Table Of ContentMinistry of Health Transitional Federal Government of Somalia
and
Ministry of Health Puntland
In collaboration with
UNFPA Somalia Office
Community Midwifery Curriculum
2012
Contents
FORWORD ............................................................................................................................................... 4
ACRONYMS ............................................................................................................................................. 6
INTRODUCTION AND RATIONALE FOR THE COMMUNITY MIDWIFERY PROGRAMME .......................... 7
CURRICULUM FOUNDATION ................................................................................................................... 9
Vision ................................................................................................................................................... 9
Programme aim .................................................................................................................................. 9
Philosophy ........................................................................................................................................... 9
The Somalia and Puntland context ................................................................................................... 11
PROGRAMME DESCRIPTION ................................................................................................................. 14
Achievements on completion ........................................................................................................... 14
PROGRAMME STANDARDS ................................................................................................................... 15
Organisation and administration ...................................................................................................... 15
Faculty and staff ................................................................................................................................ 15
Learning and teaching ....................................................................................................................... 15
Assessment strategies ....................................................................................................................... 16
Programme of studies monitoring, evaluation and re-validation .................................................... 16
ACADEMIC REGULATIONS ..................................................................................................................... 18
Student selection and admission criteria.......................................................................................... 18
Student regulations ........................................................................................................................... 18
Attendance and leave of absence ................................................................................................. 18
Annual leave .................................................................................................................................. 19
Disciplinary action ......................................................................................................................... 19
Assessment regulations .................................................................................................................... 19
Assessment of theoretical knowledge .......................................................................................... 19
Assessment of practice competence ............................................................................................ 20
External examiner and Examination Board .................................................................................. 20
ORGANISING PRINCIPLES AND MODELS OF THE CURRICULUM ........................................................... 22
Foundational principles .................................................................................................................... 22
Models of midwifery ......................................................................................................................... 23
The international model for midwifery......................................................................................... 23
A community model for midwifery ............................................................................................... 23
1
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
PROGRAMME ORGANISATION AND STRUCTURE ................................................................................. 24
Programme duration......................................................................................................................... 24
Programme structure and themes .................................................................................................... 25
Semester 1 .................................................................................................................................... 25
Semester 2 .................................................................................................................................... 26
Semester 3 .................................................................................................................................... 26
Semester 4 .................................................................................................................................... 27
Islamic studies ............................................................................................................................... 27
Semester modules and units ............................................................................................................ 27
Clinical experience ............................................................................................................................ 33
RESOURCES ........................................................................................................................................... 35
Financial resources ........................................................................................................................ 35
Human resources .......................................................................................................................... 35
Physical resources and learning environments ............................................................................ 35
The learning schedule ................................................................................................................... 36
TEACHING AND LEARNING STRATEGIES.............................................................................................. 37
Approaches to learning and teaching ............................................................................................... 37
Methods of learning and teaching .................................................................................................... 38
Lecture/discussions ....................................................................................................................... 38
Role play and drama ..................................................................................................................... 39
Clinical skills practice..................................................................................................................... 39
Records of assessment of fundamental and midwifery clinical skills, case book and log of clinical
experiences ................................................................................................................................... 40
Community and MCH centre links .................................................................................................... 40
ASSESSMENT STRATEGIES ..................................................................................................................... 43
Formative ...................................................................................................................................... 43
Summative: ................................................................................................................................... 43
Theoretical assessment methods ................................................................................................. 43
Behaviour / attitudes assessment methods: ................................................................................ 44
Skills assessment methods ............................................................................................................ 44
The case book and log of midwifery experience .......................................................................... 44
Using Annexes 5 and 6 .................................................................................................................. 45
REFERENCES .......................................................................................................................................... 47
MODULE AND UNIT OUTLINES ............................................................................................................. 49
2
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
Module CM 1 Orientation to Health Care and Community Midwifery ........................................ 50
Module CM 2 Study skills basics ................................................................................................... 52
Module CM 3 English Communication ......................................................................................... 54
Module CM 4a Fundamentals of Care: protecting yourself and others ........................................ 55
Module CM 4b Fundamentals of care: First Aid ............................................................................ 57
Module CM 4c Nutrition................................................................................................................ 59
Module CM 4d Organising and providing care .............................................................................. 61
Module CM 4e Understanding and using medicines ..................................................................... 65
Module CM 5 Understanding and working with people .............................................................. 67
Module CM 6 Anatomy and physiology basics, and introduction to changes in pregnancy ....... 69
Module CM 7 Community and Public Health ............................................................................... 71
Module CM 8 Health promotion and education .......................................................................... 74
Module CM 9 Pregnancy 1 (normal) ............................................................................................ 77
Module CM 10 Labour 1 (normal) .................................................................................................. 80
Module CM 11 Postnatal 1 (normal) .............................................................................................. 84
Module CM 12 The newborn 1 (normal) ....................................................................................... 88
Module CM 13 Childbearing 2 (complications) .............................................................................. 92
Module CM 14 The newborn 2 (complications) ............................................................................. 97
Module CM 15 Mental health and illness .................................................................................... 101
Module CM 16 Child health and illness under five ...................................................................... 103
Module CM 17a Child spacing ....................................................................................................... 106
Module CM 17b Sexually transmitted infections, HIV and AIDS................................................... 109
Module CM 17c Gender-based violence including harmful traditional practices ........................ 113
Module CM 17d Common gynaecological and breast disorders and issues ................................ 116
Module CM 18 Managing and leading community teams and facilities, and basic teaching skills119
Module CM 19 Consolidation: Emergency skills and revision ..................................................... 122
Module CM 20 Consolidation: being a Community midwife ....................................................... 124
ANNEXE 1 ICM Definition Of The Midwife .......................................................................................... 126
ANNEXE 2: ICM Philosophy And Model Of Midwifery Care ................................................................ 127
ANNEXE 3: Essential Competencies For Basic Midwifery Practice ..................................................... 130
ANNEXE 4 MIDWIFERY LOG BOOK ..................................................................................................... 151
ANNEXE 5 RECORD OF ASSESSMENT OF CORE CLINICAL SKILLS ........................................................ 152
ANNEXE 6 RECORD OF ASSESSMENT OF MIDWIFERY CLINICAL SKILLS ............................................. 153
3
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
FORWORD
4
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
5
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
ACRONYMS
AIDS Auto-immune Deficiency Syndrome
ARV Anti-retroviral drugs
BEMOC Basic emergency obstetric care
CEMOC Comprehensive emergency obstetric care
CPR Cardio-pulmonary resuscitation
FIGO International Federation of Gynecologists and Obstetricians
FGM Female genital mutilation
HIV Human Immunodeficiency Virus
ICM International Confederation of Midwives
ICN International Council of Nursing
IDP Internally displaced persons
INGO International non-governmental organisation
IT Information technology
MCH Maternal and Child Health
MDG Millennium Development Goal
MMR Maternal Mortality Ratio
MoH Ministry of Health
MTCT(P) Mother to Child Transmission (Prevention) of HIV
NGO Non-governmental organisation
OSCE Objective structured clinical examination
GBV Gender-based violence
TBA Traditional birth attendant
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
WHO World Health Organization
6
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
INTRODUCTION AND RATIONALE FOR THE COMMUNITY MIDWIFERY
PROGRAMME
A major challenge for any government is to maintain the health of the population. Poor health has
an impact on individuals, families and indeed on the whole economic development of the country.
Maternal and infant health continues to give great cause for concern in many countries but does so
particularly in Somalia. With one of the highest rates of morbidity and mortality in the world this
issue affects every community and family. Not only do women have the right to life and health when
fulfilling their childbearing role, but families do poorly when the mother is lost, infants usually die
and young children often do not survive either.
As any country in the world, Somalia has an ancient history of midwifery including for nomadic
peoples as many Somalis are. Older women had an important role helping women of the community
give birth. They would wait until the baby was about to be born and would then make an episiotomy
with an unsterile knife. Women suffered greatly in those days and still do.
In the mid-twentieth century Italian midwife educators began to train Somali midwives to assist
women and reduce their suffering and continued for many years. Since the beginnings of
professional midwifery in the region, midwifery has continued to change as circumstances change.
Although both nursing, midwifery and community health training were available in Mogadishu,
midwifery training ceased because of the conflict and insecurity after 1991. Now women are served
almost entirely by traditional birth attendants in the home, and untrained auxiliaries in hospitals and
health centres. Some women have the benefit of nurses who have received some maternity training
and a few are supported by midwives who trained before the civil war or elsewhere.
Now the intention has been expressed in Somalia to re-establish midwifery schools and upgrading
nurses to a midwifery qualification. For this reason the companion revised Post-basic curriculum for
qualified nurses was commissioned by the Ministries of Health TFG and Puntland supported by
UNFPA. This intention is also supported by the nursing associations in Somalia and Puntland.
At the same time it is acknowledged that there remains a place for less well-educated women from
rural and inaccessible communities to train to become skilled birth attendants to serve their own
communities. This is especially important in areas where hospital-based maternity care is difficult to
access, and also where education of young women may have been severely limited. For this reason,
this curriculum for ‘Community midwives’ has been commissioned, again by the Ministries of Health
and UNFPA. This includes training for the role of supporting children under five.
The review is especially timely with the recent global emphasis on midwives who fulfil the revised
1
Definition of the Midwife (ICM 2011) and international Essential Competencies (ICM 2010a) as key
1
“A competency is a combination and integration of knowledge, skills and attitudes, which result in effective
performance. These essential competencies for basic midwifery practice 2010 are based on ICM´s values,
vision, strategies and actions and used by midwives who attend to the health needs of adolescents, women
and childbearing families. Throughout this curriculum the term “competencies” is used to refer to both the
7
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
2
players in reducing maternal and neonatal morbidity and death, and with the publication for the
first time of Global Standards for Midwifery Education (ICM 2010b). Somalia aspire to meet the
standards wherever possible, a process that will continue forward through the lives of these
curricula.
This Communi ty midwifery curriculum uses the same main structure and principles as the Post - basic
midwifery programme. Indeed many of the learning experiences need to be the same despite
differences in scope of practic e. These grades of midwife differ mainly in their level of knowledge
and understanding of the theory and evidence that underpin midwifery practice , and involvement in
advanced skills . A key difference is that Community midwives need to learn fundamental kn owledge
and skills already covered by nurses in their training Post - basic students are also being prepared for
more analytical and critical thinking and independence as learners than are Community midwives. .
In order to achieve designation as skilled bir th attendants (WHO undated), both must fulfil the ICM
Definition of the Midwife (ICM 2011 and Annexe 1) and the Essential Competencies for Basic
Midwifery Practice (ICM 2010a and Annexe 3). The two Programmes present otherwise broadly
similar content, to b e addressed at different levels and from very different starting points.
Although this Programme responds to the specific needs of Somalia , several other countries facing
the challenge of providing large numbers of skilled birth attendants to rural women h ave taken
similar pathways. This is to prepare women nominated by their own communities to return there to
serve as their midwives after ‘fast-track’ vocational training despite having often reduced
3
opportunities for accessing secondary school education . In most countries the intention is to move
eventually to one grade of qualified midwife fulfilling all the international competencies at diploma
or graduate level.
broad statement heading each section, as well as the knowledge, skills and behaviours required of the midwife
for safe practice in any setting”. Ministry of Health Republic of South Sudan (2011) Diploma in Midwifery
(draft.p.14).
2
UNFPA, JHPIEGO, WHO, Global Health Workforce Alliance, UNICEF, FIGO, ICM, World Bank (2010) The global
call to action: strengthen midwifery to save lives and promote health of women and newborns (06 06 10)
available at
http://www.unfpa.org/webdav/site/global/shared/documents/events/2010/midwifery/Joint_Statement_Sym
posium_on_Strengthening_Midwifery_Final_04JUN2010.pdf
3
Examples of other countri es which have (or plan) shorter midwifery programmes for women with reduced
education levels and who are not nurses but nevertheless meet the ICM Essential Competencies for Basic
Midwifery Practice (ICM 2010)and the ICM Definition of the Midwife (ICM 2011 and Annexe 1) on completion
are Afghanistan, Laos, Malawi, Pakistan and South Sudan.
8
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
CURRICULUM FOUNDATION
The vision, mission and philosophy of the Programme are described here so that the basis of
curriculum decisions is clear. This is also required by the WHO (2009) and ICM (2010b).
Vision
The vision for the Community Midwifery Programme is that women selected by their communities
from rural and remote areas of Somalia to serve them as midwives will be able to meet the
requirements of the 2011 International Definition of the Midwife (Annexe 1) and the 2010 Essential
Competencies for Basic Midwifery practice (Annexe 3). They will also be able to provide essential
care for children under-five years and support the health of their communities.
Programme aim
The aim is that women selected by their communities will:
become midwifery practitioners who provide safe, competent and timely care to women,
their infants and families
contribute to the reduction of maternal , neonatal and child morbidity and mortality
act at all times with honesty, integrity and without discrimination to people whatever their
ethnic group, faith, gender, nationality or culture
work in collaboration with the community and with professional colleagues
become lifelong learners who are able to reflect on and improve their practice and
encourage and support others to do the same
work toward the advancement of the profession of midwifery.
Philosophy
The curriculum is based on the following concepts and assumptions:
Of the person
A person has social, cultural, religious, psychological and physical needs that should be
respected.
A person has impact on, and is affected by, the socio-cultural, religious, psychological and
physical environment.
A person has rights of self-determination regarding what happens to him or her in health,
disability and illness regardless of gender.
A person takes responsibility for his or her own well-being to whatever extent possible and
collaborates in positive ways to meet deficits.
9
Community Midwife Curriculum 2012, Ministries of Health Somalia SCZ and Puntland with UNFPA
