RESUMO
Background: Ensuring midwives deliver quality essential services requires systematic and timely updates to midwifery education based on constantly evolving global evidence and local needs. However, midwifery curricula are often not updated to incorporate new evidence, consistent with national standards. This study supported the Ministry of Health of Lao People's Democratic Republic to identify gaps in the midwifery competency framework and training packages. Methods: Stakeholder consultations and a document review were conducted to define a core package of RMNCAH interventions and care tasks that midwives should provide based on the national Essential Health Service Package (EHSP). Nationally defined midwifery competencies, the higher diploma midwifery curriculum, and in-service training packages were mapped against required interventions and care tasks. Data were used to revise midwifery education standards. Findings: Midwives were expected to provide 47 RMNCAH interventions based on the EHSP. At baseline, 7 (14.9%), 11 (23.4%) and 35 (74.5%) of the 47 interventions were included in the midwifery competency, higher diploma in midwifery curriculum, and in-service training materials, respectively. After revision, the midwifery competency framework included 42 of 47 interventions (89.4%). The data are currently being used to review and update the national midwifery pre-service diploma curriculum. Interpretation: This analysis enabled the Ministry to identify RMNCAH content gaps in national midwifery education standards and align them with the EHSP. Regular use of a quantitative approach to review educational content is essential to ensure standards are consistent with changing evidence. The approach has potential application to other service areas, cadres, and countries. Funding: Korea Foundation for International Healthcare (KOFIH) supported research operation.
RESUMO
Background: In Lao Peoples Democratic Republic, midwives are the main providers of primary reproductive, maternal, newborn, child and adolescent (RMNCAH) services. We analyzed to what extent practice regulations allow midwives to provide nationally defined essential RMNCAH services. Methods: Stakeholder consultations and document reviews were conducted to identify the essential RMNCAH interventions and care tasks midwives are expected to provide without physicians. These were defined in: 1) the Essential Health Service Package (EHSP) and 2) 18 national standards and guidelines. We then mapped whether midwifery regulations, which provide the legal framework for clinical service provision, supported delivery of these standards to identify regulatory gaps. Data were used to update regulations. Findings: Midwives were expected to provide 39 RMNCAH interventions without physicians, representing 1100 care tasks. Midwifery practice regulations allowed eight of 39 interventions (20.5%) and 705 of 1100 care tasks (64.1%) at baseline. Of the 31 interventions not allowed for provision by midwives, 83.9% (26) required prescribing and giving medicines, 51.6% (16) ordering and conducting diagnostics, 38.7% (12) making a clinical diagnosis, and 22.6% (7) use of non-pharmacological interventions. The Ministry of Health convened a multi-stakeholder group to revise the midwifery practice regulations, which increased the legally supported interventions and care tasks to 37 (94.9%) and 1081 (98.3%), respectively. Interpretation: This novel methodology enabled systematic identification and quantification of regulatory gaps in midwifery practice and data-driven revisions. Consequently, regulatory support for delivery of primary RMNCAH interventions vastly improved. The approach can be applied to other clinical cadres, service areas and countries. Funding: Korea Foundation for International Health Care (KOFIH) supported research operation.
