A collaborative development initiative to strengthen Midwifery Education in Somalia

Galkayo University, in an ongoing partnership with Benadir University and the Karolinska Institutet, reports on the co-creation of a mentorship program for midwifery educators at Galkayo University. This program was initiated in Spring 2023 with the aim of sharing experiences on midwifery education between educators from Sweden and Somalia — both countries with long traditions of midwifery care. By leveraging the expertise of Swedish and Somali midwifery educators, the mentorship program seeks to bridge gaps in knowledge and skills, ultimately contributing to better midwifery education and care in both Somalia and Sweden. This commentary describes the significance of the program and its potential for impact if scaled up after contextualization.


The reasons for collaborative development of a mentorship initiative
Galkayo University is situated in an area with a vulnerable population.Some women are illiterate and lack necessities due to prolonged droughts and widespread poverty [1].Furthermore, access to essential healthcare services is limited.The healthcare services are provided by both the private sector, government, and non-government organizations.Galkayo University, in collaboration with Benadir University, is dedicated to ensuring the wellbeing of women and newborns in the Somali region through the provision of high-quality midwifery education.With hospital facilities available for students' clinical practice and technical support for midwifery students, Galkayo University offers an ideal learning environment for those midwifery students enrolled in the midwifery program, with the potential to deliver quality education.With the intention of delivering quality education, leaders from Galkayo and Benadir Universities proposed a mentorship program at Galkayo University involving Swedish and Somali midwifery educators.To our knowledge, we were not aware of any other ongoing similar project.However, in East Africa other projects have been performed by midwives to improve midwifery education and care [2].

The collaboration, organization, evaluation and contextualization of the mentorship program
As part of a two-and-a-half-year capacity development project titled "Building Capacity for Sustainable Development in Fragile States," funded by the Swedish International Development Cooperation Agency (Sida), two midwifery educators from Galkayo University were enrolled in a capacity-building program for East African leaders [2].The capacity-building program included 5 weeks of leadership training, 5 weeks of training in quality improvement, and 10 weeks of implementing a quality improvement project in midwifery care components at a selected clinical site.In Galkayo, the hospital where the midwifery students completed their clinical placement was chosen for the intervention.The aim of the intervention was to improve the quality of the clinical placement for midwifery students.Simultaneously, the confidence in delivering the midwifery curriculum was enhanced for the two enrolled midwifery educators at Galkayo University.A blended online approach was adopted for this mentorship program, consisting of nine sessions.Two Swedish faculty members from the Karolinska Institutet, along with their two colleagues at Galkayo University, shared experiences and knowledge among themselves during each of the nine mentorship sessions.The two enrolled midwives were considered leaders in midwifery, in turn, educating other midwife colleagues.

Table 1:
The nine topics for the mentorship sessions are based on midwifery educators' competences [3].

Results
Together, the midwifery educators completed the nine sessions [3].During the evaluation after the end of the last session, they identified context-specific areas to address in a potential upcoming mentorship program in the Somali region.A long-term evaluation of the collaboration, organization, and contextualization would benefit the initiative before more educators gain access to the capacity-building program for East African leaders combined with online mentorship support.

Collaborative Development of a Mentorship Initiative
Blended online approaches, which combine digital resources with practical training, have been found to be the most effective in enhancing the confidence of midwifery educators and the delivery of quality education [4,5].The colleagues from Galkayo University did not meet physically with the colleagues from the Karolinska Institutet, which was a requirement for this program when outlining a potential forthcoming mentorship program combined with online leadership support sessions.
Through the empowerment of midwifery educators and the enhancement of the quality of midwifery education, the mentorship program might contribute to the achievement of the Sustainable Development Goals (SDGs) by 2030."Good Health and Well-being" (SDG 3) focuses on ensuring healthy lives and promoting wellbeing for all, as well as ensuring universal health coverage.
"Quality Education" (SDG 4) aims to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.This goal includes targets related to access to education, the quality of education, and the promotion of skills for employment, emphasizing education as a fundamental human right and a key driver for "Reduced Inequalities" (SDG 10) based on age, sex, disability, race, class, ethnicity, religion, and opportunities for representation in decision-making processes [6,7].
The reported mentorship program combined with online leadership support sessions can empower midwives to take the lead in promoting the social and economic inclusion of all in the area where Galkayo University is located, ensuring that development benefits women, newborns, and families in the society, with a particular focus on those who are most vulnerable or marginalized [6,7].Additionally, exploring midwifery leadership, with a focus on the challenges faced in midwifery leadership roles, is essential.Leadership is a recognized priority in the WHO Global Strategic Directions for Nursing and Midwifery 2021-2025 [7].The WHO Global Strategic Directions are evidence-based and can contribute to achieving healthcare goals.Empowering midwifery leadership at all levels can drive positive change and help achieve national health goals for individuals, families, and communities.

Contextualization and Scaling Up
Developing a context-specific mentorship model for midwifery-led care in the Somali region, offers a promising solution to bridge educational gaps and enhance the expertise of midwifery educators.The importance of keeping midwifery educators up-to-date with the best available evidence, addressing the challenges of knowledge retention, and focusing on the latest evidence regarding midwifery care in alignment with midwifery philosophy was identified as crucial for a mentorship program.This objective can be achieved through resource review, including Cochrane reviews and other literature reviews on evidence-based midwifery-care topics such as skin-to-skin care immediately after birth, delayed cord clamping, dynamic birth positions, perineal protection, and respectful maternity care [2].These topics are already integrated into midwifery curricula and can be linked to simulation based learning and Objective Structured Clinical Assessment (OSCA) examinations to ensure the sustained knowledge and skills development of midwives, students, and educators [8].Lastly, the mentorship program can emphasize the utilization of research findings in midwifery education and practice while exploring the obstacles encountered by midwifery educators in integrating research findings into education and practice.Quality midwifery education extends beyond the classroom to clinical placements.Effective communication and collaboration between educational institutions and clinical sites are vital for achieving students' learning objectives [4].The support provided by midwifery educators and clinical placement staff significantly influences students'clinical experiences [7].Strengthening iD Somali Health Action Journal this support through a contextualized mentorship program will enhance the clinical training and overall competence of midwifery students.This contextualized mentorship program might have the potential to be successfully scaled up nationwide if sustainable and up-to-date knowledge can be maintained among midwifery educators through access to resources such as Cochrane reviews, OSCA examinations, and midwifery leadership.

Further reading
Use the QR code to access the Swedish midwifery report [6], which details the organization of midwifery care in Sweden, featuring midwifery-led care for normal processes and collaborative teamwork between doctors and midwives to address complications and save lives.

Summary in Somali
Creation of an environment that facilitates learning Creation of an environment for effective clinical teaching of midwifery care Responsibility for conducting regular monitoring, evaluation and assessment of programs and students Maintaining current midwifery theory and practice based on the best evidence available Participation in formulating policies and program outcomes and in designing and implementing Effectiveness in communication and functioning as advocates, change agents and leaders Incorporation and promotion of ethical aspects of midwifery care in teaching/learning activities by being consistent role models Incorporation and promotion of legal aspects of midwifery care in teaching/learning activities by being consistent role models Promotion of the use of research and using it to inform midwifery education and practice waxa la bilaabay gu'gii 2023 iyada oo ujeedadu tahay in ay wadaagaan khibradaha saameeya barashada aqoonta umuliso ee ka dhexeeysa barayaasha Sweden iyo Soomaaliya, oo labaduba muddo dheer ku hawllanayeen dhaqan-gelinta aqoonta daryeelka umuliso.Si looga faa'iidaysto barashada aqoonta umulisooyinka Sweden iyo Soomaaliya, barnaamijkan hagitaanku, wuxuu raadinayaa siduu u dabooli lahaa daldaloolada xagga aqoonta iyo farsamada, isagoo ugu dambeyn gacan ka geysanaya sidii loo wanaajin lahaa waxbarashada umulisooyinka iyo daryeelka ay bixiyaan labada dal ee Soomaaliya iyo Sweden.Faalladani waxay qeexaysaa ahamiyadda barnaamijkan iyo awoodda saamayntiisa, haddii kor loo qaado fulintiisa, iyo markii adeegyada lagu saleeyo, xalaadaha ka jira degaanka.