Midwifery Education RAPID ASSESSMENT TOOL - …resources.jhpiego.org/system/files/resources/Handbook_Rapid_Assm... · Midwifery Education RAPID ASSESSMENT TOOL Guide and Handbook

Midwifery Education

RAPID ASSESSMENT TOOL

Guide and Handbook

Version March 6, 2015

Endorsed by


ACKNOWLEDGMENTS

Internal Respondents Sheena Currie (US) Edwin Wambari (Kenya) Rosemary Kamunya (Kenya) Chantelle Allen (Ghana) Gaudiosa Tibaijuka and Tanzania MNH team Endris Mekonnen (Ethiopia) Osborn Koech Kiptoo (Kenya) Ali Abdelmegeid (US) Ouattara Kiyali (Cote d’Ivoire) Patricia Gomez (US) Tegbar Yigzaw (Ethiopia) Marion Subah (Liberia) Nabukeera Josephine (Uganda) Ukende William Shalla (Tanzania) Peter Johnson (US) Catherine Carr (US) Nancy Kiplinger (US) Jean Pierre Rakotovao (Madagascar) Jeffrey Smith (US) Anonymous Phelelo Marole (Botswana) Nerrej Agrawal (India) Anne Hyre (Indonesia) Cherry (Myanmar)

External Respondents Anna af Ugglas, Technical Specialist Skilled Birth Attendant, UNFPA Laos Malin Bogren, Technical Specialist – Midwifery, UNFPA Afghanistan Gillian Butts-Garnett, Midwifery Specialist, UNFPA South Sudan Tamar Khomasuridze, SRH Advisor, UNFPA EECA Regional Office Michaela Michel-Schuldt, Technical Officer Midwifery, UNFPA Geneva Sharifa Mir, Midwifery Advisor, UNFPA Pakistan Affoue Nguessan, Midwife Country Adviser, UNFPA Cote D'Ivoire


Midwifery Education Rapid Assessment Tool: User’s Guide and Handbook 1

PURPOSE OF THIS RAPID ASSESSMENT TOOL The Rapid Assessment Tool is designed to provide an overview of the present-day situation of midwifery education programs, presently in the planning stages, or in anticipation of upscaling and reform. The tool focuses at the micro (the school) level, in the context of country-based programming policies. It is framed around the assessment of five evidence-based educational inputs and influencing factors that are each directly related to student achievement of competence by graduation. The Tool is complementary to and not intended to replace macro level documents that focus on health workforce planning country workforce profiles, and tools that focus on quality of on-going programming.

WHAT THE TOOL CAN DO The completed tool provides a snapshot of the present-day situation compared to standards/criteria set globally1, or for use at the regional2 or national level, as, for example, those established or recommended by professional councils, associations, Ministries of Health or Education, or global consultant organizations.3 The tool should incorporate and complement higher level standards that are established by individual education programs or their governing agencies. The Rapid Assessment Tool provides a summative account of “yes” (meets criteria) or “no” (needs priority attention) talking and/or action points that can be used to direct timely action aimed at identifying potential “quick fixes” and bottlenecks that may require long term and sustained interventions. Scores can be used to support advocacy and development of proposals to donors and 1 International Confederation of Midwives. Global Standards for Midwifery Education 2010; amended, 2013. Available at: www.internationalmidwives.org International Confederation of Midwives. Midwifery Services Framework. Guidelines for developing SRMNAH services by midwives. http://www.internationalmidwives.org/assets/uploads/documents/Manuals%20and%20Guidelines /MSF%20for%20field-testing,%2017Mar15.pdf World Federation for Medical Education .WFME Global standards for quality improvement. Available at: http://wfme.org/standards/bme/78-new-version-2012-quality-improvement-in-basic-medical-education-english/file World Health Organization. Midwifery Educator Core Competencies. 2014. Available at: http://www.who.int/hrh/nursing_midwifery/educator_competencies/en/ WHO Global Toolkit for Evaluating Health Workforce Education (2015 draft from) 2 World Health Organization. Regional Office for Africa. Guidelines for evaluating basic nursing and midwifery education and training programmes in the African region. 2007. Available at: www.afro.who.int. 3 Bailey R, Tulenko K. Scaling up Health Workforce Education and Training: Guide for applying the bottlenecks and best buys approach. 2015. Available at: www.capacityplus.org/scaling-up-health-workforce-education-and -training. Australian Nursing & Midwifery Accreditation Council National guidelines for the accreditation of nursing and midwifery programs leading to registration and endorsement in Australia. 2012. Available at: www.anmac.org.au


2 Midwifery Education Rapid Assessment Tool: User’s Guide and Handbook

other potential funders. They can also be used to guide planning decisions needed to prioritize actions, develop budgets, allocate resources, and logically sequence steps aimed at improvement. The tool can enable school-to-school comparisons, (such as between or among government- sponsored schools, or between private and public institutions) if the intention is to prioritize individual institutions for financial or technical assistance or identify schools as model good practice sites in one or more areas assessed.

WHAT THE TOOL DOES NOT DO The Rapid Assessment Tool does not provide a psychometrically accurate measure of quality. In

other words, a school that has twice the score of another should not be considered twice as good as the other. It therefore must not be used to provide any sort of total or summative score that has any definitive meaning, with respect to high or low quality.

The tool does not replace other macro level tools that serve a different purpose in health workforce planning or quality assessment. Instead, it should be used in concert with these tools where they are being employed.

The tool is not intended to replace existing quality improvement tools aimed at building towards or maintaining educational standards. These processes, which are important to maintaining optimal educational processes, can be used in conjunction with findings collected using the Rapid Assessment Tool.

The tool is not intended to serve as an accreditation instrument.



GUIDELINES FOR CONDUCTING THE ASSESSMENT These assessments will occur in various academic and clinical settings, which are presented in the following table. General guidelines, including recommended minimum numbers of respondents, follow:

1. Notify senior academic administrators at least 30 days prior to the assessment. Ask the administrator to prearrange visits with, ideally, a minimum of:

Academic Teachers/Tutors (n = 2–4)

Clinicians/Preceptors (n = 4, in hospitals and health center)

Students (n = 8–10)

Head of the library

Head/in charge of computer lab

Head/in charge of clinical simulation lab

2. Note that, ideally, administrators will allow interviews of academic teachers and preceptors without their presence in order to decrease bias. Students ideally should be interviewed without administrator or academic teachers present.

3. The assessment is anticipated to require at least two full days; but may be lengthier depending on distances that need to be traveled to review clinical sites.

4. The assessment is BEST conducted by two individuals, at least one of whom has academic experience. Ideally both individuals will be proficient in the target clinical competencies.

5. Begin with the interview of academic administrator; cross-check the information during all other interviews and observations.



STANDARDS GROUPED BY SITE OF ASSESSMENT AND SUMMARY SCORE

STANDARD SITE SCORE (√ IF YES)

Pre-Assessment 1.1 General office 3.1 General office 6.1 General office 6.2 General office 6.3 General office 6.4 General office

Educational Setting 1.2 Educational administrator’s office 1.3 Educational facility/classrooms 1.4 Education program facility and library 1.5 Clinical skills laboratory 1.6 Computer skills laboratory 2.1 Educational administrator’s office 2.2 Offices of academic teacher(s) or conference room 2.3 Offices of academic teacher(s) or conference room 2.4 Offices of academic teacher(s)

2.5 Various settings; including general or educational administrator’s office

2.7 Offices of academic teacher(s) or conference room 3.1 Educational administrator’s office or conference room 3.2 Educational administrator’s office or conference room 3.3 Educational setting conference room 3.4 Educational administrator’s office or conference room 4.1 Offices of academic teacher(s) or conference room 4.2 Offices of academic teacher(s) or conference room 5.1 General office 5.2 General office or education setting conference room 5.3 General office or education setting conference room

5.4 Educational administrator’s office or offices of academic teacher(s)

5.5 Offices of academic teacher(s) or conference room



STANDARD SITE SCORE (√ IF YES)

Hospital 2.5 Clinical midwife’s office 2.6 Clinical midwife’s office 2.7 Clinical midwife’s office 4.3 Hospital antepartum and intrapartum settings 4.4 Hospital antepartum and intrapartum settings

Health Center 4.3 Health center antepartum settings 4.4 Health center antepartum settings

Total “YES” responses across all 35 assessments, by setting /35 CONCEPTUAL MODEL: THE HEALTH IMPACTS OF PRE-SERVICE EDUCATION

Jhpiego has developed an evidence-based conceptual model to guide its investments in pre-service education. This Rapid Assessment Guide is intended to collect information needed to provide a balanced assessment of the essential inputs presented on the left side of the model and the context for which students are being prepared, presented on the right. A set of standards has been developed for each of the components of the conceptual model. Verification criteria and a scoring rubric accompany each standard. Influencing factors—such as community involvement, the engagement of professional associations, health care financing challenges and professional regulatory processes—will all have an impact on pre-service education, and are thus also reflected in this rapid assessment. The verification criteria set forth in this Rapid Assessment Guide reflect and incorporate minimum global standards and guidelines established for midwifery education programs by the International Confederation of Midwives and the World Health Organization, and thus, should be useful in a wide regional and global context. However, some countries have established their own minimum standards and guidelines for some or all of these same midwifery education issues. If the country-based criteria exceed the minimum criteria developed for this Rapid Assessment, then those higher criteria should be substituted in the assessment.



GENERAL/DEMOGRAPHIC INFORMATION Name of school of nursing/midwifery Location Institutional affiliation □ Government □ Private □ Mixed Cadres (mark all that apply) □ Nursing □ Midwifery Names of team members conducting the assessment

Assessment sites visited Site Date Visited



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

OPTION #1 Assessor takes the following steps.

Step 1: Determine the number of students enrolled in the school being assessed (E)

N of students enrolled (E) =

Step 2: Determine the number of unfilled slots (U) N of unfilled slots (U) = Step 3: Determine whether school being assessed

anticipates increasing enrollment in any of the future 5 years (I)

Increased enrollment = I

OPTION #2 Assessor takes the following action.

Step 1: Review data from State of the World’s Midwifery, 2014 “What If” scenario #2 (located in middle of right hand page for each country)

OPTION #3 Assessor takes the following action.

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

Scoring for OPTION #1: IF number obtained in Step 2 = 0, score = Yes Yes IF number obtained in Step 2 = 0 and answer to Step 3 = Yes, score = Yes Yes IF number obtained in Step 2 = ≥ 1; score = No No IF number obtained in Step 2 ≥1, and answer to Step 3 = No; score = No No

Scoring for OPTION #2: IF estimate = 100%; score = Yes Yes IF estimate < 100%; score = No No

Scoring for OPTION #3: IF: Preliminary indicator #1 (quantity) = GREEN light; score = Yes Yes IF: Preliminary indicator #1 (quantity) = YELLOW OR RED light, score = No No



Limitations and Assumptions: OPTION #1 If there is no workforce projection document; or if the projection is for a period shorter than

five years; limited information can be collected; but the formula cannot be computed. There is the assumption that the government projections for the number of midwives

needed in 5 years are accurate and based on true need. The formula operates on the basic assumption that each school (both public and private)

is similar to every other; and that each school has appropriate functional ability and operational capacity.

The formula does not account for attrition during the program of study; nor for inappropriate deployment or retention of the workforce.

OPTION #2 The SOWMy2014 projections do not address the midwifery workforce alone; but are

bundled with nurse and physician graduates; therefore only partially and indirectly address this standard.

OPTION #3 The WHO workforce projections do not address the midwifery workforce alone; but are

bundled with nurse and physician graduates; therefore do not directly address this standard.

NOTE that this indicator does not reflect on the individual school that is being assessed; but rather, provides some reflective information about country workforce projections in general.



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

Assessor asks 5 questions. 1 Is leader currently qualified as a midwife in the country? □ Yes □ No 2 Does leader have at least two years of teaching experience in a

school of nursing or midwifery? □ Yes □ No

3 Does leader have at least two years of clinical experience in midwifery practice? □ Yes □ No

4 Does leader have prior experience in administration of an education or clinical unit within an institution equivalent to at least small college or district hospital size?

□ Yes □ No

5 Has leader held any prior role as designated “in charge” for the work of 5 or more individuals? □ Yes □ No

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

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

Limitations and Assumptions: The assumption is made that prior teaching experience included the use of competency-based educational teaching methods.



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

Assessor conducts direct observation of at least one (preferably 2 or 3) classroom(s) in which class is in session

Classroom #1 a) each student has an individual desk or workspace □ Yes □ No b) there is a subjective feeling of “elbow room” for each student □ Yes □ No c) there is adequate light and ventilation □ Yes □ No d) seating arrangements allow each student and teacher an unobstructed view □ Yes □ No e) the classroom is appropriately equipped for teaching purposes □ Yes □ No f) maximum number of students in the room = 30 NOTE: If country-specific standards exist; substitute the country-based number □ Yes □ No

Classroom #2 a) each student has an individual desk or workspace □ Yes □ No b) there should be subjective feeling of “elbow room” for each student □ Yes □ No c) there is adequate light and ventilation □ Yes □ No d) seating arrangements allow each student and teacher an unobstructed view □ Yes □ No e) the classroom is appropriately equipped for teaching purposes □ Yes □ No f) maximum number of students in the room = 30 NOTE: If country-specific standards exist; substitute the country-based number □ Yes □ No

Classroom #3 a) each student has an individual desk or workspace □ Yes □ No b) there should be subjective feeling of “elbow room” for each student □ Yes □ No c) there is adequate light and ventilation □ Yes □ No d) seating arrangements allow each student and teacher an unobstructed view □ Yes □ No e) the classroom is appropriately equipped for teaching purposes □ Yes □ No f) maximum number of students in the room = 30 NOTE: If country-specific standards exist; substitute the country-based number □ Yes □ No

Scoring Note: If more than one classroom is assessed; EACH classroom must meet all criteria in order to achieve a YES score.

IF all six criteria are yes, score = Yes Yes IF one or more of the criteria = no, score = No No

Limitations and Assumptions: The scoring criteria do not address situations in which the classes may be operated in “shifts” in order to accommodate the number of students; they assess only the actual situation at the time of assessment.



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

Assessor takes four actions. 1 1. Assessor should conduct a site review of the institution and midwifery program (if

they differ) library(ies); looking specifically for: a) midwifery textbooks < 10 years old □ Yes □ No b) at least 1 copy for each 5 students of standard (major) textbooks that are listed as required reading for classes in the specialty and/or □ Yes □ No

c) internet access to electronic texts and resources □ Yes □ No 2 Assessor should make a reasonable judgment that there is sufficient

space (including tables and chairs) where students may sit for use of library resources

□ Yes □ No

3 Assessor should determine the presence of a designated head of the library; who serves the post at least the equivalent of a full-work-week a) designated □ Yes □ No b) full-time □ Yes □ No

4 3. Assessor should ask head of the library whether/not there is an annual budget for purchase of new resources □ Yes □ No

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

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

Limitations and Assumptions: The presence of a librarian and a budget do not ensure that a resource are present or

functioning, but serves as a proxy for the advocacy of these resources. “Head of the library” may or may not be qualified as a librarian. Assessors can only identify

the fact that the position is filled; they are not in a position to judge whether the individual is qualified by credential or experience to fill the position of a librarian.

The assessor is asked to make a reasonable judgment about adequacy of space; but given that the library likely is not solely dedicated to the use of the midwifery program; this judgment is likely to be very subjective.



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

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

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

Equipment may include (may or may not be available) but is not limited to:

Functional order?

electronically programmed manikin or simulator □ Yes □ No □ N/A Mama Natalie or Baby Natalie □ Yes □ No □ N/A NOELLE maternal and neonatal birthing simulator □ Yes □ No □ N/A Sterilizer □ Yes □ No □ N/A video player or DVD (may be located in computer lab) and associated teaching videos □ Yes □ No □ N/A

Other [please specify] □ Yes □ No □ N/A 2. Assessor asks academic teacher(s) to complete the following checklist, excerpted

from ICM Standard Equipment List for Competency-Based Skills Training in Midwifery Schools, to determine presence and functional status of essential equipment.

Supplies should include all of the following Present? Antiseptic solutions (for cleaning of lab equipment after use) □ Yes □ No

Blood pressure apparatus and thermometer in working order □ Yes □ No Bony pelvis □ Yes □ No Breast models □ Yes □ No Cervical dilation models □ Yes □ No Fetal skull, with landmarks □ Yes □ No IUD insertion kit and cervical insertion model □ Yes □ No Newborn resuscitation model (may include items from Step 1 above) □ Yes □ No

Perineum cutting and suturing simulators (e.g., scissors, sponge blocks and expired sutures) □ Yes □ No

Pelvic model(s) □ Yes □ No Running water and soap AND/OR hand sanitizer (for cleaning of hands before and after use of equipment) □ Yes □ No

Vaginal speculum(s) □ Yes □ No 3. Assessor should render an informed opinion about whether the

lab is sufficiently organized/arranged/accessible to accommodate student learning, based on sub-criteria 3a, 3b, 3c.

□ Yes □ No



a) Organization and arrangement is uncluttered □ Yes □ No b) There is a schedule for individual or group use of the laboratory □ Yes □ No

c) The lab is open in the evening or on weekends, on at least 3 days of each week (NOTE: optional and not included in scoring) □ Yes □ No

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

□ Yes □ No

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

No

NOTE that criteria 3c is ideal; but is not included in the scoring.

Limitations and Assumptions: These criteria cannot account for the sufficiency of resources to serve the N of students who use the lab, which may be shared with students from other disciplines.



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

Assessor should view the computer lab. 1. Each computer should have, at minimum,

a) a Microsoft Office (or similar) productivity package □ Yes □ No b) DVD player or USB flash drive port (for video viewing) □ Yes □ No

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

□ Yes □ No

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

□ Yes □ No

4. Electricity must be functional (see assumption noted below) □ Yes □ No

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

Limitations and Assumptions: The assumption is that electricity will be available when needed by students at the time of

use; this cannot be quantified further. The skill of the lab support person is a self-assumption. The computer lab will likely be used by other student learners; the ratio is set for midwifery

students only; but they may not have exclusive use of this equipment.



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

Assessor conducts four assessment steps: 1. Assessor should select at least three midwifery courses; confirm the number of

academic teachers and students enrolled in those academic/theory courses; then compute the teacher/student ratio. Course title (Insert title) N of teachers N of students Teacher/Student

Ratio Course #1: Course #2: Course #3:

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

Course #1: □ Yes □ No Course #2: □ Yes □ No Course #3: □ Yes □ No

3. Assessor should query administrator concerning a) the number of midwife teachers who teach courses that are included in the midwifery program of study (the full curriculum) N =

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

N =

c) whether there are courses (both general and specialty) for which there is no assigned teacher in the current academic year) □ Yes □ No

4. Assessor should confirm (by query of administrator) whether each general course (outside of the midwifery specialty) is taught by an individual prepared in the relevant art or science

□ Yes □ No

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

Yes

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

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



Limitations and Assumptions: It is preferable that the course be CBE focused; but at minimum, the assumption is that the

course covered pedagogical theory. The midwifery program should be accountable for having enough (sufficient) midwives to

cover all theory courses; and ensure that each midwife teacher is a fully qualified midwife (ICM definition).



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

Assessor should ask/confirm whether each academic teacher assigned to courses in the midwifery program of study (both midwives and other professionals) has completed a pedagogical/instructional skills (a.k.a. teacher preparation) course.

N of teachers who contribute to the full curriculum of the midwifery program of study

Course focus N of those who completed an

instructional skills course

General curriculum

Midwifery specialty

Teacher #1 □ Yes □ No Teacher #2 □ Yes □ No Teacher #3 □ Yes □ No Teacher #4 □ Yes □ No Teacher #5 □ Yes □ No Teacher #6 □ Yes □ No Teacher #7 □ Yes □ No Teacher #8 □ Yes □ No Teacher #9 □ Yes □ No Teacher #10 □ Yes □ No

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

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

No

Limitations and Assumptions: The midwifery program should be accountable for the quality of midwifery teachers; but may have to rely on teachers of other disciplines for general coursework; and often does not have control over that assignment.



2.3. Teachers have acquired and maintain their clinical competency

Assessor asks four questions of a minimum of 2, maximum of 4 academic teachers:

Midwife #1 1. Assessor asks each teacher of a midwifery specialty course the

number of years of clinical practice acquired prior to transferring to the role of academic teacher

N of years = <1 year >1 year

2. Assessor asks each academic midwifery teacher when s/he last practiced in a clinical setting (either public or private) (should be within the past year) and

<1 year >1 year

3. whether that practice includes: a) antepartum □ Yes □ No b) intrapartum □ Yes □ No c) postpartum □ Yes □ No d) reproductive health (including family planning) □ Yes □ No

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


number of years of clinical practice s/he acquired prior to transferring to the role of academic teacher


2. Assessor asks each academic midwifery teacher when s/he last practiced in a clinical setting (should be within the past year) and

<1 year >1 year









<1 year >1 year







<1 year >1 year





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

Yes IF answer to Q1 = > 1 year, and answer to Q2 = < 1 year, and answer to Q3 includes one or more of sub-criteria a ,b, c, or d among all academic teachers interviewed, and answer to Q4 includes at least one midwifery relevant topic and was attended less than 18 months prior to assessment for each academic teacher interviewed, score = Yes IF answer to Q1 <1 year OR answer to Q2 >1 year for ANY academic teacher interviewed, and each of sub-criteria a, b, c, d are not included among all academic teachers interviewed, score = No

No

Limitations and Assumptions: Assessor may need to ask academic teachers to describe content of the continuing education course, if it is unclear from the course topic (or title).



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

Assessor conducts site visit of at least two midwifery teacher offices; completing a checklist that covers the following criteria:

Office #1 a) office (shared office must have an individual desk for each teacher) □ Yes □ No b) located in the accessible vicinity of classrooms and skills labs □ Yes □ No c) functional computer (with Microsoft office or equivalent; and DVD or USB port), shared with no more than 1 other teacher □ Yes □ No

d) internet access □ Yes □ No e) electricity – functions majority of working day □ Yes □ No f) access to toilet and running water □ Yes □ No g) office supplies □ Yes □ No h) textbooks (< 10 years old) relevant to the courses to which the teacher is assigned □ Yes □ No

Office #2 a) individual desk for each teacher □ Yes □ No b) located in the accessible vicinity of classrooms and skills labs □ Yes □ No c) functional computer (with Microsoft office or equivalent; and DVD or USB port), shared with no more than 1 other teacher □ Yes □ No

d) internet access □ Yes □ No e) electricity – functions majority of working day □ Yes □ No f) access to toilet and running water □ Yes □ No g) office supplies □ Yes □ No h) textbooks (<10 years old)relevant to the courses to which the teacher is assigned □ Yes □ No

Office #3 a) individual desk for each teacher □ Yes □ No b) located in the accessible vicinity of classrooms and skills labs □ Yes □ No c) functional computer (with Microsoft office or equivalent; and DVD or USB port), shared with no more than 1 other teacher □ Yes □ No

d) internet access □ Yes □ No e) electricity – functions majority of working day □ Yes □ No f) access to toilet and running water □ Yes □ No g) office supplies □ Yes □ No h) textbooks (<10 years old) relevant to the courses to which the teacher is assigned □ Yes □ No



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

Limitations and Assumptions: Reliable electricity and internet connectivity are an assumption; as they are in other standards in this document; but are set as an expected component of the standard.



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

Assessor takes 2 steps: 1. Assessor requests full-time salary scales for academic teachers

and clinical staff (Possible sources: Central government office; Midwifery Program Administrator; Human Resource Department; Individual academic teacher or preceptor)

Information Available?

□ Yes □ No

2. Assessor asks at least two academic teachers and two clinical preceptors – one of whom should be at the “in charge” level - if their salary is consistent with the full-time salary figure cited on that scale Academic teacher #1 □ Yes □ No Academic teacher #2 □ Yes □ No Clinical Preceptor “in charge” □ Yes □ No Clinical Preceptor #2 □ Yes □ No

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

Limitations and Assumptions If salary information cannot be obtained; the criteria cannot be scored. Use of salary as a proxy for compensation does not take into account number of months

that teachers work, i.e. the teacher may not be paid more than an "in-charge" annually, but may work 9 months/year?

We are not making a value judgment about whether the salary is “appropriate.”



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

Assessor takes 3 steps. 1. Assessor visits 2 clinical settings (hospital and health center); identifies the number of

midwives designated as preceptors on the particular unit/shift, and compares that number to the number of students assigned in the setting (1:4 ratio).

2. Assessor approaches a minimum of 2 preceptors in each of at least 2 settings (hospital and health center), and asks them to describe the way in which they were prepared for the role; completing a checklist of acceptable ways/means of preparation.

3. Assessor approaches a minimum of 2 preceptors in each of at least 2 settings (hospital and health center), and asks them to identify any academic or facility-based criteria for service in the role of preceptor

4. Assessor asks these same preceptors whether they receive any academic or facility-based recognition for service in the role of preceptor

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

Step #1 Setting #1 (Hospital) N of Preceptors = N of Students = Ratio = Setting #2 (Health Center)

N of Preceptors = N of Students = Ratio =

Step #2 Preceptor #1 (Hospital)

2. Ways in which the individual was prepared and authorized to serve in the role of preceptor a) formal education in an academic setting (e.g., credits given for the course by an academic institution) □ Yes □ No

b) a preceptor educational skills course (e.g. continuing education short course) □ Yes □ No

c) on the job training or mentorship by members of the midwifery academic teaching staff □ Yes □ No

d) on the job training or mentorship by other clinical staff, who also serve as preceptors □ Yes □ No

3. Does the facility administration offer specific designation and/or recognition to you, in the role of preceptor? □ Yes □ No

Preceptor #2 (Hospital)








Preceptor #3 (Health center)






Preceptor #4 (Health center)



on the job training or mentorship by members of the midwifery academic teaching staff □ Yes □ No





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

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

Response to Q3 is for information only

Limitations and Assumptions This assessment does not address the quality of preceptorship, or the effectiveness of feedback and communication among teachers; preceptors and students.



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

Assessor visits 2 sites 1. At academic teaching site: Assessor asks the midwifery academic teachers whether

the preceptor receives any support from the program for her service in the role of preceptor, and to describe what is meant by the response Do the midwifery academic teachers contact preceptors while students are assigned to the clinical setting? □ Yes □ No

If answer to (1) is Yes, complete 1a. 1a. Which of the following describes this support? a) provision of learning objectives for the preceptorship experience □ Yes □ No

b) contact (by phone or in-person) to follow-up on student progress □ Yes □ No c) contact (by phone or in-person) to address preceptor concerns about the role of preceptor □ Yes □ No

d) orientation to competency-based evaluation methods □ Yes □ No 2. At clinical preceptorship site: Assessor asks the unit ‘in-charge” whether the preceptor

receives any adjustment in the expected workload when a student is present; and to describe what is meant by the response. Does a preceptor receive an adjustment to the workload when a student is present? □ Yes □ No

IF answer to (2) is Yes, complete 2a. 2a. In outpatient settings (e.g., antepartum; family planning) Which of the following describes this adjustment? a) assigned to the role of preceptor only; responsible only for the clients

that are being served by the students □ Yes □ No

b) assigned a limited caseload; preceptor and students serve a specified number of clients □ Yes □ No

In labor and delivery settings Which of the following describes this adjustment? a) assigned to 1 student, with no more than two laboring women in the

assignment □ Yes □ No

b) assigned to no more than two students per shift of work, and no other work responsibilities □ Yes □ No

c) assigned 1 to 1 with a student; with usual workload requirement □ Yes □ No In postpartum settings Which of the following describes this adjustment? a) assigned to the role of preceptor only; responsible only for the clients

that are being served by the students □ Yes □ No

b) assigned a limited caseload; preceptor and students serve a specified number of clients □ Yes □ No



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

Yes

IF either Q1 or Q2 = no; score = No No Sub-criteria are for information only

Limitations and Assumptions This assessment does not address the quality of preceptorship, or the effectiveness of feedback and communication among teachers; preceptors and students.



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

Assessor takes the following steps. 1. Check available data to ensure that 12th grade education is

minimum educational requirement for admission □ Yes □ No

2. Confirm with school administrator that all available slots were filled for current academic year. □ Yes □ No

3. Confirm with school administrator number of students admitted for current academic year

N =

4. Retrieve information from school administrator or central government office about N of qualified applicants on wait list (if one exists)

N =

5a. SUM: N of students admitted (from step 3) + N of qualified applicants on wait list (from step 4 – if no wait list exists this number = 0)

SUM =

5b. COMPUTE ratio of qualified applicants (SUM from step 5) : N of students admitted (from step 3)

Ratio =

Scoring IF ratio of qualified applicants to admitted students ≥ 2:1; score = Yes Yes IF answer to Q1 is no; score = No

No IF Answer to Q2 is no; score = No IF ratio of qualified applicants to admitted students < 2:1; score = No

Limitations and Assumptions: This strategy assumes that each school that manages its own admission process is

comparable to every other school in the way that applicants are reviewed for qualifications and selected (or assigned) to the public or private school.

The ratio of 2:1 has been set arbitrarily and may be ambitious. This standard does not allow consideration of country’s projected need for midwives +

estimates of retirement. If annual enrollment is sufficient to meet annual workforce demand + projected exodus, then enrollment could be considered sufficient.

This standard can also not address the issue of inappropriate deployment/utilization of the skilled workforce.

Note that if admissions are handled centrally (e.g., MoH or MoE) information needed for scoring of this standard may be difficult to obtain.

Assessor asks Academic administrator whether admissions are managed centrally (e.g., by MoH or MoE) or by the School/Program (locally)

□ Centrally □ Locally

IF answer to (1) is “Central” – this criterion is Not Applicable. Proceed to 3.2



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

Assessor asks 3 questions: 1. Assessor asks Administrator whether the majority of students live within

the catchment area (same or adjacent region); accessible by public or private transportation

□ Yes □ No

2. Assessor asks Administrator if residence facilities are available for students who live at a distance □ Yes □ No

3. Assessor asks Administrator whether undue tardiness and absences occur; with “transportation difficulty” (including seasonal challenges) cited as the reason.

□ Yes □ No

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

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

Limitations and Assumptions: We make no assumption about reliability of either public or private transportation.



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

Assessor assembles a group (8 – 10 students) and asks three questions of each student

Student #1 1. Did you choose midwifery as a profession, or did someone else choose

or assign midwifery to you as your profession? □ Self □ Other

2. Do you anticipate that midwifery will be your profession for most of your working life? □ Yes □ No

3. Is there a profession you would prefer over midwifery? □ Yes □ No







































Scoring

IF answer to Q1 = self, score = Yes

Yes IF answer to Q1 = other, AND answer to Q2 = yes, and answer to Q3 = no; score = Yes IF answer to Q1 = other AND answer to Q2 = either yes or no; AND answer to Q3 =no, score = Yes IF answer to Q1 = other AND answer to Q2 – either yes or no AND answer to Q3 = yes; score = No No



Individual Student Scores 1 □ Yes □ No 2 □ Yes □ No 3 □ Yes □ No 4 □ Yes □ No 5 □ Yes □ No 6 □ Yes □ No 7 □ Yes □ No 8 □ Yes □ No 9 □ Yes □ No

10 □ Yes □ No Compute the percentage score (Sum of individual YES scores /N of

interviews) % =

IF percentage = ≥ 70%; score = Yes □ Yes □ No

Limitations and Assumptions: A social desirability response bias may affect responses; unable to anticipate or accommodate for this



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

Assessor asks 3 questions of Central government office representative, Academic Administrator/and or representative of Admissions Committee:

1. Are students given extra consideration for admission based on their urban or rural region of residence? □ Yes □ No

2. Are students given extra consideration for admission based on their status as a member of an underserved or minority population group? □ Yes □ No

3. Are students given extra consideration for admission based on their stated intention to practice in an underserved area following graduation?

□ Yes □ No

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

Limitations and Assumptions: Criterion #3 is subject to social desirability response bias that student may have infused into application materials.



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

Assessor asks 2 questions of midwifery academic teachers. 1. Are there sufficient clinical sites in which to place students for practical

experience? □ Yes □ No

2. What is the average number of clinical practice experiences that students conduct on their own with supervision? (Assessor: student log books and/or portfolios may be available for verification)

Program Average

ICM Guideline N = 2a. New antenatal visits 50 N = 2b. Repeat antenatal visits 100 N = 2c. Labors and births (continuity of

care) 50 N =

2d. Newborn examinations 50 N = 2e. Primary care/family planning 100 N = 2.e. Postpartum (day 1 or 2) or 4-6

week visits 20 N =

Scoring IF answer to Q1 = yes, and answer to each of 2 a, b, c, d, e meets or exceeds ICM guidelines; score = Yes Yes

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

Limitations and Assumptions: It is assumed that students use a variety of clinical sites and settings to acquire sufficient

number and variety of clinical experiences. The requirement of a qualified preceptor as supervisor of student experiences is addressed

in standard 2.6. This rapid assessment approach does not address the quality (including, e.g., readiness to

serve, volume and variety of clients) of each clinical site)



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

Assessor asks the following questions of academic teachers. 1. Does the school use any clinical practice sites that are NOT located on

the same campus where the school is located? □ Yes □ No

2. (If answer to Q1 is yes): Does the school provide transportation to those clinical sites for students and teachers? □ Yes □ No

3. (If answer to Q2 is no): Do students or teachers report difficulties in making their way to these clinical sites that result in absence or tardiness?

□ Yes □ No

Scoring IF answer to Q1 is no, score = Yes

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

Limitations and Assumptions: We assume that transportation provided by schools is reliable.



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

Assessor takes the following actions in each health facility that is observed.

Hospital In antenatal care settings

1. Conduct an inventory of supplies/equipment present on the unit, according to the following guidelines

Commodity Required supply (n of commodities per each

clinical unit) 1a. Blood pressure apparatus

(working condition) 2 N =

1b. Fetal stethoscope (e.g., any combination of Pinard, fetoscope, Doppler)

2 N =

In intrapartum settings: 1. Conduct an inventory of supplies/equipment present on the unit,

according to the following guidelines


woman in active labor) 1a. Gloves 2:1 ratio N = 1b. Oxytocin (or alternative

uterotonic) in single or multiple use vials

2:1 ratio (single dose vials) 1:1 ratio (multiple dose vials)

N =

1c. Intravenous solution and giving set 2:1 ratio N = 1d. Sterile birth kit 2:1 ratio N = 1e. Decontamination solution Present □ Yes □ No 1f. Infant resuscitation bag and mask Present □ Yes □ No 2. Count the number of women in labor beds (or using birthing chairs or

mats); plus the number awaiting admission to labor N =

3. Compute the ratio of supplies/equipment: women in need, according to the guidelines given on the checklist (e.g., 16 giving sets; 7 women in labor or waiting = 16:7, which meets or exceeds the 2:1 standard for the item) Indicate whether each commodity meets or exceeds the given standard Gloves □ Yes □ No Uterotonic □ Yes □ No IV/giving set □ Yes □ No birth kit □ Yes □ No decontamination solution □ Yes □ No bag and mask (infant) □ Yes □ No



Health Center In antenatal care settings

1. Conduct an inventory of supplies/equipment present on the unit, according to the following guidelines


clinical unit) 1a. Blood pressure apparatus

(working condition) 2 N =

1b. Fetal stethoscope (e.g., any combination of Pinard, fetoscope, Doppler)

2 N =

In intrapartum settings: 1. Conduct an inventory of supplies/equipment present on the unit,

according to the following guidelines


woman in active labor) 1a. Gloves 2:1 ratio N = 1b. Oxytocin (or alternative

uterotonic) in single or multiple use vials

2:1 ratio (single dose vials) 1:1 ratio (multiple dose vials)

N =

1c. Intravenous solution and giving set 2:1 ratio N = 1d. Sterile birth kit 2:1 ratio N = 1e. Decontamination solution Present □ Yes □ No 1f. Infant resuscitation bag and mask Present □ Yes □ No 2. Count the number of women in labor beds (or using birthing chairs or

mats); plus the number awaiting admission to labor N =

3. Compute the ratio of supplies/equipment: women in need, according to the guidelines given on the checklist (e.g., 16 giving sets; 7 women in labor or waiting = 16:7, which meets or exceeds the 2:1 standard for the item) Indicate whether each commodity meets or exceeds the given standard Gloves □ Yes □ No Uterotonic □ Yes □ No IV/giving set □ Yes □ No birth kit □ Yes □ No decontamination solution □ Yes □ No bag and mask (infant) □ Yes □ No



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

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

Limitations and Assumptions: The list is very short, by design, in order to accommodate a rapid assessment; but can be expanded. For example WHO has published an extensive site strengthening observational tool (SARA) that could be used if a more exhaustive clinical site review is warranted.



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

Assessor takes 3 actions. 1. Request to see a copy of clinical practice guidelines (national,

regional or local) □ Yes □ No

2. Ask at least 3 midwives when they last attended a “clinical update” course (topic and date) (Standard: within the past 18 months) □ Yes □ No

3. Ask midwife “in charge” (or lead preceptor) whether a qualified preceptor is available on the unit on each shift to which a midwifery student is assigned (24 hour)

□ Yes □ No

Midwife #1 Name (or topic) of Course Date taken






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

Yes

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

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

Limitations and Assumptions: The verification criteria are partially subjective; reliant on the informed opinion of an

assessor about appropriateness of the topic to evidence-based practice. The availability of a preceptor does not guarantee that the preceptor/midwifery student

ratio is sufficient, and does not account for a preceptor’s responsibility to other student cadres (e.g., medical students)



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

Assessor conducts a brief review of most recent curriculum document noting: 1. Reference citations; which should include

a) national health plan (or equivalent document) □ Yes □ No b) at least one document relevant to country burden of disease/health statistics □ Yes □ No

c) educational resource documents including ICM Essential Competencies □ Yes □ No

2. Names/titles of those who participated in development/review/endorsement of the curriculum; which should include a) relevant ministries (e.g., but not limited to MoE; MoH) □ Yes □ No b) administration and/or midwifery academic teachers of the program □ Yes □ No c) relevant professional body and/or Council/Board □ Yes □ No

Scoring IF each of the 6 criteria/sub-criteria (a, b ,c) is present, score = Yes Yes IF any one of the 6 criteria/sub-criteria are not present, score = No No

Limitations and Assumptions: Wide latitude is given with respect to the types of documents that can be considered

relevant to country health indicators. Wide latitude is given with respect to the identities of administrator and midwifery

academic teacher participants; as there is likely to be mobility among these individuals over a course of 5 years.



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

Assessor conducts a review of at least two randomly selected courses, in the midwifery specialty, noting that course materials indicate the following:

Course #1 (topic): 1. Course methods include more than one measure of teaching/learning: Examples

include but are not limited to: a) lecture with group participation □ Yes □ No b) project-based learning □ Yes □ No c) seminar/discussion □ Yes □ No d) debate □ Yes □ No e) problem-based learning □ Yes □ No f) simulated practice (for clinical courses) □ Yes □ No g) preceptorship (for clinical courses) □ Yes □ No g) other [specify] □ Yes □ No

2. Course grade is computed on more than one method of assessment: Examples include but are not limited to: a) quizzes and examinations at several points in time □ Yes □ No b) student participation in group work and discussion □ Yes □ No c) student-led presentations on assigned topics □ Yes □ No d) various types and methods of quizzes/examinations; including, for example, multiple-choice; essay; computer-mediated, oral inquiry, OSCE stations

□ Yes □ No

e) other [specify] □ Yes □ No

Course #2 (topic): 1. Course methods include more than one measure of teaching/learning: Examples

include but are not limited to a) lecture with group participation □ Yes □ No b) project-based learning □ Yes □ No c) seminar/discussion □ Yes □ No d) debate □ Yes □ No e) problem-based learning □ Yes □ No f) simulated practice (for clinical courses) □ Yes □ No g) preceptorship (for clinical courses) □ Yes □ No g) other [specify] □ Yes □ No

2. Course grade is computed on more than one method of assessment: Examples include but are not limited to: a) quizzes and examinations at several points in time (e.g., mid-term and final) □ Yes □ No

b) student participation in group work and discussion □ Yes □ No



c) student-led presentations on assigned topics □ Yes □ No d) various types and methods of quizzes/examinations; including, for example, multiple-choice; essay; computer-mediated, oral inquiry, OSCE stations

□ Yes □ No

e) other [specify] □ Yes □ No

Scoring IF review of each of the 2 courses indicates minimum of two teaching approaches, and minimum of two evaluation strategies; score = Yes Yes

IF review of either of the 2 courses does not indicate minimum of two teaching approaches, and minimum of two evaluation strategies; score = No No

Limitations and Assumptions: It is assumed that assessors are themselves familiar with competency-based teaching and evaluation strategies; and capable of recognizing these approaches, across a wide variety of course designs and materials.



5.3. The curricular content is current and evidence-based

Option #1: Midwifery academic teacher(s) conduct(s) a full curriculum review using ICM’s curriculum mapping tool.

The curriculum of studies contains each of the items noted as basic knowledge, behavior or skill, as documented using ICM’s curriculum mapping tool

□ Yes □ No

Option #2: Assessor conducts a review of two randomly selected courses in the midwifery specialty, using ICM’s curriculum mapping tool.

Content of courses is congruent with knowledge, behaviors, skills indicated for the relevant domain, as documented using ICM’s curriculum mapping tool □ Yes □ No

(Curriculum mapping tool: available at: http://internationalmidwives.org/assets/uploads/documents/CoreDocuments/ICM%20Curriculum%20concordance%20map%20-revised%202013.pdf)

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

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

Limitations and Assumptions: It is assumed that if a full curriculum mapping has been completed;

Administration/midwifery academic teachers will develop a plan for review, discussion and remediation of content, as indicated.

Scoring criteria are deliberately lenient; to allow for broader discussion and interpretation of findings.

It is assumed that if course reviews have been conducted; assessor will advocate that Administration/Midwifery academic teachers complete a full mapping exercise in the near-term.



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

Assessor identifies date of last curriculum review 1. Acceptable sources of evidence include (but are not limited to) a) date on document □ Yes □ No

b) attestation of Administrator IF Administrator has been in office for at least 5 years prior to the date of assessment □ Yes □ No

c) attestation of 1 or more midwifery academic teachers (s) IF teacher(s) has/have been in service for at least 5 years prior to the date of assessment

□ Yes □ No

d) Other [Specify] □ Yes □ No

Scoring IF date of document is within 5 years of date of review, OR attestation of administrator or midwifery academic teachers = yes, score = Yes Yes

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

No

Limitations and Assumptions: The methodology of this review; and the quality of the process cannot be directly

determined. It is assumed that the curriculum or course mapping (5.3) will highlight the intention of

action-oriented curriculum reviews.



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

Assessor speaks with each midwifery academic teacher who has been in service for at least 5 years.

1. Midwifery academic teacher(s) is/are asked for attestation that they had an active role in the curriculum review process □ Yes □ No

2. Midwifery academic teacher(s) is/are asked to describe that role □ Yes □ No

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

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

Limitations and Assumptions: The Assessors informed opinion serves as the basis for determination of “active” role.



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

Assessor asks the following questions. 1. Is there a government Ministry, Department or organization (e.g.,

Council) that has been delegated the responsibility for the regulation of midwifery practice?

□ Yes □ No

2. (IF the answer to Q1 is yes) Is the regulatory agency responsible for setting standards for midwifery education? □ Yes □ No

3. Do midwives have a mechanism for providing direct input into these standards? □ Yes □ No

4. Has the midwifery education program established a Quality Improvement team/process that conducts an internal review (using ICM standards) at least annually?

□ Yes □ No

Scoring IF answer to each of Q1, Q2, Q3 and Q4 are yes, score = Yes

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

Limitations and Assumptions: The assumption is made that a midwifery education program QI team would include an action plan as an outcome of the annual assessment activity.



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

Assessor asks the following questions: 1. Is there a government Ministry, Department or organization (e.g.,

Council) that has been delegated the responsibility for the regulation of midwifery practice?

□ Yes □ No

2. (IF the answer to Q1 is yes) Does that department or organization have a responsibility for accreditation of education programs? □ Yes □ No

3. (If the answer to Q2 is no) Is there an external/private organization that offers an accreditation mechanism for education programs? □ Yes □ No

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

□ Yes □ No

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

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

is greater than 5 years; score = No

Limitations and Assumptions: External accreditation bodies that are not designated as “government approved

organizations” for the purpose of conducting the accreditation process on behalf of the government operate as voluntary agencies and compliance cannot be enforced.

Private schools may be able to opt out of any accreditation system.



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

Assessor asks the following questions. 1. Is there a system of licensing for midwives/nurse

midwives before they start practicing? □ Ye □ No

2. (If answer to Q1 is yes) Does this system include some measure of assessment of theoretical knowledge and/or clinical competence as a condition of licensure?

□ Yes □ No

3. (If answer to Q2 is yes) Who is responsible for developing these testing methods? [Specify]

4. What are the minimum pass criteria for this assessment? Minimum pass score =

5. Is the license to practice given for life, or is there a criterion for reassessment at a later time, including evidence of clinical practice (such as number of births) and/or for accumulation of continuing education (CE) credits prior to re-licensure?

□ Given for life □ Reassessment (retesting)

required for re-licensure □ Continuing education units

required for re-licensure

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

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

Limitations and Assumptions: Note that Q 3, 4, 5 are for information only



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

Assessor takes the following steps. Step 1 Assessor requests to review the government (country or administrative district)

midwifery budget. Is the budget information in the public domain? □ Yes □ No

Step 2 (If answer to Q1 is Yes) Is there a line item for midwifery education? □ Yes □ No Step 3 Assessor queries Program Administration about budget sufficiency for year-to-year

operational quality and status a) In the current year; or in the coming year, have you or will you

reduce staff due to cuts in budget? □ Yes □ No

b) In the current year, or in the coming year, have you or will you reduce student admissions due to cuts in budget? □ Yes □ No

c) In the current year, or in the coming year, have you had to, or do you anticipate the need to reduce spending on supplies or equipment because the budget is not sufficient for the purpose?

□ Yes □ No

d) Do you solicit external funds for general program operation expenses (including academic teacher salaries, general supplies)?

□ Yes □ No

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

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

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

Limitations and Assumptions: The actual quantity of funds allocated in the budget will differ by country; but it is assumed

that the budget is sufficient to meet the needs of public midwifery education programming It is assumed that any program may also solicit additional external funding to enhance

programming; but the program should not depend on it for year-to-year continuity.

