Although the World Health Organization (WHO) recommends one midwife for every 5,000 people, Madagascar has only one midwife per 16,000 people. In addition, the quality of midwifery graduates from public and private training institutes remains an issue due to unsatisfactory quality of instruction by teachers, supervisors, and instructors.
Several recent reforms aimed at improving the quality of midwifery have been implemented with a focus on pre-service midwifery education, including raising the minimum recruitment level of students from the secondary school diploma level to a bachelor’s degree, including midwifery in the license master doctorate system, and requiring that students pass a national test to enter public service.
A baseline assessment conducted by MCSP in 2014 revealed gaps in the availability and functional capacity of midwifery pre-service education (PSE) institutions. An International Confederation of Midwives (ICM) assessment conducted in 2016 on midwifery education showed some shortcomings related to the four essential midwifery functions related to pre-pregnancy and antenatal care, labor and birth, and ongoing care for women and newborns.