National continuous professional development programmes for midwifery educators and their effectiveness in low-and-middle-income-countries: a systematic review

BACKGROUND: Continuous professional development (CPD) for midwifery educators is essential. It strengthens their competencies, improves the quality of midwifery care, and ultimately helps reduce maternal and newborn mortality. Lack of midwifery education CPD standards and limited opportunities for educators to maintain/update their competencies are barriers to midwifery educator development. Limited information exists regarding CPD programs specifically designed for midwifery educators in LMICs, where maternal and newborn mortality and morbidity rates are highest. Consequently, their availability, content, and effectiveness largely remain unknown. This review appraises the current approaches, content and effectiveness of midwifery educator CPD programmes in LMICs. 

METHODS: Researchers undertook an in-depth literature search across five electronic databases covering 2000-2021. A quality appraisal, informed by internal and external validity, included a combined numerical summary and categorical description. A narrative synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting. The protocol was registered in PROSPERO (CRD42021283273). 

RESULTS: Twenty-two papers met inclusion criteria although many did not report on CPD directly but on midwifery educator development initiatives. All studies included were of good quality. The main CPD approach applied was twinning (international partnerships) with minimal involvement from national midwifery regulatory bodies. Content primarily covered curriculum design; teaching methodologies; clinical life-saving skills; research; leadership and management in health. However, there was less focus on student assessment, effective feedback, supervision/mentoring in clinical practice, and digital technology integration. Few studies measured effectiveness of the CPD programmes and relied on qualitative and self-reported measures. Programmes contributed to educators' personal/professional development (advanced academic qualifications, research scholarship, and career progression) and institutional improvements (curriculum reforms and new teaching approaches applied in midwifery education). Evidence on the direct impact of these programs on student learning and MNH outcomes was limited. 

CONCLUSION: There is low evidence of midwifery educator specific CPD programmes that have been designed/evaluated in LMICs. National midwifery regulatory bodies need to provide clearer guidance and have greater involvement in the design of accredited CPD programmes for midwifery educators. Evaluation of existing CPD programmes using robust experimental designs to measure effect on MNH outcomes is required.