National continuous professional development processes and systems for midwifery educators in low-and-middle-income-countries: a systematic review

Abstract Background Strengthening the capacity of midwifery educators through continuous professional development (CPD) is a critical component of improving quality midwifery care provision and thus reducing maternal and newborn mortality. Variation in the quality and standards of midwifery educator training, scope of practice, weak regulation, and lack of opportunities for educators to update their knowledge or skills competencies are known barriers to midwifery educator development in low- and middle-income countries (LMICs). Most CPD programmes specific for midwifery educators have been implemented in high income settings and little is known about the availability, content and effectiveness of such programmes in LMICs that experience the greatest burden of maternal and newborn mortality and mobidity. This review appraises the current approaches, content and effectiveness of midwifery educator CPD programmes in LMICs. Methods An in-depth literature search across five databases was undertaken between 2000–2021. Quality appraisal based on internal and external validity was conducted and a combined numerical summary and categorical description were undertaken. 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 focused on midwifery educator development initiatives. All the studies included were of good quality. Main CPD approaches identified was twinning (international collaborations employing the train-the-trainer approach). Others were greenfield, directed by regulators and formal program guided by an international midwifery/medical body. No formal CPD program managed by a national nursing/midwifery regulator or international midwifery body was identified. Content covered included: educational approaches in curriculum design and teaching; research; leadership and management in health; and project management & evaluation. Immediate outputs and outcomes of these programmes contributed to personal/professional development/promotions, institutional improvements in midwifery teaching and learning, and maternal newborn health systems. Few studies measured effectiveness of the CPD programmes. Conclusion There is low evidence of midwifery educator specific CPD programmes to maintain competence in LMICs. There is need for clear guidance from national regulatory bodies to inform the design of regulator accredited midwifery educator CPD programmes at country level. Robust evaluation of existing CPD programmes to measure effectiveness/impact is required.