SMS with the Bill and Melinda Gates Foundation


Strengthening Midwifery Services with the Bill and Melinda Gates Foundation 

There is a high incidence of maternal and new born mortality in low- or middle-income countries. A key factor is that women/girls do not have access to competent midwives, and fully functional Sexual, Reproductive, Maternal and Newborn Health (SNRMH) services. Experts have calculated that a skilled midwifery workforce would prevent close to two-thirds of all maternal and newborn deaths.

Midwife-led services are, by far, the best value option for delivering high quality maternal and newborn care. However, lack of understanding about the role midwives can play in meeting the needs of women and newborns and perceptions about midwifery as a low-skilled profession have resulted in low or no financial and political investment in education, regulation, and recognition of midwives in low- and middle-income countries. Little practical guidance has emerged to help these countries tackle these barriers and invest in midwives and midwife-led services.


Project Description:

The Strengthening Midwifery Services (SMS) project, funded by the Bill and Melinda Gates Foundation (BMGF) over 2018-20, focuses on:

  • Building national midwives associations’ capacity: e., to advocate for and deliver high quality midwife-led services and to help MAs to be better equipped to manage the day-to-day operations of the Association.
  • Reviewing and revising the Midwifery Services Framework (MSF): a tool to support the development and strengthening of midwife-led services across countries, based on the lessons learned from the 6-country pilot in 2015-17,
  • Testing the revised MSF in three new countries,
  • Implementing and evaluating the Midwifery Education Accreditation Program (MEAP) - a mechanism to accredit pre-service midwifery education programmes against the ICM global standards for midwifery education, with three new midwifery education program providers,
  • Helping to define the characteristics of the Midwifery Education Development Pathway (MEDPath) in order to assist education program providers which are not yet able to meet the ICM global education standards to increase their capacity to meet ICM standards,
  • Translating and disseminating the Essential Competencies for Basic Midwifery Practice developed in the first Gates project, and
  • Developing a global standard for assessing midwifery competencies.

Taken as a whole, the ICM believes this project will serve not only to save the lives of mothers and babies but will also help to professionalise midwives globally.


Four main components of SMS

The SMS project is a core project of the ICM with four main components. The Midwifery Services Framework (MSF) is a framework for integration of midwife led services into national health planning systems. It does so by improving the capacity of MAs (second component) and bringing the MA and ministries of health into a joint process to integrate midwife led services into the health planning system.

This is supported through a third component of the project, the Midwifery Education Assessment Programme (MEAP). The intent here is to assess the quality of training received by midwives thereby identifying areas for improvement of training for high quality services - without well trained midwives, the MSF cannot be fully implemented.

A fourth, but smaller focus of the project, is on promoting midwives' competencies. Promoting midwives' competencies is an ongoing process for ensuring high quality services through the promotion of good practices. 

Each of these components is in itself essential, but it is by combining these components that we begin to strengthen the quality of service and, over time, a reduction in maternal and neonatal mortality and morbidity. The graphic below shows inter-relationships between the above interventions and how the SMS Project will help ICM to improve maternal and neonatal health.




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