Measuring the competencies and skills of midwives in an accelerated training program in Zambia

Background: The Zambian Ministry of Health initiated the Direct Entry Midwifery (DEM) program in 2008 to train certified midwives in two years as opposed to the traditional in-service model which takes a minimum of 4 years. Methods: The USAID-funded Zambia Integrated Systems Strengthening Program conducted a quantitative assessment to ascertain the competence levels of certified midwives and provide recommendations for the DEM program. A structured questionnaire was used to interview a representative sample of 98 certified midwives deployed in 65 health centers and hospitals in 43 districts in Zambia. Analysis using cross tabulation in SPSS was conducted. Results: Approximately 88% of the midwives interviewed were female and 51% had worked at their respective health facilities for over 12 months. Around 92% were assigned to the labor ward. Additionally, 42% worked outside their traditional role with 34% of them screening patients in the general out-patient department. Almost all interviewees felt competent to manage all midwifery responsibilities. However, 25% felt they were not competent to treat patients with pneumonia while only 2% felt incompetent to manage patients with malaria; neither were statistically associated with duration of service (X2=61539;2=3.163, p=0.075; X2=61539;2=0.002, p=0.962 respectively). Conclusions: The assessment showed that the certified midwives felt fully competent to provide midwifery services but have limited skills in providing additional general medical services. There is need to review placement of certified midwives and their training to ensure competence in managing both non-midwifery and midwifery cases.