International maternity care: My work in Somaliland

In 2018, the United Nations Population Fund ranked Somaliland among the highest maternal and infant mortality rates in the world at an estimated 732 out of 100,000 and 137 out of 1000 respectively. Access to maternal health care is low with an estimated 44% of births attended by trained birth attendants. 

My involvement in Somaliland works towards strengthening Sustainable Development Goal 3 targets and I have been privileged to collaboratively work with academics and clinical colleagues based at three leading Universities in Somaliland - Edna Adan, Amoud and the University of Hargesia. Our work focuses on a Prepared-for-Practice (PfP) initiative which comprise of a range of teaching, learning and assessment strategies for pre-qualification nurses and midwives which aims to strengthen and improve health outcomes.

The initiative has prioritised three work streams - undergraduate learning and assessment, including provision of an e-learning Medicine Africa platform, faculty and institutional development, and professional policy and regulation. A significant activity that intersects these work streams is competency-based education and the development of sound curricula mapping which reflect the International Confederation of Midwives (ICM) essential competencies for midwifery practice. I regularly support annual visits to support Objective, Structured, Clinical, Examinations (OSCEs) for nursing and midwifery students studying at both diploma and degree level and this involves evaluating and debriefing with colleagues and students on this competency-based assessment strategy.

In Somaliland there are complexities in supporting a nursing and midwifery workforce that is trained across a range of public and private learning environments and healthcare settings such as remote outreach community and tertiary referral urban settings. Part of the PfP initiative aims to bring healthcare educators and practitioners together at stakeholder conferences and discussion networks. This has enabled the development of a national task force strategy which aims to review issues such as pre-qualification standards, post qualification registration/support and national maternal and newborn policy development.