From leadership research to district action: Rapid assessment of pre-service midwifery education in conflict settings: findings from a cross-sectional study in Nigeria and Somalia

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background There is a dearth of evidence on the scale, scope and quality of midwifery education programs in conflict-affected settings. This study sought to assess the extent to which midwifery pre-service education programs meet national and global standards, and to explore how conflict affects pre-service midwifery education in Yobe State Nigeria and the Benadir and Galgaduud regions of Somalia. Methods A rapid assessment of midwifery education programs was conducted in the two midwifery education programs in Yobe State, Nigeria and in seven purposively selected programs in Somalia using an adaptation of the Midwifery Education Rapid Assessment Tool. Information was collected through interviews with program leadership, teachers, students, and clinical preceptors during school and clinical practice site visits. Researchers adapted the tool to reflect national and international standards, incorporating supplementary questions to capture considerations specific to conflict-affected contexts. Data were analyzed by program and country using Stata and Excel. Results In Nigeria, each school met 17 and 18 standards, respectively, out of 22 across assessment domains (77.3%–81.8%). In contrast, in Somalia, schools met between 6 and 10 standards out of the 18 standards for which data were available (33.3%–55.6%). The biggest gaps in Somalia were in leadership, infrastructure and resources. No schools in either setting had sufficient space or clinical practice sites that met International Confederation of Midwives (ICM) criteria, and only two were led by midwives. In Nigeria, all infrastructure, curriculum and student- and regulatory-related standards examined were met, but gaps were identified in program staffing and preceptor capacity, and support for faculty and clinical practice sites. In both countries, none of the programs met the average number of clinical practice experiences stipulated in the ICM guidelines due to a lack of teaching hospitals. Students in both countries felt safe on campus but did not feel safe traveling to and from the schools and clinical practice sites. Conclusions More investment in midwifery education is needed to ensure international standards for quality education are met. Proactive measures are needed to enhance student safety between school and practice settings in conflict-affected settings. By addressing these gaps, we can strive toward improving midwifery education. Supplementary Information The online version contains supplementary material available at 10.1186/s12960-025-00977-6.

Study methods

In Nigeria, research was conducted in Yobe State located in the Northeast Zone of Nigeria. Yobe has been acutely affected by the decade-long conflict around the Boko Haram insurgency, with the majority of people living in security-compromised areas and experiencing high displacement, social and economic suffering, and severe food insecurity [9, 10]. Some health facilities have been attacked, looted, or shut down. There is also a serious shortage of health workers in the country (1.83 health workers per 1000 population) [11]. Challenges with maternal and newborn health (MNH) service delivery include difficult terrain and lack of access and shortage of and poor training of health workers [12]. Overall, Nigeria has a high maternal mortality ratio of 1047 deaths per 100,000 livebirths, but in the Northeast, the situation is even worse with more than 1500 per 100,000 live births [13].

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Emilia Iwu; Shatha Elnakib; Hawa Abdullahi; Rejoice Helma Abimiku; Charity Maina; Asia Mohamed; Kazeem Olalekan Ayodeji; George Odonye; Rifkatu Sunday; Maryan Abdulkadir Ahmed; Mohamed Ahmed Omar; Abdirisak A. Dalmar; Emilie Grant; Hannah Tappis. Rapid assessment of pre-service midwifery education in conflict settings: findings from a cross-sectional study in Nigeria and Somalia. Human Resources for Health (2025-02-03). https://doi.org/10.1186/s12960-025-00977-6

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.