Midwifery Education Program in Nepal: Recommence in the Tribhuvan University

In Nepal, there are large of number of nursing, medical and health science colleges from where large number of different types and level of health professionals are producing every year. Every year almost 1000 doctors, 5000 nurses and more than 6000 paramedics and allied health workers are graduating in the country. However, even in this 21th century still there is no separate education program from where professional midwife can be produced or trained. 

A midwife is a health professional considered expert in caring and assisting women during their normal pregnancies and childbirths. They provide care to childbearing women respecting their rights in a humanistic manner taking into consideration of social-cultural aspects of a woman.

However, in Nepal nurses involve in providing maternity care. In their nursing pre-service training midwifery subjects have been incorporated because of this they are able to provide both nursing and midwifery care to the needy clients. There are mainly three types of pre-service nursing training provision in the country, namely Auxillary Nurse-Midwives-18 month course after grade 10, Diploma in Nursing (Proficiency Certificate level in Nursing)-3 years course after grade 10, and Bachelor of Nursing-4 years course after grade 12. 

The Diploma in Nursing and Auxiliary Nurse-Midwives courses are mainly provide by the Council for Technical Education and Vocational Training (CTEVT). CTEVT provides affiliation to private colleges to run these programs thus quality of the graduates are not satisfactory. They don't have adequate clinical placements because of the limited case-load in the clinical sites. On the other hand, the universities provide Post Basic Bachelor of Nursing (after diploma in nursing) 2 years course and Bachelor in Science in Nursing-4 years (direct entry after grade 12) and Master of Nursing-2 years courses. But these programs are under the faculty of medicine. In Nepal, there is no separate faculty of nursing in the universities.

Only two universities, namely BP Koirala Institute of Health Sciences (deemed university), Dharan and Tribhuvan University provide Master of Nuring Program whereas Bachelor level nursing programs are provides by six universities. These include BP Koirala Institute of Health Sciences, Tribhuvan University, National Academy of Medical Sciences (deemed university), Kathmandu University, Purbaanchal University and Pokhara University. Purbaanchal University provides affiliation to private colleges to run their programs (Bachelor programs) so they are compromising in the quality of nursing education and graduates' future.

In 1976, a year Diploma in post basic midwifery programme was started at Mahaboudha Nursing Campus (currently known as Maharajgunj Nursing Campus, Tribhuvan University) with 10 students. But at that time this course was not recognized by Tribhuvan University as a certifying course for the bachelor level (undergraduate). Therefore, in 1978, a two year Bachelor of Nursing specializing in Midwifery Program was started with the support of the World Health Organization midwife consultants and 20 students were enrolled. The first batch graduates who did one year midwifery program in 1976 were also advised to join the program to recognise them as a bachelor's level. So, there were total 30 students. However, only 25 of them had completed the course.  Unfortunately, after producing two batches of nurses specialising in Midwifery this program had be closed down due to the unavailability of competent midwifery faculty members including other reasons. 

The Nepal Nursing Council stipulates the norms for number of faculty at each level based on student intake, and the colleges/universities need to be recognised by the Nepal Nursing Council and the affiliated colleges/ campuses need to fulfil the stipulated requirements. However, midwifery education and services related rules and regulations yet to be formulated and incorporated in the Nepal Nursing Council Act. In Nepal, almost all the nursing colleges/campuses are managed by the nurses. This gives autonomy to nursing faculty to design and implement the curriculum. However, quality of nursing educations (especially Auxiliary Nurse-Midwives, diploma in nursing and post- basic bachelor in nursing) has been criticised heavily by other health professionals mainly by medical and public health professionals. There is still vast work needs to be done to improve the quality of nursing education in Nepal. Since there is no separate program to produce a professional midwife therefore, is no separate cadre of midwifery workforce in the country, who can provide leadership in the midwifery field. Thus, country is facing challenges in achieving millennium development goal 4 and 5. Nurses working in the maternity and birthing units are generally called nurse-midwives.

The government of Nepal in the National Policy for Skilled Birth Attendants developed in 2006 acknowledged the need of producing a separate cadre of Professional Midwife to provide leadership for safe motherhood program. In line with this, Tribhuvan University is going to recommence the Bachelor of Nursing Program specialisation in Midwifery with 3 years duration from this year intake possibly in November if academic council of the university approves the curriculum. It is a great pleasure knowing about this from an Associate Professor Kiran Bajrachara at Maharajgunj Nursing Campus, Tribhuvan University, who also happened to be a President of Midwifery Society of Nepal. According to her right now group of five faculty members from the University are working in a speed to finalise it incorporating midwifery contents and competencies based on the International Confederation of Midwives’ global standard for Midwifery Education Program in the existing two years bachelor of nursing course.