Exploring local views on strengths and challenges in pre-service education for skilled birth attendants, skilled health professionals, and midwives in Nepal

Despite worldwide increases in coverage of skilled health personnel during childbirth Sustainable Development Goal 3.1.2 (SDG), enormous variance in maternal and neonatal mortality and morbidity persists among many regions including Asia. Varying quality of care provided by health professionals is recognized as a contributor to this gap. Nepal has made exemplary progress in reducing maternal and neonatal mortality, making it a critical setting to analyse the strengths and challenges of pre-service education and training programs for skilled birth attendants (SBAs), skilled health personnels (SHP) and midwives. 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-four key informant interviews were conducted in Nepal with educational institutions, development partners, government, regulatory and professional bodies. Pre-service training curricula were analysed in comparison to global standards set by the International Confederation of Midwives. Respondents discussed relatively robust pre-service curricula, qualified educators, and sufficient infrastructure across SBAs and SHP training programs, especially the Bachelors of Midwifery programs. Challenges included a misaligned job market for the numbers of each cadre trained (i.e., insufficient positions for midwives), delays in the implementation and launch of new SHP training modules, and recent changes in regulation which may have impacted clarity of responsibilities, oversight and quality of pre-service education. Curricula assessments covered most competencies, with some gaps related to care during labour and birth. This work identifies strengths, challenges and recommendations for the implementation of a maternal and newborn health (MNH) program to improve SBA/SHP training and develop a new cadre of midwives in Nepal. Recommendations include implementing multiple pathways to train in-service SBAs and SHP, developing job posts for midwives, accelerating the launch of the SHP training modules, and clarifying responsibilities for regulation. These are crucial for sustainable improvements in the quality of MNH care and for meeting the SDG for MNH.