOORZWKHPWRSUDFWLFHZKDWWKH\KDYHEHHQWDXJKWLQWKHFODVVURRP 7KHFXUULFXOXPLVOHGE\DQH[SHULHQFHGPLGZLIHWHDFKHUZKRKDVDEDFNJURXQGLQ PLGZLIHU\DQGKDVEHHQWUDLQHGDVDWHDFKHU 7HDFKLQJDQGOHDUQLQJUHVRXUFHVDUHDGHTXDWHDQGH[SRVHVWXGHQWVWRUHFHQWUHVHDUFK ¿QGLQJV Students have opportunities to practice in the clinical area under the direct supervision RIDQH[SHULHQFHGPLGZLIHDQGKDYHWKHLUSUDFWLFHDVVHVVHG Developing a midwifery curriculum for safe motherhood: guidelines for midwifery education programs $QQH[ FRQWLQXHG Yes No Not known 2QFRPSOHWLRQRIWKHHGXFDWLRQSURJUDPPLGZLYHVDUHDEOHWRSUDFWLFHDVDXWRQRPRXV VHOIGLUHFWLQJSUDFWLWLRQHUV DEOHWRSUDFWLFHDVRXWOLQHGLQWKH,QWHUQDWLRQDO'H¿QLWLRQRI D0LGZLIH 2QFRPSOHWLRQRIWKHHGXFDWLRQSURJUDPPLGZLYHVDUHDEOHWRSUDFWLFHDVDIXOO\ SDUWLFLSDWLQJPHPEHURIDPXOWLGLVFLSOLQDU\WHDP 2QFRPSOHWLRQRIWKHHGXFDWLRQSURJUDPPLGZLYHVDUHDEOHWRSURYLGHPLGZLIHU\FDUH LQDQ\VHWWLQJ FRPPXQLW\FOLQLFKHDOWKIDFLOLW\KRVSLWDORUFOLHQW¶VRZQKRPH 2QFRPSOHWLRQRIWKHHGXFDWLRQSURJUDPPLGZLYHVDUHDEOHWRSURYLGHDOOHVVHQWLDOOLIH VDYLQJVNLOOVWRZRPHQDQGQHZERUQV $OODVVHVVPHQWVDUHFOHDUO\LGHQWL¿HGLQWKHFXUULFXOXPDQGDVVHVVPHQWSRLQWVDUH known to the students. &OHDUFULWHULDKDYHEHHQVHWIRUDOOWKHRU\DQGFOLQLFDODVVHVVPHQWV $OODVVHVVRUVLQFOXGLQJFOLQLFDODVVHVVRUVKDYHEHHQVSHFLDOO\SUHSDUHGIRUWKHLUUROH 7KHFXUULFXOXPKDVDFOHDUDQGWUDQVSDUHQWTXDOLW\LPSURYHPHQWPHFKDQLVP VWXGHQWV DUHDEOHWRJLYHIHHGEDFNWRWHDFKHUV $OODVVHVVPHQWWRROVKDYHEHHQWHVWHGIRUYDOLGLW\DQGUHOLDELOLW\. 6WXGHQWUHFRUGVHQVXUHWKDWLQGLYLGXDOSURJUHVVFDQEHWUDFNHGWKURXJKRXWWKH program. Module 5 $QQH[ (VVHQWLDOVWHSVLQFXUULFXOXPGHYHORSPHQWWRHQVXUH ¿WQHVVIRUSXUSRVH Establish curriculum review/development group 0HPEHUVVKRXOGLQFOXGHDOOVWDNHKROGHUV UHSUHVHQWDWLYHVIURP ZRPHQ¶VJURXSVFRPPXQLW\OHDGHUVSROLF\PDNHUVSUDFWLWLRQHUV WHDFKHUVHGXFDWLRQDOVSHFLDOLVWVHWF 5HYLHZDQGLIQHFHVVDU\UHYLVHWKH Evaluation of curriculum Terms of reference UROHDQGUHVSRQVLELOLWLHVRIWKHPLGZLIH MREGHVFULSWLRQ WRHQVXUHWKDWLW PHHWVQDWLRQDOQHHGV (VWDEOLVKUHYLVH SKLORVRSK\ 5HYLHZDVVHVVPHQWUHSRUWV 'HFLGHRQVWUXFWXUH DQGOHQJWKRISURJUDP 5HYLHZPRGXOHHYDOXDWLRQ 'HFLGHRQPRGXOH FRQWHQW Establish a philosophy for midwifery Review module evaluation (VWDEOLVKDVVHVVPHQW reports DQGUHYLVHPRGXOHDV VFKHGXOHLQFOXGLQJ DSSURSULDWH FULWHULDWREHXVHGIRU DOODVVHVVPHQWV (VWDEOLVKPRQLWRULQJ V\VWHP Develop detailed content of Recruit students and curriculum LQFOXGLQJGHWDLOHGFRQWHQW implement curriculum process (QVXUHFXUULFXOXP DQGVWUXFWXUHRIDOOPRGXOHV LGHQWLI\ PHHWVHGXFDWLRQDODQG WHDFKLQJDQGSUDFWLFHKRXUV SURIHVVLRQDOVWDQGDUGV $JUHHRQDQGRYHUVHH Prepare clinical sites LPSOHPHQWDWLRQ SURFHVV Devise assessment strategy 0RQLWRULPSOHPHQWDWLRQ ,QFOXGLQJDVVHVVPHQWWRROV (YDOXDWHFXUULFXOXP Prepare teaching faculty 8SGDWHWHDFKLQJVNLOOVZKHUH UHTXLUHG Devise implementation plan Audit all teaching and ,GHQWLI\UHVRXUFHVUHTXLUHGFRVWV learning areas UHFUXLWPHQWSODQSUHSDUDWLRQRIWHDFKHUV LQFOXGLQJFOLQLFDOSODFHPHQWV DQGFOLQLFDODUHDVDVVHVVRUV Module 5 Module 6 ,QWURGXFWLRQ 7KH:RUOG+HDOWK2UJDQL]DWLRQ :+2 LVFRPPLWWHGWRUHGXFLQJVLJQL¿FDQWO\WKHPDWHUQDOPRUELGLW\DQGPRUWDOLW\ DVVRFLDWHGZLWKFKLOGELUWK3DUWRIWKH:+2¶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or to prepare new such programs. This module in the Toolkit for strengthening professional midwifery in the Americas LV FRPSOHPHQWHG E\ PRGXOHV WR DVVLVW QDWLRQV LQ GHYHORSLQJ DQ HQDEOLQJ SROLF\ HQYLURQPHQW WKDW SURPRWHV EHVW SUDFWLFHVLQPLGZLIHU\DQGPDWHUQLW\FDUHWKURXJKWKHHQDFWPHQWRIHQDEOLQJOHJLVODWLRQDQGE\PRGXOHVWRHQFRXUDJH high standards of practice through education, supervision, and the assessment of continued competency. 6.1.1 - Aims and rationale 7KHTXDOLW\RIHGXFDWLRQSURYLGHGIRUWKHSUHSDUDWLRQRIPLGZLIHWHDFKHUVKDVDPDMRULQÀ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¿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¿FPLGZLIHU\VNLOOVDQG VXSHUYLVLQJ VWXGHQWV LQ WKHLU SUDFWLFH RI WKHVH FOLQLFDO WHFKQLTXHV$V D UHVXOW DOO WRR RIWHQ WKH PLGZLIH VWXGHQWV¶ HGXFDWLRQLVLQDGHTXDWHWRSUHSDUHWKHPIRUWKHLUUROHDVSUDFWLWLRQHUVEHFDXVHWKH\KDYHQRWDFTXLUHGWKHDSSURSULDWH clinical competence necessary for safe practice. Attention to the recruitment and education of midwife teachers is therefore crucial to improving the education of midwives and, in turn, promoting safe motherhood. Developing effective programs for preparing midwife teachers The aims of these guidelines for the development of education programs for the midwife teacher are: To provide information and tools to assist countries with limited resources to plan, implement, and monitor KLJKTXDOLW\SURJUDPVIRUWKHHGXFDWLRQRIPLGZLIHWHDFKHUV WRSURPRWHWKHSUHSDUDWLRQRIVXI¿FLHQWQXPEHUVRIPLGZLIHWHDFKHUVZLWKDKLJKOHYHORIFRPSHWHQFHERWKLQ SUDFWLFHDQGHGXFDWLRQWRPHHWWKHHGXFDWLRQQHHGVRIWKHFRXQWU\ to provide a range of options for the education of midwife teachers, such as sharing programs and resources ZLWKRWKHUGLVFLSOLQHVRUHYHQRWKHUFRXQWULHVWKXVSURYLGLQJHFRQRPLFDOO\YLDEOHFRXUVHVRIDKLJKVWDQGDUG *XLGHOLQHVIRUWHDFKHUHGXFDWLRQSURJUDPV $JORVVDU\RIWHUPVUHODWHGWRPLGZLIHWHDFKHUHGXFDWLRQ Intercountry cooperation for the education of midwife teachers: Two or more countries plan and implement a shared program for the education of midwife teachers. 0HQWRU $QH[SHULHQFHGPLGZLIHEDVHGLQDFOLQLFDODUHDRUDPLGZLIHWHDFKHUEDVHGLQDVFKRRORIPLGZLIHU\ZKR provides support, guidance, and supervision to the student midwife teacher. 0LGZLIHWHDFKHU $TXDOL¿HGFRPSHWHQWPLGZLIHZKRKDVVXFFHVVIXOO\FRPSOHWHGDUHFRJQL]HGHGXFDWLRQSURJUDP to prepare her to teach midwifery. 6.2.1 - Entry requirements 7KHSXUSRVHRIHVWDEOLVKLQJHQWU\UHTXLUHPHQWVIRUDGPLVVLRQWRPLGZLIHWHDFKHUHGXFDWLRQSURJUDPVLVWRSURPRWH HTXLW\DQGMXVWLFHZKHQFRQVLGHULQJWKHTXDOL¿FDWLRQVRILQGLYLGXDODSSOLFDQWV7KHUHDUHFHUWDLQIDFWRUVWKDWIDFLOLWDWH WKLVUROHWUDQVLWLRQDQGFHUWDLQFRQVLGHUDWLRQVWKDWDUHHVVHQWLDOIRUDQ\WHDFKHUZKRZLOODVVXPHWKHUHVSRQVLELOLW\IRU VXSHUYLVLQJRWKHUVLQDFRPSHWHQF\EDVHGFOLQLFDOSUDFWLFHUROH7KHVHDUHSUHVHQWHGLQ7DEOH Module 6 7DEOH $GPLVVLRQFRQVLGHUDWLRQV Age There is no evidence to support a minimum age requirement for admission. However, DSSOLFDQWVDUHOLNHO\WREHVHYHUDO\HDUVROGHUWKDQEDVLFVWXGHQWVEHFDXVHWKH\ZLOODOUHDG\ have completed a program of midwifery education and also have acquired some years of FOLQLFDOSUDFWLFHH[SHULHQFH &RXQWULHVZLOOGHFLGHRQDPD[LPXPDJHIRUPLGZLYHVVWDUWLQJWKHPLGZLIHWHDFKHUSURJUDP This will depend on a range of factors, including retirement age. (GXFDWLRQ Applicants should already have acquired a good general education, normally of 12 years GXUDWLRQ 7KH SURVSHFWLYH PLGZLIH WHDFKHU VKRXOG KDYH DWWDLQHG WKH DSSURSULDWH VFKRRO OHDYLQJFHUWL¿FDWHVRIWKHFRXQWU\LQZKLFKVKH1 was educated, including studies in a science VXEMHFW7KH\VKRXOGDOVREHÀXHQWLQWKHPDLQVWUHDP³OLQJXDIUDQFD´RIWKHUHJLRQ HJ (QJOLVK)UHQFK6SDQLVK&KLQHVH EHFDXVHPXFKRIWKHOLWHUDWXUHWREHVWXGLHGLVZULWWHQ in those key languages. Midwifery Applicants should possess the credential that is appropriate in their country that acknowledges WKDWWKH\KDYHVXFFHVVIXOO\FRPSOHWHGDEDVLFSURJUDPRIPLGZLIHU\HGXFDWLRQDQGKDYH TXDOL¿FDWLRQ GHPRQVWUDWHGWKHDFKLHYHPHQWRIJRRGVWDQGDUGVLQERWKWKHRU\DQGSUDFWLFH 3UDFWLFHH[SHULHQFH $ PLQLPXP RI WZR \HDUV IXOOWLPH RU SDUWWLPH HTXLYDOHQW UHFHQW FOLQLFDO H[SHULHQFH DV D midwife, in addition to the time spent in the preservice education program is recommended. 7KHFOLQLFDOH[SHULHQFHREWDLQHGGXULQJWKH\HDUVRIPLGZLIHU\SUDFWLFHVKRXOGEHFDUHIXOO\ UHYLHZHG,IH[SHULHQFHLVOLPLWHG HJOHVVWKDQDQDYHUDJHRIDERXWRQHGHOLYHU\DPRQWK IXUWKHU PLGZLIHU\ SUDFWLFH VKRXOG EH REWDLQHG EHIRUH WKH FDQGLGDWH LV FRQVLGHUHG IRU WKH SURJUDP,IVKHKDVRQO\SUDFWLFHGDVDPLGZLIHLQDFRPPXQLW\VHWWLQJH[SHULHQFHLQDKRVSLWDO ZRXOGEHDGLVWLQFWDGYDQWDJHEHIRUHHPEDUNLQJRQWKHWHDFKHUVFRXUVHDQGYLFHYHUVD *RRGNQRZOHGJHRI 7KHVH FULWHULD FDQ EH DVVHVVHG WKURXJK YDULRXV PHDQV$SSOLFDQWV FDQ EH UHTXHVWHG WR SUHVHQWDQ\HYLGHQFHWKDWWKH\PD\KDYHDYDLODEOHWRWKHPWKDWUHÀHFWVWKHLUDFKLHYHPHQW EDVLFPLGZLIHU\DQG RIWKHVHFULWHULD([DPSOHVLQFOXGH a good record of 6FRUHVRQH[DPLQDWLRQVIRUHQWU\LQWRSUDFWLFH VXFKDVWKHUHJLVWUDWLRQRU standards of practice FHUWL¿FDWLRQH[DPLQDWLRQVWKDWDUHUHTXLUHGLQVRPHFRXQWULHV UHFRUGVRISHHUUHYLHZVREWDLQHGGXULQJVXSHUYLVLRQRIWKHLUSUDFWLFH HYLGHQFHRISDUWLFLSDWLRQLQSURJUDPVRIFRQWLQXHGPLGZLIHU\HGXFDWLRQ written letters of reference from midwives and other health professionals who have KDGUHFHQWRSSRUWXQLW\WRREVHUYHWKHDSSOLFDQWLQWKHSHUIRUPDQFHRIWDVNVZLWKLQ the scope of the midwifery role. 0RWLYDWLRQWREHD $QLQWHUYLHZPD\EHUHTXLUHGRIDOODSSOLFDQWV7KHLQWHUYLHZTXHVWLRQVZRXOGIRFXVRQWKH DSSOLFDQW¶VPRWLYDWLRQWREHFRPHDWHDFKHULHWKHUHDVRQVVKHDVSLUHVWRWDNHRQWKLVUROH PLGZLIHWHDFKHU ZLWKUHVSHFWWRVHUYLQJVWXGHQWVFKLOGEHDULQJIDPLOLHVDQGWKHFRPPXQLW\7KHLQWHUYLHZHU VKRXOGDVNIRUDVHOIDVVHVVPHQWRIRQH¶VDSWLWXGHIRUWHDFKLQJZLOOLQJQHVVWRFRQIRUPZLWK WKHSKLORVRSK\RIWKHSURJUDPDQGDELOLW\WRFRSHZLWKWKHWKHRU\DQGSUDFWLFHUHTXLUHPHQWV RIWKHSURJUDP,IDQLQSHUVRQLQWHUYLHZLVGLI¿FXOWWRDUUDQJHEHFDXVHRIGLVWDQFHRUH[SHQVH DZULWWHQDSSOLFDWLRQWKDWDGGUHVVHVWKHVHVDPHTXHVWLRQVFRXOGEHH[WHQGHGWRLQFOXGH DVHFWLRQRQHGXFDWLRQIRUH[DPSOHZULWLQJDQHVVD\RQWKHVWXGHQWV¶RZQH[SHULHQFHRI teaching in clinical practice, or her personal concept of education in midwifery. *RRGKHDOWK It is consistent with an ethical foundation for midwifery practice that a student not have a FXUUHQWKHDOWKFRQGLWLRQWKDWFRXOGEHWUDQVPLWWHGWRWKHZRPDQDQGKHULQIDQWGXULQJWKH usual and customary delivery of health care services. Optional criteria 2WKHUFULWHULDPD\EHGHFLGHGORFDOO\EDVHGRQWKHVSHFL¿FFLUFXPVWDQFHVRIWKHFRXQWU\ situation. ([HPSWLRQFULWHULD &ULWHULD IRU H[HPSWLRQV WR SDUWV RI WKH SURJUDP FRXOG EH HVWDEOLVKHG E\ WKH SURJUDP DQGFRQVLGHUHGGXULQJWKHDGPLVVLRQVUHYLHZ)RUH[DPSOHDPLGZLIHZKRKDVDFTXLUHG DGYDQFHGPLGZLIHU\NQRZOHGJHE\XQGHUWDNLQJIXUWKHUVWXG\RIPLGZLIHU\DWDUHFRJQL]HG KLJKHUDFDGHPLFLQVWLWXWLRQRUZKRKDVJDLQHGH[SHULHQFHLQSUDFWLFHDWDOHYHOKLJKHUWKDQ EDVLFPLGZLIHU\SUHSDUDWLRQPD\EHH[HPSWIURPVWXG\RIFHUWDLQFRQWHQWLQWKHPRGHO WHDFKHUHGXFDWLRQFXUULFXOXP 17KHXVHRIWKHIHPDOHJHQGHUUHÀHFWVWKDWLQPDQ\FRXQWULHVPLGZLIHU\LVVHHQDVH[FOXVLYHO\RSHQWRZRPHQ+RZHYHULQD QXPEHURIQDWLRQVPHQQRZHQWHUWKLVSURIHVVLRQ7KHLQWHUQDWLRQDOGH¿QLWLRQKDVEHHQXSGDWHGWRUHÀHFWDPRUHJHQGHUQHXWUDO ODQJXDJH KRZHYHUWKLVJXLGDQFHXVHVWKHIHPDOHJHQGHUIRUHDVHRIXVH Developing effective programs for preparing midwife teachers 6XJJHVWHGIUDPHZRUNVIRUPLGZLIHWHDFKHUSURJUDPV 7KHPRGHOVGHVFULEHGEHORZUHSUHVHQWRSWLRQVWKDWPD\EHDGRSWHGRUDGDSWHGDVDSSURSULDWHWRWKHFRXQWU\VLWXDWLRQ LQWHUPVRIUHVRXUFHVDYDLODEOHSHUVRQQHODQGWKHTXDOLW\RIWKHDSSOLFDQWSRRO7KHHOHPHQWVWKDWDUHHVVHQWLDOWRWKH YDULRXVPRGHOVDUHGHVFULEHGDQGWKHFRPPRQFRUHRIDWHDFKHUHGXFDWLRQSURJUDPLVGHWDLOHGLQWKHVHFWLRQVWKDW IROORZ7KHPRGHOVDQGRSWLRQVWKDWDUHGHVFULEHGPD\EHVHOHFWHGLQOLQHZLWKWKHSULRUTXDOL¿FDWLRQVDQGH[SHULHQFH RIDSSOLFDQWVZKRDUHHOLJLEOHIRUDGPLVVLRQWRWKHWHDFKHUHGXFDWLRQSURJUDP7KHPHWKRGVE\ZKLFKWKHFRQWHQW LV GHOLYHUHG HJ FODVVURRPEDVHG RU :HEEDVHG LQVWUXFWLRQ GRHV QRW DOWHU WKH FRQWHQW RI WKH SURJUDP DQG DOO programs must have supervised teaching practice with midwifery students. As with any education program, the length LVLQÀXHQFHGE\WKHDPRXQWRIFRQWHQWDQGRIUHTXLUHGVXSHUYLVHGFOLQLFDOWHDFKLQJLQDQHQDEOLQJHQYLURQPHQWWKH DYDLODELOLW\RITXDOL¿HGWHDFKHUVDQGWHDFKLQJVXSSOLHVWKHFDOLEHUDQGQHHGVRIDSSOLFDQWVDQGWKHSROLWLFDOGHPDQGV of the country or region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³DFDGHPLFPLQRUV´RIIHUHGZLWKLQJUDGXDWHSURJUDPV RI VWXG\ )RXU XQLWV RI VWXG\ WKDW FRYHU WKH FRQWHQW DUHDV GHVFULEHG LQ VHFWLRQ RI WKLV PRGXOH DUH W\SLFDOO\ RIIHUHG D FRPSHWHQF\EDVHGWHDFKLQJPHWKRGVDQGVWUDWHJLHVE FXUULFXOXPGHVLJQF HYDOXDWLRQPHWKRGVDQGG DGPLQLVWUDWLYHDQGOHJDODVSHFWVRIWHDFKLQJ(DFKXQLWRIVWXG\ZLOOYDU\IURPWRKRXUVRIWKHRUHWLFDOFRQWHQW and an associated period of supervised teaching practice that is typically calculated at a ratio of 3 hours of practice for each 1 hour of credit. 6.3.2 - Options for midwife-teacher programs: further exploration 7KHUHDUHDQXPEHURIRSWLRQVWKDWFDQEHDSSOLHGLQGHVLJQLQJDVWDQGDORQHPLGZLIHWHDFKHUSURJUDP7KH¿UVWRIWKH WZRRSWLRQVSUHVHQWHGEHORZUHSUHVHQWVDWZRSDUWSURJUDPWKDWVHHNVWR¿UVWVWUHQJWKHQWKHFOLQLFDOPLGZLIHU\VNLOOV RIWKHIXWXUHWHDFKHUDQGWKHQEXLOGLQJRQWKDWFRPSHWHQF\IRVWHUFDSDFLW\LQWHDFKLQJDQGVWXGHQWHYDOXDWLRQ7KH VHFRQGRSWLRQVKRUWHQVWKHSURJUDPRIVWXG\WRIRFXVRQWHDFKHUHGXFDWLRQDVVXPLQJWKDWWKHWHDFKHUFDQGLGDWHV KDYHDOUHDG\DFTXLUHGDQGGHPRQVWUDWHGSUR¿FLHQF\LQPLGZLIHU\FOLQLFDOSUDFWLFH Module 6 2SWLRQ 7ZRGLVWLQFWSDUWV DGYDQFHGSRVWEDVLFPLGZLIHU\VWXGLHVDQGWHDFKHU HGXFDWLRQVWXGLHV 7KHUDWLRQDOHIRUGLYLGLQJWKHSURJUDPLQWRWZRVHSDUDWHSDUWVIRFXVLQJ¿UVWRQPLGZLIHU\ 3DUW DQGWKHQRQHGXFDWLRQ 3DUW LVWRHQVXUHWKDWWKHPLGZLIHWHDFKHUKDVDQLQGHSWKNQRZOHGJHRIPLGZLIHU\WKHRU\DQGFRPSHWHQFHLQ SUDFWLFHEHIRUHHPEDUNLQJRQWKHHGXFDWLRQSDUWRIWKHSURJUDP7KLVLVDQHVVHQWLDOUHTXLUHPHQWIRUPLGZLIHWHDFKHUV :LOOLDPVRQ 7KLVRSWLRQKDVPDQ\DGYDQWDJHVQRWWKHOHDVWRIZKLFKLVWKDWLWDOVRRIIHUVWKHRSSRUWXQLW\IRU VRPHPLGZLYHVZKRZLVKWRH[WHQGWKHLUPLGZLIHU\NQRZOHGJHEXWGRQRWZLVKWREHFRPHWHDFKHUVWRFRPSOHWHRQO\ 3DUWRIWKHSURJUDP7KLVVKRXOGEHHQFRXUDJHGEHFDXVHEHWWHUHGXFDWHGPLGZLYHVLQFOLQLFDOSUDFWLFHZRXOGQRW RQO\SURPRWHKLJKHUVWDQGDUGVRIFDUHEXWDOVRSURYLGHPRUHHIIHFWLYHWHDFKLQJDQGVXSHUYLVLRQRIPLGZLIHVWXGHQWV LQWKHSUDFWLFHDUHDV$QRWKHUDGYDQWDJHRIRSHQLQJ3DUWRIWKHSURJUDPWRDOOVXLWDEOHPLGZLYHVLVWKDWWKLVZRXOG LQFUHDVHWKHQXPEHURISDUWLFLSDQWVDQGWKHUHIRUHKHOSPDNHWKHFRXUVHPRUHYLDEOH,WVKRXOGEHPDGHFOHDUKRZHYHU WKDWPLGZLYHVZKRZLVKWREHFRPHWHDFKHUVPXVWFRPSOHWHERWK3DUWVDQGRIWKHSURJUDP0LGZLYHVZKRKDYH DOUHDG\VXFFHVVIXOO\FRPSOHWHGDQDGYDQFHGSRVWEDVLFPLGZLIHU\VWXGLHVSURJUDPWKDWPHHWVWKHFULWHULDDJUHHGWR E\WKHLQVWLWXWLRQRIIHULQJWKHSURJUDPFDQEHH[HPSWIURP3DUW 3DUWRIWKHSURJUDP HGXFDWLRQVWXGLHV ZRXOGQRUPDOO\EHVWDUWHGZLWKLQDIHZZHHNVRIFRPSOHWLQJ3DUW,IWKLVSDUW LVQRWVWDUWHGZLWKLQ¿YH\HDUVRIVXFFHVVIXOO\FRPSOHWLQJ3DUWWKHPLGZLYHVZRXOGQRUPDOO\EHUHTXLUHGWRSURYLGH HYLGHQFHWKDWWKH\KDGUHFHQWO\XSGDWHGWKHLUPLGZLIHU\NQRZOHGJH$OVRLIWKH\KDYHQRWEHHQLQFOLQLFDOSUDFWLFHIRU a large part of this time, the midwives must arrange immediately prior to commencing Part 2 to spend a period of time in clinical practice and have a reference from a clinical supervisor to testify that they are clinically competent in all aspects of midwifery practice. 7KHIROORZLQJDOWHUQDWLYHVIRUGHVLJQRI2SWLRQ3DUW HGXFDWLRQVWXGLHV PD\EHFRQVLGHUHG $SURJUDPGHVLJQHGRQO\IRUPLGZLIHWHDFKHUV DPXOWLGLVFLSOLQDU\SURJUDPZKLFKZRXOGLQFOXGHVWXGHQWWHDFKHUVIURPRWKHUKHDOWKUHODWHGGLVFLSOLQHVHJ QXUVLQJSK\VLRWKHUDSLVWVHWF &RSSHUPDQDQG1HZWRQ 7KLVPD\EHQHFHVVDU\LIWKHUHDUHLQVXI¿FLHQW PLGZLIHWHDFKHUVWXGHQWVWRPDNHWKHSURJUDPYLDEOHDOWKRXJKRWKHURSWLRQVDUHGLVFXVVHGLQVHFWLRQ LQFOXGLQJLQWHUFRXQWU\FRRSHUDWLRQ DPXOWLGLVFLSOLQDU\SURJUDPWRLQFOXGHPLGZLYHVRWKHUKHDOWKUHODWHGVWDIIDQGDOVRSURIHVVLRQDOVIURPRWKHU GLVFLSOLQHVZKRDUHJRLQJWRWHDFKDGXOWVHJKLVWRU\OLWHUDWXUHHWF6KDULQJUHVRXUFHVEHWZHHQDQXPEHURI GLVFLSOLQHVPDNHVWKHSURJUDPYLDEOH :KDWHYHUWKHW\SHRIRSWLRQVHOHFWHGLWLVHVVHQWLDOWKDWDVHQLRUPLGZLIHWHDFKHUEHIXOO\LQYROYHGLQDOODVSHFWVRIWKH planning, implementation, and delivery of the program. :KHUH PXOWLGLVFLSOLQDU\ SURJUDPV DUH RIIHUHG LW LV UHFRPPHQGHG WKDW WKHUH EH D FRUH FXUULFXOXP WKDW ZRXOG EH DWWHQGHGE\DOOVWXGHQWVSOXVVSHFLDOPRGXOHVIRUWKHVWXGHQWVIURPWKHGLIIHUHQWGLVFLSOLQHV,QWKRVHVSHFLDOPRGXOHV WKHVWXGHQWVIURPDSDUWLFXODUGLVFLSOLQHFDQEHWDXJKWE\DWXWRUIURPWKHLURZQVXEMHFW¿HOGRUKDYHWKHRSSRUWXQLW\ WRGLVFXVVZLWKWKHWXWRUWKHDSSOLFDWLRQRIWKHFRUHFRQWHQWWRWKHLUGLVFLSOLQHVSHFL¿FDUHD7HDFKLQJSUDFWLFHZRXOG Developing effective programs for preparing midwife teachers DOVREHDUUDQJHGDQGVXSHUYLVHGE\WKHVSHFLDOLVWWXWRU7KHUHIRUHDPLGZLIHWHDFKHURQWKHVWDIIRIWKHLQVWLWXWLRQ FRQGXFWLQJEHDUUDQJHGDQGVXSHUYLVHGE\WKHVSHFLDOLVWWXWRU7KHUHIRUHDPLGZLIHWHDFKHURQWKHVWDIIRIWKHLQVWLWXWLRQ FRQGXFWLQJWKHPLGZLIHWHDFKHUSURJUDPZRXOGVXSHUYLVHPLGZLIHWHDFKHUVWXGHQWV,QDGGLWLRQWKHVWXGHQWWHDFKHU should also have a named midwife teacher in the teaching placement site who can act as a mentor and supervisor. 2SWLRQ ,QWHJUDWHGDGYDQFHGPLGZLIHU\WKHRU\HGXFDWLRQDQGSUDFWLFHVWXGLHV $GYDQFHGSRVWEDVLFPLGZLIHU\WKHRU\SUDFWLFHDQGHGXFDWLRQVWXGLHVZRXOGEHLQFOXGHGWKURXJKRXWWKH PLGZLIHWHDFKHUSURJUDP The advantages of Option 2 are: 0LGZLIHU\WKHRU\SUDFWLFHDQGHGXFDWLRQFDQEHLQWHJUDWHGWKURXJKRXWWKHSURJUDP WKHUHLVOHVVULVNRIPLGZLYHVEHLQJDSSRLQWHGWRWHDFKLQJSRVWVDIWHUFRPSOHWLRQRIRQO\3DUW LHRQO\ KDYLQJDGYDQFHGSRVWEDVLFPLGZLIHU\VWXGLHVDQGQRHGXFDWLRQDOFRPSHWHQFLHV The disadvantages of Option 2 are: 7KHUHLVOHVVÀH[LELOLW\EHFDXVHWKHLQWHJUDWHGQDWXUHRIWKHFRXUVHZRXOGPDNHLWPRUHGLI¿FXOWWRRSHQWKH DGYDQFHGPLGZLIHU\VWXGLHVSDUWRIWKHSURJUDPWRRWKHUPLGZLYHV WKHUHDUHVXEVWDQWLDOFRVWDQGUHVRXUFHLPSOLFDWLRQVRISURYLGLQJVHSDUDWHSURJUDPVWRXSGDWHPLGZLYHVLQ FOLQLFDOSUDFWLFH WKHLQWHJUDWHGSURJUDPGHVLJQPHDQVLWZRXOGEHPRUHGLI¿FXOWWRJLYHH[HPSWLRQVWRPLGZLYHVIRUSUHYLRXV DGYDQFHGPLGZLIHU\VWXGLHV ERWKDGYDQFHGSRVWEDVLFPLGZLIHU\DQGHGXFDWLRQZRXOGKDYHWREHVWXGLHGLQWKHVDPHORFDWLRQ 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(DFKVWXGHQWWHDFKHUUHTXLUHVDSODFHPHQWLQDQLQVWLWXWLRQZKHUHPLGZLIHU\HGXFDWLRQWDNHVSODFH6RPHFRXQWULHV PD\ZLVKWRJLYHVWXGHQWVH[SHULHQFHLQDVHFRQGLQVWLWXWLRQSHUKDSVWRZDUGVWKHHQGRIWKHLUSURJUDPZKHQWKH\ KDYHJDLQHGFRQ¿GHQFH$QH[SHULHQFHGPLGZLIHWHDFKHULQWKHLQVWLWXWLRQZKHUHVWXGHQWVDUHSODFHGZLOOEHVHOHFWHG WREHKHUPHQWRUVXSHUYLVRU. 3UHSDUDWLRQRIPHQWRUVVXSHUYLVRUV ,WLVUHFRPPHQGHGWKDWPHQWRUVVXSHUYLVRUVEHSUHSDUHGIRUWKHLUUROHLQVXSHUYLVLQJDQGDVVHVVLQJVWXGHQWWHDFKHUV E\WKHLQVWLWXWLRQUHVSRQVLEOHIRUWKHSUHSDUDWLRQRIPLGZLIHWHDFKHUV Module 6 $UHDVWREHFRQVLGHUHGLQWKHSUHSDUDWLRQRIPHQWRUVVXSHUYLVRUVLQFOXGH ,QIRUPDWLRQDERXWWKHVWXGHQWWHDFKHUVSURJUDP H[SHULHQFHUHTXLUHGE\VWXGHQWVGXULQJWKHLUSODFHPHQW WKH\VKRXOGEHLQYROYHGLQDOODVSHFWVRIWKHPLGZLIH WHDFKHU¶VUROHDVZHOODVWHDFKLQJLQWKHRUHWLFDODQGFOLQLFDODUHDV UROHRIWKHPHQWRUVXSHUYLVRU DVVHVVPHQWSURFHGXUHVDQGWRROVIRUDVVHVVPHQWRIWKHRUHWLFDOFODVVURRPDQGFOLQLFDOWHDFKLQJ OLDLVRQZLWKDPLGZLIHWHDFKHULQWKHLQVWLWXWLRQZKHUHWKHWHDFKHUVFRXUVHLVEDVHG 7KHUHVKRXOGEHRQJRLQJGLDORJXHEHWZHHQWKHPLGZLIHWHDFKHUVDQGWKHPHQWRUVVXSHUYLVRUVWRGLVFXVVWKHSURJUDP VWXGHQWV¶SURJUHVVDQGDQ\SUREOHPVHQFRXQWHUHG$SDUWQHUVKLSDSSURDFKEHQH¿WVERWKSDUWLHVEXWHVSHFLDOO\WKH students. $UUDQJHPHQWRIWHDFKLQJSUDFWLFH ,GHDOO\WKHUHVKRXOGEHVKRUWSHULRGVRIRULHQWDWLRQDQGREVHUYDWLRQLQWKHWHDFKLQJSODFHPHQWWKH¿UVWZHHNVRIWKH WHDFKHUVSURJUDPIROORZHGE\ORQJHUEORFNVODWHU&OHDUOHDUQLQJRXWFRPHVVKRXOGEHIRUPXODWHGIRUHDFKSHULRG LQWKHWHDFKLQJSODFHPHQW6WXGHQWVVKRXOGDOVREHHQFRXUDJHGWRNHHSDUHÀHFWLYHMRXUQDODQGZULWHXSDQXPEHU RI VLJQL¿FDQW LQFLGHQWV WKDW KDYH RFFXUUHG IRU H[DPSOH KRZ VKH RU RQH RI WKH WXWRUV GHDOW ZLWK D VWXGHQW ZKR ZDVGLVUXSWLYHLQFODVVRUDUHODWLRQVKLSSUREOHPWKDWKDVRFFXUUHGEHWZHHQVWDII5HÀHFWLRQRQDQGGLVFXVVLRQRI these incidents with their peer group and tutor on return to their classes (without revealing names of the individuals FRQFHUQHG SURPRWHVOHDUQLQJIURPWKHLQFLGHQWV $URQVRQ 7KHXVHRIOHDUQLQJFRQWUDFWVIRUPXODWHGE\WKH VWXGHQWDQGGLVFXVVHGZLWKKHUPHQWRUVXSHUYLVRUGXULQJWHDFKLQJSUDFWLFHSODFHPHQWVDOVRDLGVOHDUQLQJ $QQH[ $VVHVVPHQWVRIWHDFKLQJLQERWKLQWKHWKHRUHWLFDODQGFOLQLFDOFRPSRQHQWVZLOOEHUHTXLUHG7KHUHVSRQVLELOLW\IRU DVVHVVPHQWRIVWXGHQWSURJUHVVVKRXOGEHVKDUHGE\WKHVWXGHQWWHDFKHUVWKHIDFXOW\IURPWKHSURJUDPDQGWKH VWXGHQW¶VPHQWRUVXSHUYLVRU,IGLVWDQFHDQGWUDYHOSUHVHQWFKDOOHQJHVWRGLUHFWVXSHUYLVLRQPHQWRUVDQGVXSHUYLVRUV VKRXOGEHDVNHGWRZULWHLQWHULPDQG¿QDOUHSRUWVRQWKHLUVWXGHQWV¶SURJUHVV 7HDFKLQJDQGOHDUQLQJVWUDWHJLHV 0LGZLIHWHDFKHUVWXGHQWVDUHDGXOWOHDUQHUVVRWKH\ZLOOEULQJDZHDOWKRIOLIHDQGSURIHVVLRQDO H[SHULHQFH WRWKH course. It is widely acknowledged that adult students learn most effectively when they are actively involved in their RZQOHDUQLQJ .QRZOHV+ROWRQDQG6ZDQVRQ 0HUULPDQ 6WXGHQWFHQWHUHGPHWKRGVSURPRWHWKLVW\SH RILQYROYHPHQWDQGLWLVEHFRPLQJLQFUHDVLQJO\DSSDUHQWWKDWWKH\DUHWKHPRVWHIIHFWLYHWHDFKLQJOHDUQLQJDSSURDFKHV %DVK 7KH\DOVRKHOSVWXGHQWVWRWDNHUHVSRQVLELOLW\IRUWKHLURZQOHDUQLQJDQGGHYHORSLQWROLIHORQJOHDUQHUV an essential characteristic for midwife teachers. 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Teaching assessments 6WXGHQWVFRXOGJDLQH[SHULHQFHLQFRQGXFWLQJDVVHVVPHQWVRIWKHWHDFKLQJVNLOOVRIWKHLUSHHUV,QWXUQWKHVWXGHQWV ZLOOUHFHLYHVLPLODUDVVHVVPHQWVIURPERWKWKHLUWKHLUSHHUVDQGWKHLUPHQWRUVXSHUYLVRU&RQVWUXFWLYHIHHGEDFNZRXOG EHDQHVVHQWLDOHOHPHQWRIWKLVH[HUFLVH%RWKWKHRUHWLFDOFODVVURRPDQGFOLQLFDOWHDFKLQJVKRXOGEHDVVHVVHG Module 6 4XDOLW\DVVHVVPHQW 6.8.1 - Quality in education 4XDOLW\LQHGXFDWLRQLVDVVHVVHGE\PHDVXULQJZKDWLVSURYLGHGDQGFRPSDULQJWKLVWRZKDWLVH[SHFWHG,IWKLVUHYHDOV GH¿FLHQFLHVRUZHDNQHVVHVLQWKHSURYLVLRQRIHGXFDWLRQ IRUH[DPSOHORZVWDI¿QJOHYHOVSRRUVWDQGDUGVRIWHDFKLQJ RULQDGHTXDWHUHVRXUFHV JHQXLQHDWWHPSWVPXVWEHPDGHWRFRUUHFWWKHVKRUWFRPLQJV7KHTXDOLW\RISURJUDPVWKDW SUHSDUHWHDFKHUVRIPLGZLYHVKDVDGLUHFWLPSDFWRQWKHTXDOLW\RIWKHHGXFDWLRQRIIHUHGWRVWXGHQWPLGZLYHV 7DXEHW DO 7HDFKHUHGXFDWLRQSURJUDPVVKRXOGEHUHYLHZHGDWDPLQLPXPIRUEHVWSUDFWLFHVLQ 3ROLF\ IDLUQHVVHWKLFVJHQGHUHTXLW\ VWDII VXI¿FLHQWLQQXPEHUFXUUHQWLQNQRZOHGJHDQGVNLOOVHIIHFWLYHDWWKHLUWDVN FRXUVHV FRPSUHKHQVLYHLQVFRSHHYLGHQFHEDVHGFRQWHQW PDUNHWLQJ EURDGRXWUHDFKDFFHVVLELOLW\RSWLRQV WHDFKLQJDQGOHDUQLQJ YDULHW\RIDSSURDFKHVPXOWLSOHPHDQVRIDVVHVVPHQW RXWFRPHV DFKLHYHPHQWVDWERWKLQGLYLGXDODQGSURJUDPOHYHOV 6.8.2 - Evaluation of the teacher-education program and its component courses The students should have the opportunity to evaluate individual courses at regular intervals during the program and also the program as a whole. Methods of evaluation may include: ,QIRUPDOJURXSGLVFXVVLRQVZLWKWHDFKLQJVWDII ZULWWHQFRPPHQWVDQGRUTXHVWLRQQDLUHV DUDQGRPVDPSOHRIXQVWUXFWXUHGLQWHUYLHZV H[LWLQWHUYLHZV graduate surveys. 'DWD REWDLQHG IURP HYDOXDWLRQV VKRXOG LQFOXGH DOO DVSHFWV RI WKH SURJUDP 7KLV LQIRUPDWLRQ VKRXOG JR WR WKH DGPLQLVWUDWLYHWHDPWKDWLVUHVSRQVLEOHIRUUHVSRQGLQJZLWKDSSURSULDWHGHFLVLRQVUHJDUGLQJWKHRQJRLQJGHYHORSPHQW RISURJUDPFRPSRQHQWV5HVXOWVRIHYDOXDWLRQVDQGDFWLRQSODQVEDVHGRQWKLVLQIRUPDWLRQVKRXOGEHVKDUHGZLWK other appropriate authorities in the institution in which the program is located. 6.8.3 - Individual performance review $QQXDOLQGLYLGXDOSHUIRUPDQFHUHYLHZLVUHFRPPHQGHGIRUDOOVWDIIPHPEHUVZKRFRQWULEXWHWRWKHSURJUDPIRUWKH HGXFDWLRQ RI PLGZLIH WHDFKHUV RQ D UHJXODU EDVLV$ VHQLRU VWDII PHPEHU LQ WKH GHSDUWPHQW ZRXOG QRUPDOO\ FDUU\ WKLVRXW6WUHQJWKVDVZHOODVDQ\ZHDNQHVVHVZRXOGEHLGHQWL¿HGDQGVWUDWHJLHVGHYLVHGIRUFRQWLQXLQJSHUVRQDO professional development. Developing effective programs for preparing midwife teachers 5HVRXUFHV 6.9.1 - Education institution $GHTXDWHUHVRXUFHVDUHHVVHQWLDOWRDZHOOUXQPLGZLIHWHDFKHUFRXUVH7KHVHUHVRXUFHVLQFOXGHDIXOOFRPSOHPHQW RI ZHOOWUDLQHG WHDFKHUV OLEUDULDQV DXGLRYLVXDO SHUVRQQHO DQG DGPLQLVWUDWLYH VWDII ,W DOVR LQFOXGHV ZHOOHTXLSSHG FODVVURRPVVHPLQDUURRPVDUDQJHRIDXGLRYLVXDODQGRWKHUWHDFKLQJDLGVFRPSXWHUIDFLOLWLHVDQGDZHOOVWRFNHG OLEUDU\2I¿FHDQGVWXG\VSDFHVKRXOGEHDYDLODEOHIRUWHDFKHUVVWXGHQWVDQGVWDII$PHDQVRIWUDQVSRUWWRWHDFKLQJ SODFHPHQWVPLJKWEHQHFHVVDU\LQVRPHFLUFXPVWDQFHV7KHUHVKRXOGDOVREHDOLQNDJH HJWHOHSKRQH,QWHUQHW EHWZHHQWKHVLWHRIWKHWHDFKHUHGXFDWLRQSURJUDPDQGRWKHUSURJUDPVIRUSUHSDULQJWHDFKHUVRIDGXOWDQGKLJKHU education, if these programs are not offered in the same institution. 3ODFHPHQWV $QDGHTXDWHQXPEHURIVXLWDEOHFOLQLFDOSODFHPHQWVZLOOEHUHTXLUHGWRSURYLGHVWXGHQWVZLWKPLGZLIHU\H[SHULHQFH LQFOXGLQJOLIHVDYLQJVNLOOVDQGIRUFOLQLFDOWHDFKLQJ3ODFHPHQWVLQVFKRROVRIPLGZLIHU\DQGRUQXUVLQJZKHUHWKHUHDUH VWXGHQWPLGZLYHVDQGRUQXUVHVVWXG\LQJPLGZLIHU\ZLOODOVREHUHTXLUHGIRUWHDFKLQJSUDFWLFH 7KHQXPEHURIVWXGHQWWHDFKHUVDVVLJQHGWRHDFKSODFHPHQWPXVWPDWFKWKHDPRXQWRIH[SHULHQFHDYDLODEOHWKHUH 0RVWSODFHPHQWVZLOORQO\EHDEOHWRRIIHUVXI¿FLHQWH[SHULHQFHDQGJRRGVXSHUYLVLRQIRUWZRRUWKUHHVWXGHQWWHDFKHUV The education institution organizing the teachers course will therefore need to form links with several different clinical DUHDVDQGVFKRROVRIPLGZLIHU\WKDWFRXOGEHXVHGIRUVWXGHQWSODFHPHQWV7KHFULWHULDIRUVHOHFWLRQRILQVWLWXWLRQVKDYH EHHQSUHVHQWHGLQ6HFWLRQRIWKLVWRRONLW 2SWLRQVIRUWKHSURYLVLRQRISURJUDPVIRUPLGZLIHWHDFKHUV 0DQ\FRXQWULHV¿QGLWGLI¿FXOWWRVHFXUHWKHQHFHVVDU\UHVRXUFHVWRSURYLGHDSSURSULDWHHGXFDWLRQSURJUDPVIRUWKH SUHSDUDWLRQRIPLGZLIHWHDFKHUV+RZHYHUKDYLQJHQRXJKZHOOSUHSDUHGWHDFKHUVLVHVVHQWLDOLIFRXQWULHVDUH WRWUDLQNQRZOHGJHDEOHDQGFRPSHWHQWPLGZLYHVZKRDUHFDSDEOHRISURYLGLQJVDIHDQGVNLOOHGFDUHIRUZRPHQDQG WKHLULQIDQWV7KLVVHFWLRQWKHUHIRUHLQFOXGHVDQXPEHURIRSWLRQVIRUWKHHGXFDWLRQRIPLGZLIHWHDFKHUVWKDWQDWLRQV may wish to consider. 6.10.1 - Option 1: National programs (DFKFRXQWU\SURYLGHVLWVRZQSURJUDP V IRUWKHSUHSDUDWLRQRIPLGZLIHWHDFKHUV )RUPLGZLIHWHDFKHUVDORQH IRUPLGZLIHWHDFKHUVWRJHWKHUZLWKRWKHUKHDOWKFDUHSURIHVVLRQDOVZKRDUHSUHSDULQJWREHFRPHWHDFKHUVRI WKHLUSURIHVVLRQDOJURXSHJQXUVHVSK\VLFDOWKHUDSLVWVHWF for midwife teachers, other health care professional groups, and professionals in other disciplines who are SUHSDULQJWRWHDFKDGXOWVVXFKVXEMHFWVDVKLVWRU\DQGHFRQRPLFV Module 6 ,WLVLPSRUWDQWWRQRWHWKDWRQO\WKHHGXFDWLRQSDUWRIWKHSURJUDPFRXOGEHVKDUHGZLWKRWKHUSURIHVVLRQDOJURXSV7KH DGYDQFHGPLGZLIHU\VWXGLHVSDUWRIWKHSURJUDPZRXOGKDYHWREHFRPSOHWHGEHIRUHWKHVWXGHQWHQWHUVWKHVHTXHQFH RIWHDFKHUHGXFDWLRQVWXGLHV 6.10.2 - Option 2: Intercountry programs 5HVWULFWHGUHVRXUFHVPD\PDNHLWLPSRVVLEOHIRUVRPHQDWLRQVWRRIIHUSURJUDPVIRUWKHHGXFDWLRQRIPLGZLIHWHDFKHUV ,WLVWKHUHIRUHVXJJHVWHGWKDWWZRRUPRUHFRXQWULHVLQWKHVDPHUHJLRQFRPELQHWKHLUOLPLWHGUHVRXUFHVDQGRIIHURQH SURJUDPWKDWWKH\VKDUH$ODUJHUQXPEHURIVWXGHQWVZRXOGKHOSWRPDNHWKHSURJUDPYLDEOH 7KLVSURJUDPPD\EH %HVLWHGLQRQHFRXQWU\ EHVLWHGLQWZRFRXQWULHVZLWKIRUH[DPSOHWKHDGYDQFHGPLGZLIHU\VWXGLHVSDUWRIWKHFRXUVHLQRQHFRXQWU\ DQGWKHHGXFDWLRQSDUWLQWKHRWKHUFRXQWU\ have the education part of the program shared with other disciplines from the participating countries. :LWKDOOWKHVHRSWLRQVIXQGLQJZRXOGEHDJUHHGXSRQDQGVKDUHGEHWZHHQSDUWLFLSDWLQJJRYHUQPHQWV Issues to consider if intercountry programs are planned include the following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strategies for including the input of all the countries wishing to share in the provision of the course in the SODQQLQJDQGRQJRLQJGHYHORSPHQWRIWKHSURJUDP ZD\VWRDVVXUHDJUHHPHQWRQWKHFXUULFXOXPDQGRQDOORWKHUNH\LVVXHV HJH[WHUQDODFFUHGLWDWLRQRIWKH SURJUDPWKHGLSORPDRUGHJUHHWKDWZRXOGEHDZDUGHG VRWKDWDOOJUDGXDWHVRIWKHSURJUDPDFKLHYHD FRPPRQGHVLJQDWLRQWKDWLVUHFRJQL]HGDQGUHVSHFWHGLQDOOSDUWLFLSDWLQJFRXQWULHV ZD\VRIHVWDEOLVKLQJJRRGFRPPXQLFDWLRQVEHWZHHQFRXQWULHVSDUWLFLSDWLQJLQWKHSURYLVLRQRIWKHPLGZLIH WHDFKHUSURJUDP FRVWLQJDQGDJUHHPHQWVEHWZHHQFRXQWULHVRQEXGJHWV Developing effective programs for preparing midwife teachers 6.10.3 - 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This can FRQWULEXWHWRWKDWWHDFKHU¶VORVVRIXSWRGDWHNQRZOHGJHPRWLYDWLRQDQGHQWKXVLDVP2SSRUWXQLWLHVIRUUHJXODUSHULRGV of continuing education for midwife teachers are therefore essential. It is recommended that all midwife teachers have DPLQLPXPVSHFL¿HGSHULRGIRUFRQWLQXLQJSHUVRQDOSURIHVVLRQDOGHYHORSPHQWDWUHJXODULQWHUYDOVHJHYHU\WKUHH years. 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Action plan Feelings If the situation arose What were you again, what would you do? thinking and feeling? Reflection process Conclusion Evaluation What else could you What was good and have done? bad about the experience? Analysis What sense can you make of the situation? Module 6 $QQH[ /HDUQLQJFRQWUDFW The following is an example of a learning contract form /HDUQLQJREMHFWLYH 6WUDWHJ\ /HDUQLQJUHVRXUFHV :KRFDQKHOS" :KDWLVDYDLODEOH" (YLGHQFHRIDFFRPSOLVKPHQW 6LJQDWXUHRIVWXGHQW 'DWH 6LJQDWXUHRIWXWRUPHQWRU 'DWH Developing effective programs for preparing midwife teachers $QQH[ 0LGZLIHWHDFKHUFRPSHWHQFH 7KHIROORZLQJFKHFNOLVWFDQEHXVHGDVDVHOIDVVHVVPHQWIRUPRUDVSDUWRIWHDFKHUDVVHVVPHQWSUR¿OH7KHVNLOOVOLVW LVH[WHQGHGWRLQFOXGHWKHNQRZOHGJHWKDWWKHWHDFKHUPXVWSRVVHVVLQRUGHUWRSUDFWLFHWKLVVNLOOWRWKHOHYHOUHTXLUHG and also the attitudinal traits that should underpin the practice. Skill Knowledge $WWLWXGH Always No 8QVXUH Practice all clinical Biological and social sciences 5HÀHFWLYH midwifery skills to underpinning midwifery to SUDFWLWLRQHU mastery level. DGYDQFHGOHYHO HPSDWKHWLF PLGZLIHU\VXEMHFWVWRDGYDQFHG women and OHYHO QHZERUQIRFXVHG DSSOLHVUHVHDUFK¿QGLQJVLQ applies practice. professional ethics. Conduct simple research %DVLFHSLGHPLRORJ\ 7KRURXJK using qualitative EDVLFVWDWLVWLFV and quantitative WKRXJKWIXO DQDO\WLFDOIUDPHZRUN methodologies. analytical. research resources. Teach students /HDQLQJVW\OHV 3DWLHQW effectively. teaching and training good sense of PHWKRGRORJLHV KXPRU WKHRU\ logical. clinical. Assess students fairly. Assessment strategies. &RQVLGHUDWH develops rapport easily. Clear accurate, concise 5HSRUWZULWLQJ &DUHIXO UHSRUWDQGUHFRUG national legislation on WUXWKIXO keeping. UHFRUGNHHSLQJ accurate. Management. (GXFDWLRQDOPDQDJHPHQW 7UXVWZRUWK\ WKHRULHV FROODERUDWLYH WLPHWDEOLQJDQGVFKHGXOLQJ PHWKRGLFDO curriculum design and calm. 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Continuous quality improvement:$SURFHVVE\ZKLFKDQDVVHVVPHQWLVPDGHRILQGLYLGXDODQGRUJURXSSUDFWLFH DQGFRPSDUHGWRH[WHUQDOVWDQGDUGVRIVDIHDQGHIIHFWLYHSUDFWLFHDQGZKHQLQGLFDWHGUHFRPPHQGDWLRQVDUH generated for enhancing quality of care. Critical incident analysis:$SURFHVVLQZKLFKWKRVHLQYROYHGLQDGLI¿FXOWFOLQLFDOVLWXDWLRQHQJDJHLQGLVFXVVLRQ RIWKHFLUFXPVWDQFHVWKDWPD\KDYHDIIHFWHGWKHRXWFRPHLQWKHLQWHUHVWRILGHQWLI\LQJIDFWRUVWKDWFDQEHPRGL¿HG LQRUGHUWRSURPRWHEHWWHURXWFRPHV 0HQWRUVKLS $GHYHORSPHQWDOSURFHVVWKDWRFFXUVZKHQDOHVVH[SHULHQFHGSDUWQHUUHIHUUHGWRDVDPHQWHHRU SURWpJpLVJXLGHGE\DPRUHH[SHULHQFHGSHUVRQZKRDVVLVWVWKHPHQWHHWRJDLQLQVLJKWLQWRQHZVLWXDWLRQVRU H[SHULHQFHVWKURXJKWKHLQWHJUDWLRQRISULRUOHDUQLQJ 3UHFHSWRUVKLS $VXSSRUWLYHSURFHVVWKDWRFFXUVZKHQDPRUHH[SHULHQFHGSHUVRQZRUNVDORQJVLGHDQRWKHUWR SURYLGHFOLQLFDOVXSSRUWDQGGLUHFWLRQWRDOHDUQHUZKRLVDFTXLULQJQHZVNLOOV VWXGHQWSUHFHSWRUVKLS RUWRDQHZO\ TXDOL¿HGSUDFWLWLRQHUZKRLVPDNLQJWKHWUDQVLWLRQWRWKHUROHRILQGHSHQGHQWSUDFWLWLRQHU 3URIHVVLRQDO VHOIUHJXODWLRQ 7DNLQJ SHUVRQDO UHVSRQVLELOLW\ IRU DGKHULQJ WR VWDWXWRU\ UXOHV UHJXODWLRQV DQG guidelines for midwifery practice. 5HÀHFWLYHSUDFWLFH 3URYLGLQJWKHRSSRUWXQLW\WRUHYLHZRQH¶VSUDFWLFHHLWKHULQDJURXSRULQGLYLGXDOO\ Statutory supervision: A formal process of clinical oversight and review of practice according to standards that is UHTXLUHGE\VWDWXWRU\UHJXODWLRQ DV\VWHPRIVXSHUYLVLQJPLGZLYHVZLWKLQDUHJXODWRU\IUDPHZRUN Supportive supervision:2IIHULQJVXSSRUWDQGJXLGDQFHWKURXJKPXWXDOHQJDJHPHQWLQGLDORJXHDERXWLVVXHV of clinical practice. Supervision of midwives 7.1.2 - Supportive supervision 6XSSRUWLYHVXSHUYLVLRQLVDGHVFULSWLRQRIWKHZD\VXSHUYLVLRQFDQEHFDUULHGRXWWRSURYLGHPD[LPXPVXSSRUWWR PLGZLYHV7KHFKDOOHQJHVRIZRUNLQJLQGHSHQGHQWO\FDQEHRYHUZKHOPLQJ-XVWNQRZLQJWKDWVRPHRQHLVWKHUHIRU\RX personally has great value, even if that person is simply someone with whom you can discuss your ideas or questions, RUVRPHRQHZLWKZKRP\RXFDQVSHDNDIWHUKDYLQJKDGDGLI¿FXOWRUFKDOOHQJLQJH[SHULHQFH7KHDELOLW\WRVKDUH\RXU FRQFHUQVLQWKHVHFLUFXPVWDQFHVFDQEHYHU\EHQH¿FLDO &KDQJHRFFXUVDWDUDSLGUDWHLQPRGHUQKHDOWKVHUYLFHV7KLVFDQEHYHU\VWUHVVIXOIRUPLGZLYHVHVSHFLDOO\LILWPHDQV a change in practice or work area. The supervisor of midwives is well placed to advise and guide midwives who are FKDOOHQJHGE\FKDQJH 0XWXDOUHVSHFWEHWZHHQVXSHUYLVRUVRIPLGZLYHVDQGPLGZLYHVLVQHHGHGLIWKHUHLVWREHDEHQH¿WIURPVXSHUYLVLRQ *OXFN .DSODQ0HVWHODQG)HOGPDQ :RUNLQJLQSDUWQHUVKLSZLOOHQDEOHWKHJUHDWHVWEHQH¿WVWREH JDLQHGIURPVXSHUYLVLRQDQGZLOOH[WHQGWKHHIIHFWLYHQHVVRIWKHVXSHUYLVLRQSURFHVVQRWRQO\WRPLGZLYHVEXWDOVRWR WKHPRWKHUVDQGEDELHVIRUZKRPWKH\FDUH$PLGZLIHVKRXOGIHHOPRUHFRQ¿GHQWLQKHU1SUDFWLFHZKHQVXSSRUWHGE\ a supervisor of midwives. 7.1.3 - Statutory supervision of midwives 7KHSXUSRVHRIVWDWXWRU\VXSHUYLVLRQRIPLGZLYHVLVWRSURWHFWWKHSXEOLFDQGWRVXSSRUWDQGSURPRWHJRRGPLGZLIHU\ SUDFWLFH 1XUVLQJ DQG 0LGZLIHU\ &RXQFLO 0LGZLYHV LQ PDQ\ FRXQWULHV FDQ SUDFWLFH LQGHSHQGHQWO\ LH DXWRQRPRXVO\ PHDQLQJWKDWWKH\DUHQRWUHTXLUHGWRUHIHUFOLHQWVWRDGRFWRUXQOHVVWKHUHLVGHYLDWLRQIURPQRUPDORU WKHUHDUHFRPSOLFDWLRQV 6NnU ,WLVWKHUHIRUHHVVHQWLDOWKDWWKHUHDUHVXSHUYLVRUVRIPLGZLYHVWRIDFLOLWDWHVDIH autonomous midwifery practice. 7KHWHUPVWDWXWRU\VXSHUYLVLRQUHIHUVWRWKHV\VWHPRIVXSHUYLVLQJPLGZLYHVZLWKLQDUHJXODWRU\IUDPHZRUN*RYHUQPHQW DXWKRULWLHVFUHDWHVWDWXWHV ODZV WKDWJRYHUQWKHSUDFWLFHRIPLGZLYHVLQWKHVSHFL¿FFRXQWU\ VHH0RGXOH ³0LGZLYHV DFWV´RU³QXUVHVDQGPLGZLYHVDFWV´DUHH[DPSOHVRIWKHVHVWDWXWHVDVHQDFWHGLQWKH8QLWHG.LQJGRP7KHHDUOLHVW UHJXODWLRQLQÀXHQFLQJPLGZLYHVLQWKH8QLWHG.LQJGRPZDVLQWURGXFHGZLWKWKHSDVVDJHRIWKH0LGZLYHV$FWLQ 7KH0LGZLYHV$FWUHTXLUHGWKDWDOOPLGZLYHVEHUHJLVWHUHGZLWKWKHJRYHUQPHQWLQRUGHUWREHHOLJLEOHWRSUDFWLFH7KDW DFWDQGWKHUROHRIUHJLVWHUHGPLGZLYHVKDVEHHQUHJXODUO\XSGDWHGVLQFHWKDWWLPH 7KHDFW V HVWDEOLVKHGDVWDWXWRU\ERG\WRUHJXODWHPLGZLIHU\7KDWHQWLW\ZDVUHVSRQVLEOHIRUNHHSLQJWKHUHJLVWHU of midwives and for regulating education and practice of the profession. 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This approach works particularly well ZLWKPLGZLYHVZKRQHHGWRUHÀHFWRQWKHLUSHUVRQDODSSURDFKWRSUDFWLFH 7KHVXSHUYLVRULVDEOHWRSURYLGHIHHGEDFNRUGLUHFWLRQGXULQJWKHVHUHÀHFWLYHVHVVLRQVZKHWKHUJURXSRULQGLYLGXDO WRDVVLVWLQGHYHORSPHQWRIVNLOOVDQGWKHRUHWLFDONQRZOHGJHWRLPSURYHFRPSHWHQFH 5DOVWRQ 7KHVXSHUYLVRU LVWKHUHWROLVWHQDQGVXSSRUWEXWDOVRWRFRQIURQWWKHVXSHUYLVHHZKHQLVVXHVGRXEWVDQGLQVHFXULWLHVDULVHDQGWR WDNHDFWLRQLIWKHUHÀHFWLYHGLVFXVVLRQVXJJHVWVWKDWDPLGZLIHLVSUDFWLFLQJVXERSWLPDOO\RULVGHPRQVWUDWLQJDODFNRI FRQ¿GHQFHIROORZLQJDFULWLFDOLQFLGHQWRUEHFDXVHRISHUVRQDOFLUFXPVWDQFHV 7.1.5 - Cross-supervision &URVVVXSHUYLVLRQLVDWHUPWKDWGHVFULEHVWKHSURFHVVLQZKLFKDVXSHUYLVRUVXSSRUWVSUDFWLWLRQHUVZKRDUHZRUNLQJ LQDGLIIHUHQWSUDFWLFHDUHD7KLVFRXOGEHDVXSHUYLVRURIPLGZLYHVVXSHUYLVLQJPLGZLYHVLQDGLIIHUHQWKRVSLWDORU FRPPXQLW\IURPWKDWRIWKHVXSHUYLVRU¶VUHJXODUDUHDRISUDFWLFHRUVLPSO\DVXSHUYLVRURIPLGZLYHVEDVHGLQDKRVSLWDO supervising midwives who work in the community. &URVVVXSHUYLVLRQFDQEHQHFHVVDU\ZKHQWKHUHDUHQRVXSHUYLVRUVRIPLGZLYHVDYDLODEOHDWRQHDUHDDQGDUHTXHVW is made to a supervisor of midwives from another area to provide cover. The distance involved will vary from area to Module 7 DUHDDQGFRXQWU\WRFRXQWU\,WLVYHU\OLNHO\WKDWWKHUHZLOOEHDUHDVZKHUHGLUHFWDFFHVVWRDPLGZLIHQHHGLQJKHOSDQG DGYLFHLVLPSRVVLEOHEHFDXVHRIORFDOLW\DQGODFNRIWUDQVSRUW&RPPXQLFDWLRQE\WHOHSKRQHPD\EHDQRSWLRQLQWKHVH FLUFXPVWDQFHV7KLVDSSURDFKLVSHUIHFWO\DFFHSWDEOHIRUJLYLQJDGYLFHDQGLWLVYHU\UHDVVXULQJIRUWKHPLGZLIHZDQWLQJ to have a second opinion in an emergency. :K\VXSHUYLVLRQ" %\ VXSHUYLVLQJ QXUWXULQJ GHYHORSLQJ DQG HPSRZHULQJ PLGZLYHV WKURXJK VXSHUYLVLRQ WKH ZRPHQ DQG EDELHV they care for will, in turn, receive a higher level of care from safe practitioners. There are two ways to address the FLUFXPVWDQFHVZKHQPLGZLYHVGRSUDFWLFHVXERSWLPDOO\GHVSLWHWKHVXSSRUWDQGSURIHVVLRQDOGHYHORSPHQWRIIHUHG WKURXJK VXSHUYLVLRQ )LUVW WKH VXSHUYLVRU FDQ SURYLGH PRUH VXSSRUW DQG VSHFL¿F SURIHVVLRQDO GHYHORSPHQW LQ WKH attempt to improve practice. 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Regular contact and discussion will promote a mutual regard and commitment to meet regularly. 6XSHUYLVLRQ KDV EHHQ VKRZQ WR EH D SRVLWLYH DSSURDFK WR WKH VXSSRUW RI SUDFWLFH QRW RQO\ IRU PLGZLYHV EXW DOVR IRU RWKHU SURIHVVLRQV +DOO 6XSHUYLVLRQ FDQ HYHQ KDYH D UHVWRUDWLYH HIIHFW SDUWLFXODUO\ LQ FLUFXPVWDQFHV ZKHUHSURIHVVLRQDOVZRUNLQVWUHVVIXORUFKDOOHQJLQJZRUNHQYLURQPHQWV $EERWWHWDO 7KHVXSSRUWSURYLGHG E\VXSHUYLVRUVKDVDOVREHHQVKRZQWRKDYHDSRVLWLYHLPSDFWRQMREVDWLVIDFWLRQDQGSDWLHQWFDUHRXWFRPHVDQG WR UHGXFH OHYHOV RI EXUQRXW HPRWLRQDO H[KDXVWLRQ DQG GHSHUVRQDOL]DWLRQ +\UNlV$SSHOTYLVW6FKPLGOHFKQHU DQG +DDWDMD (GZDUGVHWDO /DUVVRQ$OGHJDUPDQQDQG$DUWV 3URWHFWLQJWKHSXEOLFPRWKHUVDQGEDELHV 3URWHFWLRQRIWKHSXEOLFZDVDPDLQREMHFWLYHRIVWDWXWRU\VXSHUYLVLRQDVHQYLVLRQHGGXULQJLWVRULJLQDOGHVLJQDQGWKDW REMHFWLYHFHUWDLQO\UHPDLQVUHOHYDQWWRSUHVHQWGD\KHDOWKFDUHVHUYLFHGHOLYHU\7KHUHODWLRQVKLSEHWZHHQWKHFRQFHSWV RIVXSHUYLVLRQRIPLGZLYHVDQGWKHSURWHFWLRQRIPRWKHUVDQGEDELHVFDQEHGLI¿FXOWWRJUDVSVLQFHLWLVDQLQGLUHFW PHFKDQLVP+RZHYHUWKHUHLVHYLGHQFHWKDWPLGZLYHVZKRZRUNLQDQHQYLURQPHQWLQZKLFKWKH\FDQEHVXSHUYLVHG DQGVXSSRUWHGDUHOHVVOLNHO\WRPDNHHUURUVLQFOLQLFDOMXGJPHQWRUSUDFWLFH1HYHUWKHOHVVGHVSLWHWKLVVXSSRUWWKHUH Supervision of midwives ZLOOEHLQVWDQFHVRIVXERSWLPDOSUDFWLFH7KHVHFDQRFFXUDWPDQ\OHYHOVIURPWKHPLGZLIHZKRSXWVLQOHVVHIIRUWWR WKHPLGZLIHZKRGRHVQRWFRQWLQXDOO\HYDOXDWHWKHVDIHW\DQGTXDOLW\RIKHUSUDFWLFHDFFHSWUHVSRQVLELOLW\ZKHQHUURU occurs, or take action to correct her unsafe practice. &OLQLFDOZRUNORDGFDQQRWEHSUHGLFWHGLQPLGZLIHU\SUDFWLFH(YHQZLWKFDUHIXOSODQQLQJWKHUHZLOOLQHYLWDEO\EHSHULRGV ZKHQ WKHUH DUH LQVXI¿FLHQW VWDII WR FDUH IRU HYHU\RQH 0RUH LQFLGHQWV KDSSHQ ZKHQ PLGZLYHV DUH ZRUNLQJ XQGHU SUHVVXUHZKHQFLUFXPVWDQFHVHQWLFHWKHPWRWDNHVKRUWFXWVWKDWPLJKWFRPSURPLVHVDIHW\LQSXUVXLWRIH[SHGLHQF\ 0LGZLYHVZRUNLQJLQLVRODWHGFRPPXQLWLHVZKHUHWKHUHDUHEDUULHUVWRWKHDFFHVVLELOLW\RIHPHUJHQF\REVWHWULFFDUH LQHYLWDEO\KDYHGLI¿FXOWGHFLVLRQVWRPDNH7KHODFNRIWHFKQLFDOVXSHUYLVLRQDQGLQDGHTXDWHLQVHUYLFHRUFRQWLQXLQJ HGXFDWLRQKDVEHHQLGHQWL¿HGDVWKHPDLQFDXVHRISRRUTXDOLW\FDUHLQVRPHSUDFWLFHVHWWLQJV :DUZLFN 0LGZLYHVZKRKDYHEHHQLQYROYHGLQFKDOOHQJLQJVLWXDWLRQVZLWKDSRRURXWFRPHPD\EHDQ[LRXVDERXWUHWXUQLQJWR the workplace, although many do not have a choice in this matter. Whatever the circumstances, they need support in FRPLQJWRWHUPVZLWKZKDWKDVKDSSHQHG7KH\ZLOOEHKHOSHGGXULQJWKLVWLPHE\UHFHLYLQJDVVXUDQFHWKDWWKH\ZLOO KDYHWKHRSSRUWXQLW\WRUHFHLYHIXUWKHUWUDLQLQJUHODWHGWRWKHLQFLGHQWVRWKDWWKH\FDQSURYHERWKWRWKHLUVXSHUYLVRU RIPLGZLYHVDQGWRWKHPVHOYHVWKDWWKH\DUHFDSDEOHRISUDFWLFLQJVDIHO\6XFKVXSSRUWWKURXJKVXSHUYLVLRQPHDQV WKDWZRPHQDQGEDELHVZLOOUHFHLYHVDIHDQGFRPSHWHQWFDUHIURPPLGZLYHVZKRZLWKRXWWKLVFRXOGKDYHFRQWLQXHG WRSUDFWLFHVXERSWLPDOO\RUSUDFWLFHGLQVHFXUHO\DQGZLWKRXWFRQ¿GHQFH 7.2.3 - Enabling lifelong learning A commitment to lifelong learning is required of midwives so they can continually develop, update, and modernize their practice in line with new and emerging evidence. Ongoing education is essential to sustained personal professional development. The notion of professional development is crucial to maintaining standards of practice and ensuring that practice is FXUUHQWHYLGHQFHEDVHGDQGVDIH,WLVUHFRJQL]HGWKDWH[SHULHQFHFDQHQKDQFHSUDFWLFHEXWQRWLILWLVDUHSHWLWLRQRI WKHVDPHH[SHULHQFH\HDUDIWHU\HDUZLWKQRQHZOHDUQLQJ([SHULHQWLDOOHDUQLQJKDVHQRUPRXVYDOXHFRPSDUHGZLWK ZDWFKDQGOHDUQSULQFLSOHV )RZOHU The supervisor of midwives can support the midwife in determining what additional education is relevant to her LQGLYLGXDOQHHGV$SURIHVVLRQDOSUR¿OHRIOHDUQLQJDFWLYLW\VKRXOGEHNHSWLQRUGHUWRUHFRUGWKHZD\LQZKLFKDOHDUQLQJ DFWLYLW\ KDV LQIRUPHG DQG LQÀXHQFHG SHUVRQDO SURIHVVLRQDO SUDFWLFH 7KLV DVVLVWV WKH VXSHUYLVRU LQ PRQLWRULQJ WKH professional development of a midwife. $PLGZLIHZKRLVFRPPLWWHGWRGHOLYHULQJTXDOLW\KHDOWKFDUHVHUYLFHVVKRXOGEHH[SHFWHGWRLQGHSHQGHQWO\ XQGHUWDNH D UHJXODU VHW DPRXQW RI VWXG\ GXULQJ KHU ZRUNLQJ OLIH -R\FH DQG &RZPDQ &RXQWU\ PLGZLIHU\ UHJXODWRU\ERDUGVPD\HVWDEOLVKDPLQLPXPQXPEHURIFRQWLQXLQJHGXFDWLRQXQLWVWREHDFTXLUHGRYHUDVSHFL¿HG period of time either as standard for practice or for reauthorization for practice. Module 7 3URPRWLQJSURIHVVLRQDOVHOIUHJXODWLRQ 0LGZLYHVJHQHUDOO\KDYHDQXQGHUVWDQGLQJRIRFFXSDWLRQDODQGSURIHVVLRQDOUHJXODWLRQGH¿QHGDVWKHVWDWXWRU\UXOHV UHJXODWLRQVDQGJXLGHOLQHVIRUPLGZLIHU\SUDFWLFHWKDWDUHIRUPXODWHGIRUWKHFRXQWU\E\WKHDXWKRULWDWLYHERG\HVWDEOLVKHG IRUWKDWSXUSRVH VHH0RGXOH 3URIHVVLRQDOVHOIUHJXODWLRQLVDUHODWHGSURFHVVEXWSHUKDSVOHVVZHOOXQGHUVWRRG E\WKHLQGLYLGXDOPLGZLIH7KHWUXHPHDQLQJRIDFFRXQWDELOLW\LHWDNLQJSHUVRQDOUHVSRQVLELOLW\IRUDGKHULQJWRWKHVH UHJXODWLRQVDQGIXUWKHUWDNLQJDGGLWLRQDOSHUVRQDOUHVSRQVLELOLW\IRUPRQLWRULQJWKHTXDOLW\RISHUVRQDOSUDFWLFHPD\ QRWEHFOHDUWRDOOPLGZLYHV 7KHUHPD\EHVRPHFRQÀLFWEHWZHHQPLGZLYHV¶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circumstance in which midwives may wish to seek the help of their named supervisor or another local supervisor. The VXSHUYLVRUFDQKHOSE\VXSSRUWLQJWKHPLGZLIHLQFRQWLQXLQJWRFDUHIRUWKHZRPDQLQKHUKRPHDQGJLYLQJDGYLFHDERXW GRFXPHQWLQJWKHZRPDQ¶VGHFLVLRQDQGWKHJXLGDQFHWKDWWKHPLGZLIHKDVJLYHQKHU7KHVXSHUYLVRUFDQDOVRVXSSRUW WKHPLGZLIHDIWHUWKHHYHQWLQLQLWLDWLQJDUHYLHZRIORFDOSROLF\LQOLJKWRIQHZHYLGHQFH %HUJJUHQ%DUERVDGD6LOYD DQG6HYHULQVVRQ 7KHOHYHORIDYDLODELOLW\RIVHUYLFHVFDQDOVRLQKLELWDZRPDQ¶VFKRLFH)RUH[DPSOHDFFHVVWRHPHUJHQF\ REVWHWULFFDUHVHUYLFHVPD\EHYHU\OLPLWHGLQVRPHFRXQWULHV$ZRPDQZKRH[SHULHQFHVDQREVWUXFWHGODERUDQGLV EHVWVHUYHGE\WUDQVIHUULQJWRDIDFLOLW\WKDWLVIDUGLVWDQWRUUHTXLUHVSD\PHQWRIIHHVRUWKHFRQVHQWRIIDPLO\PHPEHUV PD\FKDOOHQJHDPLGZLIH¶VUHVSRQVLELOLWLHVERWKDVDPLGZLIHDQGDVDQHPSOR\HH7KHPLGZLIHZLOOQHHGWRXUJHQWO\ VHHNRXWWKHVXSSRUWRIDVXSHUYLVRURIPLGZLYHVWRDVVLVWLQGHFLVLRQPDNLQJDQGWDNLQJDFWLRQ %HQH¿WVRIVXSHUYLVLRQWRWKHZLGHURUJDQL]DWLRQ 7.3.1 - Supporting clinical governance &OLQLFDOJRYHUQDQFHLVDIUDPHZRUNWKURXJKZKLFKRUJDQL]DWLRQVDUHDFFRXQWDEOHIRUFRQWLQXDOO\LPSURYLQJWKHTXDOLW\ RIWKHLUVHUYLFHVDQGVDIHJXDUGLQJKLJKVWDQGDUGVRIFDUH 6FRWW $UXONXPDUDQ 7KHLQWHQWLRQRIFOLQLFDO JRYHUQDQFHLVWRFUHDWHDQHQYLURQPHQWLQZKLFKWKHUHLVH[FHOOHQFHLQFOLQLFDOFDUHDQGLQZKLFKULVNPDQDJHPHQW LVSUDFWLFHGWKURXJKRXWWKHRUJDQL]DWLRQ0LGZLIHU\VXSHUYLVRUVVXSSRUWWKHFOLQLFDOJRYHUQDQFHIUDPHZRUNE\DFWLQJ DVDQDGYRFDWHIRUWKHPRWKHUDQGEDE\DQGPRQLWRULQJWKHSURIHVVLRQDOSHUIRUPDQFHRIPLGZLYHV 6RP 7KLV promotes a safe standard of midwifery practice that enhances the quality of care. Supervision of midwives 6XSHUYLVRUVRIPLGZLYHVIXO¿OOWKHLUUROHRISURWHFWLQJWKHSXEOLFE\EHLQJDZDUHRIWKHFXUUHQWVDIHW\FXOWXUHLQWKHLU ZRUNDUHDVDQGE\EHLQJSUHSDUHGWRLQIRUPVHQLRUKHDOWKPDQDJHUVRIWKHULVNVWKDWDULVHZKHQPDWHUQLW\XQLWVDUH QRWVWDIIHGZLWKVXI¿FLHQWQXPEHUVRISURIHVVLRQDOVWDIIDQGVXSSRUWVWDII7KHVXSHUYLVRURIPLGZLYHVZKRWDNHVWKH SXEOLFSURWHFWLRQUROHVHULRXVO\ZLOODOVRUHFRJQL]HWKHQHHGWRLQIRUPVHQLRUPDQDJHUVRIWKHULVNVEHLQJWDNHQZLWKLQ their area of management. +RZHYHU ULVN PDQDJHPHQW LV D UHVSRQVLELOLW\ VKDUHG E\ ERWK VXSHUYLVRUV DQG SUDFWLFLQJ PLGZLYHV 8SKROGLQJ SURIHVVLRQDODFFRXQWDELOLW\PDLQWDLQVWKHVDIHW\FXOWXUHRIWKHPLGZLIHU\SURIHVVLRQ7KLVPHDQVWKDWPLGZLYHVVKRXOG DFNQRZOHGJHDQ\OLPLWDWLRQVLQWKHLUNQRZOHGJHDQGFRPSHWHQFHDQGGHFOLQHGXWLHVRUUHVSRQVLELOLWLHVWKH\DUHXQDEOH WRSHUIRUPLQDVDIHDQGVNLOOHGPDQQHU,WLVKRZHYHURIWHQGLI¿FXOWIRUWKHSUDFWLFLQJPLGZLIHWRDFWRQWKLVSULQFLSOH SDUWLFXODUO\ZKHQWKHUHLVQRRQHHOVHWRFDUU\RXWWKHWDVNVDQGWKHUHIRUHDFOLHQWV¶QHHGVZLOOQRWEHPHW +LJK VWDQGDUGV RI FDUH FDQ DOVR EH VXSSRUWHG WKURXJK D SURJUDP RI VXSHUYLVRU\ DXGLWV -RKQVRQ -HIIHULHV DQG /DQJGRQ 6XSHUYLVLQJDXWKRULWLHVFDQDUUDQJHVXSHUYLVRU\DXGLWYLVLWVWRHDFKPDWHUQLW\FHQWHULQIDFLOLWLHVDQG LQFRPPXQLWLHV7KHPDQQHULQZKLFKPLGZLIHU\LVSUDFWLFHGLQWKHVHVHWWLQJVFDQEHHYDOXDWHGDJDLQVWHVWDEOLVKHG VWDQGDUGVRISUDFWLFHVXFKDVWKH:+20DNLQJ3UHJQDQF\6DIHUVWDQGDUGV :+2 7KHDXGLWRUDVDQRXWVLGH DVVHVVRULVLQDSRVLWLRQWRUHFRPPHQGUHPHGLDODFWLRQLQWKHFLUFXPVWDQFHVZKHUHWKHUHDUHXQDFFHSWDEOHYDULDWLRQV LQFOLQLFDOPLGZLIHU\SUDFWLFHRUFDUHLVLQDSSURSULDWHIRUZRPHQ¶VQHHGV 3URIHVVLRQDO VHOIUHJXODWLRQ DQG OLIHORQJ OHDUQLQJ DUH DOVR NH\ WKHPHV RI FOLQLFDO JRYHUQDQFH7KHVH KDYH DOUHDG\ EHHQGHVFULEHGDVLQWHJUDOWRWKHVXSHUYLVLRQRIPLGZLYHVSURPRWLQJDQGGHYHORSLQJVDIHSUDFWLFHDQGGLVVHPLQDWLQJ JRRGHYLGHQFHEDVHGSUDFWLFHDQGLQQRYDWLRQ6XSHUYLVRUVKDYHDUROHLQVXSSRUWLQJWKLVIUDPHZRUNIRUFRQWLQXHG professional development and refreshment of midwifery knowledge. 7.3.2 - Supporting continuous quality improvement &RQWLQXRXV TXDOLW\ LPSURYHPHQW &4, LV D SURFHVV E\ ZKLFK DQ DVVHVVPHQW LV PDGH RI LQGLYLGXDO DQGRU JURXS SUDFWLFHDQGFRPSDUHGWRH[WHUQDOVWDQGDUGVRIVDIHDQGHIIHFWLYHSUDFWLFHDQGZKHQLQGLFDWHGUHFRPPHQGDWLRQV IRUHQKDQFLQJTXDOLW\RIFDUHDUHJHQHUDWHG7KHLQWHUHVWRIPDWHUQLW\VHUYLFHVLQHQJDJLQJLQD&4,SURFHVVLVWR SURYLGHWKHHYLGHQFHWKDWTXDOLW\UHODWHGDFWLYLWLHVDUHEHLQJSHUIRUPHGHIIHFWLYHO\7KLVVKRXOGSURPRWHFRQ¿GHQFH DPRQJDGPLQLVWUDWLRQSHHUSURYLGHUVDQGWKHSXEOLFWKDWTXDOLW\FDUHLVEHLQJRIIHUHG &OLQLFDODXGLWPD\EHYLHZHGDVDQHOHPHQWRIRUWKHVDPHDVTXDOLW\DVVHVVPHQWDQGVKRXOGEHDQLQWHJUDOSDUWRIDOO health care delivery and continuous quality improvement activities. Such endeavors may include peer review, quality VWXGLHVDQGDXGLWRIDOOW\SHV GH5HXHWDO 7KHV\VWHPVXVHGIRUTXDOLW\FRQWUROLQKHDOWKVHUYLFHVDUHEDVHGRQFOLQLFDOVWDQGDUGVHYLGHQFHEDVHGSUDFWLFHDQG learning the lessons from poor performance. A program of supervision of midwives and supervisory audit can serve as an important component of these quality control systems. Module 3 of this toolkit discusses the development of national standards for midwifery practice. It supports the theory WKDWLIVWDQGDUGVDUHWREHVHWIRUPLGZLIHU\SUDFWLFHWKHQPLGZLYHVVKRXOGEHSDUWRIWKHPXOWLGLVFLSOLQDU\FROODERUDWLRQ LQSURGXFLQJWKHVHVWDQGDUGV$VXSHUYLVRURIPLGZLYHVZKRLVDOVRDQDFWLYHPLGZLIHU\SUDFWLWLRQHUZRXOGEHZHOO SODFHGWRUHSUHVHQWPLGZLYHVRQWKHZRUNLQJERG\WKDWHVWDEOLVKHVWKHVHVWDQGDUGV Module 7 (YLGHQFHEDVHG SUDFWLFH LV FUXFLDO WR DQ\ SURJUDP RI TXDOLW\ LPSURYHPHQW DFWLYLWLHV ZLWKLQ FOLQLFDO JRYHUQDQFH 6XSHUYLVRUVRIPLGZLYHVKDYHDUHVSRQVLELOLW\WRPRQLWRUPLGZLIHU\SUDFWLFH5HJXODUPRQLWRULQJRIPLGZLIHU\SUDFWLFHE\ supervisors who work in the clinical environment can help to identify the potential for risk and take action to address it. 6XSHUYLVRUVPXVWHQVXUHWKDWWKHSUDFWLFHZLWKLQWKHLURZQFOLQLFDODUHDLVHYLGHQFHEDVHG 6SLE\DQG0XQUR They must also challenge practice that is performed out of a sense of tradition, and without any evidence. Supervisors DUH DOVR H[SHFWHG WR HQVXUH WKDW PLGZLYHV XQGHUVWDQG WKH PHDQLQJ RI HYLGHQFHEDVHG SUDFWLFH DQG NQRZ ZKHUH DQGKRZWR¿QGHYLGHQFHDQGHYDOXDWHLWDGHTXDWHO\WKXVEHLQJDEOHWRGLIIHUHQWLDWHEHWZHHQSRRUDQGKLJKTXDOLW\ UHVHDUFKVWXGLHV *RUGRQHWDO &ULWLFDOLQFLGHQWDQDO\VLVLVDSURFHVVLQZKLFKWKRVHLQYROYHGLQDGLI¿FXOWFOLQLFDOVLWXDWLRQHQJDJHLQGLVFXVVLRQRIWKH FLUFXPVWDQFHVWKDWPD\KDYHDIIHFWHGWKHRXWFRPHLQWKHLQWHUHVWRILGHQWLI\LQJIDFWRUVWKDWFDQEHPRGL¿HGLQRUGHU WRSURPRWHEHWWHURXWFRPHVLQWKHIXWXUH 0F&RROHWDO 9DFKRQDQG/H%ODQF &ULWLFDOLQFLGHQWDQDO\VLVLV DYLWDOSDUWRIWKHVXSHUYLVRU¶VUROH $UYLGVVRQDQG)ULGOXQG 6FKOXWHU6HDWRQDQG&KDER\HU $OOXQWRZDUG HYHQWVLQYROYLQJPLGZLYHVVKRXOGEHUHFRUGHGLQYHVWLJDWHGDQGPRQLWRUHGE\VXSHUYLVRUV7KLVLVRQHPHFKDQLVPE\ which supervisors can assist midwives to learn the lessons from poor performance. Many institutions have regular perinatal audit meetings, designed to review the outcomes of clinical care and identify SRVVLEOHDUHDVIRULPSURYHPHQW7KHVHDUHH[FHOOHQWDUHQDVIRUVXSHUYLVRUVRIPLGZLYHVWRPRQLWRUPLGZLIHU\SUDFWLFH DQGWDNHDSSURSULDWHDFWLRQZKHUHVXERSWLPDOFDUHKDVEHHQGHPRQVWUDWHG3HULQDWDODXGLWPHHWLQJVSURYLGH RSSRUWXQLWLHVIRUPXOWLGLVFLSOLQDU\GLVFXVVLRQLQWROHVVRQVOHDUQHGIURPDXGLWDQGWRGHEDWHKRZSRRURXWFRPHVFDQEH avoided in the future. 0RGHOVRIVXSHUYLVLRQ 7ZRPRGHOVRIVXSHUYLVLRQDUHRIIHUHGIRUFRQVLGHUDWLRQ7KH¿UVWLVDSSOLFDEOHWRPLGZLYHVZKRSUDFWLFHLQGHYHORSHG FRXQWULHV DQG FRQGXFW IDFLOLW\EDVHG ELUWKV 7KH VHFRQG PRGHO LV LQWHQGHG IRU PLGZLYHV ZRUNLQJ LQ GHYHORSLQJ FRXQWULHV7KHGLVFXVVLRQZLOOIRFXVRQKRZVXSHUYLVLRQFRQWULEXWHVWRZHOOHVWDEOLVKHGKHDOWKRUJDQL]DWLRQVDQGDOVR DGGUHVVWKHSUDFWLFDOLWLHVRIVXSHUYLVLRQZLWKLQOHVVGHYHORSHGFRPPXQLWLHV 7.4.1 - Supervision for all midwives A formal program of supervisory review provides dedicated time for midwives to meet regularly with their supervisor DQGUHÀHFWRQWKHLUSUDFWLFHRYHUWKHSUHFHGLQJSHULRGRIWLPH$QDQQXDOUHYLHZLVUHFRPPHQGHGLIWKLVLVIHDVLEOH 0HHWLQJVFDQEHDUUDQJHGPRUHIUHTXHQWO\LIQHHGHGRULIGHVLUHGE\WKHPLGZLIH0LGZLYHVZKRDUHFRQFHUQHGDERXW DQ\DVSHFWVRIWKHLUSUDFWLFHFDQGLVFXVVWKHVHLVVXHVIUDQNO\NQRZLQJWKDWWKHVHGLVFXVVLRQVDUHFRQ¿GHQWLDODQGWKDW WKH\DUHWKHRSSRUWXQLW\WRUHFHLYHVXSSRUWDQGJXLGDQFHUDWKHUWKDQFULWLFLVP0LGZLYHVVKRXOGDOVREHDEOHWRVSHDN with their supervisor as, and when, they need or want to. It is an advantage if supervisors of midwives hold clinical posts, so they have the opportunity to work alongside the midwives they supervise and have more regular contact on DQLQIRUPDOEDVLV The supervisory review is an opportunity to discuss professional development. The supervisor can serve as a sounding ERDUGRIIHULQJDGYLFHDQGJXLGDQFHDQGKHOSLQJWKHLQGLYLGXDOPLGZLIHWRPDNHGHFLVLRQV7KHVXSHUYLVRURIPLGZLYHV Supervision of midwives LV LQ IDFW UHVSRQVLEOH IRU IDFLOLWDWLQJ RSSRUWXQLWLHV WR PDLQWDLQ DQG DGYDQFH WKHLU VNLOOV DQG WR GHYHORS QHZ VNLOOV knowledge, and competencies. 0LGZLYHVZKRKDYHEHHQLQYROYHGLQDFKDOOHQJLQJVLWXDWLRQDUHHQFRXUDJHGWRPHHWZLWKWKHLUVXSHUYLVRUVDQGUHÀHFW on how the emergency was handled, the events leading up to it, and the outcome. The role of the supervisor in these VLWXDWLRQVLVWRSURYLGHVXSSRUWIRUWKHPLGZLIHDQGWRSURWHFWWKHEHVWLQWHUHVWRIWKHPLGZLIHU\SURIHVVLRQDQGWKH FOLHQWV ZKR DUH VHUYHG 'HDOLQJ ZLWK VRPH YHU\ VHULRXV FLUFXPVWDQFHV PD\ EHQH¿W IURP WKH DVVLVWDQFH SURYLGHG E\DQRWKHUVXSHUYLVRUZKRFDQEHDVNHGWRFDUU\RXWDVXSHUYLVRU\LQTXLU\ZKLOHWKHQDPHGVXSHUYLVRUSURYLGHV support for the midwife, helping to identify any gaps in knowledge or weaknesses in practice. These gaps can then EHDGGUHVVHGWKURXJKDSSURSULDWHOHDUQLQJVXSSRUWHGE\WKHVXSHUYLVRURIPLGZLYHVLQWKHZRUNDUHDOLDLVLQJZLWKWKH local midwifery education department if academic input is required. 7.4.2 - Supervision of midwives conducting facility-based births :KHUHPLGZLYHVFRQGXFWIDFLOLW\EDVHGELUWKVRUELUWKVLQZRPHQ¶VKRPHVFORVHWRDELUWKLQJXQLWWKHUHLVXVXDOO\ ready access to a supervisor of midwives. Structured programs of monitoring and supervision of midwifery practice FDQEHGHYHORSHGDQGLPSOHPHQWHGZLWKRXWJUHDWGLI¿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ÀHFWLRQRQSUDFWLFHFDQEHIDFLOLWDWHGLQWKLVZD\ 3HUVRQDO YLVLWV FDQ EH VXSSOHPHQWHG E\ SHULRGLF FRQWDFW WKURXJK RWKHU PHDQV LQ RUGHU WR SURYLGH PLGZLYHV ZLWK advice, guidance, and support in their practice. 5HYLHZLQJSUDFWLFHWKURXJKPDWHUQLW\UHFRUGVFDQEHGLI¿FXOWLQFRXQWULHVZKHUHWKHSURGXFWLRQRIVXFKUHFRUGVLV OLPLWHG+RZHYHUVXSHUYLVRUVRIPLGZLYHVFDQEHUHVSRQVLEOHIRULQWURGXFLQJUHFRUGNHHSLQJDQGWUDLQLQJ midwives in these standards. (TXLSPHQWDQGSUHPLVHVFDQEHLQVSHFWHGE\VXSHUYLVRUVGXULQJWKHLUYLVLWVWRUXUDODUHDVWRHQVXUHWKDWWKH\DUHZHOO maintained and adequate for the needs of the community. The emphasis of such supervision visits should, however, EHSODFHGRQVXSSRUWDQGSURIHVVLRQDOGHYHORSPHQWQHHGVDQGZD\VRI³EHLQJWKHUH´IRUWKHPLGZLYHVZKHQWKH\DUH LQQHHG7KHVHHPSKDVHVSURYLGHDFRQ¿GHQWLDOIUDPHZRUNIRUDVXSSRUWLYHUHODWLRQVKLSEHWZHHQVXSHUYLVRUVDQG midwives wherever they are working. Module 7 +RZWRSODQIRUDQGGHYHORSDVXSHUYLVLRQV\VWHP 7KLV VXEVHFWLRQ GHVFULEHV D VHULHV RI VWHSV WKDW FRXQWULHV FDQ XVH WR SODQ GHYHORS DQG LQWURGXFH D V\VWHP IRU thesupervision of midwives. 3URYLGLQJDUHJXODWRU\IUDPHZRUNDQGVWDQGDUGVIRUVXSHUYLVLRQ 7KH ¿UVW HVVHQWLDO LQ GHYHORSLQJ D V\VWHP IRU WKH VXSHUYLVLRQ RI PLGZLYHV ZLOO EH WR FRQVLGHU WKH LQWURGXFWLRQ RI UHJXODWLRQRIPLGZLIHU\SUDFWLFHWKDWFDQEHVXSSRUWHGE\VXSHUYLVLRQ7KLVUHJXODWLRQPDNHVLWSRVVLEOHWRVHWDIRUPDO DJHQGDIRUWKHFUHDWLRQRIVWDQGDUGVIRUVXSHUYLVLRQ7KHVHVWDQGDUGVLQWXUQIRUPWKHEDVLVIRUDHGXFDWLRQSURJUDP for midwife supervisors. Regulation is addressed thoroughly in Module 2 of this toolkit. The autonomy of midwives differs from country to FRXQWU\DQGVWDWHWRVWDWHVRWKHOHYHORIUHJXODWLRQZLOOYDU\DFFRUGLQJO\7KHOHYHORIUHJXODWLRQPXVWEHVXI¿FLHQWWR VXSSRUWDUREXVWV\VWHPRIVXSHUYLVLRQWKURXJKRXWWKHSHULRGRIWLPHRYHUZKLFKWKHPLGZLIHLVDXWKRUL]HGE\ODZWR FDUU\IXOOUHVSRQVLELOLW\IRUPRWKHUVDQGWKHLUEDELHV7KHVWDQGDUGVIRUVXSHUYLVLRQFDQEHFUHDWHGE\DPXOWLGLVFLSOLQDU\ WHDPRQZKLFKWKHUHLVVWURQJPLGZLIHU\UHSUHVHQWDWLRQ7KHVWDQGDUGVZRXOGEHGHYHORSHGWRUHÀHFWWKHUXOHVDQG FRGHVODLGGRZQE\WKLVPLGZLIHU\UHJXODWLRQ 7.5.2 - Selection of supervisors of midwives 3HUVRQDODQGSURIHVVLRQDOTXDOL¿FDWLRQVIRULQGLYLGXDOVVHOHFWHGWRVHUYHDVVXSHUYLVRUVVKRXOGEHEDVHGRQWKHVH VWDQGDUGV6XSHUYLVRUVRIPLGZLYHVZLOOEHIXOO\TXDOL¿HGPLGZLYHVLGHDOO\ZLWKDWOHDVWWKUHH\HDUVRIH[SHULHQFH 2WKHUTXDOLWLHVWKDWZRXOGEHLGHDOLQDSRWHQWLDOVXSHUYLVRUDUHWKDWWKHLQGLYLGXDOEH $SSURDFKDEOH FOLQLFDOO\H[SHULHQFHG LQWRXFKDQGXSWRGDWH willing to take action. $GGLWLRQDOH[SHFWDWLRQVRISRWHQWLDOVXSHUYLVRUVDUHWKDWWKH\EH &RPPLWWHGWRZRPDQFHQWHUHGFDUH DVRXUFHRISURIHVVLRQDONQRZOHGJHDQGH[SHUWLVH DEOHWRUHVROYHFRQÀLFW sympathetic and encouraging. 6XSHUYLVRUV RI PLGZLYHV SURYLGH SURIHVVLRQDO OHDGHUVKLS VR PLGZLYHV ZLWK OHDGHUVKLS VNLOOV DQG TXDOLWLHV ZLOO EH H[FHOOHQWFDQGLGDWHV*RRGOHDGHUVVXSSRUWFKDOOHQJHDQGSURYLGHYLVLRQ +\UNlV$SSHOTYLVW6FKPLGOHQFKQHUDQG .LYPlNL 7KH\ SRVVHVV FHUWDLQ FKDUDFWHULVWLFV VXFK DV VHOIEHOLHI DQG VHOIDZDUHQHVV7KH\ KDYH SHUVRQDO LQWHJULW\DQGDUHSROLWLFDOO\DVWXWH6XSHUYLVRUVQHHGWREHDEOHWRFRQ¿UPDPLGZLIH¶VDELOLW\DQGFUHDWHRSSRUWXQLW\ Supervision of midwives IRUUHÀHFWLRQDQGZLOOLQJQHVVWRHQJDJHLQDFKDQJHSURFHVVZKHQQHFHVVDU\/HDGHUVKLSXVHVWKHSURFHVVHVRI PLUURULQJDQGUHÀHFWLQJKHOSLQJVXSHUYLVHHVFRQVLGHUWKHLURZQWKLQNLQJDQGVHHWKHLURZQEHKDYLRUVLQDQHZZD\ VRWKDWWKH\XQGHUVWDQGWKHLUSHUVRQDOVWUHQJWKVDQGZHDNQHVVHVPRUHFOHDUO\,WZLOOEHLPSRVVLEOHWR¿QGDOOWKHVH FKDUDFWHULVWLFVLQRQHPLGZLIHEXWE\¿QGLQJDJURXSRIPLGZLYHVZLWKWKHVHFRPELQHGFKDUDFWHULVWLFVDQGTXDOLWLHV WKHWHDPRIVXSHUYLVRUVZLOOEHDQDVVHWWRWKHRUJDQL]DWLRQDQGWKHPLGZLYHVZLWKLQLW 7KHDELOLW\WRPDLQWDLQFRQ¿GHQWLDOLW\LVLPSOLFLWLQWKHUROHRIWKHVXSHUYLVRURIPLGZLYHV$PLGZLIHPXVWIHHODVVXUHG DWDOOWLPHVWKDWGLVFXVVLRQVZLWKDVXSHUYLVRURIPLGZLYHVZLOOUHPDLQFRQ¿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¿QDOVHOHFWLRQ 3UHSDUDWLRQRIVXSHUYLVRUVRIPLGZLYHV $VSHFLDOL]HGHGXFDWLRQSURJUDPPXVWEHFUHDWHGIRUWKRVHFRQVLGHUHGDVSRWHQWLDOVXSHUYLVRUVRIPLGZLYHV,QLWLDOO\ DGHFLVLRQLVQHHGHGRQWKHDSSURSULDWHOHYHORIHGXFDWLRQIRUWKHSURJUDP,WLVVXJJHVWHGWKDWWKDWOHYHOEHRQHVWHS XSIURPWKHOHYHOIRUPLGZLIHU\SUHSDUDWLRQ6RLIPLGZLYHVDUHHGXFDWHGDWWKHFHUWL¿FDWHOHYHOWKHQDGLSORPDOHYHO SURJUDPZRXOGEHDSSURSULDWHDQGLIPLGZLYHVDUHHGXFDWHGDWWKHGLSORPDOHYHOWKHQVXSHUYLVRUVVKRXOGEHSUHSDUHG at the degree level, and so forth. 7KHHGXFDWLRQSURJUDPVKRXOGEHEURDGUDQJLQJLQFOXGLQJFRYHULQJWKHFRQFHSWVRISROLWLFDODZDUHQHVV6XSHUYLVRUV QHHGWREHFRQVFLRXVRIWKHRYHUDUFKLQJSROLWLFDOFOLPDWHDQGQDWLRQDOKHDOWKVHUYLFHVSROLFLHVWKDWLQÀXHQFHFOLQLFDO SUDFWLFHDVZHOOWKHORFDOSROLWLFVWKDWVKDSHDQDUHD¶VSURYLVLRQRIPDWHUQLW\VHUYLFHV:KHQKHDOWKSROLFLHVDUHPDGH ERWKORFDOO\DQGQDWLRQDOO\WKHVXSHUYLVRUZLOOEHH[SHFWHGWROHDGPLGZLYHVLQWKHLPSOHPHQWDWLRQRIWKRVHSROLFLHV VXFKDVPLJKWEHWKHFDVHZLWKWKHORFDOLQWURGXFWLRQRIDQHZQDWLRQDOVFUHHQLQJSURJUDP 7KHOHQJWKRIWKHHGXFDWLRQSURJUDPVKRXOGEHLQOLQHZLWKWKHFRQWHQW3URJUDPVRIIHUHGDWWKHGHJUHHRUGLSORPD OHYHOVKRXOGFRPSULVHDWOHDVWRQHVHPHVWHU6HOIGLUHFWHGOHDUQLQJZLOOEHDSSURSULDWHLQPDQ\HGXFDWLRQDOLQVWLWXWLRQV $GGLWLRQDOVWXG\GD\VFDQEHDUUDQJHGLQRUGHUWRRIIHURSSRUWXQLWLHVIRUVKDUHGOHDUQLQJZLWKRWKHUSRWHQWLDOVXSHUYLVRUV $QH[SHULHQFHGVXSHUYLVRURIPLGZLYHVVKRXOGVXSSRUWDQGJXLGHWKHVWXGHQWVXSHUYLVRUVRQWKHDFWLYLWLHVDQGSUDFWLFDO HOHPHQWVRIVXSHUYLVLRQ2EYLRXVO\WKLVVWHSLQWKHGHYHORSPHQWRIDVXSHUYLVRU\V\VWHPFDQRQO\KDSSHQRQFHWKH V\VWHPRIVXSHUYLVLRQKDVEHHQHVWDEOLVKHGDQGDFDGUHRIH[SHULHQFHGVXSHUYLVRUVLVDYDLODEOHWRVHUYHLQWKLVUROH The education program should incorporate the following topics: 6XSSRUWLYHVXSHUYLVLRQ UROHRIWKHVXSHUYLVRURIPLGZLYHV SXUSRVHRIVXSHUYLVLRQ Module 7 OHDGHUVKLS LQÀXHQFHVRQVXSHUYLVLRQ HPSRZHUPHQWDQGDGYRFDF\ SURDFWLYHVXSHUYLVLRQ GHFLVLRQPDNLQJDQGSUREOHPVROYLQJ RUJDQL]DWLRQRIVXSHUYLVLRQ PRGHOVRIVXSHUYLVLRQ OHJLVODWLRQ DFFRXQWDELOLW\ SURIHVVLRQDOVWDQGDUGV VXSHUYLVRU\SDUWQHUVKLSV FOLQLFDOJRYHUQDQFHDQGULVNPDQDJHPHQW VXSHUYLVRU¶VUROHLQSURIHVVLRQDOGHYHORSPHQW ¿WQHVVWRSUDFWLFH LGHQWLI\LQJDOOHJHGPLVFRQGXFW conducting an investigation. 0XFKRIWKHV\OODEXVFDQEHFRYHUHGE\WKHXVHRIFDVHVWXGLHVDQGH[DPSOHV'HYHORSPHQWRIDOHDUQLQJSRUWIROLR VKRXOGEHHQFRXUDJHG$VVHVVPHQWFDQEHFRQGXFWHGHLWKHUE\ZULWWHQDVVLJQPHQWZLWKDQRUDOSUHVHQWDWLRQRUE\ portfolio assessment. 7.5.4 - Appointment of supervisors of midwives 7KH SRWHQWLDO VXSHUYLVRU ZLOO EH HOLJLEOH IRU DSSRLQWPHQW DV D VXSHUYLVRU RI PLGZLYHV XSRQ VXFFHVVIXO FRPSOHWLRQ RIWKHHGXFDWLRQSURJUDP7KHDSSRLQWPHQWV\VWHPVKRXOGDOORZVRPHOHHZD\IRU¿QDOVHOHFWLRQRIFDQGLGDWHVVR WKDWLIDQ\GRXEWVDERXWDPLGZLIH¶VDELOLW\WRSHUIRUPDVDVXSHUYLVRURIPLGZLYHVKDYHEHHQLGHQWL¿HGWKHUHLVQR REOLJDWLRQWRDSSRLQWWKHLQGLYLGXDOWRWKDWUROH7KLVLVQRWDQXQXVXDOVLWXDWLRQVLQFHVHOHFWLRQWKURXJKLQWHUYLHZGRHV QRWQHFHVVDULO\LGHQWLI\DQDSSOLFDQW¶VZHDNQHVVHV 7.5.5 - Allocation of caseload ([SHULHQFHLQGHYHORSHGFRXQWULHVZRXOGVXJJHVWWKDWDFDVHORDGRIWRPLGZLYHVWRRQHVXSHUYLVRURIPLGZLYHVLV UHDVRQDEOH+RZHYHUWKLVFRXOGEHWRREXUGHQVRPHLIWKHGLVWDQFHEHWZHHQIDFLOLWLHVLVJUHDWDQGDFFHVVWRVXSHUYLVHHV LVOLPLWHG$OORFDWLRQZLOOWKHUHIRUHEHGHWHUPLQHGDFFRUGLQJWRWKHDYDLODEOHQXPEHURIVXSHUYLVRUVDQGWKHORJLVWLFVRI DFFHVVLQJVXSHUYLVHHVEHDULQJLQPLQGWKDWWKHVXSHUYLVRUVWLOOKDVWRIXO¿OOKHUVXEVWDQWLYHSRVWDVDPLGZLIH Supervision of midwives 7.5.6 - Choosing a supervisor 7KHVXSHUYLVRU\UHODWLRQVKLSZLOOEHQH¿WIURPDPLGZLIHEHLQJDEOHWRFKRRVHKHURZQVXSHUYLVRUZKHQHYHUSRVVLEOH &DWKHULQHDQG6WHZDUW0RRUH 7KHSHUFHLYHGTXDOLW\RIVXSHUYLVLRQKDVEHHQVKRZQWREHKLJKHULQWKRVH FDVHVZKHUHVXSHUYLVHHVKDYHFKRVHQWKHLUVXSHUYLVRUV (GZDUGVHWDO +RZHYHULWLVOLNHO\WKHUHZLOODQHHG IRUVRPHVRUWRIDVVLJQPHQWRUDOORFDWLRQSURFHVVLQWKHHDUOLHU\HDUVZKLOHWKHVXSHUYLVRU\V\VWHPLVEHLQJLQWURGXFHG 2QFHDVXSHUYLVLRQV\VWHPLVZHOOHVWDEOLVKHGWKHV\VWHPOHDGHUVPD\¿QGWKHRSSRUWXQLW\WRDGGWKHLUQDPHVWRWKH OLVWRIDYDLODEOHVXSHUYLVRUVRIPLGZLYHVIURPZKLFKPLGZLYHVFDQVHOHFWWKHLUSHUVRQDOQDPHGVXSHUYLVRU 0DNLQJFRQWDFW Supervisors of midwives will receive a list of names of midwives allocated to them and/or the names of midwives who have selected the supervisor to serve in that role for them. The supervisor should try to make informal contact as VRRQDVSRVVLEOHZLWKHDFKVXSHUYLVHHIRUWKHSXUSRVHRILQWURGXFWLRQDQGWRVWDUWWKHSURFHVVRIFRPPXQLFDWLRQ7KH SUDFWLFLQJPLGZLIHZRXOG¿QGLWPXFKHDVLHUWRFRQWDFWWKHVXSHUYLVRULQWLPHRIQHHGLIWKHWZRRIWKHPKDYHDOUHDG\ HVWDEOLVKHGDUHODWLRQVKLS$UUDQJHPHQWVIRUDIRUPDOJHWWRJHWKHUVKRXOGLGHDOO\EHPDGHDWWKHWLPHRI¿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¿WVRDFKDQJHRIVXSHUYLVRUFDQEHDUUDQJHG 7.5.8 - Responsibilities of the supervisor of midwives 7KH VXSHUYLVRU RI PLGZLYHV WDNHV RQ WKH UHVSRQVLELOLWLHV SUHYLRXVO\ GHVFULEHG ZLWKLQ WKLV PRGXOH 6XSHUYLVRUV ZLOO FRQVWDQWO\DQGRIWHQVXEFRQVFLRXVO\PRQLWRUWKHSUDFWLFHRIDOOWKHPLGZLYHVLQWKHLUSUDFWLFHDUHD7KLVDWWLWXGHRI EHLQJFRQVWDQWO\³SUDFWLFHDZDUH´ZLOOSURPSWWKHVXSHUYLVRUWRVHHWKDWDOOSUDFWLFHLVFXUUHQWHYLGHQFHEDVHGDQGLQ FRPSOLDQFHZLWKVWDQGDUGV 0RGXOHVDQGRIIHUDGGLWLRQDOJXLGDQFH 6XSHUYLVRUVZLOOEHHPSRZHULQJOHDGHUVLQ their maternity service. Midwives will recognize that their supervisors are also sources of information, guidance, and support. 7KHSULQFLSDOUHVSRQVLELOLW\RIDVXSHUYLVRULVWRPRQLWRUPLGZLIHU\SUDFWLFHZKLFKLVFDUULHGRXWLQVHYHUDOZD\V :RUNLQJLQWKHFOLQLFDODUHDVZLWKPLGZLYHV DXGLWLQJUHFRUGVDQGDVVHVVLQJFOLQLFDORXWFRPHV FRQWULEXWLQJWRFOLQLFDODXGLWLQFOXGLQJFRQGXFWLQJFRQ¿GHQWLDOLQTXLULHVLQWRPDWHUQDOGHDWKVDQGVWLOOELUWKV PHHWLQJZLWKPLGZLYHVWRGLVFXVVSUDFWLFH investigating clinical incidents. Module 7 7KHSURYLVLRQRIVXSSRUWWRPLGZLYHVLVRIHTXDOLPSRUWDQFH7KLVLVDFKLHYHGE\ 0HHWLQJUHJXODUO\ZLWKWKHPLGZLYHVRQKHUDOORFDWHGFDVHORDGWRGLVFXVVSUDFWLFH UHVSRQGLQJWRUHTXHVWVIURPPLGZLYHVIRUDGYLFHDQGJXLGDQFHRQFOLQLFDOLVVXHV EHLQJDYDLODEOHWRDFWDVDVRXQGLQJERDUGZKHQPLGZLYHVQHHGDVHFRQGRSLQLRQ VXSSRUWLQJPLGZLYHVZKRKDYHKDGDFKDOOHQJLQJFOLQLFDOH[SHULHQFH UHÀHFWLQJZLWKPLGZLYHVRQWKHLUSUDFWLFH HQFRXUDJLQJPLGZLYHVWRUHDFKWKHLUJRDOV DUUDQJLQJDSSURSULDWHSURIHVVLRQDOGHYHORSPHQWIRUPLGZLYHV DFWLQJRQLQIRUPDWLRQUHFHLYHGZKHQDPLGZLIHUHSRUWVVXERSWLPDOSUDFWLFH Some countries have enacted the requirement that midwives have to notify their intention to practice as a midwife HYHU\\HDU6XSHUYLVRUVRIPLGZLYHVUHFHLYHDQGSURFHVVWKHQRWL¿FDWLRQIRUPVIURPWKHPLGZLYHVRQWKHLUFDVHORDGWR YHULI\WKDWVWDWXWRU\UHTXLUHPHQWVKDYHEHHQPHWLQWKHVHFLUFXPVWDQFHV ([SHFWDWLRQVRIVXSHUYLVLRQ 0LGZLYHV¶H[SHFWDWLRQV 0LGZLYHV¶SHUVRQDOH[SHULHQFHZLOOGLFWDWHWKHLURZQH[SHFWDWLRQVRIVXSHUYLVLRQ7KRVHZKRKDYHUHFHLYHGVXSSRUWLYH FDULQJVXSHUYLVLRQDUHPRVWRIWHQYHU\SRVLWLYHDERXWVXSHUYLVLRQDQGZLOOLQJWRSURPRWHLWLQDQ\DUHQD,QFRQWUDVW WKHUHZLOOEHPLGZLYHVZKRKDYHUHFHLYHGSXQLWLYHVXSHUYLVLRQZLWKLQDKLHUDUFKLFDOHQYLURQPHQW(YHQWKRXJKWKLV FRXOGKDYHKDSSHQHGPDQ\\HDUVEHIRUHWKHVHPLGZLYHVPD\¿QGWKHPVHOYHVXQDEOHWRVHHDQ\WKLQJSRVLWLYHDERXW VXSHUYLVLRQEHFDXVHRIWKHLUGHHSURRWHGIHHOLQJV 7KHVXSHUYLVLRQUHODWLRQVKLSPXVWKDYHWKHHVVHQWLDOHOHPHQWVRIPXWXDOUHVSHFWDQGFRQ¿GHQWLDOLW\LILWLVWREHPRVW effective. Therefore, it is important that midwives carefully consider the selection of their supervisor. They should FKRRVHDVXSHUYLVRUZLWKZKRPWKH\EHOLHYHWKH\FDQIRUPDQRSHQDQGKRQHVWUHODWLRQVKLS7KHFKRVHQVXSHUYLVRU VKRXOGLQWXUQEHDEOHWRDSSUHFLDWHWKHHQYLURQPHQWLQZKLFKWKHPLGZLIHLVFXUUHQWO\SUDFWLFLQJ 0LGZLYHVZKRIHHOHPSRZHUHGE\WKHLUVXSHUYLVRURIPLGZLYHVIHHODEOHWRHPSRZHUWKHLUFOLHQWVLQWXUQ +HUPDQVVRQ DQG 0nUWHQVVRQ 7KH VXSHUYLVRU\ GHFLVLRQV SHUFHLYHG DV HPSRZHULQJ DUH WKH RQHV PDGH E\ FRQVHQVXV EHWZHHQWKHVXSHUYLVRUDQGWKHPLGZLIH 0DWWKHZV6FRWWDQG*DOODKJHU Where midwives have ideas for changing and improving practice, supervisors of midwives can empower the midwives to introduce such change and support them in their initiatives, acting as their advocate with senior staff. Professional FRQ¿GHQFH LV HQKDQFHG ZKHQ WKH PLGZLIH IHHOV WKDW VKH LV YDOXHG DQG VXSSRUWHG E\ KHU VXSHUYLVRU DQG WKDW KHU DFKLHYHPHQWVKDYHEHHQUHFRJQL]HG Supervision of midwives 7KHRSSRUWXQLW\WRFKDQJHVXSHUYLVRUFDQEHWDNHQE\WKHPLGZLIHLIWKHVXSHUYLVRU\UHODWLRQVKLSGRHVQRWDFKLHYH ZKDWHLWKHUWKHPLGZLIHRUWKHVXSHUYLVRUH[SHFWVSURYLGHGWKDWWKHUHDUHRWKHUVDYDLODEOH 0F*LOWRQ 6RPH midwives have reported that their personal supervisors were not supportive and that they felt they did not want to stay LQPLGZLIHU\EHFDXVHRIWKLV &XUWLV%DOODQG.LUNKDP 7KHVXSHUYLVRUKHUVHOIPD\FRQVLGHUWKDWDFKDQJHLQWKH VXSHUYLVRU\UHODWLRQVKLSLVQHFHVVDU\LIWKHUHLVQRUDSSRUWRUFRQ¿GHQFHLQWKHVXSHUYLVRU\UHODWLRQVKLS6RPHKDYH VXJJHVWHGWKDWWKHUHLVDEHQH¿WWRFKDQJLQJWKHVXSHUYLVRUHYHU\IHZ\HDUV2WKHUVVXJJHVWWKHQHHGIRUDORQJHU term relationship. 7.6.2 - Supervisors’ expectations 6XSHUYLVRUVDOVRVWDQGWREHQH¿WIURPVXSHUYLVLRQ7KH\WKHPVHOYHVKDYHDSHUVRQDOVXSHUYLVRUWRVXSSRUWWKHPDV FOLQLFDOSUDFWLWLRQHUVDQGWRDVVLVWWKHPLQZRUNLQJWKURXJKDGLI¿FXOWVXSHUYLVRU\LVVXH6HUYLFHLQWKHUROHRIVXSHUYLVRU can help an individual to gain greater insights into her own personal issues, strengths, and weaknesses. Supervisors FDQJDLQSHUVRQDOVDWLVIDFWLRQIURPWKHLUUROHZKLFKRIIHUVWKHRSSRUWXQLW\WRVKDUHWKHH[FLWHPHQWRIVXSHUYLVHHVDV they grow and develop in their own professional practice. 6XSHUYLVRU\QHWZRUNVFDQEHHVWDEOLVKHG7KHVHQHWZRUNVFDQSURYLGHSHHUVXSSRUWIRUWKHVXSHUYLVRUV6XSHUYLVRUV are well positioned to identify good practice in their own areas and to share this with supervisors in other maternity FHQWHUV6LPLODUO\WKH\FDQOHDUQRIH[DPSOHVRIJRRGSUDFWLFHLQRWKHUXQLWVWKDWFDQEHDGRSWHGZLWKLQWKHLURZQDUHD $VXSHUYLVRURIPLGZLYHVVKRXOGDOVREHDPHPEHURIDQ\PXOWLGLVFLSOLQDU\IRUXPWKDWLQÀXHQFHVPDWHUQLW\SUDFWLFHLQ her own community and country. 7.6.3 - Women’s expectations 7KHZRPHQDQGIDPLOLHVVHUYHGE\PLGZLYHVVWDQGWREHQH¿WIURPVXSHUYLVLRQ1HYHUWKHOHVVPRVWZRPHQLQFRXQWULHV ZKHUHVXSHUYLVLRQLVDOUHDG\ZHOOHVWDEOLVKHGKDYHOLWWOHNQRZOHGJHRIWKHVXSHUYLVRU\V\VWHP7KHUHLVPXFKWKDW UHPDLQVWREHDFFRPSOLVKHGLQFRPPXQLFDWLQJWKHSRWHQWLDOEHQH¿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¿WIURPKDYLQJWKHDVVLVWDQFHRIDVXSHUYLVRURIPLGZLYHVWR LQWURGXFHRUH[SDQGDYDLODELOLW\WRDSURIHVVLRQDOVHUYLFHVXFKDVIDPLO\SODQQLQJ 6XSHUYLVRUVLQFRPPXQLW\VHWWLQJVZLOOEHFDOOHGXSRQPRUHRIWHQWKDQLQDUHDVZKHUHPLGZLYHVDUHFRQGXFWLQJELUWKV LQIDFLOLWLHVZKHUHDVVLVWDQFHLVPRUHUHDGLO\DYDLODEOH0LGZLYHVZRUNLQJLQLVRODWLRQLQWKHFRPPXQLW\ZLOOXVHWKH VXSHUYLVRUIRUDGYLFHZKHQLWLVQHFHVVDU\7KHZRPHQIRUZKRPWKHVHPLGZLYHVSURYLGHFDUHVKRXOGEHPDGHDZDUH of the source of this guidance. This creates the opportunity to promote the value of midwifery supervision to women in the community. Module 7 5HIHUHQFHV $EERWW6'DZVRQ/+XWW--RKQVRQ%6HDO\$,QWURGXFLQJFOLQLFDOVXSHUYLVLRQIRUFRPPXQLW\EDVHGQXUVHV%U- &RP1XUV $OUXONXPDUDQ6&OLQLFDOJRYHUQDQFHDQGVWDQGDUGVLQ8.0DWHUQLW\FDUHWRLPSURYHTXDOLW\DQGVDIHW\0LGZLIHU\ $UYLGVVRQ%)ULGOXQG%)DFWRUVLQÀXHQFLQJQXUVHVXSHUYLVRUFRPSHWHQFH DFULWLFDOLQFLGHQWDQDO\VLVVWXG\-1XUVLQJ 0DQ %HUJJUHQ,%DUERVDGD6LOYD$6HYHULQVVRQ(&RUHHWKLFDOLVVXHVRIFOLQLFDOQXUVLQJVXSHUYLVLRQ1XUVLQJ+HDOWK 6FLHQFHV %RRQ-*UDKDP%:DLQZULJKW0:DUULQHU6&XUUHU%ULJJV9,VSUHFHSWRUVKLSYDOXDEOH"5&00LGZLYHV &DWKHULQH06WHZDUW0RRUH-6XSHUYLVLRQ KRZFDQWKHJDSEHEULGJHG"5&00LGZLYHV &HULQXV07KHUROHRIUHODWLRQVKLSVLQHIIHFWLYHFOLQLFDOVXSHUYLVLRQ1XUVLQJ7LPHV &OHPHQWV&-6WUHHÀDQG3+0DODX&6XSHUYLVLRQLQSULPDU\KHDOWKFDUH FDQLWEHFDUULHGRXWHIIHFWLYHO\LQGHYHORSLQJ FRXQWULHV"&XUU'UXJ6DIHW\ &XPPLQV$&OLQLFDOVXSHUYLVLRQ 7KHZD\IRUZDUG"$UHYLHZRIWKHOLWHUDWXUH1XUVH(GXF3UDFWLFH &XUWLV3%DOO/.LUNKDP0%XOO\LQJDQGKRUL]RQWDOYLROHQFH &XOWXUDORULQGLYLGXDOSKHQRPHQD"%U-0LGZLIHU\ 'HHU\5$QDFWLRQUHVHDUFKVWXG\H[SORULQJPLGZLYHV¶VXSSRUWQHHGVDQGWKHDIIHFWRIJURXSFOLQLFDOVXSHUYLVLRQ 0LGZLIHU\ 'H5HX37KH'XWFK3HULQDWDO$XGLW3URMHFW DIHDVLELOLW\VWXG\IRUQDWLRQDOZLGHSHULQDWDODXGLWLQWKH1HWKHUODQGV$FWD 2EVWHWULFLD*\QHFRORJLFD6FDQGLQDYLFD 'XII\$*XLGHGUHÀHFWLRQ DGLVFXVVLRQRIWKHHVVHQWLDOFRPSRQHQWV%U-1XUV (GZDUGV'%XUQDUG3+DQQLJDQ%&OLQLFDOVXSHUYLVLRQDQGEXUQRXW WKHLQÀXHQFHRIFOLQLFDOVXSHUYLVLRQIRUFRPPXQLW\ PHQWDOKHDOWKQXUVHV-&OLQ1XUV (GZDUGV'&RRSHU/%XUQDUG3+DQQLJDQ%-XJJHVXU7$GDPV-)DFWRUVLQÀXHQFLQJWKHHIIHFWLYHQHVVRIFOLQLFDO VXSHUYLVLRQ-3V\FKLDWULF0HQWDO+HDOWK1XUVLQJ )DOHQGHU&$&RUQLVK-$*RRG\HDU5+DWFKHU5.DVORZ1-/HYHQWKDO*'H¿QLQJFRPSHWHQFLHVLQSV\FKRORJ\ VXSHUYLVLRQ DFRQVHQVXVVWDWHPHQW-&OLQ3V\FKRORJ\ )RZOHU-([SHULHQWLDOOHDUQLQJDQGLWVIDFLOLWDWLRQ1XUVH(GXF7RGD\ *OXFN3$3DWLHQWVDIHW\LQZRPHQ¶VKHDOWKFDUH DIUDPHZRUNIRUSURJUHVV%HVW3UDFWLFHDQG5HVHDUFK&OLQ2EVWHW *\QDHFRO *X\DWW*+2[PDQ$'9LVW*(.XQ]5)DOFN +DOO'67KHUHODWLRQVKLSEHWZHHQVXSHUYLVRUVXSSRUWDQGUHJLVWHUHGQXUVHRXWFRPHVLQQXUVLQJFDUHXQLWV1XUVLQJ $GPLQ4XDU +HUPDQVVRQ(0nUWHQVVRQ/(PSRZHUPHQWLQWKHPLGZLIHU\FRQWH[W DFRQFHSWDQDO\VLV0LGZLIHU\ +RGJHV%)DFWRUVWKDWFDQLQÀXHQFHPHQWRUVKLSUHODWLRQVKLSV3DHGLDWULF1XUVLQJ Supervision of midwives +ROODQG.5R[EXUJK0-RKQVRQ07RSSLQJ.:DWVRQ5/DXGHU:)LWQHVVIRUSUDFWLFHLQQXUVLQJDQGPLGZLIHU\ HGXFDWLRQLQ6FRWODQG8QLWHG.LQJGRP-&OLQ1XUV)HE +\UNlV./HKWL.&RQWLQXRXVTXDOLW\LPSURYHPHQWWKURXJKWHDPVXSHUYLVLRQVXSSRUWHGE\FRQWLQXRXVVHOIPRQLWRULQJ RIZRUNDQGV\VWHPDWLFSDWLHQWIHHGEDFN-1XUVLQJ0DQ +\UNlV . $SSHOTYLVW6FKPLGOHFKQHU . +DDWDMD 5 (I¿FDF\ RI FOLQLFDO VXSHUYLVLRQ LQÀXHQFH RQ MRE VDWLVIDFWLRQ EXUQRXWDQGTXDOLW\RIFDUH-$GY1XUV +\UNlV.$SSHOTYLVW6FKPLGOHFKQHU..LYLPlNL.)LUVWOLQHPDQDJHUV¶YLHZVRIWKHORQJ±WHUPHIIHFWVRIFOLQLFDOVXSHUYLVLRQ KRZGRHVFOLQLFDOVXSHUYLVLRQVXSSRUWDQGGHYHORSOHDGHUVKLSLQKHDOWKFDUH"-1XUVLQJ0DQ /HGHPD5%URZQKLOO6+DLQHV0/DQFDVKLUH%6KDZ76WUHHW-³+DQGVRQ+DQGVRII´ DPRGHORIVXSHUYLVLRQWKDW UHFRJQLVHVWUDLQHHV¶QHHGIRUVXSSRUWDQGLQGHSHQGHQFH$XVWUDOLDQ+HDOWK5HYLHZ -RKQVRQ 0 -HIIHULHV ' /DQJGRQ 5 7KH 1XUVLQJ DQG 0LGZLIHU\ &RQWHQW $XGLW 7RRO 10&$7 D VKRUW QXUVLQJ GRFXPHQWDWLRQDXGLWWRRO-1XUVLQJ0DQ -RQHV60D[¿HOG0/HYLQJWRQ$$PHQWRUSRUWIROLRPRGHOIRUHQVXULQJ¿WQHVVIRUSUDFWLFH1XUVLQJ0DQDJ +DUURZ 0DU -R\FH3&RZPDQ6&RQWLQXLQJSURIHVVLRQDOGHYHORSPHQW LQYHVWPHQWRUH[SHFWDWLRQ"-1XUVLQJ0DQ .DSODQ.0HVWHO3)HOGPDQ'&UHDWLQJDFXOWXUHRIPXWXDOUHVSHFW$251- .HQ\RQ&5LVNPDQDJHPHQWVWDQGDUGVLQPLGZLIHU\DUHQRVXEVWLWXWHIRUSHUVRQDONQRZOHGJHDQGDFFRXQWDELOLW\ &RPSOHPHQWDU\7KHUDSLHV&OLQ3UDFWLFH /DFNH\77UDQVLWLRQRIWKHQHZO\TXDOL¿HG5&00LGZLYHV /DWKDP&/+RJDQ05LQJO.1XUVHVVXSSRUWLQJQXUVHV FUHDWLQJDPHQWRULQJSURJUDPIRUVWDIIQXUVHVWRLPSURYHWKH ZRUNIRUFHHQYLURQPHQW1XUVLQJ$GPLQ4XDU /DUVVRQ0$OGHJDUPDQQ8$DUWV&3URIHVVLRQDOUROHDQGLGHQWLW\LQDFKDQJLQJVRFLHW\ WKUHHSDUDGR[HVLQ6ZHGLVK PLGZLYHV¶H[SHULHQFHV0LGZLIHU\ /LYQL ' &URZH73*RQVDOYH] &- (IIHFWV RI VXSHUYLVLRQ PRGDOLW\ DQG LQWHQVLW\ RQ DOOLDQFH DQG RXWFRPHV IRU WKH VXSHUYLVHH5HKDELOLWDWLRQ3V\FKRORJ\ 0DWWKHZV$6FRWW3$*DOODJKHU37KHGHYHORSPHQWDQGSV\FKRPHWULFHYDOXDWLRQRIWKH3HUFHSWLRQVRI(PSRZHUPHQW LQ0LGZLIHU\6FODH0LGZLIHU\ 0DXVW',PSOHPHQWDWLRQRIDQHOHFWURQLFPHGLFDOUHFRUGLQDKHDOWKV\VWHP OHVVRQVOHDUQHG-1XUVHV6WDII'HY ( 0F&RRO*XLGHUD06WHQVRQ0'DXSKLQHH/7KHSDLQWKDWELQGVXV PLGZLYHV¶H[SHULHQFHVRIORVVDQGDGYHUVH RXWFRPHVDURXQGWKHZRUOG+HDOWK&DUH:RPHQ,QW 0F*LOWRQ .6 'HYHORSPHQW DQG SV\FKRPHWULF WHVWLQJ RI WKH 6XSSRUWLYH 6XSHUYLVRU\ 6FODH - 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7HOHPHGLFLQH7HOHFDUH Supervision of midwives $QQH[ &KHFNOLVWIRULQWURGXFLQJVXSHUYLVLRQRIPLGZLYHV Stage 4XHVWLRQ Yes No $FWLRQ5HTXLUHG 3URYLGLQJD Is there regulation for midwifery practice against which UHJXODWRU\ standards for supervision can be set? framework and standards for VXSHUYLVLRQ Does the regulation provide rules and a code of practice so that supervisors can monitor implementation? 6HOHFWLRQRI ,VWKHUHDVWDWHPHQWRITXDOL¿FDWLRQVDQGDMREGHVFULSWLRQ VXSHUYLVRUVRI designed for the supervisor of midwives? PLGZLYHV ,VWKHUHDQDWLRQDOGH¿QLWLRQ DJUHHGXSRQE\DOO VWDNHKROGHUV RIDVXSHUYLVRURIPLGZLYHV" Has a selection process for supervisors been determined? Are those responsible for selection aware of the qualities they require in the candidates? 3UHSDUDWLRQRI Has the level and length of the education program for VXSHUYLVRUVRI supervisors of midwives been agreed upon nationally? PLGZLYHV Has an educational program been prepared that contains all the essential elements required for training supervisors of midwives? Have mentors been prepared to support potential supervisors during their education? $SSRLQWPHQWRI Is there an appointment system for supervisors of VXSHUYLVRUVRI midwives that does not include automatic appointment on PLGZLYHV successful completion of the education program? $OORFDWLRQRI Is there a locally agreed-upon ratio of midwives to FDVHORDG supervisor that does not exceed 15 in developed areas and is much smaller in less-developed areas, according to availability? Module 7 $QQH[ FRQWLQXHG Stage 4XHVWLRQ Yes No $FWLRQ5HTXLUHG &KRRVLQJD Wherever possible, are midwives able to choose their own VXSHUYLVRU supervisor from a list of those available? )LUVWFRQWDFW Is there ample opportunity for the supervisor to make informal contact with each of the midwives listed on the supervisor’s caseload in order to initiate regular communication with those individuals? 2QJRLQJFRQWDFW Is there a locally agreed-upon system for facilitating midwives having regular contact with their supervisor that never falls below the minimum of one meeting per year, and much more frequently in rural areas? 5HVSRQVLELOLWLHVRI Are all supervisors of midwives aware of the prescribed list WKHVXSHUYLVRURI of responsibilities set at both the national and local level? PLGZLYHV Is there ample opportunity for supervisors to audit and review standards of midwifery practice? $UHWKHPDMRULW\RIVXSHUYLVRUVFOLQLFDOO\EDVHGVRWKDWWKH\ are able to monitor midwifery practice? Are the supervisors able to provide support for all the midwives on their caseload? Is there a system that provides midwives with access to at least one supervisor at any time for advice and guidance on clinical issues? Do the supervisors take responsibility for supporting midwives with their professional development? Is there a clear process for a supervisor of midwives to investigate sub-optimal practice? Do supervisors of midwives keep appropriate records of their supervisory activities? Module 8 Module 8 ,QWURGXFWLRQ This module in the Toolkit for strengthening professional midwifery in the Americas focuses on the individual midwife HQJDJHGLQFOLQLFDOSUDFWLFH7KHPRGXOHLVEDVHGRQWKHDVVXPSWLRQWKDWWKHPLGZLIHKDVEHHQHGXFDWHGIRUHQWU\ LQWRSUDFWLFHDFFRUGLQJWRWKHFULWHULDIRUHGXFDWLRQDO³EHVWSUDFWLFH´ WKDWWKHPLGZLIHUHFHLYHVDSSURSULDWHVXSSRUWLYH supervision for her work, including the opportunity to participate in an ongoing program of continued professional GHYHORSPHQW DQGWKDWWKHPLGZLIHSUDFWLFHVZLWKWKHHQDEOLQJHQYLURQPHQWRISROLF\UHJXODWLRQDQGVWDQGDUGVWKDW are set forth in the companion modules in this toolkit. The purpose of this module is to propose strategies for monitoring and evaluating the continued competency of midwives in current practice, in order to promote maintenance of the highest standards of quality in practice, across WKHSURIHVVLRQDOOLIHVSDQ7KHPRGXOHRIIHUVDIUDPHZRUNIRUFRQVLGHUDWLRQRIWKHGHWHUPLQDQWVRIKHDOWKFDUHSURYLGHU SHUIRUPDQFHDFFRUGLQJWRHVWDEOLVKHGVWDQGDUGVRISUDFWLFH7KDWIUDPHZRUNDI¿UPVWKDWFRPSHWHQF\DVVHVVPHQWLV RQO\RQHRIVHYHUDOLVVXHVDQGIDFWRUVWKDWPXVWEHDGGUHVVHGVLPXOWDQHRXVO\ZKHQEXLOGLQJKHDOWKV\VWHPFDSDFLW\ IRUVDIHPRWKHUKRRG(WKLFDOYDOXHVSURIHVVLRQDODWWLWXGHVDQGEHKDYLRUVVKRXOGDOVREHDVVHVVHGDVFRPSRQHQWVRI SURIHVVLRQDOKLJKTXDOLW\PLGZLIHU\FDUH 7KHGH¿QLWLRQRISURIHVVLRQDOFRPSHWHQFH $QRSHUDWLRQDOGH¿QLWLRQRISURIHVVLRQDOFRPSHWHQFH 7KH WKHRUHWLFDO DQG SUDFWLFDO GH¿QLWLRQV RI SURIHVVLRQDO FRPSHWHQFH DUH GLVFXVVHG LQ 0RGXOH RI WKLV WRRONLW )XQGDPHQWDOO\FRPSHWHQFHFDQEHGH¿QHGDVWKHFRPELQDWLRQRINQRZOHGJHDQGRISV\FKRPRWRUFRPPXQLFDWLRQDQG GHFLVLRQPDNLQJVNLOOVWKDWHQDEOHVDQLQGLYLGXDOWRSHUIRUPDVSHFL¿FWDVNWRDGH¿QHGOHYHORISUR¿FLHQF\ )XOOHUWRQHW DO &RPSHWHQFHZRXOGEHREMHFWLYHO\PHDVXUHGWKURXJKDSURFHVVRIVWUXFWXUHGDVVHVVPHQWXVLQJREMHFWLYH VWDQGDUGVRISURIHVVLRQDOSUDFWLFH NQRZOHGJHVNLOOVDQGDELOLWLHV DVWKHFULWHULDRITXDOLW\LQRUGHUWRGRFXPHQWDQ DFFHSWDEOHOHYHORISHUIRUPDQFH $QHYROYLQJGH¿QLWLRQRIFRPSHWHQFHRYHUDSURIHVVLRQDOOLIHWLPH 7KHGH¿QLWLRQRIFRPSHWHQFHLVQRWVWDWLF UDWKHULWLVGLIIHUHQWO\GH¿QHGRYHUDQLQGLYLGXDO¶VSURIHVVLRQDOOLIHWLPH7KH PLGZLIHZLOOQHHGWRDFTXLUHQHZLQIRUPDWLRQDQGQHZVNLOOVLQRUGHUWRFRQWLQXHWRSURYLGHVDIHKLJKTXDOLW\FDUH 6RPHRIWKHNH\FRQVLGHUDWLRQVLQGH¿QLQJOLIHWLPHFRPSHWHQFHDUH (YHU\ LQGLYLGXDO SUDFWLWLRQHU FRQWLQXDOO\ SURJUHVVHV EDFN DQG IRUWK RQ WKH FRQWLQXXP IURP QRYLFH WR H[SHUW %XUJHU HW DO *DUGQHU :KHQ LQGLYLGXDOV KDYH LQLWLDOO\ DFTXLUHG D VNLOO ZKHWKHU FRJQLWLYH RU SUDFWLFDO WKHVNLOOPXVWEHUHLQIRUFHGIURPWLPHWRWLPHLQRUGHUWRPDLQWDLQDVLPLODUOHYHORIFRPSHWHQFH $GGLWLRQDOO\QHZVNLOOVDUHFRQWLQXDOO\HPHUJLQJDVWHFKQRORJ\DGYDQFHV9HU\H[SHULHQFHGSUDFWLWLRQHUVPD\ EHQRYLFHOHDUQHUVRIQHZVNLOOV $QGHUVRQ 7KHGHJUHHWRZKLFKRQHPDQDJHVDVLWXDWLRQLQGHSHQGHQWO\ or with consultation, changes under these circumstances. Monitoring and assessment of continued competency for midwifery practice 6LPLODUO\ WKH NQRZOHGJH EDVH WKDW XQGHUSLQV SURIHVVLRQDO SUDFWLFH LV FRQWLQXDOO\ HYROYLQJ 7KH FRQFHSW RI FRPSHWHQFHUHTXLUHVWKDWHPHUJLQJNQRZOHGJHEHLQFRUSRUDWHGZLWKLQWKHERG\RIOHDUQHGNQRZOHGJHDQGWKDW the individual evaluate that new information for any implications it may have for application within practice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¿QLWLRQRIHWKLFDO SUDFWLFHLVWRDODUJHGHJUHHGH¿QHGE\XQLYHUVDOXQGHUVWDQGLQJVRIFRQFHSWVVXFKDVKXPDQULJKWVDQGHTXDO MXVWLFH+RZHYHUHWKLFDOSUDFWLFHLQGLYLGXDOO\GH¿QHGPD\UHÀHFWSHUVRQDOUHOLJLRXVPRUDODQGFXOWXUDOYDOXHV 7KHVHODWWHUPD\OHDGDQLQGLYLGXDOWRHOHFWQRWWRSDUWLFLSDWHLQFHUWDLQDVSHFWVRIFOLHQWFDUHOHDGLQJWR³GH VNLOOLQJ´ %UDGVKDZDQG0HUULPDQ RUWRWKHGHFLVLRQQRWWRDFTXLUHRUPDLQWDLQFRPSHWHQF\LQVHOHFWHG SUDFWLFDOVNLOOV1HYHUWKHOHVVWKHHWKLFDOSULQFLSOHVRIHTXLW\DQGEHQH¿FHQFHZRXOGFRPSHOWKHLQGLYLGXDOWR RIIHUJXLGDQFHDERXWKRZWKHVHDVSHFWVRIFDUHFRXOGEHOHJDOO\DQGSUDFWLFDOO\REWDLQHGIURPRWKHUSURYLGHUV 8.2.3 - The distinction between competence, capability, and performance 7KHUHLVDQHVVHQWLDOGLVWLQFWLRQEHWZHHQFRPSHWHQFHDQGSHUIRUPDQFHDQGWKHIRUPHUVKRXOGQRWEHLQIHUUHGIURP WKHODWWHU 6FRWODQGDQG%XOORXJK &RPSHWHQFHUHIHUVWRDQLQGLYLGXDO¶VFDSDELOLW\ WKHSRWHQWLDO WRSHUIRUP 3HUIRUPDQFHUHIHUVWRZKDWDQLQGLYLGXDOGRHVLQWKHDFWXDOFRQWH[WRISURIHVVLRQDOSUDFWLFHLHWKHDFWXDOEHKDYLRU WKDWLVREVHUYHG3HUIRUPDQFHFDQEHDIIHFWHGE\WKHSUDFWLFHHQYLURQPHQWZKLFKFDQHLWKHUHQKDQFHRUFRQVWUDLQ WKHDELOLW\WRWUDQVODWHWKHFDSDFLW\IRUFRPSHWHQWSUDFWLFHLQWRDFWXDOEHKDYLRUDORXWFRPHV7KHUHIRUHDQ\DWWHPSWWR PHDVXUHWKHFRQVWUXFWRIFRPSHWHQFHWKURXJKWKHREVHUYDWLRQRISHUIRUPDQFHPXVWFDUHIXOO\FRQVLGHUWKHFRQWH[W of practice. This understanding necessarily implies the importance of using multiple means and approaches to the PHDVXUHPHQWRIERWKSURIHVVLRQDOSHUIRUPDQFHDQGWKHFRQFHSWRISURIHVVLRQDOFRPSHWHQFH 7KHUHODWLRQVKLSEHWZHHQFRPSHWHQFHDQGFRQ¿GHQFH ,WKDVDOUHDG\EHHQQRWHGWKDWLQGLYLGXDOVPRYHIRUZDUGDQGEDFNZDUGDORQJWKHFRQWLQXXPRIFRPSHWHQFHIURPQRYLFH WRH[SHUWFOLQLFDOSUDFWLWLRQHUDFURVVWKHLUSURIHVVLRQDOOLIHWLPHDVQHZVNLOOVDUHDFTXLUHGRUSUHYLRXVO\OHDUQHGVNLOOV DUHUHLQIRUFHG&RQ¿GHQFH±WKHVHOIDVVHVVHGOHYHORIFRPIRUWLQDFWXDOSHUIRUPDQFHRIDSDUWLFXODUVNLOO±LVVLPLODUO\ YDULDEOH$QLQGLYLGXDOPD\EHFDSDEOHRISHUIRUPLQJDVNLOOLQDPDQQHUWKDWPHHWVDOOREMHFWLYHFULWHULDRIVDIHSUDFWLFH IRUH[DPSOHSHUIRUPLQJDOOFRPSRQHQWVRIDVNLOOLQWKHULJKWRUGHUDQGLQWKHFRUUHFWPDQQHUDVGRFXPHQWHGE\XVHRI DQREMHFWLYHFOLQLFDOFKHFNOLVW ZKLOHDWWKHVDPHWLPHQRWIHHOLQJSHUVRQDOO\DWHDVHZKHQGRLQJVR 'DYLVHWDO This personal unease may lead to reluctance to perform this skill when called upon to do so in the course of personal practice. Module 8 6LPLODUO\LWPD\EHWKHFDVHWKDWDQLQGLYLGXDOKDVDFTXLUHGERWKFRPSHWHQFHDQGFRQ¿GHQFHLQSHUIRUPLQJDFHUWDLQVNLOO -RUGDQDQG)DUOH\ EXWEHFDXVHWKHRSSRUWXQLW\WRSHUIRUPWKHVNLOOLQDFWXDOSUDFWLFHLVOLPLWHGKDVORVWVRPH GHJUHHRIHLWKHUDWWULEXWH7KLVDSSOLHVWRERWKORZYROXPHORZRFFXUUHQFHHYHQWVDQGFULWLFDO OLIHVDYLQJ VNLOOV %KXL\DQ HWDO 7KHFOLQLFDOHYHQWWKDWUHTXLUHVXVHRIDSDUWLFXODUVNLOOPD\RFFXUZLWKORZIUHTXHQF\ IRUH[DPSOHWKHQHHG WRSHUIRUPELPDQXDOFRPSUHVVLRQRIWKHXWHUXVWRVWRSDKHPRUUKDJH ,WPD\DOVRRFFXUEHFDXVHWKHSROLFLHVRIWKH clinical environment in which an individual practices restrict performance of that skill to another cadre of provider. Such DFLUFXPVWDQFHFDQOHDGWRGHVNLOOLQJ DOHVVHUGHJUHHRIFRPSHWHQFH RUWRDGLPLQLVKLQJVHQVHRISHUVRQDOFRQ¿GHQFH LQWKHDELOLW\WRSHUIRUPWKHVNLOOVDIHO\LIFDOOHGXSRQWRGRVR&RPSHWHQFHDQGFRQ¿GHQFHFDQERWKEHIRVWHUHGWKURXJK FRQWLQXHGSURIHVVLRQDOHGXFDWLRQDQGVXSSRUWLYHVXSHUYLVLRQ 9HUQRQ&KLDUHOODDQG3DSSV &ULWLFDOWKLQNLQJDVDFKDUDFWHULVWLFRIFRQWLQXHGFRPSHWHQF\ 0LGZLYHVGHYHORSDSHUVRQDOSUDFWLFHVW\OHRYHUWLPH,QGLYLGXDOSUDFWLFHLVLQÀXHQFHGE\SHUVRQDOH[SHULHQFHV HJ ZKDWZRUNHGLQRQHFLUFXPVWDQFHEXWQRWLQDQRWKHU DQGDOVRE\SHUVRQDOSUHIHUHQFHV HJZKDWVHHPVWREHDPRUH FRPIRUWDEOHZD\RISUDFWLFHWRWKHLQGLYLGXDODQGPRUHDFFHSWDEOHWRWKHZRPHQDQGIDPLOLHVZKRPVKH1 VHUYHV 0RVW LPSRUWDQWO\LQGLYLGXDOSUDFWLFHLVLQÀXHQFHGE\WKHLQGLYLGXDO¶VDQDO\VLVRIKHUFOLQLFDOHQFRXQWHUVDQGH[SHULHQFHVDQG WKHOHVVRQVOHDUQHGIURPWKLVUHÀHFWLYHWKLQNLQJ7KLVSURFHVVLQYROYHVFULWLFDOWKLQNLQJZKLFKLVDSDUWLFXODUO\LPSRUWDQW FKDUDFWHULVWLFDQGDELOLW\RIFRPSHWHQWPLGZLYHVERWKLQLWLDOO\DQGRYHUWKHSURIHVVLRQDOOLIHWLPH &KDUDFWHULVWLFV RI FULWLFDO WKLQNLQJ LQFOXGH DQDO\VLV LQIHUHQFH UHDVRQLQJ LQWHUSUHWDWLRQ HYDOXDWLRQ DQG RSHQ PLQGHGQHVV&ULWLFDOWKLQNLQJLPSOLHVDFRPELQDWLRQRIDELOLWLHVUHTXLUHGWRGH¿QHDSUREOHPVHOHFWLQIRUPDWLRQWKDWLV SHUWLQHQWWRWKHVROXWLRQRIWKHSUREOHPUHFRJQL]HWKHDVVXPSWLRQVWKDWXQGHUSLQDSURSRVHGUHVROXWLRQRIWKHSUREOHP DQGMXGJHWKHYDOLGLW\RIWKHLQIRUPDWLRQXQGHUFRQVLGHUDWLRQ 5LGGHOO &ULWLFDOWKLQNLQJLVGLIIHUHQWIURPFUHDWLYH WKLQNLQJ&UHDWLYHWKLQNLQJLQYROYHVWKHJHQHUDWLRQRIQHZLGHDVUDWKHUWKDQWKHODUJHO\UHWURVSHFWLYHUHÀHFWLYHDQG HYDOXDWLYHSURFHVVWKDWGH¿QHVFULWLFDOWKLQNLQJ 6H\PRXU.LQQDQG6XWKHUODQG 7KHSURFHVVRIFULWLFDOWKLQNLQJ FDQEHGHYHORSHGWKURXJKVXFKDFWLYLWLHVDVTXHVWLRQLQJGHEDWHDQGUHYLHZLQJFDVHVWXGLHV (GZDUGV %UXQW )LQQ +RZHYHU WKH WDOHQW IRU FUHDWLYH WKLQNLQJ LV D SHUVRQDO DELOLW\ %DVHG RQ WKH ZLVGRP WKH\ KDYH acquired over a professional lifetime, creative midwives can generate new ideas and proposals that can advance the art and science of clinical practice and lead to new models for clinical care. 17KHXVHRIWKHIHPDOHJHQGHUUHÀHFWVWKDWLQPDQ\FRXQWULHVPLGZLIHU\LVVHHQDVH[FOXVLYHO\RSHQWRZRPHQ+RZHYHULQD QXPEHURIQDWLRQVPHQQRZHQWHUWKLVSURIHVVLRQ7KHLQWHUQDWLRQDOGH¿QLWLRQKDVEHHQXSGDWHGWRUHÀHFWDPRUHJHQGHUQHXWUDO ODQJXDJH KRZHYHUWKLVJXLGDQFHXVHVWKHIHPDOHJHQGHUIRUHDVHRIXVH Monitoring and assessment of continued competency for midwifery practice 7KHPHDVXUHPHQWRIFRPSHWHQFH A glossary of terms related to professional competence Clinical practice guideline: $UHFRPPHQGDWLRQIRUDZD\RISUDFWLFHEDVHGRQVWUHQJWKRIWKHHYLGHQFHWKDW supports a particular approach to patient care. Competence:7KHFRPELQDWLRQRINQRZOHGJHDQGRISV\FKRPRWRUFRPPXQLFDWLRQDQGGHFLVLRQPDNLQJVNLOOV WKDWHQDEOHDQLQGLYLGXDOWRSHUIRUPDVSHFL¿FWDVNWRDGH¿QHGOHYHORISUR¿FLHQF\ Capability:$QLQGLYLGXDO¶VFDSDFLW\ WKHSRWHQWLDO WRSHUIRUP Evaluation: A process and procedure for formal assessment of the outcomes of learning or performance. 0RQLWRULQJ An ongoing, periodic assessment of performance in accord with standards. 3HUIRUPDQFH :KDWDQLQGLYLGXDOGRHVLQWKHDFWXDOFRQWH[WRISURIHVVLRQDOSUDFWLFHLHWKHDFWXDOEHKDYLRUWKDW LVREVHUYHG 8.3.1 - Why measure competence? There are compelling and complementary rationales for the measurement of competence. They include: Initial and ongoing assessment of the competence of a midwifery practitioner is consistent with the ethical principles that underpin professional practice. The measurement of competence is an essential component in the measurement of educational outcomes. ([DPSOHV LQFOXGH WKH HQGRISURJUDP DFDGHPLF DVVHVVPHQWV FRQGXFWHG LQ SUHVHUYLFH LQVHUYLFH DQG continuing education programs. &RPSHWHQF\ DVVHVVPHQW LV DQ LQWHJUDO SDUW RI WKH FHUWL¿FDWLRQ DQG UHFHUWL¿FDWLRQ SURFHVVHV RI PLGZLIHU\ SURYLGHUVLQVRPHFRXQWULHV([DPLQDWLRQVDUHRIWHQXVHGWRGHWHUPLQHTXDOL¿FDWLRQVIRULQLWLDOHQWU\LQWRSUDFWLFH RI D VSHFL¿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competence at a level equivalent to that of the new graduates. Module 8 6LPLODUO\DFRXQWU\JRYHUQPHQWPD\WKLQNLWWREHXVHIXODQGGHVLUDEOHWRFUHDWHDQHZFDGUHRISUDFWLWLRQHU HJDQDX[LOLDU\PLGZLIH ZKRLVSUHSDUHGWRSHUIRUPVRPHRIWKHVNLOOVWKDWDUHZLWKLQWKHVFRSHRISUDFWLFH RIDPRUHTXDOL¿HGSURIHVVLRQDO,WZRXOGEHLPSRUWDQWWRDVVHVVWKHGHJUHHWRZKLFKWKHQHZSUDFWLWLRQHUVFDQ FRPSHWHQWO\SHUIRUPHDFKRIWKHVNLOOVWKDWDUHVHOHFWHGIRULQFOXVLRQLQWKLVQHZO\GH¿QHGVFRSHRISUDFWLFH (TXLYDOHQWVNLOOVVKRXOGEHMXGJHGHTXLYDOHQWO\ &RPSHWHQF\DVVHVVPHQWVFRXOGEHXVHIXOLQVHOHFWLQJQHZVWDIIDQGLQVXSHUYLVLQJFXUUHQWVWDII$Q\ RUJDQL]DWLRQ ZRXOG EH UHTXLUHG WR GRFXPHQW WKDW DOO VWDII FDQ SHUIRUP WKHLU GXWLHV DQG IXQFWLRQV DW D OHYHO consistent with quality standards, and to facilitate a program of continued quality improvement. This is also an organizational risk management strategy. Standards are continually updated. It is critical that practicing midwives have the opportunity to acquire UHOHYDQWLQIRUPDWLRQDERXWFKDQJHVLQSUDFWLFHDQGWKHQGHPRQVWUDWHWKHLUFRPSHWHQFHLQQHZO\DFTXLUHG RU DPHQGHG ZD\VRISUDFWLFH The measurement of competence is important for individual performance improvement, in accord with the SHUVRQDODFFRXQWDELOLW\WKDWVKRXOGFKDUDFWHUL]HSURIHVVLRQDOSUDFWLFH7KLVLQFOXGHVVHOIPRQLWRULQJRISHUVRQDO FRPSHWHQF\LQWKHSHUIRUPDQFHRIQHZVNLOOVWKDWKDYHHPHUJHGWKURXJKWKHHYROXWLRQRIHYLGHQFHEDVHG SUDFWLFH 3HUULHUHWDO ,WLQFOXGHVSHUVRQDOUHDVVHVVPHQWSULRUWRUHHQJDJHPHQWLQDOLPLWHGRUIXOO VFRSHRIPLGZLIHU\FOLQLFDOSUDFWLFH HJIRUPLGZLYHVZKRKDYHEHHQGLVHQJDJHGIURPFOLQLFDOSUDFWLFHDQG QRZZLVKWRUHMRLQWKHZRUNIRUFH ,WLVDOVRIXQGDPHQWDOWRWKHSHUVRQDOSUDFWLFHRIDQ\PLGZLIHZKRVXSHUYLVHV the clinical practice of others. 8.3.2 - The timing of competency assessments Formative assessment occurs at the time of initial learning and also whenever new knowledge or new techniques (skills, SURFHGXUHVJXLGHOLQHV DUHLQWURGXFHGLQWRSURIHVVLRQDOSUDFWLFH)RUPDWLYHDVVHVVPHQWLVDFRPPRQFRPSRQHQWRI SUHVHUYLFHDQGLQVHUYLFHHGXFDWLRQ Summative DVVHVVPHQW RFFXUV DW WKH MXQFWXUHV EHWZHHQ WKH FRPSOHWLRQ RI VWUXFWXUHG OHDUQLQJ SURJUDPV DQG WKH authorization to engage in individual clinical practice. Summative assessment processes are commonly anticipated DQGXQGHUVWRRGDVEHVWSUDFWLFHVLQHGXFDWLRQ &OHODQG 7KH\DUHDOVRLQFRPPRQXVHE\UHJXODWRU\DXWKRULWLHV DVD³JDWHNHHSHU´PHFKDQLVPIRULQLWLDOHQWU\LQWRSUDFWLFH HJDVZLWKFHUWL¿FDWLRQRUOLFHQVXUHH[DPLQDWLRQV The continuous evolution of the science that underpins professional practice, along with the ongoing movement along WKH FRQWLQXXP RI ERWK FRPSHWHQFH DQG FRQ¿GHQFH LQ SUDFWLFH XQGHUSLQV WKH LPSRUWDQFH RI SHULRGLF FRPSHWHQF\ DVVHVVPHQW)RUPDWLYHDQGVXPPDWLYHDVVHVVPHQWVLQWKHFRQWH[WRIERWKPRQLWRULQJDQGHYDOXDWLRQVKRXOGFRQWLQXH to occur across the professional lifetime. Monitoring and assessment of continued competency for midwifery practice 0RQLWRULQJSURIHVVLRQDOFRPSHWHQFH 8.4.1 - The distinction between monitoring and evaluation 0RQLWRULQJDQGHYDOXDWLRQDUHERWKFRQGXFWHGIURPWLPHWRWLPHDQGRYHUWLPH+RZHYHUPRQLWRULQJRIWHQUHIHUVWR the process, and evaluation more often refers to the assessment of outcomes. This module focuses on the monitoring of individualPLGZLYHVDVSURIHVVLRQDOSUDFWLWLRQHUV,QWKDWFRQWH[WPRQLWRULQJRIIHUVWKHRSSRUWXQLW\WRYHULI\WKDWWKH individual practitioner continues to take actions that promote continued adherence to guidelines and/or standards of SUDFWLFHHVWDEOLVKHGIRUWKHRFFXSDWLRQSURIHVVLRQRIPLGZLIHU\([DPSOHVRIPRQLWRULQJLQFOXGHDUHYLHZRI³FXUUHQF\ LQSUDFWLFH´LHDUHYLHZRIKRZUHFHQWO\DQ\LQGLYLGXDOKDVKDGWKHRSSRUWXQLW\WRSHUIRUPFHUWDLQWDVNV VRPHRUDOO RIWKHNQRZOHGJHVNLOOVDQGDELOLWLHV .6$V GH¿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¿HGSURIHVVLRQDOPLGZLYHVLQWRWKHKHDOWKFDUHZRUNIRUFH 0RQLWRULQJPLGZLIHU\FRPSHWHQFLHVDFFRUGLQJWRLQWHUQDWLRQDORUFRXQWU\ VSHFL¿FJXLGHOLQHV 'HYHORSPHQWRIDSURJUDPWRPRQLWRUPLGZLIHU\FRPSHWHQF\LQYROYHVWKHLGHQWL¿FDWLRQRIWKHNQRZOHGJHVNLOOVDQG DELOLWLHVWKDWVKRXOGLQWKHLGHDOEHPDLQWDLQHGE\WKHLQGLYLGXDOSUDFWLWLRQHU7KH¿UVWWDVNLQHVWDEOLVKLQJDSURJUDPRI monitoring midwifery competencies is to select the KSA list that is most appropriate and most relevant to the purpose. These lists of KSAs form the monitoring guidelines. 6RPHFRXQWULHVLQYHVWLQWKHHGXFDWLRQRIIXOO\TXDOL¿HGPLGZLYHVEXWLQDGGLWLRQKDYHFUHDWHGRWKHU ORZHUOHYHO FDGUHVRIELUWKSURYLGHUVZKRKDYHDFTXLUHGVRPHEXWQRWDOORIWKH.6$VDVVRFLDWHGZLWKWKHSUDFWLFHRIPLGZLIHU\ 7KHVHORZHUOHYHOFDGUHVZRXOGKDYHDGLIIHUHQWVHWRI.6$V+RZHYHU HDFKFDGUHZRXOGEHH[SHFWHGWRSHUIRUPWKH VNLOOVRQWKDWVSHFL¿FOLVWDFFRUGLQJWRDQH[SOLFLWVWDQGDUGRITXDOLW\SUDFWLFH7KHUHLVDIXOOHUGLVFXVVLRQRIWKLVLVVXH LQ0RGXOHDQG0RGXOHRIWKLVWRRONLW ,QDYHU\OLPLWHGVHQVHMREGHVFULSWLRQVDQGFOLQLFDOSUDFWLFHJXLGHOLQHV 7LOOHW 4DVHHPHWDO PLJKWEH FRQVLGHUHG³VWDQGDUGV´RISUDFWLFHEHFDXVHWKH\GHVFULEHWKHWDVNVWKDWWKHPLGZLIHLVH[SHFWHGWRGR DQGWRGR ZHOO LQWKDWVHWWLQJ )UHHPDQDQG*ULHZ -REGHVFULSWLRQVGHYHORSHGDWWKHIDFLOLW\OHYHOVKRXOGQHLWKHUOLPLWQRU H[FHHGWKHWDVNVWKDWDUHDXWKRUL]HGLQWKHFRXQWU\¶VUHJXODWRU\JXLGHOLQHVIRUPLGZLIHU\SUDFWLFH 0RGXOH 8.4.3 - A model for monitoring midwifery competencies A process for monitoring the quality of the practice of professional midwives is offered in this module. 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And therefore these particular skills PLJKWEHVSHFL¿FDOO\FKRVHQWREHLQFOXGHGLQWKHPRQLWRULQJSURFHVVSHUKDSVWRWKHH[FOXVLRQRIRWKHUV 0RGXOH RIWKLVWRRONLWGHVFULEHVWKHSURFHVVWKDWQHHGVWREHIROORZHGWRHQVXUHWKDWWKHVHVHOHFWHGVNLOOVDUHDXWKRUL]HGZLWKLQ WKHVWDWXWRU\DXWKRULW\IRUWKHSUDFWLFHRIPLGZLIHU\LQWKDWFRXQWU\ Monitoring and assessment of continued competency for midwifery practice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¿FWDVNVHLWKHUDGGHGRUWDNHQDZD\ EDVHGRQWKHUHVSRQVHVUHFHLYHGIURPWKHSUHYLRXVUHYLHZ 6XUYH\SDUWLFLSDQWVFRXOGUHÀHFWWKHVDPHLQWHUHVWJURXSVDVQRWHGDERYH ,IWKHFRXQWU\KDVWDNHQVWHSVIXOO\WRGHOLQHDWHWKH.6$VWKDWGH¿QHSURIHVVLRQDOPLGZLIHU\SUDFWLFHLQWKDW FRXQWU\LWPLJKWEHVXI¿FLHQWVLPSO\WRFRPSDUHWKHIXOOOLVWRIFRPSHWHQF\VWDWHPHQWVWRWKH.6$VWDWHPHQWVWKDW DUHGHOLQHDWHGLQWKHFRXQWU\¶VUHJXODWRU\GRFXPHQW V 7KHSULPDU\LVVXHWREHFRQVLGHUHGLQDQ\DGDSWDWLRQ RUDGRSWLRQ RIWKHVHPRQLWRULQJWRROVDWWKHFRXQWU\OHYHOLVWKDW WKHPRQLWRULQJSURFHVVWKDWLVVXSSRUWHGE\XVHRIWKLVWRROEHIHDVLEOHWDUJHWHGDQGFRVWHIIHFWLYH,WLVQRWXVHIXOWR GHVLJQDSURFHVVWKDWFDQQRWEHLPSOHPHQWHGEHFDXVHRISUDJPDWLFOLPLWDWLRQVUHODWHGWRWLPHFRQVWUDLQWVDQG¿QDQFLDO EXUGHQ 0HWKRGVDQGVWUDWHJLHVIRULPSOHPHQWLQJDSURJUDPRIPRQLWRULQJ professional competence 0RQLWRULQJVKRXOGRFFXURQDSHULRGLFEXWUHJXODUO\VFKHGXOHGEDVLV7KHUHLVQRH[SOLFLWJXLGHOLQHIRUWKHSHULRGRI WLPHEHWZHHQUHYLHZV$QLPSRUWDQWSXUSRVHFDQEHVHUYHGE\FRQGXFWLQJDUHYLHZRQFHHDFK\HDU7KH H[FHUSWHG PRGHOWRROVSURYLGHGIRUWKLVSURFHVVDGGUHVVERWKFRPSHWHQFHDQGFRQ¿GHQFHDVGH¿QHGLQ6HFWLRQRIWKLV module. 7KHLQGLYLGXDOPRQLWRULQJWRROLVGHVLJQHGDVDVHOIDVVHVVPHQWH[HUFLVH $QQH[ Monitoring Midwifery Competencies Self-Assessment Tool 7KHSURFHVVRIVHOIUHÀHFWLRQLVDNH\FRPSRQHQWLQWKHXVHRIWKHLQGLYLGXDOVHOIDVVHVVPHQW WRRO 'XII\ 6HOIDVVHVVPHQWLVWKHDELOLW\RIDPLGZLIHU\SUDFWLWLRQHUWRUHÀHFWRQKHURZQSHUIRUPDQFHVWUHQJWKV and weaknesses, and to conduct a review of her own performance, in order to identify learning needs and improve SHUIRUPDQFH6HOIDVVHVVPHQWKDVEHHQGHPRQVWUDWHGWREHUHODWHGWRTXDOLW\LPSURYHPHQW 3ULFH 7KHPRQLWRULQJUHYLHZFDQEHFRQGXFWHGE\DQ\VLQJOHLQGLYLGXDO7KLVPLJKWEHDSSURSULDWHRUPRVWIHDVLEOHIRUWKH PLGZLIHZKRLVHQJDJHGLQSULYDWHSUDFWLFHRUDVLVFRPPRQLQGHYHORSLQJFRXQWU\KHDOWKFDUHVHWWLQJVIRUPLGZLYHV ZKRIXQFWLRQZLWKRXWGLUHFWVXSHUYLVLRQRUWKHDYDLODELOLW\RIDFROOHDJXHWRJXLGHWKHLUSHUIRUPDQFH Module 8 7KHVHOIDVVHVVPHQWUHYLHZFDQEHFRQGXFWHGXVLQJWKHHQWLUHVHWRI,&0EDVLFFRPSHWHQFLHV REWDLQHGIURPWKH,&0 ZHEVLWHDVSUHYLRXVO\QRWHG 7KHLQGLYLGXDOPLGZLIHFDQVLPSO\VHOHFWWKHOLVWRIFRPSHWHQF\VWDWHPHQWVWUDQVSRVH WKHPLQWRWKHPRGHOWRROWKDWLVSURYLGHGLQWKHDQQH[DQGFRQGXFWWKHSHUVRQDOUHYLHZ$Q\.6$WKDWLVQRWUHOHYDQW WRPLGZLIHU\SUDFWLFHLQKHUFRXQWU\FDQVLPSO\EHRPLWWHG LHQRWWUDQVFULEHGLQWRWKHDVVHVVPHQWWRRO 2QWKHRWKHU KDQGWKHLQGLYLGXDOSUDFWLWLRQHUPD\PDNHQRWHRIWKHVSHFL¿F.6$DVDIXQFWLRQLQZKLFKRWKHUPLGZLYHVHQJDJHDQG then set a personal learning goal related to acquiring that particular competency. 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Monitoring and assessment of continued competency for midwifery practice (YDOXDWLQJSURIHVVLRQDOFRPSHWHQFH 8.5.1 - Evaluation as a component of the monitoring process The evaluation process discussed in this module is a very narrow discussion,WKDVDOUHDG\EHHQQRWHGWKDWLQGLYLGXDO PLGZLYHVZLOOQHHGWRDFTXLUHQHZLQIRUPDWLRQDQGQHZVNLOOVLQRUGHUWRFRQWLQXHWRSURYLGHVDIHKLJKTXDOLW\FDUH RYHUWKHLUSURIHVVLRQDOOLIHWLPH,WKDVDOVREHHQQRWHGWKDWPLGZLYHVGHYHORSDSHUVRQDOSUDFWLFHVW\OHRYHUWLPHEDVHG RQWKHOHVVRQVWKDWWKH\KDYHOHDUQHGIURPSDVWH[SHULHQFHV,QWKHFRQWH[WRIWKLVPRGXOHHYDOXDWLRQLVOLQNHGWRWKH DVVHVVPHQWRIWKHFXUUHQF\RIDIXQGRINQRZOHGJHDQGDOVRWRWKHLQLWLDOGHWHUPLQDWLRQRUUHDI¿UPDWLRQRIWKHDELOLW\ WRSHUIRUPDFOLQLFDOVNLOODFFRUGLQJWRDQREMHFWLYHVWDQGDUG7KHXOWLPDWHJRDORIHYDOXDWLRQLVWKHSURPRWLRQRIEHVW SUDFWLFH 5LQJHWDO +DPLOWRQHWDO 7KHUH DUH VHYHUDO PHWKRGV RI DVVHVVPHQW RI PLGZLIHU\ NQRZOHGJH (YDOXDWLRQ PHWKRGV VHOHFWHG IRU NQRZOHGJH assessment among midwives in practice should offer the midwife the opportunity to draw on the entire range of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ource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³DOO´VWHSVLQDSURFHGXUHRURQO\WKRVHVWHSVWKDWDUHFULWLFDOWRVDIHSUDFWLFH ³VHQWLQHOVFRUHV´ &DUORXJKDQG 0F&DOO 7KHODWWHUDSSURDFKLVRIFRXUVHPRUHHI¿FLHQWDQGOHVVFRVWO\DQGGRHVQRWGLPLQLVKWKHHIIHFWLYHQHVV of any evaluation that is focused on quality of care. 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Additional statements follow…. 7KHPLGZLIHKDVWKHVNLOOVDQGRUDELOLW\WR WDNHDVSHFL¿FKLVWRU\DQGPDWHUQDO YLWDOVLJQVLQODERU Monitoring and assessment of continued competency for midwifery practice $QQH[ FRQWLQXHG ,&0(VVHQWLDO&RPSHWHQFLHV 3HHURUVXSHUYLVRUUDWLQJRIFXUUHQW %DVLVRIWKLVDVVHVVPHQW competence .QRZOHGJHVNLOORUSURIHVVLRQDO ,GLVFXVVHG ,REVHUYHG ,HYDOXDWHG EHKDYLRU .6% this topic or assisted performance with the with the of this skill LQGLYLGXDO performance XVLQJDQ of this skill REMHFWLYH assessment tool safe in skill or not safe in skill 1RWFXUUHQWLQNQRZOHGJH &XUUHQWLQNQRZOHGJHDQG 3 perform a screening physical H[DPLQDWLRQLQODERU Additional statements follow…. &RPSHWHQF\ 0LGZLYHVSURYLGHFRPSUHKHQVLYHKLJKTXDOLW\FXOWXUDOO\VHQVLWLYHSRVWQDWDOFDUHIRUZRPHQ 7KHPLGZLIHKDVWKHNQRZOHGJHDQGRUXQGHUVWDQGLQJRI physical and emotional changes that RFFXUIROORZLQJFKLOGELUWKLQFOXGLQJWKH normal process of involution. physiology and process of lactation and common variations, including engorgement, lack of milk supply, etc. Additional statements follow…. 7KHPLGZLIHKDVWKHVNLOOVDQGRUDELOLW\WR take a selective history, including GHWDLOVRISUHJQDQF\ODERUDQGELUWK perform a focused physical H[DPLQDWLRQRIWKHPRWKHU Additional statements follow…. &RPSHWHQF\ 0LGZLYHVSURYLGHKLJKTXDOLW\FRPSUHKHQVLYHFDUHIRUWKHHVVHQWLDOO\KHDOWK\LQIDQWIURPELUWKWRWZR months of age 7KHPLGZLIHKDVWKHNQRZOHGJHDQGRUXQGHUVWDQGLQJRI SULQFLSOHVRIQHZERUQDGDSWDWLRQWR H[WUDXWHULQHOLIH HJ$SJDUVFRULQJ V\VWHPIRUEUHDWKLQJKHDUWUDWH UHÀH[HVPXVFOHWRQHDQGFRORU EDVLFQHHGVRIQHZERUQ DLUZD\ warmth, nutrition, attachment ERQGLQJ Additional statements follow…. 7KHPLGZLIHKDVWKHVNLOODQGRUDELOLW\WR provide immediate care to the QHZERUQLQFOXGLQJFRUGFODPSLQJDQG cutting, drying, clearing airways, and HQVXULQJWKDWEUHDWKLQJLVHVWDEOLVKHG SURPRWHDQGPDLQWDLQQRUPDOQHZERUQ ERG\WHPSHUDWXUHWKURXJKFRYHULQJ EODQNHWFDS HQYLURQPHQWDOFRQWURO DQGSURPRWLRQRIVNLQWRVNLQFRQWDFW Module 8 $QQH[ FRQWLQXHG ,&0(VVHQWLDO&RPSHWHQFLHV 3HHURUVXSHUYLVRUUDWLQJRIFXUUHQW %DVLVRIWKLVDVVHVVPHQW competence .QRZOHGJHVNLOORUSURIHVVLRQDO ,GLVFXVVHG ,REVHUYHG ,HYDOXDWHG EHKDYLRU .6% this topic or assisted performance with the with the of this skill LQGLYLGXDO performance XVLQJDQ of this skill REMHFWLYH assessment tool safe in skill or not safe in skill 1RWFXUUHQWLQNQRZOHGJH &XUUHQWLQNQRZOHGJHDQG 3 Additional statements follow…. &RPSHWHQF\ 0LGZLYHVSURYLGHDUDQJHRILQGLYLGXDOL]HGFXOWXUDOO\VHQVLWLYHDERUWLRQUHODWHGFDUHVHUYLFHV IRUZRPHQUHTXLULQJRUH[SHULHQFLQJSUHJQDQF\WHUPLQDWLRQRUORVVWKDWDUHFRQJUXHQWZLWKDSSOLFDEOHODZVDQG UHJXODWLRQVDQGLQDFFRUGZLWKQDWLRQDOSURWRFROV 7KHPLGZLIHKDVWKHNQRZOHGJHDQGRUXQGHUVWDQGLQJRI policies, protocols, laws, and UHJXODWLRQVUHODWHGWRDERUWLRQFDUH services. factors involved in decisions relating to unintended or mistimed pregnancies. Additional statements follow…. 7KHPLGZLIHKDVWKHVNLOODQGRUDELOLW\WR assess gestational period through TXHU\DERXW/03ELPDQXDO H[DPLQDWLRQDQGRUXULQHSUHJQDQF\ testing. educate and advise women (and IDPLO\PHPEHUVZKHUHDSSURSULDWH RQVH[XDOLW\DQGIDPLO\SODQQLQJSRVW DERUWLRQ Additional statements follow…. Module 9 ,QWURGXFWLRQ 0LGZLYHV DQG WKH PLGZLIHU\ SURIHVVLRQ KDYH PDGH D VLJQL¿FDQW FRQWULEXWLRQ WR WKH LPSURYHPHQW RI WKH KHDOWK RI ZRPHQDQGQHZERUQVSDUWLFXODUO\LQWKHSHULRGRISUHJQDQF\DQGFKLOGELUWK7KLVFRQWULEXWLRQFDQEHWUDFHGWKURXJK DQHFGRWDOWDOHVSDVVHGGRZQWKURXJKWKHJHQHUDWLRQVDQGLQWKHUHFRUGHGOLWHUDWXUHRYHUWLPH9DOLGDQGUHOLDEOH FRQ¿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other health care professionals and providers at different levels of the health system, in health facilities, and in the community. 6XFKFROODERUDWLRQZLOOKHOSWRSURYLGHDFFHVVWRWKHIXOOUDQJHRIFDUHZRPHQDQGRUWKHLUQHZERUQVPD\QHHG WKXVHQVXULQJWKHUHTXLUHGFRQWLQXXPRIFDUH7KHFROODERUDWLRQKRZHYHUPXVWEHEDVHGRQPXWXDOUHVSHFWDQG UHFRJQLWLRQRIWKHVSHFL¿FFRQWULEXWLRQHDFKW\SHRIFDUHSURYLGHUPDNHVWRWKHFRQWLQXXPRIFDUH [Source: WHO/ICM/FIGO 2004] 7KH PLGZLIHU\ SURIHVVLRQ KDV EHHQ DFNQRZOHGJHG DQG DI¿UPHG E\ PDQ\ FRXQWULHV DV D SULPDU\ VWUDWHJ\ IRU WKH SURPRWLRQRIVDIHPRWKHUKRRGVHUYLFHV2WKHUFRXQWULHVKRZHYHUFRQWLQXHWRGHOLEHUDWHWKHUROHRIWKHPLGZLIHZLWKLQ WKHKHDOWKFDUHV\VWHPZLWKSDUWLFXODUGHEDWHDERXWWKHSRVLWLRQRIPLGZLYHVDVDXWRQRPRXVSUDFWLWLRQHUVDQGWKH implication of that status with respect to requirements for supervision of practice, the settings in which midwifery care FDQEHSURYLGHGDQGHOLJLELOLW\IRUGLUHFW¿QDQFLDOUHLPEXUVHPHQWIRUVHUYLFHV 1LJKWLQJDOH 2¶%ULHQHWDO 6NnU 0LGZLIHU\LVFRQWLQXLQJWRHPHUJHDVDSURIHVVLRQLQPDQ\FRXQWULHVZKHUHDZLGHYDULHW\RISURYLGHUV KDYHRIIHUHGFDUHGXULQJFKLOGELUWK7KHUROHVRIWKHVHYDULRXVWUDGLWLRQDOSURYLGHUVKDYHHYROYHGRYHUWLPHLQUHVSRQVH WRFXVWRPFLUFXPVWDQFHRULGHQWL¿HGQHHG7KHVHWUDGLWLRQDOSUDFWLWLRQHUVVKDUHHOHPHQWVRIWKHERG\RINQRZOHGJH VNLOOVDQGDELOLWLHVWKDWFKDUDFWHUL]HWKHPLGZLIHU\VFRSHRISUDFWLFH This module in the Toolkit for strengthening professional midwifery in the Americas recognizes that some countries do not have the capacity to prepare professional midwives immediately. The module therefore suggests some interim VWUDWHJLHVWKDWOHDGWRDQGEXLOGFDSDFLW\IRUSURYLGLQJVNLOOHGDWWHQGDQFHDWELUWKZKLOHWKHVHFRXQWULHVDUHGHYHORSLQJ the profession of midwifery. Countries need to have policies in place that accommodate an ongoing assessment RIKHDOWKZRUNIRUFHUHTXLUHPHQWV&RXQWULHVDOVRQHHGWRKDYHUHJXODWRU\PHFKDQLVPVWKDWHQDEOHWKHPWRPDNH PRGL¿FDWLRQVLQWKHSUR¿OHRIWKHKHDOWKZRUNIRUFHWKDWWKHVHDVVHVVPHQWVLGHQWLI\DVEHLQJQHFHVVDU\ VHH0RGXOH 7KHVHDVVHVVPHQWVVKRXOGLQFOXGHXVHRIKHDOWKZRUNIRUFHSODQQLQJLQGLFDWRUVWKDWDGGUHVVERWKJHQHUDOVWDI¿QJ DQGVSHFL¿FQHHGVIRUSURYLGHUVVNLOOHGWRRIIHUPDWHUQDOQHZERUQDQGFKLOGKHDOWK 01&+ FDUH :+2 &RXQWULHVDOVREHDUWKHFRPSHOOLQJREOLJDWLRQWRJDWKHUHYLGHQFHRQWKHRXWFRPHVRIWKHKHDOWKFDUHVHUYLFHVWKDWDUH SURYLGHGDQGRQWKHLPSDFWWKDWWKHVHVHUYLFHVKDYHRQWKHKHDOWKDQGZHOOEHLQJRIZRPHQLQIDQWVIDPLOLHVDQGWKH community. 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LQFUHDVLQJWKHSURSRUWLRQRIELUWKVDWWHQGHGE\VNLOOHGSURYLGHUV7KLVZRXOGEHFRVWO\DQGLWFRXOGLQKLELWWKH DELOLW\ RI JRYHUQPHQWV WR IXQG WKH HGXFDWLRQ RI SURIHVVLRQDO ELUWK DWWHQGDQW FDGUHV :LUWK )DXYHDX 6KHUUDWWDQGGH%HUQLV Developing midwifery capacity for the promotion of maternal and newborn health 7KHVWXGHQWVPD\YDU\ZLGHO\LQWKHLUDFDGHPLFEDFNJURXQGDQGLQWKHLUDELOLW\WRHQJDJHLQFULWLFDOWKLQNLQJ .UXN3UHVFRWWDQG*DOHD 7KHVHIDFWRUVPD\FDXVHWKHVHVWXGHQWVWRZLWKGUDZRUWREHGLVPLVVHGIURP WKHVHHGXFDWLRQSURJUDPV7KLVVLWXDWLRQZRXOGQRWVHUYHWKHSXUSRVHRIEXLOGLQJHLWKHUDQLQWHULPELUWKDWWHQGDQW workforce or a cohort of midwifery aspirants. *UDGXDWHV RI WKHVH SURJUDPV PD\ KDYH LQVXI¿FLHQW RSSRUWXQLWLHV WR DFTXLUH VNLOOV GXULQJ WKHLU HGXFDWLRQ SURJUDPVWKXVUHTXLULQJ YHU\GLOLJHQWSURJUDPVRIVXSHUYLVLRQ DQGVXSSRUWLQSODFH ZKLFKDUHWKHPVHOYHV UHVRXUFHLQWHQVLYHDQGFRVWO\ )DXYHDX &RXQWULHVWKDWDUHFRQVLGHULQJGHYHORSPHQWRIWKHVHQHZVNLOOHGDWWHQGDQWFDGUHVZRXOGEHZLVHWRZRUNFROODERUDWLYHO\ ZLWKWKHORFDOPLGZLIHU\DVVRFLDWLRQDQGZLWKWKH,QWHUQDWLRQDO&RQIHGHUDWLRQRI0LGZLYHV &KDPEHUODLQHWDO as they consider issues such as scope of practice, curriculum content, supervision strategies, regulatory approaches, DQGVWDQGDUGVRISUDFWLFH*XLGDQFHIRUHDFKRIWKHVHLVVXHVLVSUHVHQWHGLQ0RGXOHVDQGRIWKLVWRRONLW7KH JUDGXDWHRIVXFKDSURJUDPZRXOGQRWEHIXOO\SUHSDUHGDVDPLGZLIHDFFRUGLQJWRWKHVWDQGDUGVIRUHGXFDWLRQDQG HVVHQWLDOFRPSHWHQFLHVGHOLQHDWHGE\WKH,&0 VHH0RGXOH +RZHYHUWKHJUDGXDWHRIWKLVPRUHOLPLWHG SURJUDPZRXOGKDYHDFTXLUHGDIXQGRINQRZOHGJHDQGOLPLWHGVNLOOVUHODWHGWR DWPLQLPXP WKHLQWUDSDUWXPDQG QHZERUQSHULRGV7KDWFRXOGVHUYHDVWKHIRXQGDWLRQIRUIXUWKHUVWXGLHVOHDGLQJWRHYHQWXDOTXDOL¿FDWLRQDVDPLGZLIH ZKHQWKHLQGLYLGXDORUFRXQWU\FLUFXPVWDQFHVHQDEOHWKDWSURIHVVLRQDODGYDQFHPHQW If countries follow the principles and guidelines offered in this toolkit when they design and implement this type of HGXFDWLRQSURJUDPWKH\ZRXOGFRQWULEXWHWRWKHGHYHORSPHQWDQGGHSOR\PHQWRIDPRUHXQLIRUPO\SUHSDUHGFDGUH RIQRQPLGZLIH³WUDLQHG´RU³VNLOOHG´ELUWKDWWHQGDQWVSURYLGHGWKDWWKHVHLQGLYLGXDOVDUHWUDLQHGWRSUR¿FLHQF\LQWKHLU WDVNV WKH:+2GH¿QLWLRQ RIVNLOOHG ELUWKDWWHQGDQW 3UR¿FLHQF\FDQDQGPXVWEHH[WHUQDOO\YDOLGDWHGDQGQR FRPSURPLVHVKRXOGEHDFFRPPRGDWHG7KLVLQWXUQZRXOGHQDEOHYDOLGDQGUHOLDEOHUHVHDUFKDSSURDFKHVWKDWZRXOG JHQHUDWHHYLGHQFHDERXWWKHRXWFRPHDQGLPSDFWRIWKLVLQWHULPVWUDWHJ\ 3URPRWLQJDOOLDQFHV±DQHQKDQFHPHQWVWUDWHJ\ 5HFHQWUHFRPPHQGDWLRQVIRUWKHWUDLQLQJRIELUWKDWWHQGDQWVLQDUHDVDWJUHDWQHHGRIELUWKSURYLGHUVLQFOXGHSUHSDULQJ ³PLGZLIHDVVLVWDQWV´WRFRQGXFWELUWKVEXWDOVRWRVHUYHDVH[WHQVLRQVRIWKHPLGZLIHZKRVHUYHVLQWKHFRPPXQLW\DQG DVDOLQNWRPLGZLYHVZRUNLQJLQKHDOWKIDFLOLWLHV3URPRWLQJFROODERUDWLRQDQGDOOLDQFHVLQSUDFWLFHDPRQJLQGLJHQRXVRU trained TBAs, trained community workers, the new cadre of community or village midwives, and the professional skilled DWWHQGDQWZRUNIRUFHZRXOGEHXVHIXOLQDOOFRXQWULHVZKHUHWKHVHSURYLGHUFDGUHVDUHDYLDEOHSUHVHQFHLQFRPPXQLWLHV +|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¿WRIWKHH[WHQGHG ZRUNIRUFH HJFRPPXQLW\RXWUHDFKKHOSIXODVVLVWDQFH PD\EHORVWVLPSO\WKURXJKIDLOXUHWRLQFRUSRUDWHWKHVHUYLFHV RIIHUHGE\WKHVHDGGLWLRQDOFDGUHVLQWRWKHKHDOWKFDUHUHIHUUDODQGGHOLYHU\V\VWHP Module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¿FXOWLHVLQGHSOR\LQJDQGUHWDLQLQJPLGZLYHVLQOHVVGHVLUDEOHJHRJUDSKLFVHWWLQJV RUWRFRPPXQLWLHVUHPRWHIURPWKHLURZQIDPLO\DQGVRFLDOVXSSRUWQHWZRUNVKDYHEHHQZHOOQRWHG 9DQ:DJQHUHW DO 6LPLODUO\ LW PD\ EH KDUG WR UHFUXLW VWXGHQWV ZKR DOUHDG\ UHVLGH LQ WKHVH XQGHUVHUYHG FRPPXQLWLHV WR the profession if they would need to leave their support networks in order to study in more central locations. These SRWHQWLDOVWXGHQWVLQFOXGHWUDGLWLRQDOFRPPXQLW\EDVHGSURYLGHUV 7%$VDQGFRPPXQLW\KHDOWKZRUNHUV ZKRKDYHWKH UHTXLVLWHOHYHORIHGXFDWLRQDQGWKHSHUVRQDOSRWHQWLDODQGLQWHUHVWWREHFRPHPLGZLYHV &RPPXQLW\EDVHGHGXFDWLRQLVPRUHOLNHO\WRUHÀHFWWKHFXOWXUDOYDOXHVDQGWUDGLWLRQVRIWKHORFDODUHD WKHUHIRUHWKH JUDGXDWHRIVXFKDSURJUDPLVPRUHOLNHO\WREHDFFHSWHGE\WKHFRPPXQLW\DVDWUXVWHGFDUHSURYLGHU*UDGXDWHVRI WKHVHSURJUDPVDUHDOVRPRUHLQFOLQHGWRUHPDLQLQWKHLUFRPPXQLW\RIRULJLQ 0DQVRRU+LOODQG%DUVV 7KRVHDVVLVWLQJELUWKVDQGSURYLGLQJPDWHUQDOFDUHQHHGWRKDYHWKHWUXVWDQGUHVSHFWRIWKHFRPPXQLW\0LGZLYHV from outside the area would have to adapt to local customs. If the midwife does not speak the local language, does QRWDOORZWUDGLWLRQDOELUWKLQJSRVLWLRQVRUGRHVQRWUHVSHFWGHOLYHU\ULWXDOVRULVVXHVRISULYDF\IHZORFDOZRPHQDUH JRLQJWRXVHKHUVHUYLFHV%ULQJLQJLQ³RXWVLGHUV´FRXOGWKHUHIRUHHQGXSDOLHQDWLQJIURPWKHKHDOWKVHUYLFHWKRVH ZRPHQPRVWDWULVN&XOWXUDOVHQVLWLYLW\DQGWKHDELOLW\WRKDYHRQH¶VKHOSVRXJKWDQGDGYLFHIROORZHGPD\EHMXVW as important as technical skill in making an impact on maternal health. [Source: Walraven and Weeks, 1999] Countries that emphasize this strategy must, however, develop concurrent strategies that provide support to the midwifery SURIHVVLRQDOZKRSUDFWLFHVLQVHWWLQJVZKHUHLWPD\EHPRUHGLI¿FXOWWRUHFHLYHVXSSRUWLYHVXSHUYLVLRQRIKHUZRUNDQG ZKHUHRSSRUWXQLWLHVIRUFRQWLQXLQJSURIHVVLRQDOGHYHORSPHQWPD\EHOLPLWHG VHH6HFWLRQ DQG0RGXOH 8SJUDGLQJWKHVNLOOVRIDX[LOLDU\QXUVLQJSHUVRQQHO 6RPH FRXQWULHV LQWHJUDWH ³PDWHUQLW\ QXUVLQJ´ VWXGLHV ZLWKLQ WKH FXUULFXOXP RI QXUVLQJ VWXGLHV SURYLGLQJ DOO QXUVH JUDGXDWHVZLWKVRPHEDVLFNQRZOHGJHDQGVNLOOVLQWKHFDUHRISUHJQDQWZRPHQDQGQHZERUQV2WKHUFRXQWULHVH[WUDFW WKDWFRQWHQWDQGRIIHULWDVDQRSWLRQDOFRXUVHRIVWXG\IRUWKRVHZKRZLVKWREHFRPHTXDOL¿HGDVPLGZLYHV6WLOORWKHU countries educate all nurses to also qualify as midwives at completion of the course of nursing studies. 7KHFXUULFXODIRUPLGZLIHU\VWXGLHVSUHVHQWHGLQWKHDQQH[WRWKLV7RRONLWIRUVWUHQJWKHQLQJSURIHVVLRQDOPLGZLIHU\LQ the Americas provide one educational pathway for individuals who enter the midwifery profession directly and another Developing midwifery capacity for the promotion of maternal and newborn health SDWKZD\IRUWKRVHZKRVWXG\PLGZLIHU\DVDVHFRQGSURIHVVLRQ HJLQDGGLWLRQWRSUHSDUDWLRQLQQXUVLQJ &RXQWULHV WKDWQHHGWRHQKDQFHWKHLUVNLOOHGDWWHQGDQWZRUNIRUFHVKRXOGEHHQFRXUDJHGWRH[DPLQHWKHFXUUHQWQXUVLQJHGXFDWLRQ SDWWHUQVDQGWKHPDWHUQDOQHZERUQFRQWHQWZLWKLQWKDWSURJUDPPLQJ,WPD\EHSRVVLEOHZLWKUHODWLYHO\OLWWOHLQYHVWPHQW RIUHVRXUFHVWRSURYLGHWKHDGGLWLRQDOHGXFDWLRQDOLQSXWWKDWZRXOGEHUHTXLUHGWRXSJUDGHPHPEHUVRIWKHFXUUHQW QXUVHZRUNIRUFH HJDX[LOLDU\QXUVHVHQUROOHGQXUVHV WRWKHDFFUHGLWHGTXDOL¿FDWLRQRIDPLGZLIH 5HWHQWLRQRIWKHH[LVWLQJPLGZLIHU\ZRUNIRUFH 6WUDWHJLHVGHVLJQHGWRH[WHQGHQKDQFHDQGH[SDQGWKHLPSDFWRIWKHPLGZLIHU\ZRUNIRUFHDUHHVVHQWLDOWREXLOGLQJD VXI¿FLHQWFDGUHRIVNLOOHGELUWKDWWHQGDQWV$SSURDFKHVDUHDOVRQHHGHGWRUHWDLQDOUHDG\TXDOL¿HGPLGZLYHVZLWKLQWKH current workforce. Challenges to retention include factors that affect satisfaction with the workplace environment and IXO¿OOPHQWZLWKWKHFKRLFHRIPLGZLIHU\DVDFDUHHU7KLVODWWHUIDFWRULVEHFRPLQJPRUHLPSRUWDQWLQPDQ\FRXQWULHVDV PRELOLW\ZLWKLQDQGEHWZHHQFDUHHUVEHFRPHVLQFUHDVLQJO\DYDLODEOHWRZRPHQ 9.4.1 - Supporting midwifery practice in context 5HFHQWGHOLEHUDWLRQDERXWVWUDWHJLHVWRSURPRWHVDIHPRWKHUKRRGKDVIRFXVHGRQWKHDGYDQWDJHVZKHQELUWKRFFXUV LQYDULRXVOHYHOVDQGW\SHVRIKHDOWKIDFLOLWLHV LQFOXGLQJWKRVHORFDWHGLQWKHFRPPXQLW\ +RGQHWWHWDO 7KH GLVFXVVLRQKDVUHLQIRUFHGDNH\UHFRPPHQGDWLRQWKDWIDFLOLW\EDVHGELUWKRFFXUZLWKPLGZLYHVDVWKHPDLQSURYLGHUV VXSSRUWHGE\RWKHUDWWHQGDQWVZRUNLQJZLWKWKHPLQDWHDP &DPSEHOOHWDO +RZHYHUWKHFXUUHQWDQGQHDU future situation in many countries is that midwives may work alone, often in isolated and rural settings, with little RSSRUWXQLW\IRUDVVLVWDQFHWRFRYHUWKHIXOOUDQJHRIPLGZLIHU\GXWLHV HJDQWHSDUWXPFDUHFOLHQWHGXFDWLRQ LQDGGLWLRQ WRSURYLVLRQRIURXQGWKHFORFNLQWUDSDUWXPVHUYLFHV 7KHPLGZLIHZKRZRUNVLQDKHDOWKIDFLOLW\LVQRWQHFHVVDULO\LQDEHWWHUVLWXDWLRQ8QGHUVWDI¿QJKDVEHHQLGHQWL¿HGDV RQHRIWKHPDLQIDFWRUVUHVSRQVLEOHIRUSRRUTXDOLW\RIPLGZLIHU\FDUH8QGHUVWDI¿QJLQKHDOWKIDFLOLWLHVLQFOXGHVWKH practice of assigning midwives to other duties in the facility, where they have little opportunity to use their midwifery VNLOOV RIWHQUHVXOWLQJLQ³GHVNLOOLQJ´ 6FRWODQGDQG%XOORXJK )XOOHUWRQHWDO $QRWKHUIRUPRIXQGHUVWDI¿QJ LVDVVLJQLQJPXOWLSOHFRPSHWLQJGXWLHVDQGWDVNV HJKRXVHNHHSLQJDQGFOHULFDOIXQFWLRQV WRWKHPLGZLIHWKDWDUH XQUHODWHGWRSURIHVVLRQDOSUDFWLFH 0F.HQQDHWDO 0RGXOHVDQGRIWKLVWRRONLWSURSRVHDQXPEHURIVWUDWHJLHVWKDWFRXOGEHXVHGWRH[WHQGSURJUDPVRISHHUVXSSRUW consultation, and supportive supervision to midwives working in these situations and settings. Such measures could LPSURYHWKHTXDOLW\RIPLGZLIHU\FDUHDQGDOVRSURPRWHDQGHQKDQFHWKHPLGZLIH¶VMREVDWLVIDFWLRQ 0RVHOH\-HIIHUV DQG3DWHUVRQ &KKHD:DUUHQDQG0DQGHUVRQ )OLQNPDQ/HLQR.LUSLDQG6DODQWHUl 6XOOLYDQ/RFN DQG+RPHU 5HJDUGOHVVRISUDFWLFHVHWWLQJDOOPLGZLYHVFDQEHQH¿WIURPFRQWLQXLQJHGXFDWLRQRQHPHUJLQJ HYLGHQFHEDVHGSUDFWLFHVDQGIURPVNLOOVHQKDQFHPHQW LQFOXGLQJDFTXLULQJRUUHDI¿UPLQJFRPSHWHQFHLQFULWLFDOOLIH VDYLQJVNLOOV %\HQJDJLQJZLWKSHHUFROOHDJXHVLQGLVFXVVLRQVDERXWWKHLUH[SHULHQFHVDOOPLGZLYHVFDQJDLQIURP UHFHLYLQJIHHGEDFNHQFRXUDJHPHQWDQGVXSSRUW0LGZLYHVFDQDOVRSODQZD\VLQZKLFKWKH\FDQFROODERUDWHWRJHWKHU ¿QGLQJWKHLURZQRSSRUWXQLWLHVDQGVROXWLRQVWRWKHSUREOHPVWKDWDUHVSHFL¿FWRWKHLUFRXQWU\VLWXDWLRQ)RUH[DPSOH PLGZLYHVLQ,QGRQHVLDFUHDWHGDSURJUDPRIURWDWLQJLQWHUQVKLSVDWGLVWULFWKRVSLWDOVDQGWUDLQLQJFHQWHUVIRUERWKIDFLOLW\ DQGYLOODJHPLGZLYHV7KDWFRPELQHGZLWKDVWUXFWXUHGSURJUDPRISHHUUHYLHZDQGFRQWLQXLQJHGXFDWLRQZDVYHU\ VXFFHVVIXOLQUHWDLQLQJPLGZLYHVZLWKLQWKHZRUNIRUFH :DONHUHWDO Module 9 Countries also need to develop health workforce retention policies that correspond with the health services careers DYDLODEOH DW WKH FRXQWU\ 7KHVH SROLFLHV ZRXOG DGGUHVV WKH RSSRUWXQLWLHV DQG LQFHQWLYHV HJ HGXFDWLRQ ¿QDQFLDO FRPSHQVDWLRQ WKDWZRXOGEHSURYLGHGWRKHDOWKZRUNHUVZKRFKRRVHWRUHPDLQLQVHUYLFHLQWKHLUFRXQWU\ :+2E 5HLQWHJUDWLRQLQWRWKHPLGZLIHU\ZRUNIRUFH Countries that have implemented midwifery registration systems have a way and means of identifying midwives who KDYH YROXQWDULO\ OHW WKHLU SUDFWLFH DXWKRUL]DWLRQ ODSVH DQG PLGZLYHV ZKRVH OLPLWHGWLPH OLFHQVXUH KDV H[SLUHG EXW ZKR ZHUH LQ JRRG VWDQGLQJ DW WKH HQG RI WKLV WHUP7KHVH PLGZLYHV UHSUHVHQW D SRRO RI DOUHDG\ TXDOL¿HG VNLOOHG SURYLGHUVZKRFRXOGEHHQFRXUDJHGWRUHWXUQWRDFWLYHSUDFWLFH 6WHUJLRX.LWDHWDO $ELPERODHWDO Two reports from Australia provide models of reintegration programs developed to meet the needs of these midwives. 2QH SURJUDP %XOOHQ ZDV VSHFL¿FDOO\ GHVLJQHG IRU PLGZLYHV ZKR ZHUH FXUUHQWO\ LQ WKH QXUVLQJ ZRUNIRUFH EXWZKRKDGHOHFWHGWRZRUNLQRWKHUFOLQLFDOSUDFWLFHDUHDV7KHLUOHYHORIPLGZLIHU\H[SHUWLVHKDGGLPLQLVKHGGXH WRODFNRIFOLQLFDOH[SHULHQFH7KHUHLPPHUVLRQSURJUDPIRFXVHGRQSUDFWLFDODQGOLIHVDYLQJPLGZLIHU\VNLOOVWKXV SURPRWLQJFRPSHWHQFHDQGFRQ¿GHQFHIRUDUHVXPSWLRQRIPLGZLIHU\GXWLHV$VHFRQGSURJUDPPRGHOIHDWXUHGVNLOOV HQKDQFHPHQWDPLGZLIHU\MREGHVFULSWLRQWKDWSURYLGHGÀH[LEOHZRUNKRXUVIRUPLGZLYHVZLWKIDPLO\UHVSRQVLELOLWLHV DQGKLJKOHYHOVRIFOLQLFDOVXSSRUWIRUSUDFWLWLRQHUV )ORZHUV 9.4.3 - Slowing the pace of international migration Many countries face the challenge of losing midwifery practitioners who choose to practice midwifery in another LQWHUQDWLRQDOVHWWLQJ $QGHUVRQDQG,VVDFV .LQJPD 7KHUHDUHPDQ\IDFWRUVWKDWERWK³SXVKDQGSXOO´ midwives from one setting to another. Countries that wish to encourage midwives to remain in their home country need to support improvements in the economic and social status of midwives, such as enhancements in pay, working FRQGLWLRQVZRUNVFKHGXOHVDQGVDIHW\RIWKHZRUNHQYLURQPHQW %XFKDQDQG6RFKDOVNL 6WLOZHOOHWDO 0F(OPXUU\HWDO 'RYOR 7KXSD\DJDOH7VKZHQHDJDH +HQGHUVRQDQG7XOORFK 0F$XOLIIH HWDO (TXDOO\LPSRUWDQWDUHRSSRUWXQLWLHVIRUSURIHVVLRQDODGYDQFHPHQW 7KRPDV :KLWWHUHWDO &DPSEHOO0F$OOLVWHUDQG(OH\ $XWRQRP\LQSUDFWLFHLVDQRWKHUIDFWRUWKDWQHHGVWREHFDUHIXOO\FRQVLGHUHGE\FRXQWULHVDVWKH\EXLOGWKHLUVNLOOHG attendant workforce. The degree of respect afforded to the individual midwife, and the esteem afforded to the midwifery SURIHVVLRQLVUHODWHGWRSURIHVVLRQDOMREVDWLVIDFWLRQ &RXQWULHVWKDWUHFHLYHPLGZLYHVIURPRWKHUFRXQWULHVKDYHDFRPSHOOLQJREOLJDWLRQWREHFHUWDLQWKDWWKHVHPLGZLYHVDUH HTXDOO\TXDOL¿HGIRUSUDFWLFH(IIHFWLYHV\VWHPVRIVFUHHQLQJDVVHVVPHQWDQGUHJLVWUDWLRQRILQWHUQDWLRQDOO\TXDOL¿HG midwives are essential to ensure that these practitioners meet equivalent professional standards (See Modules 2 and IRUJXLGDQFH %LHVNL %RXUJHDXOW1HLWHUPDQDQG/HEUXQ 7KHPLGZLIHU\DVVRFLDWLRQRIWKHUHFHLYLQJ FRXQWU\VKRXOGEHLQFOXGHGDVDQHVVHQWLDOSDUWQHULQGHYHORSLQJWKHPHFKDQLVPVIRUDFFUHGLWLQJWKHVHLQGLYLGXDOVIRU UHFRJQLWLRQ ³WLWOLQJ´ DQGHOLJLELOLW\IRUHQWU\LQWRSUDFWLFH The health systems into which these midwives are integrated must also ensure that these practitioners receive supportive supervision during the period of transition. 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Answer all questions in each section. Yes 1R 1$ $*RYHUQDQFH A1. Board 7KHDVVRFLDWLRQKDVD%RDUGDQGRUDQ([HFXWLYH&RPPLWWHHJRYHUQHGE\DFRQVWLWXWLRQ DQGE\ODZV 7KHDVVRFLDWLRQKDVFOHDUO\GH¿QHGUROHVDQGUHVSRQVLELOLWLHVIRUWKH%RDUG([HFXWLYH &RPPLWWHHDQGPHPEHUV 7KH%RDUG([HFXWLYH&RPPLWWHHPHHWVDWOHDVWWZLFHD\HDU 7KH%RDUG([HFXWLYH&RPPLWWHHFDUULHVRXWWKHUROHVRIVWUDWHJ\GHYHORSPHQW 7KH%RDUG([HFXWLYH&RPPLWWHHFDUULHVRXWWKHUROHVRISROLF\IRUPXODWLRQ 7KH%RDUG([HFXWLYH&RPPLWWHHFDUULHVRXWWKHUROHVRIIXQGUDLVLQJ 7KH%RDUG([HFXWLYH&RPPLWWHHFDUULHVRXWWKHUROHVRISXEOLFUHODWLRQV 7KH%RDUG([HFXWLYH&RPPLWWHHFDUULHVRXWWKHUROHVRI¿QDQFLDORYHUVLJKW 7KH%RDUG([HFXWLYH&RPPLWWHHFDUULHVRXWWKHUROHVRIOREE\LQJ A2. Vision, mission 10. The association has clearly stated vision and mission statements. 7KHPLVVLRQLVGHYHORSHGLQFROODERUDWLRQZLWKPHPEHUVLQVRPHZD\ HPDLORUPHHWLQJV 1HZPHPEHUVKDYHDFFHVVDQGDUHRULHQWHGWRWKHDVVRFLDWLRQ¶VYLVLRQPLVVLRQDQG goals Developing midwifery capacity for the promotion of maternal and newborn health $QQH[ FRQWLQXHG Yes 1R 1$ 13. The activities of the association are consistent with the mission and vision. 7KHYLVLRQDQGPLVVLRQVWDWHPHQWVDUHVKDUHGZLWKPHPEHUVJLYLQJDVHQVHRISXUSRVH and direction to the association. 7KHYLVLRQDQGPLVVLRQVWDWHPHQWVDUHUHYLHZHGDQGXSGDWHGUHJXODUO\ZLWKLQSXWIURP PHPEHUVDWOHDVWHYHU\\HDUV A3. Goals and strategies. 7KHDVVRFLDWLRQKDVDFOHDUVWUDWHJLFSODQQLQJSURFHVV 7KHDVVRFLDWLRQKDVDFOHDUO\ZULWWHQVWUDWHJLFSODQZLWKDFKLHYDEOHORQJWHUPDQGVKRUW term goals. 7KHDVVRFLDWLRQ VJRDOVDQGVWUDWHJLHVGHYHORSHGZLWKLQSXWIURPPHPEHUVDUHLQOLQH with the mission and vision. 0HFKDQLVPVH[LVWIRUUHYLHZLQJDQGXSGDWLQJDVVRFLDWLRQJRDOVZLWKLQSXWIURPPHPEHUV 20. The association has realistic operational work plans, aligned with the strategic planning process. 21. The association monitors and evaluates the quality and impact of its work. 7KHDVVRFLDWLRQXVHVHYDOXDWLRQUHVXOWVWRLQÀXHQFHVHUYLFHGHOLYHU\SODQQLQJ. $/HJDOVWDWXV 7KHDVVRFLDWLRQLVUHJLVWHUHGDVDQDXWRQRPRXVRUJDQL]DWLRQDFFRUGLQJWRWKHFRXQWU\¶V legislation. 7KHDVVRFLDWLRQLVDPHPEHURIDQRWKHUKHDOWKFDUHSURIHVVLRQDVVRFLDWLRQ D2EVWHWULFDVVRFLDWLRQ E1XUVLQJDVVRFLDWLRQ c. other ,I\HVWRDERYHWKHDVVRFLDWLRQKDVLWVRZQVWUXFWXUHDQGGHFLVLRQPDNLQJSURFHVVHV and tools that are documented and transparent. 7KHDVVRFLDWLRQKDVDFRQVWLWXWLRQGHYHORSHGDQGVKDUHGZLWKPHPEHUV 7KHFRQVWLWXWLRQLVUHYLHZHGZLWKLQSXWIURPPHPEHUVHYHU\WR\HDUV $OOQHZPHPEHUVDUHJLYHQDFRS\RIWKHFRQVWLWXWLRQ Additional comments: %0DQDJHPHQW3UDFWLFHVDQG/HDGHUVKLS B1. Administrative policies and procedures. 7KHDVVRFLDWLRQKDVFOHDUSROLFLHVDQGSURFHGXUHVIRUHOHFWLQJOHDGHUVDQGRI¿FHEHDUHUV 30. The association has clear operational policies and procedures in place. 7KHDVVRFLDWLRQKDVFOHDUO\GH¿QHGUROHVDQGUHVSRQVLELOLWLHVIRUWKHOHDGHUVIRUVWDIILI DQ\DQGIRUPHPEHUV B2. Infrastructure and information systems. 7KHDVVRFLDWLRQKDVRI¿FHVSDFHWRVXSSRUWDQGIDFLOLWDWHLWVGDLO\ZRUN 7KHRI¿FHVSDFHLVZHOOHTXLSSHGDQGPDLQWDLQHGZLWKUHOHYDQWFRPPXQLFDWLRQV\VWHPV WHOHSKRQHHPDLOID[,QWHUQHW Module 9 $QQH[ FRQWLQXHG Yes 1R 1$ 34. The association has systems in place to process/manage information, including an XSGDWHGOLVWRILWVPHPEHUV B3. Authority and accountability. *XLGHOLQHVIRUWKHZRUNLQJUHODWLRQVKLSEHWZHHQWKH%RDUG([HFXWLYH&RPPLWWHHVWDIIDQG PHPEHUVDUHFOHDUO\RXWOLQHGLQWKHSROLF\GRFXPHQWV 7KH%RDUG([HFXWLYH&RPPLWWHHUHJXODUO\LQIRUPVPHPEHUVRQWKHDVVRFLDWLRQ VDFWLYLWLHV and at the annual general meeting. B4. Human resources. 7KHDVVRFLDWLRQVWDIILIDQ\DUHUHFUXLWHGLQDWUDQVSDUHQWFRPSHWLWLYHPDQQHUWRIXO¿OOLWV needs. 7KHDVVRFLDWLRQLILWKDVVWDIIKDVFOHDUKXPDQUHVRXUFHVDQGHPSOR\PHQWSROLFLHVLQ SODFH HPSOR\PHQWFRQWUDFWVVDODU\VWUXFWXUHVDQGEHQH¿WVMREGHVFULSWLRQV 7KHDVVRFLDWLRQLQFRUSRUDWHVFDSDFLW\EXLOGLQJGHYHORSPHQWRIVWDIIDVSDUWRILWVDQQXDO plan. 7KHDVVRFLDWLRQKDVLQIRUPDWLRQNLWVSROLF\PDQXDOVHWFIRULWVVWDIIDQGPHPEHUV DYDLODEOHRQUHTXHVW Additional comments: &)LQDQFLDO5HVRXUFH0DQDJHPHQW C1. Accounting. 41. The association has an accounting system. 42. The association has audits conducted yearly. 7KHDVVRFLDWLRQ VDFFRXQWLQJV\VWHPHQDEOHVLWWRSURGXFHDFOHDU¿QDQFLDOUHSRUWZKHQ required. &%XGJHWLQJ 7KHDVVRFLDWLRQKDVDQDQQXDOEXGJHWWKDWLVDSSURYHGE\WKH%RDUG([HFXWLYH&RPPLWWHH 7KHDVVRFLDWLRQKDVDSHUVRQVSHFL¿FDOO\UHVSRQVLEOHIRUEXGJHWPDQDJHPHQW &)LQDQFLDOUHSRUWV 'RQRUVPHPEHUVRURWKHUVFDQDFFHVV¿QDQFLDOLQIRUPDWLRQRQUHTXHVW 7KHDVVRFLDWLRQSURGXFHVDQQXDO¿QDQFLDOUHSRUWVWKDWDUHUHYLHZHGDQGDSSURYHGE\WKH %RDUG([HFXWLYH&RPPLWWHH 7KHDVVRFLDWLRQSUHVHQWVDIXOO¿QDQFLDOVWDWHPHQWLQLWVDQQXDOUHSRUW Additional comments: ')XQFWLRQV '0HPEHUVKLSVHUYLFHV 7KHDVVRFLDWLRQKDVPHFKDQLVPVWRLGHQWLI\WKHQHHGVRILWVPHPEHUV 7KHDVVRFLDWLRQRUJDQL]HVJHQHUDOPHHWLQJVZLWKLWVPHPEHUVDQQXDOO\ 7KHDVVRFLDWLRQKDVDPHFKDQLVPIRUUHFUXLWLQJQHZPHPEHUV 7KHDVVRFLDWLRQKDVPHFKDQLVPVIRUPHPEHUVKLSUHWHQWLRQ 7KHDVVRFLDWLRQKDVDPHPEHUVKLSVWUXFWXUH Developing midwifery capacity for the promotion of maternal and newborn health $QQH[ FRQWLQXHG Yes 1R 1$ 7KHDVVRFLDWLRQKDVDPHPEHUVKLSIHHVWUXFWXUH 7KHDVVRFLDWLRQKDVPHFKDQLVPVIRUXSGDWLQJLWVPHPEHUVKLSOLVW 1HZPHPEHUVDUHRULHQWHGWRWKHLQIRUPDWLRQDYDLODEOHDQGKRZWRUHTXHVWLW 7KHDVVRFLDWLRQKDVPHFKDQLVPVLQSODFHWRPDNHUHFRPPHQGDWLRQVRQVDODULHVDQG ZRUNLQJFRQGLWLRQVRILWVPHPEHUV 7KHDVVRFLDWLRQKDVPHFKDQLVPVWRSURYLGHFRQWLQXLQJSURIHVVLRQDOHGXFDWLRQIRULWV PHPEHUV D2. 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With women and government and other NGOs. 7KHDVVRFLDWLRQLQYROYHVZRPHQDQGIDPLOLHVDVWUXHSDUWQHUVLQVHUYLFHSURYLVLRQ LQFOXGLQJSODQQLQJGHFLVLRQPDNLQJDQGFLYLFDFWLYLWLHV 7KHDVVRFLDWLRQKDVHVWDEOLVKHGDFROODERUDWLYHUHODWLRQVKLSZLWKWKHJRYHUQPHQW . 7KHDVVRFLDWLRQKDVFROODERUDWLYHUHODWLRQVKLSVZLWKQDWLRQDODQGLQWHUQDWLRQDO1*2V LQFOXGLQJZRPHQ¶VRUJDQL]DWLRQV 7KHDVVRFLDWLRQFROODERUDWHVDQGQHWZRUNVZLWKRWKHUKHDOWKFDUHSURIHVVLRQV¶ associations in the country. E2. Relationship with donors and the private sector. 7KHDVVRFLDWLRQKDVPHFKDQLVPVRIPDLQWDLQLQJUHODWLRQVKLSVZLWKFXUUHQWGRQRUVDQG HVWDEOLVKLQJFRQWDFWZLWKSRWHQWLDO 7KHDVVRFLDWLRQHQJDJHVGRQRUVLQDIUHHDQGRSHQGLDORJXH Additional comments: )9LVLELOLW\,QFOXGLQJ0HGLD5HODWLRQV 7KHDVVRFLDWLRQHQJDJHVWKHSULYDWHVHFWRULQRSHQGLDORJXHUHODWLQJWRKHDOWKLVVXHV 7KHDVVRFLDWLRQLVDSSURDFKHGE\ZRPHQDQGWKHLUIDPLOLHVIRULQIRUPDWLRQDQGDGYLFHRQ ZRPHQ¶VKHDOWKLVVXHV 7KH%RDUG([HFXWLYH&RPPLWWHHDQGVWDIIDUHUHFRJQL]HGE\WKHLUVWDNHKROGHUVDVEHLQJ KLJKO\VNLOOHGDQGFUHGLEOHLQWKHLU¿HOG 7KHDVVRFLDWLRQLVLQYLWHGE\JRYHUQPHQWWRSURYLGHPLGZLIHU\H[SHUWLVHDQGFRQWULEXWHWR SROLF\DQGGHFLVLRQPDNLQJLQPLGZLIHU\LVVXHV 7KHDVVRFLDWLRQSURPRWHVLWVLPDJHDQGXVHVWKHPHGLDIRUSXEOLFHGXFDWLRQ Annexes $QQH[ FRQWLQXHG Yes 1R 1$ 7KHDVVRFLDWLRQGHYHORSVSRVLWLYHUHODWLRQVKLSVZLWKWKHPHGLD 7KHDVVRFLDWLRQLVLQYLWHGWRWDNHSDUWLQFLYLFPDWWHUVRUJDQL]HGE\RWKHURUJDQL]DWLRQV DQGE\JRYHUQPHQW Additional comments: *6XVWDLQDELOLW\ 7KHDVVRFLDWLRQKDVDGLYHUVL¿HGIXQGLQJEDVHFDSDEOHRIVXVWDLQLQJLWVSURJUDPVRYHUWKH ORQJWHUP 7KHDVVRFLDWLRQDFWLYHO\HQJDJHVLQIXQGUDLVLQJDQGRWKHUUHVRXUFHPRELOL]DWLRQDFWLYLWLHV as a means of limiting its dependence on donors. 7KHDVVRFLDWLRQUHJXODUO\VHHNVH[SHUWLVH DPRQJLWVOHDGHUVDQGPHPEHUVZKHQ SRVVLEOH WRZULWHIXQGUDLVLQJSURSRVDOVDQGWRKHOSJHQHUDWHLGHDVIRUUHVRXUFH PRELOL]DWLRQ Additional comments: Note: *XLGHOLQHVIRUXVHRIWKH0$&$7WRROFDQEHGRZQORDGHGIURP KWWS LQWHUQDWLRQDOPLGZLYHVRUJ3RUWDOV*OREDO6WDQGDUGV0$&$7*XLGHOLQHV(1*SGI Please return the completed questionnaire to: International Confederation of Midwives /DDQYDQ0HHUGHUYRRUW $17KH+DJXH7KH1HWKHUODQGV Annexes 3URIHVVLRQDO0LGZLIHU\(GXFDWLRQ ,&05HVRXUFH3DFNHW 0RGHO0LGZLIHU\&XUULFXOXP2XWOLQHV 1RWHWRUHDGHUVRIWKLV7RRONLWIRUVWUHQJWKHQLQJSURIHVVLRQDOPLGZLIHU\LQWKH$PHULFDV The resource packet in this annex is a slightly edited version of documents that the International Confederation of Midwives (ICM) has prepared for use by educators and policymakers as they develop or revise curricula for programs of professional midwifery education in their countries. The full set of the original documents can be obtained from the ICM website, at: http://www.internationalmidwives.org/. ,QWURGXFWLRQ 7KLV UHVRXUFH SDFNHW FRQWDLQV D VXJJHVWHG RXWOLQH RI WKH RUJDQL]DWLRQ DQG FRQWHQW IRU D WKUHH\HDU GLUHFWHQWU\ SUHVHUYLFH EDVLF PLGZLIHU\HGXFDWLRQSURJUDPDQGDVHSDUDWHVXJJHVWHGRXWOLQHIRUDSUHVHUYLFHPLGZLIHU\SURJUDP ZKHQ WKH DSSOLFDQW FRPHV ZLWK DQRWKHU KHDOWK SURYLGHU UHJLVWUDWLRQ 7KH FRQWHQW LV WDNHQ GLUHFWO\ IURP WKH ,&0 Essential Competencies for Basic Midwifery Practice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ÀXHQFHG WKH SODFHPHQW RI VSHFL¿F FRQWHQW DQG SUDFWLFDO H[SHULHQFHVLQDJLYHQ\HDUDQGDJLYHQPRGXOH$GHFLVLRQZDVPDGHDVWRZKHWKHUWKDWVSHFL¿FFRPSHWHQF\DQGHDFK RILWV.6%VZDVEHVWOHDUQHGLQ\HDURQHWZRRUWKUHHRIWKHGLUHFWHQWU\SURJUDPDQGZKHWKHUWKHUHZDVDFOXVWHURI .6%VWKDW¿WORJLFDOO\ZLWKRWKHU.6%VLQDVSHFL¿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approach requires an initial introduction to each of these areas, with reinforcement throughout the curriculum. Annexes Practical hints As there are many ways to design a curriculum and to organize the content within it, the following practical hints are offered for consideration in designing a WKUHH\HDUGLUHFWHQWU\ midwifery curriculum.1 5HYLHZWKHSURJUDPPLVVLRQDQGSKLORVRSK\VWDWHPHQWVIRUJXLGDQFHLQKRZWRRUJDQL]HWKHFRQWHQWEDVHGRQ WKH,&0FRPSHWHQFLHV HJQRUPDOWRDEQRUPDOPLGZLIHU\FDUHVLPSOHRULQWURGXFWRU\WRFRPSOH[PLGZLIHU\ FDUHREVHUYDWLRQDOH[SHULHQFHVWRDXWRQRPRXVSUDFWLFH %HJLQE\UHYLHZLQJHDFKRIWKHVHYHQ,&0FRPSHWHQFLHVDQGWKHLUUHODWHG.6%VDI¿UPLQJXQGHUVWDQGLQJDQG LPSRUWDQFHWRPLGZLIHU\SUDFWLFHLQRQH¶VFRXQWU\ 8QGHUVWDQGWKDWDOOFRPSHWHQF\GRPDLQVDQGFRUH.6%VPXVWEHLQFOXGHGWKRXJKVRPHDOORIDGGLWLRQDO.6%V PD\EHQHHGHGGHSHQGLQJRQFRXQWU\KHDOWKQHHGV 4. Have each midwifery teacher assign a temporary placement of each of the competencies and related KSBs E\\HDURUOHYHOWKURXJKRXWWKHWKUHH\HDUVRIWKHSURJUDP PD\XVHDFRPPRQZRUNVKHHWWRUHFRUGLQLWLDO GHFLVLRQVRUPDUNGLUHFWO\RQDSULQWHGFRS\RIWKH,&0FRPSHWHQF\GRFXPHQW 'LVFXVVWKHWHPSRUDU\SODFHPHQWRIFRQWHQWIURPVWHSDERYHZLWKDJURXSRIH[SHULHQFHGPLGZLIHU\WHDFKHUV H[SORULQJUDWLRQDOHIRUHDFKSODFHPHQWDQGPLQGIXORIWKHSURJUDP¶VPLVVLRQDQGSKLORVRSK\VWDWHPHQWV 0DNHDQLQWHQWLRQDODVVLJQPHQWRIFRQWHQWWRDJLYHQOHYHORIWKHFXUULFXOXPQRWLQJUDWLRQDOHIRUSODFHPHQWLQ keeping with philosophy of teaching and learning. *URXSWRJHWKHU.6%VWKDWDUHVLPLODULQWRRQHPRGXOHFRXUVHXQLWDQGPDNHGHOLEHUDWHGHFLVLRQVRQZKLFK .6%VZLOOEHUHSHDWHGIRUUHLQIRUFHPHQWRIOHDUQLQJ HJFRPSRQHQWVRIKHDOWKDVVHVVPHQWLQHDFKSUDFWLFDO area. 'HWHUPLQHKRZPXFKWLPHVKRXOGFDQEHDOORFDWHGWRHDFKPRGXOHRUFRXUVHXQLWJLYHQWKHZHHNVDQGKRXUV DYDLODEOHIRUWKHSURJUDP 'HWHUPLQH ZKLFK PRGXOHVFRXUVH XQLWV ¿W WRJHWKHU DQG FDQ EH RIIHUHG LQ WKH VDPH WLPH IUDPH JLYHQ WKH UHDOLWLHVRIDYDLODEOHOHDUQLQJUHVRXUFHV WHDFKHUVVXSSOLHVVLPXODWLRQODEVDQGRUSUDFWLFDOVLWHVDQGTXDOL¿HG SUHFHSWRUV DQGWKHOHYHORIPDWXULW\RIWKHOHDUQHUV ¿UVWVHFRQGRUWKLUG\HDU 'HFLGHZKHWKHUPRGXOHVFRXUVHXQLWVWKDWUHTXLUHSUDFWLFDOH[SHULHQFHVZLOOKDYHWKRVHH[SHULHQFHVFRQFXUUHQWO\ ZLWKOHDUQLQJWKHRU\RUZKHWKHUWKHWKHRU\ZLOOFRPH¿UVW EORFNWHDFKLQJ IROORZHGE\SUDFWLFDOH[SHULHQFH (LJKWHHQPRQWKSRVWUHJLVWUDWLRQSURJUDP ,QWKRVHFRXQWULHVWKDWFKRRVHWRSURYLGHEDVLFPLGZLIHU\HGXFDWLRQIROORZLQJFRPSOHWLRQRIDSULRUKHDOWKSURYLGHU SURJUDPVXFKDVQXUVLQJWKHVWHSVRXWOLQHGDERYHFDQEHXVHIXODVZHOO7KHPDMRUGLIIHUHQFHLQDSSURDFKIRUDSRVW UHJLVWUDWLRQPLGZLIHU\SURJUDPLVWKHQHHGIRUWHDFKHUVWRGH¿QHGLVWLQJXLVKWKHFRQWHQWWKDWZDVOHDUQHGLQWKHSULRU KHDOWKSURYLGHUSURJUDPWKDWFRQWULEXWHVWRPLGZLIHU\FRPSHWHQF\VRWKDWLWFDQEHGHPRQVWUDWHG XVXDOO\VRPHIRUP RIFKDOOHQJHPHFKDQLVP SULRUWRFRQWLQXLQJZLWKWKHDGGLWLRQDOPLGZLIHU\.6%V6RPHPLGZLIHU\SURJUDPs will set 1 The ICM accepted a consensus decision in 2011 that the most common time length to allow the average learner time to acquire, DSSO\DQGGHPRQVWUDWHFRPSHWHQFHLQHDFKRIWKHVHYHQ,&0FRPSHWHQFLHVDQGWKHLUUHODWHGNQRZOHGJHVNLOOVDQGEHKDYLRUVZDV WKUHH\HDUV7KHUHDUHSURJUDPVWKDWDUHDWWHPSWLQJWRVKRZWKDWWKH,&0FRPSHWHQFLHVFDQEHGHPRQVWUDWHGLQOHVVWKDQWKUHH \HDUVEXWIXUWKHUUHVHDUFKLVQHHGHGWRGHWHUPLQHZKHWKHUVXFKJUDGXDWHVKDYHUHDFKHGWKDWJRDO Annexes SUHUHTXLVLWHVIRUSRVWUHJLVWUDWLRQKHDOWKSURYLGHUVWREHFRPSOHWHGFKDOOHQJHGSULRUWRHQWHULQJDQPRQWK preservice midwifery program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¿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¿FFRPSHWHQF\ VWDWHPHQWLQWKHVXJJHVWHGPRGXOHV([DPSOHVRIVRPHRIWKH.6%VDUHLQFOXGHGEXWDQ\RQHRUJDQL]LQJHYDOXDWLQJDQ H[LVWLQJPLGZLIHU\FXUULFXOXPQHHGVWRPDNHVXUHDOOWKHEDVLF.6%VDUHLQFOXGHG3URJUDPWHDFKHUVPD\LQFOXGHWKH .6%VDJUHHGXSRQDVEHLQJ³DGGLWLRQDO´DVQHHGHGDORQJZLWKDGGLWLRQDOFRPSHWHQFLHVQHHGHGZLWKLQWKDWSDUWLFXODU FRXQWU\RUUHJLRQ(DFKRIWKHVHDGGLWLRQVQHHGDGGLWLRQDOWLPHDOORWWHGIRUWKHP 2 $VHFRQG,&0GHFLVLRQZDVEDVHGRQFRQVHQVXVWKDWRQDYHUDJHDSRVWUHJLVWUDWLRQOHDUQHUZLOOQHHGDERXWPRQWKVWREHDEOH WRGHPRQVWUDWHDOOWKH,&0FRPSHWHQFLHV$JDLQWKLVWLPHIUDPHKDVQRWEHHQEDVHGRQIRUPDOUHVHDUFKDQGLWLVVXEMHFWWRDOWHUDWLRQ LIDSRVWUHJLVWUDWLRQJUDGXDWHFDQGHPRQVWUDWHFRPSHWHQF\LQIXOOVFRSHPLGZLIHU\SUDFWLFH 32QHRIWKHPRVWGLI¿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education programs. The important point is that if a country/education program can demonstrate that graduates have achieved the predetermined level of competency for full scope midwifery practice in less time or in designated hours of supervised midwifery prac tice, the ICM would consider that program as having met the competency standard. Annexes ,WLVLPSRUWDQWWRQRWHWKDWWKH,&0FRPSHWHQF\VWDWHPHQWVLQFOXGHPLGZLIHU\FDUHRILQGLYLGXDOVZKRDUHKHDOWK\ DV ZHOO DV WKRVH ZLWK FRPSOLFDWLRQV LQ D JLYHQ SUDFWLFH DUHD HJ DQWHQDWDO 6LQFH WKH QDUUDWLYH GHVFULSWLRQV RI module content in the sample curriculum outlines focus primarily on the separation of normal or healthy aspects of the UHSURGXFWLRQFKLOGEHDULQJH[SHULHQFHVIURPWKRVHFRPSOLFDWLRQVHQFRXQWHUHGWKURXJKRXWWKHUHSURGXFWLYHF\FOHWKH .6%VLQHDFKFRPSHWHQF\KDYHEHHQVHSDUDWHGLQWRQRUPDODQGFRPSOLFDWLRQV7KHWKLUGRUKLJKHVWOHYHORIFXUULFXOXP FRQWHQW UG\HDULQGLUHFWHQWU\DQG¿QDOPRQWKVLQSRVWUHJLVWUDWLRQFXUULFXOD KDVWKHOHDUQHUSURYLGLQJFRPSHWHQW autonomous midwifery care across the full scope of midwifery practice in which they care for all women regardless RIQRUPDOF\RUFRPSOLFDWLRQV7KHGRPLQDQWRUSULPDU\FRPSHWHQF\VWDWHPHQWLVUHÀHFWHGDWWKHEHJLQQLQJRIWKH \HDUOHYHORULQHDFKPRGXOHIRUHDVHRIUHIHUHQFHNQRZLQJWKDWVRPH.6%VIURPRWKHUFRPSHWHQFLHVPD\DOVREH included/repeated for emphasis. 7KHVHFRQGVHFWLRQRIWKLVSDFNHWLQFOXGHVDPRUHGHWDLOHGH[SODQDWLRQRIKRZDPRGXOHXQLWRILQVWUXFWLRQPLJKW EHVHWXS7ZRVDPSOHPRGXOHV RQHSULPDULO\WKHRUHWLFDODQGRQHZLWKERWKWKHRU\DQGSUDFWLFDOFRPSRQHQWV DUH included to demonstrate how midwifery teachers might organize the required content in the two types of preservice midwifery curricula. Here it is important to note that the length of time spent in a given module is directly related to the TXDOLW\DQGDYDLODELOLW\RIPLGZLIHU\WHDFKHUVOHDUQLQJUHVRXUFHVDQGSUDFWLFDOH[SHULHQFHV3UDFWLFDOLW\DOVRHQWHUV the time equation if a midwifery program is housed within an academic setting, where semesters or quarters have DGH¿QHGOHQJWKLQZHHNVDQGRUKRXUVVSHQWDQGFUHGLWDOORWPHQW&UHGLWDOORWPHQWQRUPDOO\IROORZVD KRXUUDWLR IRUWKHRUHWLFDOOHDUQLQJDQG KRXUVUDWLRIRUSUDFWLFDOOHDUQLQJ:HHNVDUHRIWHQXVHGWRGHVFULEHWKHOHQJWKRIWLPH LQDSDUWLFXODUPRGXOHEDVHGRQWKHKRVWLQVWLWXWLRQ¶VUHTXLUHPHQWVDORQJZLWKPLGZLIHU\WHDFKHUV¶HVWLPDWLRQRIWKH DYDLODELOLW\RISUDFWLFDOOHDUQLQJVLWHVIRUWKHQXPEHURIVWXGHQWVLQWKHSURJUDP:KDWHYHUPHWKRGRIGHVFULELQJWKH OHQJWKRIWLPHVSHQWLQDJLYHQPRGXOHWKHLPSRUWDQWIDFWRUWRUHPHPEHULVWKDWFRPSHWHQF\GHPRQVWUDWLRQLVWKHNH\ WRVXFFHVVDVDFRPSHWHQWPLGZLIH6RPHOHDUQHUVUHTXLUHPRUHSUDFWLFDOH[SHULHQFHVWRGHPRQVWUDWHFRPSHWHQF\ ZKLOHRWKHUOHDUQHUVUHTXLUHIHZHUSUDFWLFDOH[SHULHQFHV$OORIWKHVHIDFWRUVDUHWDNHQLQWRDFFRXQWZKHQGHVLJQLQJD midwifery education program. Annexes 6HFWLRQ 2YHUYLHZRIVXJJHVWHGRUJDQL]DWLRQRIPLGZLIHU\FRQWHQW Generic three-year direct-entry preservice midwifery program VXPPDUL]HGJUDSKLFDOO\LQ$SSHQGL[$ Competency 1: Midwives have the requisite knowledge and skills from obstetrics, neonatology, the social sciences, public health, and ethics that form the basis of high-quality, culturally relevant, appropriate care for women, newborns, and childbearing families 1. 0LGZLIHU\VFLHQFHV %LRORJ\ HPEU\RORJ\DQGKXPDQGHYHORSPHQW EDVLFFKHPLVWU\DQGPLFURELRORJ\KXPDQ DQDWRP\DQGSK\VLRORJ\SKDUPDFRORJ\DQGSKDUPDFRNLQHWLFVRIFRPPRQGUXJVXVHGGXULQJFKLOGEHDULQJ 2. %DVLFKHDOWKVNLOOVIRUPLGZLYHV Knowledge and skills generic to performing health assessment (history, FRPPRQODERUDWRU\WHVWVDQGSK\VLFDOH[DPLQDWLRQ RIKHDOWK\ZRPHQDQGQHZERUQVUHFRUGNHHSLQJ5HYLHZ RIDGXOWFDUGLRSXOPRQDU\UHVXVFLWDWLRQ &35 EDVLFPDQDJHPHQWRIVKRFNLQFOXGLQJVWDUWLQJLQWUDYHQRXVOLQHV DGPLQLVWHULQJEORRGSURGXFWVDGPLQLVWUDWLRQRIR[\JHQDQGEDVLF¿UVWDLG >6HOHFWHGPLGZLIHU\.6%VWDNHQIURP&RPSHWHQFLHV@ 3. /LIHF\FOHQXWULWLRQ %DVLFNQRZOHGJHRIQXWULWLRQDOQHHGVIRUKHDOWK\ZRPHQWKURXJKRXWWKHLUOLIH QHZERUQ QXWULWLRQDOQHHGVLQFOXGLQJEUHDVWPLON LQIDQWQXWULWLRQDOQHHGV >6HOHFWHG.6%VWDNHQIURP&RPSHWHQFLHVZLWKIRFXVRQKHDOWK\LQGLYLGXDOV@ 4. ,QWURGXFWLRQWRPLGZLIHU\FDUH 0LGZLIHU\SKLORVRSK\DQGPRGHORIFDUH PLGZLIHU\FDUHSURFHVVLQFOXGLQJ FULWLFDO WKLQNLQJ DQG FOLQLFDO GHFLVLRQVPDNLQJ RYHUYLHZ RI VFRSH RI PLGZLIHU\ SUDFWLFH UROHV DQG UHVSRQVLELOLWLHVRIWKHPLGZLIH >$OVRLQFOXGHVVHOHFWHGPLGZLIHU\.6%VWDNHQIURPFRPSHWHQF\@ %HFRPLQJDPLGZLIH, (IIHFWLYHFRPPXQLFDWLRQVWUDWHJLHVWHDPZRUNSURIHVVLRQDODQGSHUVRQDOLGHQWLW\ *OREDOKHDOWKVWDWXVRIZRPHQDQGFKLOGEHDULQJIDPLOLHV UHSURGXFWLYHKHDOWK JOREDOVWDWXVRISURIHVVLRQDO midwifery and introduction to ICM, country perspectives, and challenges for professional midwifery. >6HOHFWHG.6%VWDNHQIURP&RPSHWHQFLHV@ 0LGZLIHU\ 0: FDUH +HDOWK\SUHJQDQF\ $QDWRP\DQGSK\VLRORJ\RIUHSURGXFWLRQFRQ¿UPDWLRQRI pregnancy and weeks of gestation, monitoring growth and development of fetus, care during pregnancy, common complications of pregnancy, physiological and psychological adaptation and changes. >&RPSHWHQF\ 0LGZLYHVSURYLGHKLJKTXDOLW\DQWHQDWDOFDUHWRPD[LPL]HKHDOWKGXULQJSUHJQDQF\DQGWKDW LQFOXGHVHDUO\GHWHFWLRQ«RIVHOHFWHGFRPSOLFDWLRQV@ 0LGZLIHU\ 0: FDUH +HDOWK\ ODERUELUWK 3K\VLRORJ\ RI ODERU DQG ELUWK LQGLFDWRUV RI QHHG IRU WLPHO\ LQWHUYHQWLRQ FDUHDQGVXSSRUWGXULQJODERU SDLQUHOLHI DWWHQGDQFHRIELUWKDQGLPPHGLDWHFDUHRIPRWKHUDQG QHZERUQ LQFOXVLRQRIVXSSRUWSHUVRQVIRUODERULQJZRPDQ GLIIHUHQWPRGHOVRIELUWKDQGPDWHUQLW\FDUH >&RPSHWHQF\ 0LGZLYHVSURYLGHKLJKTXDOLW\FXOWXUDOO\VHQVLWLYHFDUHGXULQJODERUFRQGXFWDFOHDQDQGVDIH ELUWKDQGKDQGOHVHOHFWHGHPHUJHQF\VLWXDWLRQWRPD[LPL]HWKHKHDOWKRIZRPHQDQGWKHLUQHZERUQV@ Annexes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education and services to all in the community in order to program healthy family life, planned pregnancies and SRVLWLYHSDUHQWLQJ@ Annexes 1. 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Annexes 6HFWLRQ 6DPSOHPRGXOHV ,QWURGXFWLRQ 7KHUH DUH PDQ\ ZD\V WR SDFNDJH WKH FRQWHQW WKH ,&0 FRPSHWHQF\ VWDWHPHQWV DQG UHODWHG .6%V QHHGHG LQ DQ HGXFDWLRQDOFXUULFXOXPDQGDOVRPDQ\GLIIHUHQWWHUPVWRGHVFULEHWKHSDFNDJHV)RUH[DPSOHWKHPRUHWUDGLWLRQDOWHUP ZLWKLQXQLYHUVLWLHVLV³FRXUVH´2WKHUVXVH³LQVWUXFWLRQDOXQLW´WRGHVFULEHWKHFRQWHQWWKDWLVLQFOXGHGLQDVSHFL¿FDUHD RIVWXG\7KHFKRLFHRI³PRGXOH´IRUWKHVH,&0UHVRXUFHSDFNHWVZDVGHOLEHUDWHDQGEDVHGRQWKHVHOIVWXG\DSSURDFK WRDGXOWOHDUQLQJDQGWKHUHTXLUHGGHPRQVWUDWLRQRISUDFWLFHFRPSHWHQF\DVDEHJLQQLQJPLGZLIH $PRGXOHLVDVHOIFRQWDLQHGXQLWRILQVWUXFWLRQWKDWSURYLGHVFOHDUGLUHFWLRQVWRERWKOHDUQHUDQGWHDFKHURQZKDWLV WREHGHPRQVWUDWHGDWWKHHQGRIWKHXQLW OHDUQLQJRXWFRPHV WKHHOHPHQWVRINQRZOHGJHDQGVSHFL¿FVNLOOVQHHGHG DQGWKHSURIHVVLRQDOEHKDYLRUVH[SHFWHGWRVXFFHVVIXOO\FRPSOHWHWKHOHDUQLQJRXWFRPHV&RPSHWHQF\LQPLGZLIHU\ SUDFWLFH LQ DOO WKUHH GRPDLQV RI OHDUQLQJ LV HYDOXDWHG E\ OHDUQHU VHOIDVVHVVPHQW DQG E\ GLUHFW REVHUYDWLRQ E\ D TXDOL¿HGPLGZLIHU\SUHFHSWRUEDVHGRQWKHOHDUQLQJRXWFRPHVH[SHFWHG2QHVXJJHVWHGDSSURDFKWRGHYHORSLQJD PRGXOHFDQEHIRXQGLQWKH0RGXOHGHYHORSPHQWZRUNVKHHWSUHVHQWHGLQ$SSHQGL[& This section of the resource packet includes an outline of two sample modules: ,QWURGXFWLRQWRPLGZLIHU\ midwifery care during healthy pregnancies. 7KHVHPRGXOHVZHUHFKRVHQVLQFHWKH\UHSUHVHQWIRXQGDWLRQDOWKHRU\ ,QWURGXFWLRQWR0LGZLIHU\ DQGKRZDQWHQDWDO .6%VDUHGHPRQVWUDWHGLQSUDFWLFH 0LGZLIHU\&DUHGXULQJ+HDOWK\3UHJQDQFLHV 7KH\DOVRLOOXVWUDWHKRZDJLYHQ PRGXOHPD\EHEURNHQGRZQLQWRVXEXQLWVEDVHGRQOLNHRUVLPLODUFRQWHQW6XEXQLWVPD\H[LVWLQVRPHRUDOORIWKH PRGXOHVGHSHQGLQJRQZKRZLOOEHWKHWHDFKHURIUHFRUG H[SHUW DQGWKHORJLFDOJURXSLQJRIFRQWHQW)RUH[DPSOH WKH%DVLF6FLHQFHVPRGXOHPRVWOLNHO\ZLOOKDYHVXEXQLWVRQELRORJ\PLFURELRORJ\JHQHUDOFKHPLVWU\KXPDQDQDWRP\ and physiology, pathophysiology, and pharmacology, with different teachers for each. The Reproductive Health PRGXOHPD\KDYHVXEXQLWVVXFKDVZRPHQ¶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reference point, the midwife teacher decides how to group like content and word the KSBs in language appropriate to WKHHGXFDWLRQDOVHWWLQJDQGFRXQWU\7KLVPHDQVWKHUHLVVRPHÀH[LELOLW\LQXVHRIWKH,&0FRPSHWHQFLHV7KH\FDQEH adopted as is, adapted to the common language of the country, or added to as country needs demand. However, each RIWKH.6%VWKDWKDYHEHHQLQGLFDWHGDV³EDVLF´PXVWEHLQFOXGHGLQWKHFXUULFXOXP QRQHFDQEHGHOHWHGZKHQRQHLV SUHSDULQJDIXOO\TXDOL¿HGPLGZLIHLQNHHSLQJZLWKWKH,&0GH¿QLWLRQ Annexes 6DPSOH0RGXOH ,QWURGXFWLRQWRPLGZLIHU\ ZHHNV 0RGXOHLQWURGXFWLRQGHVFULSWLRQ This module is an introduction to the profession of midwifery and how midwives and midwifery care can promote the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This module is a continuation of your practical application of knowledge, VNLOOVDQGSURIHVVLRQDOEHKDYLRUVWRWKHFDUHWKDWZRPHQDQGIDPLOLHVUHFHLYHGXULQJRQHRIWKHPRVWLPSRUWDQWOLIH HYHQWV±WKDWRISUHJQDQF\DQGSUHSDULQJIRUELUWK7KLVPRGXOHRIIHUV\RXPDQ\RSSRUWXQLWLHVWRZRUNWRJHWKHUZLWK ZRPHQDQGIDPLOLHVWRDFKLHYHWKHEHVWRXWFRPHVRIHDFKSUHJQDQF\(QMR\ 2YHUDOOOHDUQLQJRXWFRPHV $WWKHHQGRIWKLVPRGXOHWKHOHDUQHUZLOOEHDEOHWR 3URYLGHKLJKTXDOLW\HYLGHQFHEDVHGDQWHQDWDOFDUHIRUZRPHQVHHNLQJPLGZLIHU\VHUYLFHV &RQGXFWDVHULHVRIFKLOGELUWKHGXFDWLRQFODVVHVZLWKDJURXSRISUHJQDQWZRPHQ Overall content taken primarily from healthy aspects of ICM Competency #3: Midwives provide high-quality antenatal care to maximize health during pregnancy, and that includes early detection and treatment or referral of selected complications. 1RWHWROHDUQHU ,QWKLVPRGXOHWKHUHDUHPDQ\.6%VUHODWHGWRWKHSURYLVLRQRIDQWHQDWDOFDUH 6XEXQLW (DFKRI WKHPQHHGVWREHXQGHUVWRRGSULRUWRZRUNLQJZLWKSUHJQDQWZRPHQDQGIDPLOLHVWRKHOSWKHPSUHSDUHIRUFKLOGELUWK DQGSDUHQWLQJ 6XEXQLW :KHQHYHUSRVVLEOH\RXZLOOEHDSSO\LQJNQRZOHGJHDQGVNLOOVWRWKHDFWXDOFDUHRISUHJQDQW women while you are continuing to learn the KSBs of antenatal care. 6XEXQLW &RPSRQHQWVDQGSUDFWLFHRIDQWHQDWDOFDUH $WWKHHQGRIWKLVVXEXQLWWKHOHDUQHUZLOOEHDEOHWR 7KHRUHWLFDORXWFRPHV 8QGHUVWDQGNH\HOHPHQWVRIUHSURGXFWLYHDQDWRP\SK\VLRORJ\JHQHWLFVDQGELRORJ\ 1.2 Articulate the principles for correctly dating a pregnancy. ,GHQWLI\WKHFRPSRQHQWVRIDKHDOWKKLVWRU\DQGIRFXVHGSK\VLFDOH[DPLQDWLRQIRUHDFKDQWHQDWDOYLVLW .QRZWKHQRUPDO¿QGLQJV UHVXOWV RIEDVLFVFUHHQLQJODERUDWRU\WHVWV ,WLVWKHPLGZLIHWHDFKHUV¶GHFLVLRQRQKRZWRVHTXHQFHPRGXOHVLQ 'HVFULEHWKHQRUPDOSURJUHVVLRQRISUHJQDQF\IRUWKHZRPDQDQGKHUGHYHORSLQJIHWXV .QRZWKHEDVLFSULQFLSOHVRISKDUPDFRNLQHWLFVRIGUXJVWDNHQE\ZRPHQGXULQJSUHJQDQF\DQGHIIHFWVRQ woman and fetus. 8QGHUVWDQGFRPIRUWPHDVXUHVXVHGWRUHOLHYHFRPPRQFRPSODLQWVRIWKHSUHJQDQWZRPDQ /LVWWKHFRPSRQHQWVRIDQHZDQGUHSHDWDQWHQDWDOYLVLW 3UDFWLFDOFOLQLFDORXWFRPHV 1.1 Conduct a complete antenatal visit according to the midwifery care process. 1.2 Perform health assessment of the pregnant woman safely with minimum discomfort to the woman and REWDLQLQJDFFXUDWHUHVXOWV 3HUIRUPDQDEGRPLQDOH[DPLQDWLRQRIWKHZRPDQLQDV\VWHPDWLFPDQQHUXVLQJFRUUHFWWHFKQLTXHV &RUUHFWO\FRQ¿UPSUHJQDQF\DQGLWVQRUPDOSURJUHVVLRQ $FFXUDWHO\GHWHUPLQHQRUPDOIHWDOJURZWKDQGGHYHORSPHQWWKURXJKRXWSUHJQDQF\ 7HDFKDQGRUGHPRQVWUDWHPHDVXUHVWRGHFUHDVHFRPPRQGLVFRPIRUWVRISUHJQDQF\ ,GHQWLI\WKHSUHJQDQWZRPDQ¶VVSHFL¿FFRQFHUQVDQGRUQHHGVGXULQJHDFKYLVLWDQGZRUNZLWKKHUWRGHYHORS and implement a plan of care. &RUUHFWO\ LGHQWLI\ FRPPRQ YDULDWLRQV IURP QRUPDO GXULQJ SUHJQDQF\ DQG LQVWLWXWH DSSURSULDWH ¿UVWOLQH PDQDJHPHQWEDVHGRQHYLGHQFHEDVHGJXLGHOLQHVORFDOVWDQGDUGVDQGDYDLODEOHUHVRXUFHV 5HFRUG¿QGLQJVDFFXUDWHO\DQGFRPSOHWHO\IRUHDFKDQWHQDWDOYLVLW 1.10 Accurately assess the effectiveness of your midwifery care. 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Annexes 2WKHUOHDUQLQJUHVRXUFHV 7KHSURJUDPPD\KDYHWHDFKLQJDLGVWKDWFDQEHXVHGGXULQJFKLOGELUWKSUHSDUDWLRQFODVVHV 5HTXHVWWLPHWREHREVHUYHGWHDFKLQJDFKLOGELUWKHGXFDWLRQFODVVZLWKIHHGEDFNIURPWHDFKHUDQGSHHUV $GGFRXQWU\VSHFL¿FDUWLFOHVDQGPDWHULDOVDVRSWLRQVWRHQKDQFHOHDUQLQJ Assessment of learning strategies and timing 6PDOOJURXSSODQIRUDQWLFLSDWRU\JXLGDQFHE\WULPHVWHURISUHJQDQF\ 6LPXODWLRQSUHVHQWDWLRQRIPHDVXUHVWRUHOLHYHFRPPRQGLVFRPIRUWVRISUHJQDQF\ 7HDFKHUDQGSDUHQWIHHGEDFNRQFKLOGELUWKHGXFDWLRQFODVVHV 2YHUDOOPRGXOHHYDOXDWLRQ ,ZDVDEOHWRPHHWWKHIROORZLQJOHDUQLQJRXWFRPHVLQWLPHDOORWWHG D 3URYLGHKLJKTXDOLW\HYLGHQFHEDVHGDQWHQDWDOFDUHIRUZRPHQVHHNLQJPLGZLIHU\VHUYLFHV Yes Partially No E &RQGXFWDVHULHVRIFKLOGELUWKHGXFDWLRQFODVVHVZLWKDJURXSRISUHJQDQWZRPHQ Yes Partially No 11. The learning activities helped me to learn Yes Partially No 7KHOHDUQLQJUHVRXUFHVZHUHDYDLODEOHDQGKHOSIXO Yes Partially No 13. The teacher was an effective facilitator of my learning Yes Partially No 14. The teacher stimulated me to learn Yes Partially No 7KHWHDFKHUZDVIDLUDQGXQELDVHGLQDVVHVVLQJP\OHDUQLQJ Yes Partially No 7KHSUDFWLFDOH[SHULHQFHZDVVXI¿FLHQWIRUGHPRQVWUDWLQJDQWHQDWDOFDUH Yes Partially No 7KHFOLQLFDOWHDFKHUSUHFHSWRUZDVDYDLODEOHWRPHDWDOOWLPHV Yes Partially No 7KHPRVWKHOSIXODVSHFW V RIWKHPRGXOHZDV SOHDVHH[SODLQ 6XJJHVWHGFKDQJHVLQWKHPRGXOH SOHDVHEHVSHFL¿F 1DPHBBBBBBBBBBBBBBBBBBB 'DWHBBBBBBBBBBBBBBBB ,WLVVXJJHVWHGWKDWOHDUQHUVVLJQWKHLUHYDOXDWLRQVRWKDWGHWDLOVFDQEHGLVFXVVHGZLWKWKHPLGZLIHU\WHDFKHU7KLVLV DQLPSRUWDQWOHVVRQLQEHLQJDFFRXQWDEOHIRURQH¶VFULWLTXHDQGLWRIWHQHOLPLQDWHVXQZDUUDQWHGFRPPHQWVRQWKRVH DVSHFWVRIWHDFKLQJDQGOHDUQLQJWKDWFDQQRWEHFKDQJHG HJFORWKLQJSK\VLFDOIHDWXUHVSHUVRQDOLWLHV/LNHZLVH DQ\OHDUQHUHYDOXDWLRQE\DWHDFKHUQHHGVWREHRSHQO\GLVFXVVHGZLWKWKHOHDUQHU 7KHPRGXOHHYDOXDWLRQFDQEHEULHIRUYHU\GHWDLOHGGHSHQGLQJRQFKRLFHVRIWKHPLGZLIHU\WHDFKHUV Annexes References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nnexes Appendix A.1 Suggested modules for professional three-year direct-entry midwifery (MW) program Y e a r 0 1 Midwifery Basic health skills Life-cycle Introduction to Becoming a sciences for midwives nutrition midwifery care midwife I MW care healthy MW care normal MW care healthy Well-woman pregnancy labor/birth PP/NB and family health care Y e a r 0 2 Public health Midwifery ethics MW teaching Becoming a Pharmacology for midwives and law and counseling midwife II for midwives MC complications MC complications MC complications Basic life-saving pregnancy labour/birth PP/NB and families skills for midwives Y e a r 0 3 Midwifery Life-cycle Introduction to Becoming a sciences nutrition midwifery Care midwife I Autonomous midwifery care during reproductive years demonstration of all 7 ICM competencies with KSBs Successful program completion Annexes Appendix A.2 Suggested modules for professional 18-month post-registration health provider midwifery program F i r s t s i x m o n t h s Introduction to Midwifery model Public health Midwifery standards of care Ethics for midwives midwifery process for midwives of practice MW communication Health assessment Midwifery care Midwifery care during healthy and counseling skills of women reproductive health pregnancy S e c o n d s i x m o n t h s Demographics MC normal MC abortion Basic life- Pharmacology labor and birth saving skills for MCH health related services midwives for midwives MC healthy MC healthy Professional Common complications newborns postpartum issues in midwifery I of childbearing I T h i r d s i x m o n t h s Advanced Professional Evidence-based MC issues in complications midwifery midwifery II midwifery practice reproductive years II Autonomous midwifery care during reproductive years demonstration of all 7 ICM competencies Successful program completion Annexes $SSHQGL[% 0LGZLIHU\FDUHSURFHVV This care process is dynamic, continuous, and circular when needed, following an orderly succession of steps and UHTXLULQJFULWLFDOWKLQNLQJDQGYDULRXVW\SHVDQGOHYHOVRIGHFLVLRQPDNLQJWKURXJKRXW$WWLPHVGDWDFROOHFWHGRU GHFLVLRQVPDGHRUXQDQWLFLSDWHGRXWFRPHVZLOOUHTXLUHUHYLVLWLQJDQHDUOLHUVWHSDQGUHSODQQLQJZLWKWKHZRPDQ1RWH also the following graphic, which illustrates the circular nature of the care process. 1. Assessment: ,QFOXGHV +LVWRU\DQGFXUUHQWQHHGVH[SUHVVHGE\ZRPDQSK\VLFDOH[DPLQDWLRQODERUDWRU\ ¿QGLQJV>FRJQLWLYHSV\FKRPRWRUDIIHFWLYHIXQFWLRQV@ 6RXUFHVRIGDWD :RPDQIDPLO\DYDLODEOHUHFRUGVREVHUYDWLRQ Criteria for success: Systematic and accurate data collection done in culturally appropriate, respectful manner. 2. 'HFLVLRQPDNLQJ ,QFOXGHV 2UJDQL]LQJGDWDFROOHFWHGWRFODULI\DFWXDORUSRWHQWLDOPLGZLIHU\GLDJQRVHVEDVHGRQ ZRPDQ¶VQHHGVSUREOHPVDQGGHWHUPLQLQJLIHPHUJHQF\DFWLRQUHTXLUHG>&RJQLWLYHDQG DIIHFWLYHIXQFWLRQV@ Sources of data: See Step 1. Criteria for success: Correct interpretation of data that results in accurate midwifery diagnoses. 3. 3ODQQLQJ Includes: Prioritizing need for action in partnership with the woman, determining which needs/ SUREOHPVZLOOEHUHVROYHGE\PLGZLIHU\DFWLRQV QHHGIRUFRQVXOWDWLRQRUUHIHUUDO >&RJQLWLYHDQGDIIHFWLYHIXQFWLRQV@ Sources of data: Steps 1 and 2. &ULWHULDIRUVXFFHVV &RPSUHKHQVLYHSODQZLWKLQSXWIURPZRPDQIDPLO\LQFOXGLQJDOWHUQDWHVZKHQDYDLODEOH EDVHGRQHYLGHQFHVRXQGUDWLRQDOH 4. Implementation: Includes: Timely, appropriate, safe midwifery care provided with compassion and cultural sensitivity, SURPRWLQJVHOIFDUHZKHQSRVVLEOH>&RJQLWLYHDIIHFWLYHSV\FKRPRWRUIXQFWLRQV@ Sources of data: Steps 1, 2, and 3. &ULWHULDIRUVXFFHVV 7LPHO\LQWHUYHQWLRQZLWKVDIHHYLGHQFHEDVHGHI¿FLHQWHWKLFDOFRPSDVVLRQDWHFDUH giving, along with appropriate recording of data and plan of care 7KLVVFKHPDWDRIWKHPLGZLIHU\PRGHORIFDUHKDVEHHQXVHGZLWKPLGZLIHU\WHDFKHUVDQGOHDUQHUVLQDYDULHW\RIFRXQWULHVIRUWKH SDVW\HDUV,WZDVXSGDWHGLQNHHSLQJZLWKWKUHH,&0SXEOLFDWLRQV Midwifery Philosophy and Model of Care, Essential Competen- cies for Basic Midwifery Practice, and the International Code of Ethics for Midwives DORQJZLWKWKH$&10Life-Saving Skills Manual for Midwives -7KRPSVRQ Annexes Evaluation: ,QFOXGHV )HHGEDFNIURPZRPDQIDPLO\RQQHHGVPHWVDWLVIDFWLRQ PLGZLIHVHOIDVVHVVPHQW DQGUHÀHFWLRQRQRXWFRPHVDQGZKHWKHUQHZDSSURDFKQHHGHG FRQ¿UPDWLRQYDOLGDWLRQ IURPFROOHDJXHVWHDFKHUV>&RJQLWLYHDIIHFWLYHIXQFWLRQV@ Sources of data: Self, woman, family, peers, supervisors. &ULWHULDIRUVXFFHVV ([WHQWWRZKLFKFDUHJLYHQPHWQHHGVRIZRPDQDQGPLGZLIHU\JRDOV2XWFRPHVRI PLGZLIHU\FDUHLQFOXGHVLPSURYHGKHDOWKZHOOEHLQJRIZRPHQDQGQHZERUQV. Annexes The midwifery care process Foundational midwifery knowledge, skills, and professional behaviors (KSBs) Critical thinking Assessment Ź History Ź Physical examination Ask listen Ź Laboratory findings Look feel Evaluation Decision-making Ź Needs met? Woman’s Ź Organize data collected Ź Problems resolved? needs Ź Clarify needs/potential Ź Woman satisfied? problems problems Ź Midwife self-assessment Ź Emergency action needed? Ź Reflection Appropriate action Implementation Planning Ź Timely, appropriate care Ź Promote self-care Ź Prioritize needs Ź Compassionate, culturally Ź Create plan with woman appropriate care Ź Need for consultation or Ź Safe care referral? Annexes $SSHQGL[& 0RGXOHGHYHORSPHQWZRUNVKHHW ,QWURGXFWLRQWRPRGXOH Brief description of what is in the module. Should convince the learner that the module is important and worth learning. 0RGXOHWLWOH 6SHFL¿FHQRXJKIRUOHDUQHUWRXQGHUVWDQGWKHFHQWUDOIRFXVRIWKHFRQWHQW +RXUVRIVWXG\ (VWLPDWHRIWLPHWKDWZLOOQHHGWREHVSHQWOHDUQLQJWRPHHWRXWFRPHV0D\DOVRUHÀHFWWKHWRWDOWLPH allotted for a given module. /HDUQLQJRXWFRPHV 9HU\VSHFL¿FVWDWHPHQWVDERXWZKDWWKHOHDUQHULVH[SHFWHGWRNQRZGRRUIHHODWWKHHQG RIWKHPRGXOH7KHUHDUHXVXDOO\RXWFRPHVLQHDFKPRGXOHHVSHFLDOO\LIVXEXQLWVDUHLQFOXGHG,IVXEXQLWV LQFOXGHGEHJLQZLWKRYHUDOOOHDUQLQJRXWFRPHVWKHQWKHPRUHVSHFL¿FOHDUQLQJRXWFRPHVIRUHDFKVXEXQLWWKDWZKHQ completed, will allow the learner to demonstrate successful completion of the overall module outcomes. ,QZULWLQJRXWFRPHVXVHYHU\FOHDUDQGVSHFL¿FSHUIRUPDQFHYHUEV 10 R /LVW R QDPH R GHVFULEH o outline a plan R GHPRQVWUDWH R H[SODLQ R FRPSXWH o determine o perform. &RQWHQWLQFOXGHG 7KLVPD\EHDOLVWRIWKH,&0(VVHQWLDOFRPSHWHQF\DQG.6%VLQFOXGHGRUDJURXSRIUHODWHG concepts, such as health assessment or parent education. /HDUQLQJDFWLYLWLHVIRUDFTXLULQJNQRZOHGJHDQGVNLOOV 7KHVHPD\EHPDQ\W\SHVRIDFWLYLWLHV7KHPLGZLIHU\ teacher needs to use different types of learning activities that promote competency development and demonstration. 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