Dr. Lamia Eltigani Elfadil MahmoudNational Reproductive Health DirectorFederal Ministry of Health, Sudan

Turning a corner on the road to maternal health;

A New Vision for Midwifery in Sudan

Sudan... the largest country on the African Continent...

• MM - 1107/ 100,000 LB; Neonatal 82/1000 LB• Sudan pioneer in midwifery – started in 1921; now

38 midwifery schools • 13,800 village MWs all over the country• Various categories of midwifery cadres• 80.6% of deliveries occur at home• 49% of deliveries attended by trained providers• EmOC coverage 79%, but of questionable quality• Policy- a midwife for every village (deployment)• Non- employment of village midwives

Too many challenges…..

• Village MWs versus SBAs• Only 56.4% of villages covered with VMWs• Poor condition of schools (physical)-

teaching material, schools not functioning at full capacity

• Donor dependance of schools• Tutor competencies (state level)• Untill recently, no standardization of

curricula• Job security & recognition

Window of Opportunity

Timely moment for new initiatives:• Growing global movement to support

midwifery• Government commitment to midwifery• Collaborative national effort and ownership• Academy of Health Sciences & universities• Formulation of the National Midwifery

Association• International midwifery advisor (3 for Sudan)• Launching of Sudan Midwifery Strategy on

the International Day of the Midwife

National Midwifery Strategy; framework for scaling up midwifery

Midwifery services

Supervisionsupport

TrainingEducation Access

equity

Policy, legal regulation

Stewardship

FundingImage

attractiveness

MonitoringEvaluation

Enabling Environment

What have we done?

Adoption of 2 new pathways for midwifery training;

• 4 yrs BSc curriculum, started on 18th October 2009 (national)

• 2 yrs midwifery technician curriculum, piloted in 5 schools (states with highest MM)

• What’s new?– Higher entry educational level– Revised curriculum, aligned to WHO standards for

SBAs– Improved training environment

Lessons learned

• Advocacy, advocacy, advocacy• Inclusion of midwives into the formal

health system is a MUST• Recruiting candidates from remote villages

is a challenge• Availing core teams of competent trainers

in the states• A regulatory framework for midwifery must

be initiated• Supportive supervision to VMWs• Close monitoring of implementation

process

Sudan needs midwives now more than ever….