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      Midwifery education, regulation and association in the Democratic Republic of Congo (DRC) – current state and challenges

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          Background: In the Democratic Republic of Congo (DRC), maternal and neonatal health outcomes are poor and delivering healthcare services of sufficient quality is a challenge as there are only 0.6 midwives, physicians, or nurses for every 1,000 inhabitants.

          Objective: To explore the current state of the midwifery profession in the DRC and to suggest suitable strategies for increasing the quality and quantity of a highly competent midwifery health workforce in the DRC.

          Methods: Data were collected at a workshop with 17 key persons using three questionnaires developed by the International Confederation of Midwives, and three focus group discussions. The analysis was focusing on quantitative and qualitative content.

          Results: In DRC the midwife profession is not legislated. A midwifery association is well established, but due to a lack of resources does not function optimally. Two midwifery education programmes exist: a three-year direct-entry programme resulting in a diploma in midwifery, and a 12-month postgraduate programme for nurses resulting in a certificate in midwifery. Neither of the programmes leads to a bachelor’s or master’s degree. At the institutions offering the midwifery programmes (n = 16), the educators’ academic qualifications are lower than required and there is a lack of teaching and training equipment for meeting the education needs.

          Conclusions: The Sustainable Development Goal on health, and specifically the health of mother and newborn, will be difficult to meet in the DRC. We therefore suggest that (i) the midwifery education programmes be improved to meet international standards; (ii) these programmes be designed in a way that allows for an academic degree at either the bachelor’s or master’s level; (iii) the competence level of the midwifery educators be increased; and, most crucially, (iv) a regulatory structure be formed that legislates and regulates the midwifery profession and its autonomous practice.

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          Most cited references 24

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          The Sociological Analysis of Professionalism: Occupational Change in the Modern World

           Julia Evetts (2003)
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            The projected effect of scaling up midwifery.

            We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality.

              This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention. Copyright © 2014 Elsevier Ltd. All rights reserved.

                Author and article information

                Glob Health Action
                Glob Health Action
                Global Health Action
                Taylor & Francis
                27 January 2020
                : 13
                : 1
                [a ]Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
                [b ]SANRU Asbl , Ville de Kinshasa, Democratic Republic of Congo
                Author notes
                CONTACT Malin Bogren malin.bogren@ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg , Arvid Wallgrens backe 1, Gothenburg 413 46, Sweden
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Tables: 1, References: 40, Pages: 10
                Funded by: Swedish International Development Cooperation Agency 10.13039/100004441
                Award ID: -
                The workshop was conducted with the help of financial support from a Swedish International Development Aid-funded project in the DRC, administrated by SANRU in the DRC. The funding body played no role in the data collection, the analysis, or in writing the manuscript.
                Original Article


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