"How are you going to remove that cobweb?" Midwifery Services Framework implementation in Zambia: A case study

Area of Science:

• Global Health
• Health Systems Strengthening
• Midwifery Education

Background:

• The International Confederation of Midwives (ICM) developed the Midwifery Services Framework (MSF) as an evidence-based strategy.
• The MSF aims to improve sexual, reproductive, maternal, and newborn health by strengthening the midwifery workforce.
• The updated MSF was implemented in Zambia between 2020 and 2023.

Purpose of the Study:

• To examine the process of implementing the MSF in Zambia.
• To understand the perspectives of stakeholders involved in the MSF implementation.
• To identify factors contributing to the success of the MSF implementation.

Main Methods:

• A qualitative approach using Appreciative Inquiry was employed.
• Semi-structured interviews were conducted with nine key stakeholders.
• Content analysis was performed on the collected data, guided by a process evaluation framework.

Main Results:

• MSF implementation positively impacted policy and health systems in Zambia.
• Success factors included political will, alignment with national plans, stakeholder engagement, and local ownership.
• Areas for improvement involved broader stakeholder engagement, enhanced understanding of concepts, and stronger data systems.

Conclusions:

• Future MSF implementation and midwifery workforce initiatives should incorporate identified success factors.
• Intentional design and integration of these factors from the outset are crucial for maximizing impact.
• Lessons learned in Zambia offer valuable insights for global health programming.