Findings
Literature review
A comprehensive review of literature on midwifery education across the four identified domains revealed several potential gaps, particularly within the partner countries.
Our review revealed three key findings that demonstrate a degree of generalizability, which could be significant for our gap analysis, despite the absence of studies from the partner countries, Vietnam and Cambodia.
Theory-practice gap (between written curriculum and what is implemented in the institutional education)
Implementing curriculum changes in nursing and midwifery education often faces significant challenges, particularly with competency-based curricula (Evans et al., 2015) A study in Lesotho highlighted that, even three years after introducing a new competency-based midwifery training program, necessary structural adjustments to integrate the new curriculum into existing systems were still incomplete This delay negatively impacted both teaching and student learning experiences (Nyoni et al., 2019) It is essential to investigate whether similar issues exist in our partner higher education institutions and address them in the SafeMa "Advanced Midwifery Course."
Knowledge translation gap (gap between academic knowledge and clinical practice, lack of confidence to put theory into practice)
Numerous studies in nursing and midwifery reveal challenges in applying theoretical knowledge to clinical practice Graduates often rely on traditional routines, neglecting innovative techniques learned in training (Chearaghi et al., 2010) Although students recognize obstacles in clinical settings, they lack the empowerment needed to confidently implement their knowledge (Liao et al., 2014) The prevalent use of teacher-centered, passive learning models, even during clinical electives, hinders problem-based learning and the integration of theory into practice (Kermansaravi et al., 2015) Additionally, the disconnection between theoretical lectures and clinical training, along with ineffective assessment methods, exacerbates the knowledge translation gap Dadgaran et al highlight that despite having sufficient theoretical knowledge, students struggle to apply it in clinical scenarios due to significant time lapses between learning and practice.
The European Commission's support for this publication does not imply endorsement of its content, which solely represents the authors' views; the Commission is not liable for any usage of the information provided The transition towards academic midwifery education may restrict undergraduate midwives' clinical practice exposure, resulting in a notable lack of confidence among newly qualified midwives, especially in emergency situations.
Whether this applies for our partner HEIs needs to be explored and evt addressed in the SafeMa
Student satisfaction (gap between student’s expectations and perceptions of students of an educational program)
Research indicates a significant disparity between students' expectations and their perceptions of the quality of education services, especially in health sciences This gap is notably pronounced among midwifery students, particularly concerning the reliability of teaching staff and the tangible resources utilized in the educational process (Norouzinia et al., 2014; Asefi et al., 2017).
Whether this applies for our partner HEIs needs to be explored in the subsequent gap analysis and evt addressed in the SafeMa “Advanced Midwifery Course”
Numerous studies from low and middle-income countries (LMICs) have highlighted poor clinical skills and a lack of core competencies among qualified midwives in critical areas, including obstetric emergencies, cancer screening, prevention of vertical transmission, and public health (Yigzaw et al., 2016; Arif et al., 2010; Munabi-Babigumira et al., 2017).
In Cambodia, studies indicate significant knowledge gaps among qualified midwives regarding labor, post-partum, and newborn care practices There is a concerning lack of adherence to hygienic principles during labor, often leading to inappropriate antibiotic use for infection prevention Additionally, midwives demonstrate a lack of confidence in managing obstetric complications such as pre-eclampsia and post-partum hemorrhage Essential practices, including the use of partographs, documentation of APGAR scores, immediate skin-to-skin contact, and monitoring of newborns in the first hour after birth, are frequently overlooked, while procedures like episiotomy are overused.
Vietnam has one of the lowest exclusive breastfeeding rates in Southeast Asia, influenced by various socioeconomic and cultural factors Additionally, inadequate breastfeeding counseling and awareness provided by midwives significantly contribute to this issue Evidence suggests that insufficient training in labor practices may also be linked to the country's exceptionally high rates of episiotomy.
Midwifery plays a crucial role in ensuring women's and children's health rights are upheld, aiming to deliver the highest attainable standard of health care This includes providing dignified and respectful services that support the realization of essential health-related human rights.
The European Commission's backing of this publication does not imply endorsement of its contents, which solely represent the authors' views; the Commission is not liable for any use of the information provided Despite the importance of respectful care during pregnancy and childbirth, instances of disrespect and abuse in midwifery services remain a pervasive and complex issue.
In Cambodia, research indicates that midwives occasionally use offensive language while mocking the clothing and behavior of laboring women, particularly those from low socio-economic backgrounds (Ith P, et al., 2012) Additionally, instead of promoting social support and companionship during labor, many practicing midwives view these as obstructive, highlighting a significant gap in the human rights-based approach to midwifery education (Ith P, et al., 2012).
The choice of companionship during childbirth is a crucial aspect of respectful maternity care, yet it remains relatively uncommon in Vietnam (Miller S, 2016) A 2016 survey linked to the Vietnam midwifery report revealed that participants emphasized the importance of respectful communication with clients, particularly those from ethnic minorities Despite legal guarantees for informed consent, there is a pressing need to further integrate and promote these practices in everyday midwifery (Bales S, Kildea).
S, 2017) Evidence suggests that, communication skills training for dealing with sensitive clinical situations, such as diagnosis of HIV positive status, is urgently needed (Oosterhoff P, 2008)
In the age of evidence-based practice, it is crucial for health sciences professionals to be aware of research However, many health workers, especially nurses and midwives, still struggle with the ability to produce evidence and comprehend or critique research reports effectively.
A study conducted in central Vietnam revealed that most nurses struggle to comprehend and apply research findings in their daily practice, relying significantly on informal information for guidance.
Informal inquiries of the partners’ focal persons for the gap analysis
Key representatives from partner higher education institutions (HEIs) were tasked with identifying 3-4 areas perceived as weaknesses in midwifery education at their respective institutions The summarized findings are detailed below, with additional information available in annexes I and II.
Domain 1: Knowledge translation gap, limited opportunities to practice/academization, limited encouragement of critical thinking and clinical reasoning, lack of tangible resources for pre-clinical training, lack of life-long learning skills
Domain 2: Poor family planning and breastfeeding counseling, poor skills in health promotion/education, managerial skills like planning, implementing, assessing needs are limited, limited neonatal resuscitation skills
The European Commission's backing for this publication does not imply endorsement of its content, which solely represents the authors' perspectives The Commission is not liable for any use of the information provided within.
Domain 3: Communication skills with family members and clients are poor, lack of culturally sensitive approaches in communication with ethnic minorities
Domain 4: Low research awareness and research engagement/participation in scientific conferences, poor reading proficiency in English/low computer literacy, and no involvement of midwifes in evidence generation/guidelines
Academic and Research Excellence in Midwifery Education and Research Report (WP1.1)
In WP1 task 1, P7 has developed a comprehensive report detailing best practices, standards, and methodologies in midwifery education and research This report critically evaluates the WHO and ICM standards related to midwifery education Following the outlined methodology, it categorizes midwifery education into four distinct subcategories.
1 Teaching methods, best practices and methodologies within midwifery education
3 Human rights-based approach and ethical considerations 4) Research considerations and evidence-based practice
Major findings of the report are summarized below:
The report emphasizes the need for a gap analysis that prioritizes the evaluation of continuous quality improvement and lifelong learning teaching methods in midwifery education It highlights the importance of assessing pedagogic practices that foster critical thinking and clinical reasoning, as well as understanding national and international standards, which are vital to modern midwifery Additionally, it points out the limited involvement of midwives in the development of guidelines and regulatory processes The analysis should also examine the balance of practical and theoretical components in the curriculum, underscoring the necessity of maintaining a low teacher-student ratio and ensuring a curriculum mix of at least 60% practice and 40% theory.
It is essential to evaluate whether undergraduate midwives acquire fundamental skills and confidence in providing basic services across various areas, including antenatal care, labor management, postpartum treatment, postnatal infant care, and abortion-related services Additionally, understanding their familiarity with social determinants of health, referral pathways, and the functioning of the health system within their work environment is crucial for effective service delivery.
It is essential to evaluate midwives' understanding of the Human Rights-based approach in their practice, particularly regarding obstetric violence and its prevention Additionally, assessing their confidence in communicating professionally and respectfully with clients is vital for supporting informed decision-making.
The European Commission's backing of this publication does not imply endorsement of its content, which solely represents the authors' views The Commission is not liable for any use of the information provided.
It is crucial to investigate the level of research awareness among undergraduate students and practicing midwives, particularly their understanding of evidence-based practice This exploration should include targeted inquiries regarding their skills and attitudes as lifelong learners in the field.
Crossmatch of the national code of conduct and existing curriculum in the partner HEIs
To assess the readiness of future midwives to meet the expectations of the national code of conduct within the Vietnamese health system, we analyzed potential discrepancies between the code and the curricula from partner higher education institutions (HEIs) Our evaluation of the P3 curriculum revealed several potential gaps that need to be addressed.
1) Though rehabilitation is being mentioned as a core competency of midwifes in the national code of conduct, the curriculum was lacking a subject on rehabilitation (potentially part of other subjects but maybe not covered in depth)
2) Nutritional needs and nutrition care – including breastfeeding (not mentioned at all in curriculum as specific bullet point)
3) Palliate care/care of end-stage patients (mentioned as integral part of midwife´s code of conduct – no relevant subject in the curriculum)
4) Psychological support to women and end stage patients (again no specific subject on this encountered in the curriculum)
5) PHC and National programs (mentioned as integral part of midwife´s code of conduct, but is apparently only an optional subject in the curriculum)
6) Record keeping is mentioned as a core competency in the code of conduct (curriculumpart of midwifery management?)
7) Recognizing and managing victims of gender violence is being described as a core competency in the national code of conduct (missing as bullet point in the curriculumpartly being covered in another subject?)
8) Advocate for rights of mothers/infants/patients constitutes a core duty of midwifes (there is a subject on laws in the curriculum – unclear if this covers the subject satisfactorily)
With respect to Cambodia and based on the curriculum provided by partner P6, following potential gaps have been identified:
9) According to the code of conduct midwifes should be able to perform a death review and near miss audits (does not appear as a subject in the curriculum)
10) Methods of infection prevention and control (maybe this is part of other subjects – however there is no subject description containing these keywords)
The European Commission's backing of this publication does not imply endorsement of its content, which solely represents the authors' perspectives Consequently, the Commission is not liable for any use of the information provided.
11) Usage of referral systems (no specific topic on health system´s structure, referral pathways, continuum of care – maybe partly covered in “Sociology on women, birth and Cambodia”)
12) Contraception methods/family planning (code of conduct is putting a lot of emphasis in family planning activities/strategies – while the curriculum sporadically contains aspects of family planning and it might not cover the subject to the desired extend)
13) Screening methods for cervical and breast cancer (these are explicitly being mentioned in the code of conduct, however missing in the curriculum)
14) Diagnosis of ectopic pregnancy/use of ultrasound/Doppler (mentioned as competency in the code of conduct, missing as a topic in the curriculum)
15) Micronutrient substitution and other preventive measures during pregnancy (perhaps covered partly in more than one session)
16) Adult resuscitation (mentioned in the code of conduct, however not mentioned in the curriculum as a keyword)
Crossmatch of ICM competencies guide with the curriculum
In order to further assess potential gaps in the curricula of the partner HEIs/countries a close examination and comparison of the following documents has been undertaken:
• International Confederation of Midwives (ICM), essential competencies for midwifery practice, 2018
• Midwifery curriculum at university level of Ministry of Health, Nam Dinh university of Nursing at Socialist Republic of Vietnam (Training level, Bachelor)
• Codes and Standards of occupational title for Midwifery, joint circular 26/2015/TTLT- BYTBNV Midwives of class 3-Code: V.08.06.15 (classified parts “d” named as
“communications, education and counseling on reproductive health” and “d” named as
“coordination and support in treatment” of category 1 “responsibility” as di and dii correspondingly) Cambodia:
• International Confederation of Midwives (ICM),essential competencies for midwifery practice, 2018
• Minimum Standard Bachelor of Sciences in Midwifery Curriculum (BSM 4-Year Program)
• Core Competency Framework for midwives in the Kingdom of Cambodia, MoH (2013)
The findings of this cross- match revealed following potential gaps of midwifery education in the case of Vietnam:
1) “Accountability and transparency” are stated as the first ICM competency They are not clearly stated in both curriculum and code of conduct
2) “Evidence - based practice in intrapartum care” Specifically “To promote to avoid routine interventions in normal labor and care” stated on 3a ICM competence and “to promote delay
The European Commission's support for this publication does not imply endorsement of its contents, which solely represent the authors' views, and the Commission is not liable for any use of the information provided The topic of "cord clamping during the third stage of normal labor" is included in the ICM competence framework, yet evidence-based practices in intrapartum care are not distinctly highlighted Additionally, while "emergency contraception" is mentioned in the ICM competence, it is absent from the curriculum and code of conduct regarding education and counseling on reproductive health.
4) “Promote early and exclusive breastfeeding”, stated on 3c ICM competency There are references to breastfeeding in the curriculum - nevertheless it appears to be only partially covered
5) “Immunization in infancy”, mentioned on 4b ICM competency There is no reference to that subject neither in the curriculum nor in the code of conduct
Counseling and follow-up care for women experiencing stillbirth and neonatal death are crucial components of perinatal care The mourning process following these losses requires attention and support While the curriculum and code of conduct address postpartum care for high-risk mothers, there is a notable lack of explicit references to the necessary care for women after stillbirth and neonatal death.
The findings of this cross- match revealed following potential gaps of midwifery education in the case Cambodia:
1)“Accountability and transparency” are stated as the first ICM competency They are not clearly stated in the curriculum
Summary of findings of the preparatory phase:
Through review of all these different sources of information, we suspected probable significant gaps lying in following areas:
The literature review highlights significant gaps in midwifery education, including the theory-practice gap, knowledge translation gap, and discrepancies between students' expectations and perceptions These challenges are particularly relevant to our partner higher education institutions (HEIs) The knowledge translation gap has been recognized as a crucial issue by a partner during an informal inquiry, indicating that the gap analysis implementation phase should prioritize these areas Additionally, it is essential to investigate the extent to which current teaching methods promote critical analytical thinking and clinical reasoning, in line with WHO and ICM recommendations Furthermore, the lack of tangible resources for (pre-)clinical education, identified as a major educational challenge by gap analysis focal persons, must be thoroughly evaluated within the context of the gap analysis.
Insufficient understanding of the health system and referral pathways, along with the significance of social determinants of health, may create critical gaps in both countries.
The European Commission's backing of this publication does not imply endorsement of its content, which solely represents the authors' perspectives Consequently, the Commission is not liable for any use of the information provided.
Research indicates a significant educational gap in Vietnam concerning breastfeeding, nutritional care, rehabilitation, palliative and psychological support, immunization, family planning methods, labor practices in both normal and complicated pregnancies, and the management of neonatal emergencies.
In Cambodia, significant educational gaps exist in crucial areas such as hygiene and infection control, screening techniques for breast and cervical cancer, adult resuscitation, and the application of ultrasound and Doppler technology Additionally, there are deficiencies in labor practices for both normal and complicated pregnancies, as well as in standard newborn care practices.
Evidence from various sources indicates that enhancing communication skills and fostering a respectful, culturally sensitive relationship between midwives and clients should be a primary focus of gap analysis in both settings Furthermore, obstetric violence and its various aspects appear to be overlooked in current curricula, highlighting the need for greater attention to this critical issue.
Vietnam's current education system may inadequately address the issue of gender violence, highlighting the need for improvement Additionally, a gap analysis should evaluate the understanding of transparency and accountability in midwifery practices.
Assessing research awareness is crucial during the gap analysis, as it may be suboptimal among undergraduate and practicing midwives in both countries There is a need to enhance their lifelong learning skills, and adherence to evidence-based practice requires thorough evaluation Gaps in this area may stem from various factors, including inadequate reading proficiency in English, limited computer literacy, and a lack of understanding of evidence-based practice and its significance in daily responsibilities Additionally, it is essential to determine the current involvement of both undergraduate and practicing midwives in the development and knowledge of national and international midwifery guidelines.
In response to the identified gaps in midwifery education across four domains, adapted survey questionnaires tailored to the specific contexts of Vietnam and Cambodia were developed in collaboration with partner institutions Additionally, semi-structured interview questions and focus group discussion (FGD) prompts were created to address the key findings from the preparatory phase All participants involved in the surveys and interviews provided written informed consent.
The implementation phase commenced in August 2019, with data collection completed across all partners by mid-October 2019 Convenience sampling was utilized for all surveys targeting predefined groups, and participants in these surveys were excluded from focus group discussions and interviews to maintain the integrity of the data.
The European Commission's backing of this publication does not imply endorsement of its content, which solely represents the authors' views; the Commission is not liable for any potential misuse of the information provided During the analysis, questions were examined both individually and collectively, leading to the development of composite variables when relevant.
In total, 18 key informants have been interviewed and or participated in a FGD while 367 different persons have been surveyed (self-administrated or data collector administrated questionnaires)
Table 1: Gap analysis participants composition
Table 1 Gap analysis participants composition
Data from each country have been merged and analyzed in an aggregated mode
FDGs and key informant interviews:
Key informants and focus group discussion participants identified the gap between theory and practice, along with issues in knowledge translation, as significant challenges in midwifery education in the country There is a notable shortage of tangible equipment and infrastructure for preclinical practice, and teaching methods such as case simulations are entirely absent Additionally, the absence of standardized quality control and effective feedback mechanisms between students further exacerbates these challenges.
The European Commission's backing of this publication does not imply endorsement of its content, which solely represents the authors' views; the Commission is not liable for any subsequent use of the information provided Additionally, interviews with Ministry of Health staff have identified a shortage of 17 lecturers/teachers as a significant weakness in Vietnam's midwifery education system.
Discussion
Following a comprehensive preparation phase that identified potential gaps in midwifery education in Vietnam and Cambodia, we conducted a focused exploration during the implementation phase Utilizing mixed methods, including both quantitative and qualitative data, we engaged various stakeholder groups, particularly in Vietnam, to perform an in-depth evidence synthesis that confirmed or challenged initial assumptions However, contradictory findings among stakeholders necessitated careful interpretation, as outlined in the summary table (see annex VIII) Methodological challenges, such as convenience sampling and response bias—especially from students and clients—along with inconsistent questionnaire administration across higher education institutions, complicated the analysis Despite exceeding the target for survey questionnaires, time constraints and last-minute cancellations limited our ability to meet the goals for focus group discussions (FDGs) and key informant interviews While additional FDGs could have enriched our insights into the identified gaps, our engagement with diverse stakeholder groups through surveys, interviews, and FDGs suggests that we likely captured all significant gap categories.
The main conclusions per country in detail were:
The theory-practice gap in midwifery education, which highlights the discrepancy between the written curriculum and its implementation, has been identified as a significant issue within higher education institutions (HEIs) Nearly half of the obstetricians surveyed acknowledged this gap, and it was consistently noted by focus group discussion (FGD) participants and key informants as a major weakness in midwifery training While the extent of this gap across all HEIs involved in the SafeMa project remains uncertain, it is crucial to consider when revising or introducing new study curricula Additionally, knowledge translation emerged as an area needing improvement, with many practicing midwives and students expressing a lack of opportunities to apply their knowledge in real-world settings This sentiment was echoed by the majority of obstetricians and FGD participants Furthermore, a shortage of tangible teaching resources, including high-quality puppets and virtual clinical case videos, was highlighted as a barrier to effective midwifery education There is also a pressing need to enhance critical analytical thinking and clinical reasoning skills within the curriculum.
The European Commission's support for this publication does not imply endorsement of its content, which solely reflects the authors' views, and the Commission is not liable for any use of the information provided Survey results indicate potential deficiencies in midwifery education among a significant percentage of practicing midwives and students Additionally, interviewed Ministry of Health officials criticized the lack of feedback mechanisms and the insufficient involvement of students and midwives in the development and enhancement of midwifery education, highlighting areas for improvement in future initiatives.
The clinical skills and core competencies of midwives in Vietnam reveal significant gaps, as evidenced by surveys of practicing midwives and obstetricians These surveys highlighted a lack of knowledge regarding the health system, deficiencies in identifying and referring high-risk pregnancies, and inadequacies in addressing social determinants of health Core competencies such as palliative care and gynecological cancer screening, although included in the national code of conduct, are underdeveloped in midwifery education Additionally, the assessment of mental health and provision of psychological support are notably insufficient, indicating a critical need for enhancement in midwifery training Furthermore, focus group discussions and key informant interviews underscored the necessity of improving training in breastfeeding counseling, a gap that, while not confirmed by student or client surveys, was supported by the majority of obstetricians.
Given the low rates of exclusive breastfeeding among Vietnamese women, it is essential to enhance breastfeeding counseling within midwifery education A survey revealed that 80% of obstetricians identified deficiencies in family planning counseling and services provided by midwives, although these issues were not evident in other surveys or focus group discussions This discrepancy suggests a need for further analysis to understand the potential gap While qualitative data indicate a significant lack of skills in managing normal and abnormal labor—evidenced by a high episiotomy rate—quantitative surveys show high client satisfaction with midwifery services during labor This contradiction warrants additional investigation, as biased responses may arise from midwives and students, but not from obstetricians or clients One possible explanation for the high episiotomy rates could be the prevalence of routine and traditional practices rather than a lack of competence Therefore, further examination of this issue is recommended.
The European Commission's backing for this publication does not imply endorsement of its contents, which solely represent the authors' views The Commission is not liable for any use of the information provided.
The gap analysis revealed significant deficiencies in midwives' communication skills, particularly in conveying sensitive information like HIV status and in interactions with clients from ethnic minorities and critically ill patients Obstetricians reported that midwives often lack effective communication with other healthcare professionals, which may stem from a limited understanding of their roles and responsibilities Although there was no clear evidence of obstetric violence, the analysis indicated practices inconsistent with respectful, patient-centered care; notably, only 18% of clients were allowed free choice of companionship, and less than half felt they could voice concerns during labor Additionally, the implementation phase highlighted a considerable gap in the identification and management of gender-based violence cases.
Research indicates a concerning lack of awareness and familiarity with evidence-based practices among practicing midwives and midwifery students Only a small percentage of midwives consult guidelines and protocols in their daily clinical work, with many relying on traditional practices that significantly influence their decision-making While a notable number of midwives engage in lifelong learning, data reveal that both midwifery students and practicing midwives may lack the necessary skills for autonomous learning Additionally, there are significant gaps in English reading proficiency and basic computer skills, which are essential for developing these competencies Therefore, midwifery education should prioritize enhancing English reading and computer skills among students to better prepare them for future challenges in the field.
The qualitative data gathered during the implementation phase reveal a significant knowledge translation gap, although this was not evident among the surveyed midwifery students This aligns with earlier assumptions from the preparatory phase Both the Ministry of Health official and the lecturers emphasized the need to enhance the internship system by creating smaller groups for clinical instruction, providing capacity-building opportunities for instructors, and ensuring their exclusive focus on teaching during the elective period Additionally, midwifery lecturers suggested increasing the theoretical lecture hours for specific subjects, highlighting the importance of improving both the quality and quantity of teaching resources available.
The European Commission's funding for this publication does not imply endorsement of its content, which solely represents the authors' views, and the Commission is not liable for any information use All three stakeholder groups involved in the gap analysis implementation identified deficiencies, highlighting the need for infrastructure upgrades and the incorporation of new teaching materials, such as simulation videos and role-playing activities.
A significant number of students reported having a limited understanding of Cambodia's health system, particularly in areas such as abnormal labor assistance, neonatal emergency handling, and assessing social determinants of health, which were less developed compared to other core competencies in midwifery education Contrary to initial assumptions, the gap analysis revealed no major deficiencies in hygiene, infection prevention, and control within midwifery training Interestingly, despite two-thirds of the surveyed students being in their prefinal years, nearly 65% felt fully prepared to use ultrasound/doppler in practice, with an additional 25% feeling somewhat prepared, contradicting earlier expectations These conflicting results warrant a critical evaluation by partner higher education institutions.
Despite the lack of significant gaps identified in quantitative and qualitative data, minor deficiencies were noted among midwifery students in their professional communication skills, particularly with critically ill patients and ethnic minorities Additionally, a considerable number of students appeared to have an inadequate understanding of their roles, rights, and obligations as future midwives This finding aligns with the concerns raised by a Ministry of Health official regarding insufficient instruction in professional ethics.
The data collected during the implementation phase revealed no significant gaps in domain 4 of midwifery education; however, focus group discussions and key survey findings highlighted practical challenges in fostering research awareness, lifelong learning, and adherence to evidence-based practices Lecturers noted that many references used in midwifery lectures were outdated and often difficult for students to access Additionally, low English reading proficiency emerged as a significant barrier to enhancing research awareness among students, as identified by the lecturers Furthermore, nearly half of the students reported having poor or fair basic computer skills, which poses another considerable challenge.
The European Commission's backing for this publication does not imply endorsement of its contents, which solely represent the authors' perspectives; therefore, the Commission is not liable for any use of the information provided.
Conclusion
In summary, the comparison of results from the preparatory and implementation phases enhanced the accuracy and depth of our gap analysis, revealing various gaps across all four educational domains It is clear that the upcoming Advanced Course in Midwifery, to be developed in both countries, should comprehensively address these major gaps While some assumptions from the preparatory phase were confirmed and others dismissed, many findings remain contradictory, possibly due to methodological flaws and response bias among certain stakeholder groups, including students and clients Therefore, partner higher education institutions should critically evaluate these discrepancies and consider further investigations into specific gaps Notably, we successfully gathered data from a diverse range of stakeholders, including Ministry of Health officials, facilitating a thorough analysis of potential gaps in midwifery education and practice in Vietnam and Cambodia.
The findings from the gap analysis will play a crucial role in advancing the project by informing the creation of specialized "Advanced Midwifery Courses" that target the urgent needs and overlooked aspects of midwifery education and practice in both partner countries.
The European Commission's funding for this publication does not imply endorsement of its content, which solely represents the authors' perspectives The Commission is not liable for any use of the information presented.
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The European Commission's backing for this publication does not imply endorsement of its content, which solely represents the authors' perspectives; consequently, the Commission is not liable for any use of the information provided.
WRITTEN BRIEF ANALYSIS BY GAP ANALYSIS FOCAL PERSON (P1); PREPARATORY PHASE
The General Department of Population of Vietnam reports that millions of children are born annually, with 1,563,911 newborns in 2017 and 1.6 million in 2018 Notably, maternal and infant mortality rates in certain mountainous regions are 3-4 times higher than in urban and plain areas, and twice the national average.
Preliminary Conference) (2016-2018) and 2-year plan (2019-2020) of the 2016-2020 HealthPopulation Target Program in April 2019 in Hanoi by the Ministry of Health)
There is a growing demand for professionals in obstetrics, particularly midwives, due to the critical need for skilled care in this field Expanding midwifery services is essential to meet this urgent need, highlighting the significant job potential and opportunities available in this profession.
1 Duties and roles of midwives
Midwifery is a field related to childbirth, assisting the physicians to take care of pregnant women before and after giving birth It is considered as a high quality profession
Missions and work of midwives:
At health facilities, obstetric clinics, their mission is being a caregiver, counseling for pregnant women, discovering abnormalities, then setting out specific care plans
They are maybe also the health consultants for both women and their families in many related tasks such as birth control, gender imbalance, disease prevention
The mandate and quality standards of this profession have been setting up and controlling by Ministry of Health
Midwives play a crucial role in maternal and newborn healthcare, varying their responsibilities based on their work environment, whether at commune health stations or hospitals Their primary functions include providing prenatal care and counseling to pregnant women, identifying common physiological disorders, and developing individualized care plans During childbirth, midwives monitor the process closely, detecting early complications and abnormal signs to mitigate risks of medical accidents or fatalities Collaboration with doctors is essential, especially in complex cases, to enhance healthcare services, guide pregnant women, diagnose abnormalities, and care for newborns during hospitalization.
The European Commission's backing for this publication does not imply endorsement of its content, which solely represents the authors' opinions Consequently, the Commission is not liable for any potential use of the information presented.
In areas with limited access to doctors, healthcare providers can perform essential obstetric procedures, including regulating menstruation, fitting contraceptive devices, and examining gynecological inflammation, highlighting their crucial role in women's health.
2 The gap in the current training program
The quality of midwifery is influenced by various factors, with training being the most crucial The Ministry of Health has established standard capacities for this sector, yet the criteria for training health human resources remain inadequate Additionally, the scale of training does not align with actual demand, resulting in inconsistent training quality Furthermore, there is a disconnect between professional capabilities and job positions, along with a lack of clearly defined qualifications.
The training period for midwives currently ranges from 2 to 4 years, followed by 9 months of practical experience, after which they receive a lifetime practice certificate as per Clause 3, Article 16 of Circular 41/2011/TT-BY, without the need for examinations However, there is minimal communication between training institutions and human resources units regarding personal needs, necessary equipment, and additional information required in this sector.
In addition to fundamental subjects, the training program for midwives includes foreign languages and information technology; however, there remains a significant gap in communication and informatics skills among professionals in the midwifery sector Many midwives are not meeting the necessary standards for foreign language proficiency and informatics, highlighting the need for improved training in these areas.
Knowledge of basic medical subjects: almost is only theory, there is no link between theoretical learning and clinical application
Specialization in Midwifery offers limited opportunities for practical experience in skill rooms, hospitals, and community settings Additionally, there is a lack of emphasis on communication courses, which are essential for effective practice in this field.
3 The gap in the midwife industry today
In fact, the current demand in our country shows that the midwifery sector in recent years is suffering from a serious shortage in both human resources and quality Specifically:
A study titled "World Maternity Status 2014" reveals a critical situation in 73 countries across Africa, Asia, and Latin America, where 96% of global maternal deaths and 93% of neonatal deaths occur The report highlights a significant shortage of midwives in these regions, contributing to the high rates of obstetric complications and maternal mortality.
In Vietnam, the midwifery rate is notably low, with only 3.5 midwives per 10,000 people Approximately 5% of commune health stations, equivalent to 517 communes, lack midwifery services Furthermore, around 17% of women, primarily in remote and inaccessible regions, do not have access to essential reproductive health services, as reported by the Ministry of Health.
However, there are still large differences in service quality between the plain and mountainous areas - the cause of higher maternal mortality rates in remote and ethnic minority areas
The European Commission's backing of this publication does not imply endorsement of its contents, which solely represent the authors' perspectives Consequently, the Commission is not liable for any potential use of the information provided.
Many midwives have become disconnected from current knowledge regarding human body structure and function, particularly in relation to reproductive systems in both normal and pathological states Their education primarily occurs during university, and once they enter the workforce, opportunities for ongoing training and updates are severely limited Even those midwives who work until retirement often do not participate in any further educational courses, relying instead on their past experiences This lack of continuous learning can be attributed to various factors, including reluctance to pursue updates, fear of change, or insufficient staffing that prevents them from attending training sessions.
- Knowledge of social sciences to care for mothers and children which is suitable for culture and physiology is still limited
- The learning environment of clinical skills has not yet met the needs of learning and working There are not enough spaces, skills training, models to implement sample skills
Effective communication skills among midwives, particularly in their interactions with colleagues, mothers, children, and families during reproductive health care, remain inadequate This deficiency often leads to lawsuits and negative feedback from patients and family members, primarily stemming from the attitudes of medical staff A study by Le Thu Thuy in 2018 highlighted that 43.89% of patients reported a lack of attentive and thoughtful care, while 42.8% felt that their concerns were not adequately explained Consequently, there is a pressing need for basic training in the code of conduct and ethical standards for midwives to enhance their professional interactions.
The assessment, planning, implementation, and evaluation of women's and children's health care remain inadequate, lacking effective problem-solving skills and systematic thinking in practice Currently, lessons are primarily drawn from specific cases post-incident, rather than proactive measures Additionally, the family planning examination and counseling skills of community health workers, including midwives, are substandard and require significant improvement, as highlighted in project VIE/027.
