Dr. Lamia Eltigani Elfadil Mahmoud National Reproductive Health Director Federal 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 / 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 Supervision support Training Education Access equity Policy, legal regulation Stewardship Funding Image attractiveness Monitoring Evaluation Enabling Environment

What have we done? Adoption of 2 new pathways for midwifery training; 4 yrs BSc curriculum, started on 18 th 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….