1. 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

2. 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

3. 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

4. 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

5. 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

7. 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

8. 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

9. Sudan needs midwives now more than ever….