Rapid assessment of pre-service midwifery education in conflict settings: findings from a cross-sectional study in Nigeria and Somalia.

Background: There is a dearth of evidence on the scale, scope and quality of midwifery education programs in conflict-affected settings. This study sought to assess the extent to which midwifery pre-service education programs meet national and global standards, and to explore how conflict affects pre-service midwifery education in Yobe State Nigeria and the Benadir and Galgaduud regions of Somalia.

Methods: A rapid assessment of midwifery education programs was conducted in the two midwifery education programs in Yobe State, Nigeria and in seven purposively selected programs in Somalia using an adaptation of the Midwifery Education Rapid Assessment Tool. Information was collected through interviews with program leadership, teachers, students, and clinical preceptors during school and clinical practice site visits. Researchers adapted the tool to reflect national and international standards, incorporating supplementary questions to capture considerations specific to conflict-affected contexts. Data were analyzed by program and country using Stata and Excel.

Results: In Nigeria, each school met 17 and 18 standards, respectively, out of 22 across assessment domains (77.3%-81.8%). In contrast, in Somalia, schools met between 6 and 10 standards out of the 18 standards for which data were available (33.3%-55.6%). The biggest gaps in Somalia were in leadership, infrastructure and resources. No schools in either setting had sufficient space or clinical practice sites that met International Confederation of Midwives (ICM) criteria, and only two were led by midwives. In Nigeria, all infrastructure, curriculum and student- and regulatory-related standards examined were met, but gaps were identified in program staffing and preceptor capacity, and support for faculty and clinical practice sites. In both countries, none of the programs met the average number of clinical practice experiences stipulated in the ICM guidelines due to a lack of teaching hospitals. Students in both countries felt safe on campus but did not feel safe traveling to and from the schools and clinical practice sites.

Conclusions: More investment in midwifery education is needed to ensure international standards for quality education are met. Proactive measures are needed to enhance student safety between school and practice settings in conflict-affected settings. By addressing these gaps, we can strive toward improving midwifery education.