For nearly 40 years, in 68 countries and more than 120 education programs, Jhpiego has worked to strengthen pre-service education around the globe. Beginning in the early 1970s, Jhpiego strengthened education in medical and nursing schools in countries such as the Philippines, Mexico, Somalia and Kenya. One of the first programs was at the Autonomous University of Tamaulipas, Mexico. This program, on Fertility Management Education for Medical Students, eventually launched a medical education program in 28 of the 56 Mexican medical schools. The emphasis of the course was on preparing students to provide family planning services.
In the early 1980s, Jhpiego partnered with the International Federation of Gynecology and Obstetrics (FIGO) to send the FIGO teaching manual, known as the Manual of Human Reproduction (with accompanying slides), to more than 700 nursing and medical colleges in developing countries for use by faculty in their teaching. A peer-reviewed article published in 1980, co-authored by Jhpiego’s Vice President for Technical Leadership, Dr. Ronald Magarick, found that more than 30,000 students around the world were exposed to the content of the manual. This work has been cited in the literature as the first example of an organization working to strengthen medical and nursing education in developing countries.
Next was Jhpiego’s development of the International Nurse Education Program. This initiative worked to strengthen nursing education throughout Asia and Africa. Later, Jhpiego developed a course in Academic Skills in Reproductive Health, which was designed to strengthen the ability of mid-career medical and nursing/midwifery faculty to teach and assume leadership positions at their respective schools. Many graduates of the course have noted that participation in the course helped launch their academic careers in the teaching of family planning and reproductive health (FP/RH).
Examples of Jhpiego’s work in pre-service education include early efforts to strengthen minilaparotomy training for interns in Kenya. As a result of this effort, upon graduation every intern in 13 affiliated hospitals of the University of Nairobi was certified as competent in minilaparotomy—a sentinel undertaking by Jhpiego. In the Philippines, Jhpiego worked with the Association of Deans of Philippine Colleges of Nursing to strengthen the FP/RH curriculum, and also worked with the nursing/midwifery accreditation council to require questions on FP/RH in the certification exam for nurses and midwives. A study conducted in the 1980s demonstrated that nurses/midwives who graduated from the schools where Jhpiego had provided support scored better on the national licensure exam for nurses, compared to those who graduated from schools where Jhpiego had not provided the support.
More recently, Jhpiego has worked to strengthen midwifery education globally, particularly in Afghanistan. In 2002, Jhpiego provided technical leadership in the expansion of a national Community Midwifery Education program. This program launched 27 midwifery schools in 29 provinces in six years—a nearly four-fold increase—and graduated more than 2,200 skilled midwives. Between 2006 and 2011, almost 1,000 additional midwives have graduated.
A program evaluation in 2009 found not only that the midwifery program delivered critical services to women, but also that “substantial health system strengthening” was accomplished in the Ministry of Public Health at central and provincial levels. In addition, Jhpiego has left behind an evidence-based curriculum that uses a competency-based approach to ensure that the midwives are “fit for purpose.” Perhaps more important, in 2004 Jhpiego provided direction in the establishment of a midwifery education accreditation program to ensure that all programs provide a standardized education. This has evolved into the effective functioning of the Afghanistan Midwifery and Nursing Education Accreditation Board, and Schools are accredited by this board when they meet set requirements. And to further support the professionalization of midwifery, the national Afghan Midwifery Association was established. It is thriving today, representing more than 2,000 members http://www.afghanmidwives.org.
A USAID-initiated formal evaluation of Jhpiego’s work in pre-service education conducted in Africa through the ACCESS program from 2005-2010 found that not only did individual midwives and teachers enhance their life-saving and teaching skills, but health facilities were better prepared and women and families better served.
Finally, Jhpiego has recently conducted an integrative review of the literature on pre-service education and its link to health outcomes which has informed a shift in strategy towards greater use of e-learning, more attention to clinical practice, student selection criteria, student assessment and professional regulation. Jhpiego has also moved into e-Learning and currently is engaged in a project with Intel, UNFPA and the World Health Organization—a project that is expected to be transformational for pre-service education. E-learning modules on topics such as pre-eclampsia/eclampsia, postpartum hemorrhage and family planning have been developed and will be integrated into midwifery education, beginning in Ghana. Students in these schools will be able to learn the technical content at their convenience, and more efficiently and effectively than through traditional lectures, and will be better prepared to enter their clinical rotations.
Jhpiego continues to break down barriers and explore new frontiers in pre-service education, enabling students to begin to provide high-quality services immediately upon their graduation from colleges and universities.