Stakeholders' insights and perceptions on nursing and midwifery care providers' pre-service education, training, and regulations in Senegal: a mixed-methods study

Few countries in sub-Saharan Africa (SSA) are on track to meet the Sustainable Development Goals (SDG) related to maternal and neonatal mortality, despite widespread progress towards the SDG target for births assisted by skilled health personnel. The inconsistent quality of care provided by skilled health professionals (SHPs) also known as skilled birth attendants (SBAs) has been identified as one contributor of this disconnect. Senegal has made exemplary progress reducing maternal and neonatal mortality, making it a strong setting to explore the myriads of factors that contribute to quality of childbirth care. This research was conducted as part of a multi-country study to assess the quality of pre-service education of health professionals providing childbirth care and to enhance the measurement related to the coverage of SBAs and SHP. Twenty-five key informant interviews (KIIs) were conducted in Senegal with government bodies responsible for maternal and newborn health (MNH) at central and regional levels and MNH data collectors, training institutions, professional associations, as well as technical and financial partners. An online survey was carried out to assess the quality of pre-service education programs among 30 students and 15 program administrators, and SBAs pre-service training curricula were evaluated against international standards. Interviews suggested that the growing number of private training schools has led to insufficient oversight from government bodies and some schools not meeting national regulations or quality standards. Respondents shared that responsibilities for the regulation of pre-service education and training are split by three different government bodies, and the development of professional associations for nurses and midwives has been delayed. KIIs revealed that graduates can fail to pass the national licensing exam but may still be awarded a school diploma and recruited by health facilities. Additionally, respondents reported poor success rates on both annual school and licensing exams. The surveys also revealed quality gaps in pre-service education are due to lack of access to libraries, computers, equipment for skills labs, as well as the number of educators and their competencies at practical training sites. Amid commendable progress, this research reveals key gaps that continue to undermine the quality of care during childbirth in one of highest-performing countries in SSA. Recommendations include improving the regulation of SBAs pre-service education programs, introducing renewal process for licensing, developing professional orders, and ensuring continued training programs. Continuing to enhance pre-service education and in-service training programs in Senegal is crucial for sustainable improvements in the quality of MNH care.