Improving the Quality of Midwifery Education in Kenya

Kim Ozano: 00:00:04

Hello and welcome to our short mini-series focused on sharing lessons learned from the programme

Kim Ozano: 00:00:12

This is a UK funded programme by the Foreign Commonwealth and Development Office (FCDO), and is

Kim Ozano: 00:00:20

In each of the episodes, we have been discussing different ways that the programme has strengthened the capacities

Kim Ozano: 00:00:32

This episode is the third of four and is focused on improving the quality of midwifery education in Kenya,

Kim Ozano: 00:00:45

Evidence has suggested that if universal health coverage of midwifery delivered interventions was achieved, we could

Kim Ozano: 00:00:57

We know that globally nurses and midwives are really the leading providers of assistance during childbirth,

Kim Ozano: 00:01:10

We will be speaking with guests today to find out what is being done in Kenya to improve such education.

Kim Ozano: 00:01:16

We have Dr.

Kim Ozano: 00:01:17

Kelly Oluoch, who is the Chief Executive Officer of the Kenya Medical Training College, together with Benson

Kim Ozano: 00:01:29

We also have with us Edna Tellum, who is the Chief Executive Officer at the Nursing College of Kenya.

Kim Ozano: 00:01:36

So welcome to our guests.

Kim Ozano: 00:01:38

We have the pleasure of having our co-host, Lucy Nyaga, who is going to help us through the questions and the learning from the programme.

Kim Ozano: 00:01:46

She is the country director of the Liverpool School of Tropical Medicine in Kenya and is a medical anthropologist by background,

Kim Ozano: 00:01:57

So Lucy, ideally, midwives and nurses, when they are educated to a very good level, can deliver 90% of reproductive, maternal,

Kim Ozano: 00:02:08

However, I believe the training at the moment in some lower middle income countries, including Kenya, is suboptimal.

Kim Ozano: 00:02:15

Why don't you tell us a little bit about why this is the case and what does this mean for mothers and children before we

Lucy Nyaga: 00:02:24

Kim, thank you for that introduction.

Lucy Nyaga: 00:02:26

The key reason why we did this intervention of enhancing the skills of midwifery is because current curriculum for lower and middle income

Lucy Nyaga: 00:02:40

The educators that we targeted, we wanted to increase their confidence in terms of delivering clinical teaching

Lucy Nyaga: 00:02:53

You need to have this continuous professional education so that we can keep improving the skills of midwives, nurses, and in fact doctors

Lucy Nyaga: 00:03:04

So basically the programme that we implemented together with the National Ministry, the Nursing Council, the

Lucy Nyaga: 00:03:18

That is broadly what we can do and is what we are going be talking about, the programme that we implemented.

Lucy Nyaga: 00:03:24

Now, we'd like to hear from our guests; Edna Tallam, the Chief Executive Officer of Nursing Council of Kenya.

Lucy Nyaga: 00:03:31

Edna, how did your institution address the gap of below shortage in training in midwifery through the programme that we implemented

Edna Tallam: 00:03:41

Thank you so much and I'll say that it's great that the Nursing Council of Kenya participated in this project.

Edna Tallam: 00:03:47

The council regulates both nursing education and practice and in that regards, they need to be able to monitor the competencies for the

Edna Tallam: 00:04:03

So in regard to this project, the council of course, together with all the stakeholders, with a gap analysis, which had been

Edna Tallam: 00:04:37

So the syllabus is a guidance for the training institution to ensure that they review their curriculum and enhance

Edna Tallam: 00:04:47

The other issue again was in regards of ensuring, yes, we've reviewed the syllabus, but then we need to disseminate to

Edna Tallam: 00:05:11

And this is where then we went ahead and, uh, worked with the training institutions to ensure that the lecturers who will be able

Lucy Nyaga: 00:05:28

Thank you very much Edna for that so basically, the Nursing Council of Kenya supported the syllabus, uh, review

Kelly Oluoch: 00:05:41

Kenya Medical Training College is, uh, the training arm of the Ministry of Health.

Kelly Oluoch: 00:05:45

We have 72 campuses and, uh, we have over 54,000 students.

Kelly Oluoch: 00:05:51

One of the major courses that is being conducted at Kenya Medical Training College is nursing.

Kelly Oluoch: 00:05:57

The vision of the institution is to train competent health professionals and, uh, do consultancy and research.

Kelly Oluoch: 00:06:05

There are various aspects and I will talk about development of curricula, training of lecturers, mentorship programmes,

Kelly Oluoch: 00:06:19

The LSTM programme has enabled KMTC to update its curricular in nursing, midwifery, and clinical medicine in relation

Kelly Oluoch: 00:06:34

We have had the benefit of having 40 of our campuses being equipped with emergency obstetrics and new newborn

Kelly Oluoch: 00:06:48

Again, this training has been very key in terms of ensuring that 233 nursing midwifery and clinical medicine lecturers are trained and

Kelly Oluoch: 00:07:10

This has also been done online and hence making it possible to all lecturers to access this kind of training.

Kelly Oluoch: 00:07:19

This programme has been very key in terms of training and follow up mentoring of midwifery educators in the 20 KMTC

Kelly Oluoch: 00:07:35

Now, the preliminary results of this study show improved knowledge and skills of tutors to teach

Kelly Oluoch: 00:07:47

This programme has been very key in developing a blended midwifery educator CPD programme that is continuous professional

Kelly Oluoch: 00:08:00

This is now ready for piloting in Kenya and if possible, in Nigeria.

Kelly Oluoch: 00:08:05

Finally, KMTC is also mandated to research and so much research is being done.

Kelly Oluoch: 00:08:11

KMTC has participated in implementation of research findings for sustainable impact.

Lucy Nyaga: 00:08:18

Dr.

Lucy Nyaga: 00:08:18

Olouch Tell us how, the interventions that you've done, could or have, contributed to improving the life of a mother and a child.

Kelly Oluoch: 00:08:25

The role of this institution is to provide human resources for health, which is one of the key pillars

Kelly Oluoch: 00:08:43

It has reduced maternal, newborn and child mortality because now our trained health workers who have come through this

Kelly Oluoch: 00:09:04

So this programme has helped us to equip our health workers with skills, knowledge, and competencies

Lucy Nyaga: 00:09:14

Benson, we come from a university setting, tell us how this has trained them and then how this has

Benson Milimo: 00:09:23

Allow me to mention three things that the LSTM through this programme has contributed at university level.

Benson Milimo: 00:09:31

It touches on three main areas, which is capacity building, curriculum support, and lastly about equipment.

Benson Milimo: 00:09:38

First of all, we appreciate the gap that was identified by LSTM and that is whereby the skills were a bit inadequate

Benson Milimo: 00:09:52

Within our training, we have been equipped as a lecturer to be able to support the students during training with EmONC skills and therefore,

Benson Milimo: 00:10:12

Mostly, most institutions at university level have put these skills, in the fourth year.

Benson Milimo: 00:10:19

That is just preceding graduation, therefore, we are sure of competent and skilled midwives who are getting into the field.

Benson Milimo: 00:10:27

We also have the aspect of curriculum support, which is part of what I've just talked in terms of

Benson Milimo: 00:10:37

Nursing Council of Kenya is our regulator in terms of training.

Benson Milimo: 00:10:43

So once, uh, nursing council came up with a syllabus of midwifery, which incorporates, emergency and obstetric and

Benson Milimo: 00:10:55

So as an institution, we picked up that syllabus and at the moment we included in the Bachelor of Science in nursing training.

Benson Milimo: 00:11:05

The curriculum is in progress almost at advanced level, but we have some institutions, universities in Kenya, who have

Benson Milimo: 00:11:16

This line of thought was highly driven by LSTM involvement encouraging the skills for midwives.

Benson Milimo: 00:11:25

Some in universities in Kenya have now established a Master of Sciences in midwifery specifically, so that

Benson Milimo: 00:11:42

I know MOI University has also has a master's curriculum specifically in midwifery which is advancing, and in that line

Benson Milimo: 00:12:00

Lastly, to add is that the equipment support of the skills lab has also been highly facilitated by the LSTM and other

Lucy Nyaga: 00:12:12

Thank you very much Benson.

Lucy Nyaga: 00:12:13

For me, what I feel it was a programme that has had spiral effect in terms of, not just very focused on one aspect, but

Lucy Nyaga: 00:12:38

I would like to then come back in terms of the best practice from these programmes.

Lucy Nyaga: 00:12:42

What would you say are the best practices that we can take forward from implementing the programme on

Edna Tallam: 00:12:51

The best practice that I have seen is the continuous assessment, the monitoring that, we have experienced with our partner.

Edna Tallam: 00:12:59

We have also seen the provision of the equipment and the skills, so that has helped the skill transfer from the lecturers to the students.

Edna Tallam: 00:13:08

We started with the training of the lecturers, which has been very good, and they're able to transfer the skills to the students.

Edna Tallam: 00:13:16

And that has also translated to the good care of the patient wherever they have been.

Edna Tallam: 00:13:21

So we've got a very good results and the information about how our students are doing.

Edna Tallam: 00:13:26

So that's one thing, and also, I realised there was that cross monitoring of the lecturers.

Edna Tallam: 00:13:33

The good interaction and communication that has been there has also been very good.

Edna Tallam: 00:13:38

That is some that I wish any other person would carry forward whenever they are helping another institution.

Lucy Nyaga: 00:13:46

Just a follow on quickly because I think eventually, when we train and you've given us, you know, a sentence that

Lucy Nyaga: 00:14:08

Do you have some suggestions on how this can be truly, truly associated with the programme?

Edna Tallam: 00:14:13

I think we could also kind do a survey or a research checking on where we have posted those people who have gone through

Edna Tallam: 00:14:23

So now we can be able to tell have they been able to translate what they learned to the community.

Edna Tallam: 00:14:29

The feedback would get from there I think would be very helpful if you could be able to follow them up to their working areas.

Edna Tallam: 00:14:36

I also would, wish, I dunno whether it is also part of the, the project that the environment should also be very conducive because if

Edna Tallam: 00:14:57

So the support also should go to the places where they're working.

Lucy Nyaga: 00:15:02

What I hear you saying, you know, it's just not one, it's not one aspect.

Lucy Nyaga: 00:15:06

We have to look at things wholesomely.

Lucy Nyaga: 00:15:08

We could have very well trained midwives and nurses out there, but if the other health building blocks are not in

Lucy Nyaga: 00:15:17

I think lobbying others stakeholders to also input so that the training translates into real life impact.

Edna Tallam: 00:15:24

You see this, uh, project was a collaboration between the policymakers, Ministry of Health, the educators.

Edna Tallam: 00:15:30

We've seen our two colleagues here, the regulators, and we have generated evidence-based researchers, which will be able to

Edna Tallam: 00:15:41

Going forward and replicating is ensuring that we need to bring all the policy makers on the round table, design the project,

Edna Tallam: 00:15:53

Also pride on the little lessons that we've done, the outcomes of the project and continuously monitor for the sustainability to achieve

Lucy Nyaga: 00:16:13

Dr.

Lucy Nyaga: 00:16:13

Olouch what would you say are the key best practices that other medical training institutions across lower and

Kelly Oluoch: 00:16:22

The best practices that we have identified from this programme is number one; regular update of curricula.

Kelly Oluoch: 00:16:30

That curricula should reflect the reality of practice that curricula should enable us to offer solutions to emerging issues in practice.

Kelly Oluoch: 00:16:42

The second issue that I think is a best practice is the issue of training mentors.

Kelly Oluoch: 00:16:49

Mentorship training is very key in practice so that, uh, as we continue offering services, we have mentors

Kelly Oluoch: 00:17:02

The other issue that I can say is the best practice is continuous professional development, that all professionals

Kelly Oluoch: 00:17:19

Finally, research.

Kelly Oluoch: 00:17:21

That one of the best practices is to advance knowledge and develop knowledge that influences practice and influences policy.

Kelly Oluoch: 00:17:33

Through this programme, we've been able to practice research, be able to generate knowledge, be able

Kelly Oluoch: 00:17:43

Thank you so much.

Lucy Nyaga: 00:17:45

Thank you, Dr.

Lucy Nyaga: 00:17:46

Oluoch.

Lucy Nyaga: 00:17:46

I would like to hand over back to Kim.

Kim Ozano: 00:17:48

This has been a very interesting conversation and so much has been done in the programme.

Kim Ozano: 00:17:54

Lucy, I would like to hear from you a little bit on how the programme has gone from your perspective and any advice that you would

Lucy Nyaga: 00:18:05

From LSTM perspective, we actually have achieved more than we really actually imagined that we could achieve and have

Lucy Nyaga: 00:18:24

This is very cost effective, time effective, and it'll be able to, uh, increase, uh, the number of competent midwives and nurses

Lucy Nyaga: 00:18:45

So thank you very much to our colleagues that we've been able to work with.

Lucy Nyaga: 00:18:49

I guess from where we are now, although the programme is coming to an end, what has been achieved is just for institutions to carry forward.

Lucy Nyaga: 00:18:57

So it has been institutionalised and we are happy that this will go forward.

Lucy Nyaga: 00:19:00

Thank you, Kim.

Kim Ozano: 00:19:01

Thank you, Lucy.

Kim Ozano: 00:19:02

I just have one final question for Edna.

Kim Ozano: 00:19:04

Edna, one of the things we heard at the beginning of this episode is a need to increase the confidence

Kim Ozano: 00:19:13

Is there any evidence that confidence is increased and that they feel better able to deliver quality services?

Edna Tallam: 00:19:19

Yes, indeed.

Edna Tallam: 00:19:20

Uh, we need to be able to increase confidence, and confidence comes once we are able to enhance their competence.

Edna Tallam: 00:19:27

At the moment we are undertaking the monitoring and evaluation in the information of the curriculum and perhaps now as

Edna Tallam: 00:19:47

There'll be confidence to ensure that they collaborate with the other clinicians, including obstetricians.

Edna Tallam: 00:19:53

So this is an ongoing work but in regards of the confidence of the learners of, and also the confidence for the lecturers, yes,

Kim Ozano: 00:20:12

That's great.

Kim Ozano: 00:20:13

So it sounds like across all the programmes, there's been not just a focus on the technical aspect, but those soft

Edna Tallam: 00:20:25

That's correct.

Edna Tallam: 00:20:26

In regards of the overview of the syllabus, apart from the technical.

Edna Tallam: 00:20:29

Note that we have the general competencies as prescribed by National Confederation of the Midwives,

Edna Tallam: 00:20:38

It talks about the autonomy for the practice, the policies and that, that has still been enhanced within the syllabus, because it'll go

Kim Ozano: 00:21:15

Benson, you're coming from a university perspective there, have you changed the mechanisms

Benson Milimo: 00:21:23

We have actually improved, our approaches in teaching based on the outcomes of collaboration and this

Benson Milimo: 00:21:45

So that is one of the greatest approach that has improved after this collaboration.

Kim Ozano: 00:21:50

Thank you very much.

Kim Ozano: 00:21:51

So, much more practical aspects there.

Kim Ozano: 00:21:53

So it's great to hear.

Kim Ozano: 00:21:54

Thank you so much for this conversation.

Kim Ozano: 00:21:56

Thank you to Lucy, who's been a wonderful co-host and also to all of our guests for really sharing the immense amount of work