Table 3.

LMIC experiences with deployment of midwives (Van Lerberghe et al., 2014)

	Morocco	Burkina Faso	Indonesia	Cambodia
Turning point	Competency-based midwifery training course; training capacity was raised to nine midwifery schools. Education of midwives consists of a direct-entry 3-year training system	Professionalization of childbirth: Traditional birth attendants refocused their role on preparing women for childbirth, identifying the nearest health centre as place of birth and organizing reliable transport. Targeted one midwife per 130 women of reproductive age. Training of auxiliary midwives as an interim strategy	Village midwife programme: massive scale up of access to midwives to provide a range of primary care services. The programme initially required that a midwife should receive only 1 year of midwifery training after 9 years of schooling and 3 years of nursing training; Extended to a 3-year diploma course through midwifery academies in the 1990s	1990s: Transition from administrative-based to a population-based approach: package of activities included maternal health care, with at least two midwives per health centre. 2000s: Re-opening of direct-entry midwife training schools
Employment	Deploy the freshly trained midwives: minimum of two midwives per health centre with a maternity ward. Midwives work at all levels with maternity wards under the supervision of GP, in both public and private secondary- and tertiary-level hospitals. Midwives are government employees; no performance-related financial incentives to complement their modest salaries	The auxiliary midwives—originally intended as a temporary solution—oriented towards a formal midwifery training curriculum with a longer education programme. Allowing midwives to move towards a management or teaching career through an additional 3-year public health training made the profession more attractive	Employment status varied—from civil servants to short-term contract staff (local or national) to private practitioners	Each health facility has at least one midwife
Challenge	Roles and responsibilities remain poorly defined; Midwives have no autonomy in responding to obstetric complications	Delays in obtaining care, poor referral linkages, premature discharge of women and inadequate follow-up of unresolved health problems	Inadequate supervision and deficiencies in basic training consequent to the pace of scaling up and deployment strategy. Many midwives practising at village level, in remote postings or in private practice were put to work as sole providers	Shift from midwife to doctor among the richest quintile was associated with fast-rising caesarean section rates