Supporting Quality Midwifery Care Across the Far Reaches of the Globe
Through the programmatic and technical expertise of its staff and membership, ACNM utilizes education, research, advocacy, and relationship building to strengthen maternal health care worldwide. The global reach and impact ACNM midwife consultants have on families worldwide can be seen in the various global projects we have collaborated on with partners who share similar goals to advance the care of women and their families.
Accessible Continuum of Care and Essential Services Sustained Program (ACCESS) — Madagascar
ACNM’s expertise in midwifery and healthcare systems capacity building is making a difference in the quality of maternal, newborn and women’s reproductive health care in Madagascar. In a cooperative agreement with the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, and leading efforts as part of USAIDS’s Accessible Continuum of Care and Essential Services Sustained (ACCESS) program, ACNM is utilizing education technology and specialized clinical expertise to build a foundation for the delivery of sustainable maternal care in Madagascar. The College is collaborating with partners and key stakeholders to design a clinical training approach and quality assurance tools to support in-service maternal, newborn and reproductive health care at both the regional and district levels through leveraging the train-the-trainer approach and low-dose, high frequency theoretical models. ACCESS aims to accelerate sustainable health impacts for the Malagasy people by focusing on three main objectives: quality health services are available and accessible to all Malagasy communities in the targeted regions; health systems function effectively to support quality health service; and Malagasy people sustainably adopt healthy behaviors and social norms.
Sustaining Health Outcomes Through the Private Sector (SHOPS Plus) — South Asia; Africa
Through a USAID cooperative agreement, the expanse of ACNM’s global network is allowing the College to leverage the technical knowledge and skills of midwives from around the world to improve and sustain global health outcomes in Africa and South Asia. Working as part of USAID’s Sustaining Health Outcomes Through the Private Sector (SHOPS Plus) program, ACNM has mobilized professional health associations to implement clinical training and proven quality of care approaches across the SHOPS Plus program. ACNM leads educational efforts on in-service and pre-service clinical training and quality health care. It also supports the activities of the Human Resources for Health (HRH) effort and participates in policy dialogues related to women’s health in Nepal, Nigeria, Rwanda, and Tanzania.
Every Preemie—SCALE (Scaling, Catalyzing, Advocating, Learning, Evidence-Driven) — South Asia; Africa
Every Preemie—SCALE (Scaling, Catalyzing, Advocating, Learning, Evidence-Driven) was a USAID Cooperative Agreement designed to provide practical, catalytic, and scalable approaches for expanding the uptake of preterm birth (PTB) and low birth weight (LBW) interventions in 24 USAID priority countries in Africa and Asia. The program utilized ACNM’s global midwifery expertise to lead health care provider capacity building and performance improvement activities aimed at increasing newborn survival through evidence-based interventions. Highly skilled midwives with long-term experience in the challenges of low-resources setting, took the lead in training health care providers on the Family-Led Kangaroo Mother-Care Model, an innovative approach to providing supportive care to increase the chances of survival for preterm and low birth weight baies. ACNM is using the FLC model to benefit communities in other sub-Saharan countries.
Survive and Thrive Global Development Alliance (S&T GDA) —Worldwide
The Survive and Thrive Global Development Alliance (S&T GDA) was a public/private partnership among obstetric, pediatric, and midwifery professional associations working with country governments and health professionals to improve health outcomes and the quality of facility-based maternal, newborn, and child health (MNCH) interventions. ACNM’s experience working in diverse communities around the world facilitated the identification of opportunities for MNCH interventions and the deployment of solutions. In addition, the College strengthened professional associations between GDA partners and USAID countries. The GDA project aimed to: develop facility-based MNCH interventions and clinical competencies that are supported and sustained through training and quality improvement approaches and processes; ensure members of professional associations are equipped to improve the quality of high-impact MNCH interventions in health facilities and serve as champions; and mobilize new graduate clinicians as global health scholars dedicated to mastering the high-quality, high-impact MNCH programs.
Systems for Better Health Program in Zambia (SBH) —Zambia
Systems for Better Health Program in Zambia (SBH) was a USAID funded project developed to increase the quality, availability, and use of priority health services. The project benefited from the vast knowledge and training experience ACNM consultants have in the area of simulations/skills laboratories. ACNM was directly involved with strengthening pre-service education institutions for midwives and community health assistants with a focus on their simulation/skills laboratories and clinical practice systems. ACNM supported the design as well as implemented and monitored the national level interventions to strengthen health stewardship by the Ministry of Health. Working with implementing partners to build on the College’s previous work in pre-service midwifery education (Zambia Integrated Systems Strengthening Program), ACNM collaborated with the General Nursing Council to upgrade simulation/skills laboratories, and to train tutors and clinical instructors in their use in midwifery schools.
Health Systems Strengthening II Bridge (HSS II Bridge) —Jordan
HSS II Jordan was a USAID subcontracted grant effort that built on the momentum and relationships core to ACNM successes in HSD Jordan by leveraging ACNM Expertise in three main initiatives. These initiatives included strengthening institutional compliance with Active Management of Third Stage of Labor (AMTSL) protocols, strengthening the midwifery work force and assisting in developing a model for preconception care appropriate to the Jordanian context. ACNM midwife consultants provided technical assistance to review AMSTL protocols and developed job aids and quality assurance processes to promote conformance to best practice standards in 6 public hospitals in Jordan. Working within the Ministry of Health, ACNM supported institutionalization of midwifery core competencies and career ladders for midwives and performed reviews and recommendations for improvement of pre-service training curricula. ACNM developed and conceptualized the clinical components of the preconception care model, and to assisted in the development of standards, guidelines and protocols for implementation of the model.
Jordan Health Service Delivery Activity (HSD) —Jordan
The focus of Jordan Health Service Delivery Activity (HSD) is to expand the availability of quality integrated women’s and children’s health services. Multiple initiatives are under way to improve the health of both Jordanian nationals and Syrian refugees and ACNM midwifery consultant provide important technical assistance. ACNM has provided consultant expertise to support and encourage mother to mother breastfeeding support groups, provide technical support to increase knowledge and develop clinical standards for use of episiotomies, review and updated evidence-based clinical guidelines and training methods for contraceptive implants and provide in-service education on Respectful Maternity Care. The goal is to alleviate the impact of rapid population growth by increasing access to quality health services and by improving availability and quality of family planning services. The HSD approach will stimulate management, clinical, and behavioral changes in public and private health services that will lead to better reproductive, maternal, neonatal, and child health outcomes.
Strengthening Midwifery Education in Comprehensive Family Planning —Ghana
Following the successful pilot of ACNM’s pre-service education program on comprehensive family planning at the Kumasi Nurses and Midwifery Training College in Kumasi, Ghana, the College was awarded a grant to scale up their program to include 2 more midwifery schools. Once again the project utilized ACNM’s strength in developing innovative programs and curricula that addressed critical aspects of the midwifery profession. The educational program focused on strengthening 4 core areas:
- Program standards and regulation
- Curricula development and teaching methodologies
- Clinical and teaching skills of teachers (tutors) and preceptors
- Infrastructure, equipment, and supplies
Zambia Integrated Systems Strengthening Program (ZISSP) —Zambia
ZISSP is a USAID program that furthered the successes of the previous USAID-funded Zambia Health Services and Systems Program (HSSP). ZISSP was designed to increase utilization of high-impact public health interventions in HIV/AIDS, malaria, family planning, maternal and newborn care, and child health and nutrition by adopting a health system strengthening approach. The College’s unique woman-centered practices that help to strengthen national and community-based health care systems around the world was instrumental in gaining a contract to provide technical support and direction to the maternal health components of ZISSP's projects. The College lent their expertise to support the national emergency obstetric and neonatal care (EmONC) training system; develop a postnatal home visiting program; strengthen pre-service education within the new direct entry midwifery programs; and bolster community preparation and response to EmONC via the College’s Home Based Life Saving Skills (HBLSS).
Human Resources for Maternal Survival: Facilitating a Community of Practice for Non-Physician Clinicians (NPCs) —Africa
The Averting Maternal Death and Disability (AMDD) program at Columbia University contracted with ACNM to develop a community of practice (CoP) among non-physician clinicians in 6 African countries where their scope and training included emergency obstetric care. As acting secretariat of the CoP, the project benefited from the College’s experience in establishing infrastructures to advance midwifery, collaborating across diverse communities, and developing specialized curricula. To ensure the success of this significant endeavor, ACNM designed and implemented a survey to gather intelligence on training, practice, and regulatory standards in each participating country. Although non-physician clinicians exist in many countries, this cadre of health care workers is just beginning to develop their professional identity. For this effort ACNM drew on its extensive experience developing core competencies, regulatory frameworks, and a professional identity for midwives to assist non-physician clinicians with this process.
Developing a National Training Program for Life-Saving Skills in Namibia —Namibia
In Namibia the infant mortality rate is high and maternal deaths have more than doubled since 2000. The Namibian government is committed to ensuring quality maternal and child health, but there are challenges. The causes of maternal mortality were related to emergency obstetric care services. However, increased numbers of births (81%) were found to occur in facilities with skilled birth attendants. In 2010, Namibia's Ministry of Health, Social Service, and some of their donor partners (WHO, UNFPA, UNICEF and the CDC) asked ACNM to provide assistance in designing and establishing its national Life Saving Skills (LSS) training program. The program provides updates in emergency obstetric care knowledge, skills, and attitudes for health care providers such as midwives, doctors, and nurses. As with other LSS programs, a systems approach has been used so critical elements including assessment, up-grading of training facilities, curriculum adaptation, preparation of trainers, and monitoring and evaluations are addressed. ACNM's technical assistance to this program is ongoing.
Partnership for Transforming Health Systems (PATHS2) —Nigeria
PATHS2 is a project funded by the United Kingdom Department for International Development (DFID) to assist the Nigerian government in improving access to quality health care in vulnerable areas, particularly at the community primary health center level across 5 states. One strategy of PATHS2's efforts to strengthen health systems is establishing in-service training for Community Health Extension Workers (CHEWs) and midwives on essential obstetric skills. Building on the Train-the -Trainer model, ACNM was asked to implement a monitoring and supervision system for the delivery of the Advanced Life Saving Skills curriculum by Master Trainers. ACNM consultant expertise was also utilized to support the design of a competency-based training for CHEWS and to conduct an assessment of the school of midwifery related to the quality of the pre-service training.
ACNM/CORE Group Healthy Moms, Healthy Babies Initiative —Worldwide
CORE Group is a network of practitioners and public health professionals working in global community health who share knowledge, evidence, and best practices to improve and expand community health practices for underserved populations, especially women and children, through collaborative action and learning. One of its functions is to develop and diffuse innovative cross-cutting community health program strategies, tools, and best practices in order to overcome barriers to program coverage, quality, equity, and sustainability. This network includes many of the organizations who have implemented ACNM's pioneering community maternal and neonatal health program, Home Based Life Saving Skills (HBLSS). ACNM and CORE Group have partnered to leverage the experience of HBLSS implementing organizations to promote program learning, improve field implementation, and integrate HBLSS into existing programs. The collaboration will also address the need to expand the number of Master Trainers, update curriculum materials, and streamline monitoring and evaluation. To date, a “training of trainers” for HBLSS has been conducted with CORE Group members and the curriculum materials have been updated and finalized into a second edition. Future work will focus on creating a field-friendly implementation and facilitation guide.
Reducing Maternal and Newborn Mortality in Guatemala with Home-Based Life Saving Skills (HBLSS) —Guatemala
Since 2012, ACNM has partnered with Curamericas Global in rural Guatemala, to reduce the high maternal mortality rate prevalent in the northwest region of the country ? a place locals of San Sebastián Coatán call "The Triangle of Death." With a rate of 584 maternal deaths per 100,000 live births, these women face a 1-in-20 lifetime chance of dying in childbirth. At the root of this high mortality is a lack of timely access to adequate health care. The College’s expertise in developing solutions to meet the unique needs of women and newborns globally was called upon to improve maternal and newborn health in the region. Due to the location, and the lack of resources available locally, the College’s Home-Based Life Saving Skills (HBLSS) program represented a sustainable solution to empower members of the community to improve maternal and newborn health through education. Using ACNM's HBLSS curriculum, training was conducted to increase the knowledge and skills of local communities in the early recognition of maternal and neonatal problems and appropriate referral; the goal is to reduce maternal and newborn mortality in this area.
The various teaching methods offered through the HBLSS program maximized communication and learning among participants. Despite language and cultural barriers, the program effectively allowed for the successful training of pregnant women, family caregivers, and home birth attendants that will keep pregnant women healthy, recognize life-threatening complications, and promote the adoption of healthy behaviors.
Following the HBLSS Master Trainer Training, ACNM is now working with Curamericas to develop a sustainable and effective HBLSS training cascade and supportive supervision system in 12 communities.
Scaling Up Family Planning — Zambia
Beginning in 2012, ACNM was awarded a four-year grant to lend its training expertise to the Scaling Up Family Planning Program (SUFP), a project funded by the United Kingdom Department for International Development (DFID). The project aimed to expand access to high-quality family planning services in 26 underserved and vulnerable districts in Zambia. Zambia has one of the highest rates of maternal mortality in the world. The need for family planning and fertility are the highest in rural areas where the poorest and least education women reside. ACNM helped to build the capacity of the public sector to deliver quality family planning services through in-service programs for family planning providers, focusing on areas with the highest fertility rates and the most unmet need. Emphasis was given to expanding availability of long-term reversible contraception methods and providing family planning services, with focus on adolescent girls and the poorest women. The program also engaged community health workers to sensitize men and others who influence family planning and to provide information to correct popular myths and misconceptions about family planning. To ensure sustainability of the project, outreach services as well as training and mentoring of public health workers and community leaders, was successfully conducted.
SHaRP: Strengthening Human Resources in Partnership ?Zambia & Kenya
In 2012, the Averting Maternal Death and Disability (AMDD) Program at Columbia University was asked to study the implementation of task shifting of cesarean sections (C-sections) from physicians to associate clinicians (previously known as non-physician clinicians) in Zambia and Kenya. The goal of the research was to develop guidance for low-income countries seeking to implement and improve task shifting programs. The research aimed to understand the process of moving from policy adoption of task shifting to actual implementation on the ground. ACNM was asked to assist in developing guidance on how to successfully implement task shifting programs and ACNM consultants provided technical support consisting of:
- Collaborating with Kenya to review prior analyses of health workforce needs;
- Deploying an ACNM hired consultant to work closely with the AMDD and CHPK (Kenyan partner) teams to collect data on Clinical Officers with Reproductive Health specialty in Kenya;
- Analyzing the data from the Zambian and Kenyan research to identify themes and relevant findings; and
- Designing a replicable implementation model and set of regionally applicable guidance notes based on lessons learned and successes of the Zambia and Kenyan models, coupled with evaluations performed in 2010-2011.