Findings from a context specific accreditation assessment at 38 public midwifery education institutions in Bangladesh.

BACKGROUND: In order to promote sustainable midwifery education, it is important to understand what the structural shortcomings are. In this study of 38 public nursing institutions in Bangladesh, we aim to identify a number of structural shortcomings and to discuss strategies for limiting them. METHODS: An evaluated context-specific accreditation assessment tool consisting of 37 multi-choice closed-response questions encompassing 14 educational standards aligned with international standards for midwifery education programs and competences for midwifery educators was used to assess all public nursing institutions in Bangladesh (n=38), the results of which are presented in simple descriptive statistics; number (n), percentage (%), mean, SD and minimum-maximum value. RESULTS: Provision around clinical practice sites is the key structural shortcoming within the Bangladeshi midwifery educational system. Twenty-five percent of the institutions provided no opportunity for midwifery students to practice comprehensive sexual and reproductive health care. Twenty-nine per cent of the clinical sites were not aware of the content of midwifery courses and syllabi. Finally, one third of students achieving a midwifery qualification did not meet the learning outcomes to support women in birth. CONCLUSIONS: To measure progress towards national and global milestones to ensure students are equipped with required competencies before graduating as registered midwives will be difficult to meet unless shortcomings within the educational system are addressed. We recommend (i) the inclusion of clinical placement sites in future assessments, (ii) the introduction of an integrated feedback-appeal-response system, and (iii) the development of a system for improved communication links between educational institutions and clinical placement sites.

Implementation of a context-specific accreditation assessment tool for affirming quality midwifery education in Bangladesh: a qualitative research study.

Background: Only recently did midwifery become a profession in Bangladesh. As such, sufficient quality education, both theory and practice, remains a challenge. In 2018, a context-specific accreditation assessment tool for affirming quality midwifery education was therefore developed and implemented.Objectives: To describe both the positive and negative aspects of the implementation of an accreditation process at midwifery education institutions in Bangladesh and to sketch out areas for possible improvement.Method: Forty focus group discussions were conducted with 276 policymakers, regulatory authorities and educators involved in midwifery education and services in Bangladesh. The Consolidated Framework for Implementation Research (CFIR) was used in a directed content analysis approach.Results: The accreditation assessment tool was developed using a participatory and consensus-building approach, building on existing policies, which resulted in the national ownership of its implementation. Staff from clinical sites were not included in the accreditation process; unless this changes, this will make it difficult for Bangladesh to achieve the set accreditation standards. The accreditation process has improved communication between the midwifery teaching institutions, policymakers and regulatory authorities. Educators started to visit the clinical sites more frequently. The planning process was complex and time-consuming, and emphasis was put on the importance of developing a plan of action for measuring improvements.Conclusion: In the move from the initial assessment of an accreditation process to its implementation, it is essential to make public the results found at all educational institutions. This encourages acceptance, while soliciting feedback and suggestions for future action. Only then can an accreditation process have an impact on the provision of high-quality midwifery education and services. This paper aims to encourage and guide other countries in their development, planning and implementation of a national accreditation process for midwifery education.

Development of a context specific accreditation assessment tool for affirming quality midwifery education in Bangladesh.

OBJECTIVE: using the International Confederation of Midwives (ICM) Global Standards for Midwifery Education as a conceptual framework, the aim of this study was to explore and describe important 'must haves' for inclusion in a context-specific accreditation assessment tool in Bangladesh. DESIGN: A questionnaire study was conducted using a Likert rating scale and 111 closed-response single items on adherence to accreditation-related statements, ending with an open-ended question. The ICM Global Standards guided data collection, deductive content analysis and description of the quantitative results. SETTING: twenty-five public institutes/colleges (out of 38 in Bangladesh), covering seven out of eight geographical divisions in the country. PARTICIPANTS: one hundred and twenty-three nursing educators teaching the 3-year diploma midwifery education programme. FINDINGS: this study provides insight into the development of a context-specific accreditation assessment tool for Bangladesh. Important components to be included in this accreditation tool are presented under the following categories and domains: 'organization and administration', 'midwifery faculty', 'student body', 'curriculum content', 'resources, facilities and services' and 'assessment strategies'. The identified components were a prerequisite to ensure that midwifery students achieve the intended learning outcomes of the midwifery curriculum, and hence contribute to a strong midwifery workforce. The components further ensure well-prepared teachers and a standardized curriculum supported at policy level to enable effective deployment of professional midwives in the existing health system. KEY CONCLUSIONS: as part of developing an accreditation assessment tool, it is imperative to build ownership and capacity when translating the ICM Global Standards for Midwifery Education into the national context. IMPLICATIONS FOR PRACTICE: this initiative can be used as lessons learned from Bangladesh to develop a context-specific accreditation assessment tool in line with national priorities, supporting the development of national policies.