Capacity building of skilled birth attendants: A review of pre-service education curricula Adetoro A. Adegoke, RN, RM, RNE, BSc, MSc, PhD (Lecturer in Sexual and Reproductive Health) a,n , Safiyanu Mani, RN, RNE, CHO, ADEM (Provost) b , Aisha Abubakar, RN, RM, RNE, DPH (Midwifery Advisor) c , Nynke van den Broek, MBBS, PhD (Reader) d a Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK b Katsina State College of Health Sciences (COHESKAT), 49, Hassan Usman (WTC) Road, Katsina State, Nigeria c Partnership for Reviving Routine Immunization in Northern Nigeria and Northern States Maternal, Newborn and Child Health Initiative (PRRINN-MNCH), 2 Mallam Bakatsine Street (off Dawaki Road) Nassarawa GRA, Kano, Nigeria d Maternal and Newborn Health Unit, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK article info Article history: Received 22 November 2011 Received in revised form 19 June 2012 Accepted 20 August 2012 Keywords: Midwifery education Maternal mortality Nigeria, skilled birth attendants Skilled birth attendance abstract Objective: to assess the level, type and content of pre-service education curricula of health workers providing maternity services against the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. We reviewed the quality and relevance of pre-service education curricula of four cadres of health-care providers of maternity care in Northern Nigeria. Design and setting: we adapted and used the ICM global standards for Midwifery Education and Essential competencies for midwifery practice to design a framework of criteria against which we assessed curricula for pre-service training. We reviewed the pre-service curricula for Nurses, Midwives, Community Health Extension Workers (CHEW) and Junior Community Health Extension Workers (JCHEW) in three states. Criteria against which the curricula were evaluated include: minimum entry requirement, the length of the programme, theory: practice ratio, curriculum model, minimum number of births conducted during training, clinical experience, competencies, maximum number of students allowable and proportion of Maternal, Newborn and Child Health components (MNCH) as part of the total curriculum. Findings: four pre-service education programmes were reviewed; the 3 year basic midwifery, 3 year basic nursing, 3 year Community Health Extension Worker (CHEW) and 2 year Junior Community Health Extension Worker (JCHEW) programme. Findings showed that, none of these four training curricula met all the standards. The basic midwifery curriculum most closely met the standards and competencies set out. The nursing curriculum showed a strong focus on foundations of nursing practice, theories of nursing, public health and maternal newborn and child health. This includes well-defined modules on family health which are undertaken from the first year to the third year of the programme. The CHEW and JCHEW curricula are currently inadequate with regard to training health-care workers to be skilled birth attendants. Key conclusions: although the midwifery curriculum most closely reflects the ICM global standards for Midwifery Education and Essential competencies for midwifery practice, a revision of the competencies and content is required especially as it relates to the first year of training. There is an urgent need to modify the JCHEW and CHEW curricula by increasing the content and clinical hands-on experience of MNCH components of the curricula. Without effecting these changes, it is doubtful that graduates of the CHEW and JCHEW pro- grammes have the requisite competencies needed to function adequately as skilled birth attendants in Health Centres, PHCs and MCHs, without direct supervision of a midwife or medical doctor with midwifery skills. & 2012 Elsevier Ltd. All rights reserved. Background Complications resulting from pregnancy and childbirth remain the leading cause of disability and death among women of reproductive age. Each year, 358,000 women die during preg- nancy, childbirth and the puerperium. The majority of these deaths (99%; n ¼355,000) occur in developing countries (Hogan et al., 2010; WHO, 2010). About 80% of maternal deaths are due to direct obstetric conditions which are preventable if skilled care is available (Khan et al., 2006). It has been internationally agreed that provision of skilled birth attendance and ensuring availability of Essential (or Emergency) Obstetric Care (EOC) coupled with Newborn Care (NC) are the key strategies that if implemented Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.midw.2012.08.009 n Corresponding author. E-mail addresses: a.a.adegoke@liverpool.ac.uk (A.A. Adegoke), abusufyanmani@yahoo.com (S. Mani), oakaisha@yahoo.com (A. Abubakar), vdbroek@liverpool.ac.uk (N. van den Broek). Midwifery 29 (2013) e64–e72