Sustaining a newly implemented competence-based midwifery programme in Lesotho: Emerging issues

The need to develop midwives who improve maternal and neonatal outcomes underpins decisions to adopt competence-based education models in low- and middle-income countries. Competence-based education means a shift in the training of midwives to include student self-directed performance-oriented training. Sustaining the implementation of a curricular innovation, such as a competence-based curriculum, requires new skills and resources by countries adopting such innovation. The skills and resources needed to sustain such a curricular innovation are influenced by issues that arise during implementation of the curricular innovation. Through structured interviews with stakeholders in midwifery education and document analysis in a small sub-Saharan African country, we reveal emerging issues that threaten the sustainability of a newly implemented competence-based midwifery curriculum. In this article, we argue that monitoring and supporting the implementation of a curricular innovation, is essential in enhancing midwifery education institutions ability to sustain curricular innovation. Regulation through professional bodies and councils enhance institutional, programmatic and classroom accountability.