About Developing Midwives Project (DMP)

AN OVERVIEW: 

Over the years, there has been gradual reduction of maternal deaths nationwide. However, with maternal mortality rate reducing by 12.5% between 2010 and 2016 (BMMS, 2016), the country still loses 14 mothers a day due to delivery complications; complications in the post-partum period; delivery by unskilled home birth attendants; and, lack of appropriate care by a skilled provider, for obstetric complications.

Bangladesh has made a commitment to end preventable child and maternal deaths by 2030 to achieve the goals of Sustainable Development. For reaching the goal the healthcare planners have prioritized antenatal and postnatal care, normal vaginal delivery, emergency obstetric care and new born care which directly links to quality maternal health services. Given the large number of maternity cases in Bangladesh, the country demands a huge supply of midwives to ensure healthy pregnancy for women and newborn. An estimated 22000 midwives will be required to meet the national need.

  Bannernov16

The Prime Minister of Bangladesh committed at the UN General Assembly Special Session in September 2010 to train 3000 midwives at the first go. To fulfill the commitment of the Honorable Prime Minister and with the purpose of developing a cadre of competent and compassionate midwives, in January 2012, a three-year Diploma in Midwifery Program was introduced by the Government of Bangladesh (GoB). 

The plan for professional development of midwives is also the result of years of collaboration and relationship building among stakeholders such as the government, non-government organizations, donors, academia, professional associations, United Nations Agencies and donors.
Forty-one Government Midwifery Institutes are offering a three-year Diploma in Midwifery Programme since 2012. Every year huge number of students are being enrolled in the course and more in the waiting list. Simultaneously, midwifery education has also been expanded by the 41 private institutes. The most significant private sector initiative has been from BRAC University which introduced the Diploma in Midwifery side by side with government. This innovative educational initiative, which is co-funded by the UK government and BRAC, is the first of its kind in the private sector of Bangladesh.

Apart from Diploma in Midwifery, if BSc in Midwifery in the private sector starts, it is expected that increasing numbers of graduates will accelerate reaching the national target, the rate of institutional deliveries to 85 percent from 47.1 percent and deliveries by skilled midwives to 90 percent from 50 percent 2030. At the same time it also expected that, despite the fact, almost 14 mothers die every day due to complications during pregnancy such as haemorrhage, eclampsia and obstructed or delayed deliveries, country would be able to ensure quality health services to pregnant women and mothers in near future.

BACKGROUND:

The Government of Bangladesh is taking the lead to set standards in midwifery education and regulation and has created posts for midwives in public facilities. It also has invested tremendously in faculty development to bring midwifery in Bangladesh towards and academic level, based on international standards. Bachelor in Midwifery graduates will be positioned to practice autonomously in midwife-led centers providing evidence-based, respectful woman-centered care and will be involved in practical and theoretical education of the Diploma midwifery programme meeting the strong need to expand the midwifery faculty in Bangladesh. In the future, a Bachelor degree will be the basic entry-level into the profession, following other countries in the region and internationally.
BRAC University, through its organizational structure and core competencies has joined hands with the Government of Bangladesh and followed its set standards to create Diploma midwives since 2012. Of 602 graduates today, 161 have already been absorbed by the public sector, there is a strong need to continue with its efforts educating midwives on Diploma level to meet the need of women and newborns to receive quality care. Another 164 BRACU midwifery graduates are serving in Rohingya Refugee camps meeting the maternal healthcare needs of a vulnerable population.
By 2021, the Government of Bangladesh has projected the need for about 20,000 full-time equivalent skilled birth attendants, ideally midwives, to reach universal health coverage of 95%. This could avert thousands of additional maternal, neonatal and intrapartum deaths by 2021.

 Midwifery Education

STRATEGY TO SCALE UP THE MIDWIFERY WORKFORCE IN BANGLADESH
The commitment from the Honorable Prime Minister of Bangladesh was a key component of a broader set of actions to provide universal access to maternal, newborn and child health services in Bangladesh to accelerate achievement of the health-related MDGs. To fulfill the Prime Minister’s commitment to educate 3000 midwives by 2015, a draft strategy entitled three thousand midwives by 2015: a strategy to scale-up the midwifery workforce in Bangladesh” was developed by the Ministry of Health and Family Welfare in collaboration with the JPGSPH, BRACU in 2011. The strategy outlined a systemic approach to scaling up midwifery education capacity inclusive of both the public and private sectors and with special attention to the needs of communities in greatest needs. A workshop was convened by the JPGSPH, BRACU in May 2011 and attended by high level officials from the MOHFW including the Honorable Minister and around 100 other stakeholders to discuss the national strategic plan for scaling up the midwifery workforce. There was broad agreement on the importance of the systemic approach to education and the benefits of working with core competencies of midwifery education identified by the International Confederation of Midwives (ICM). In recognition of the need to move forward on multiple fronts, there was an understanding on the benefits of a division of labor among partners according to relative comparative advantages in pursuing specific entry-points or pathways for training.

DEVELOPING MIDWIVES PROJECT 

To develop competent and compassionate midwives, increase their usage particularly in underserved rural and urban areas to reduce maternal and neonatal deaths, also, increase the usage of family planning methods in Bangladesh, BRAC University initiated Developing Midwives Project (DMP-1) in 2012 with funding from the UK Government. 
After completing the first phase in September 2016 DMP has started its second phase from October 2016 which is called DMP-2. The DMP-2 builds upon the achievements of DMP and taking lessons from the implementation of rather ground-breaking DMP, deepens the project design while extending the reach and scope of the project. One of the important departures for DMP-2 (from DMP-1) is that it recognizes the importance of sustainability after 2021. As such a number of elements have been built into it including integrating DMP into the regular program of JPGSPH, BRAC University, offering post basic BSc in Midwifery and charging fee for 70% students and free education for 30% students.
The Diploma in Midwifery Education Programme was approved by the Ministry of Health and Family Welfare (MoH&FW) and accredited by the Bangladesh Nursing and Midwifery Council (BNMC). Since its beginning DMP has focused on strengthening health care system through midwifery services to different communities of Bangladesh. This ‘Diploma in Midwifery’ course, the very first of its kind in private sector of Bangladesh, is working to ensure that mothers could easily avail a respectful maternity care.

DMP IMPLEMENTATION APPROACH

To achieve its objectives the project has adopted an innovative ‘hub and spokes’ model wherein BRACU is the hub and seven Academic Sites serve as the spokes.
BRACU is responsible for overall implementation at these seven academic sites and is accountable to carry out all the three outputs defined in the DMP 2 logical framework. All the seven ASs receive consistent support from Brac U which is considered as hub in terms of quality education, faculty development , procurement of necessary logistics, grants management and timely reporting. Overall BRACU is responsible for:
 Developing agreed number of midwives and contribute to developing national midwifery capacity and their professionalization; and
 Ensuring selection of midwifery students from diverse population, from remote rural areas, distant communities etc.

COMMUNITY ENGAGEMENT-min

HUB SPOKE MODEL

Hub Spoke Model

PARTNERSHIPS

BRAC University has started the DMP in partnership with six non-governmental partner organizations who plays vital role to the project. Alongside there are national partners from government and non-government sectors.
 Ministry of Health and Family Welfare (MoHFW)
 Bangladesh Nursing and Midwifery Council (BNMC)
 Directorate General of Nursing and Midwifery (DGNM)
 Bangladesh Midwifery Society (BMS)
 Obstetrical and Gynaecological Society of Bangladesh (OGSB)
 BRAC
The underserved and hard-to-reach areas with the greatest maternal health needs have been identified based on maternal and neonatal mortality and morbidity data as per the Bangladesh Maternal Mortality and Health Care Survey (BMMS), Bangladesh Demographic and Health Survey (BDHS) and United Nations Development Assistance Framework (UNDAF). Adapted to the specific context and needs of Bangladesh, this programme is being pursued in close collaboration with partners from the state and non-state sectors. JPGSPH, BRACU is collaborating with the Bangladesh Nursing and Midwifery Council (BNMC), which is responsible for accreditation and registration of the midwives as a professional cadre as well as the Ministry of Health and Family Welfare (MOHFW). The programme is also engaging the Bangladesh Midwifery Society (BMS) and the Obstetrical and Gynaecological Society of Bangladesh (OGSB) to establish a strong framework of support for midwives.

 

 group photo-min

Here is the FB page link of Midwifery-

https://www.facebook.com/MidwiferyBracU

BLOG

https://medium.com/@jpgsph.comms/maternity-care-amid-covid19-outbreak-story-of-midwives-in-a-remote-union-health-centre-decbef45ca7f

 

DMP Brochure (PDF

Midwifery in Bangladesh: A brief introduction (PDF)