Reforming Midwifery Education in Somalia: Development and Validation of the National BSc Curriculum

Introduction

Strengthening midwifery education is widely recognized as a critical strategy for improving maternal and newborn health outcomes, particularly in low‑ and middle‑income countries experiencing high maternal and neonatal mortality(1). Bachelor‑level midwifery education has increasingly been adopted to expand the professional scope of midwives beyond basic service provision to include leadership, education, research, and health system strengthening roles(2). In this context, the development and validation of a National Bachelor of Science in Midwifery (BSM) curriculum represents a significant step toward aligning pre‑service education with contemporary health system demands and internationally recognized professional standards(3).

The curriculum discussed in this paper was developed through a national, multi‑stakeholder process and formally validated through a consultative workshop involving health, education, and regulatory authorities, academic institutions, professional associations, and technical experts. Such nationally driven approaches are increasingly emphasized as best practice for ensuring relevance, ownership, and sustainability of health professions education reforms(4).

Institutional Context and Commissioning Role

The National Bachelor of Science in Midwifery curriculum was commissioned by SOS College of Health Science University, a specialized health sciences higher education institution engaged in the training of mid‑ and high‑level health professionals in Somalia. The University is known for its competency‑based training approach, strong integration of theory and supervised clinical practice, and systematic alignment with national accreditation and professional regulation requirements(5,6).

Academic programs implemented by the institution are coordinated with key public sector bodies, including the Federal Ministry of Health, the National Health Professionals Council (NHPC), the Ministry of Education, Culture and Higher Education (MoECHE), the National Commission for Higher Education, and the Benadir Regional Administration (BRA) Education Directorate, ensuring coherence between education, regulation, and health workforce planning. The commissioning of the BSM curriculum built upon earlier institutional experience, including the commissioning of the National Nursing Curriculum in 2024, thereby strengthening methodological continuity and stakeholder confidence. Within this initiative, the institution’s role remained facilitative and technical, contributing capacity and coordination rather than proprietary ownership of the curriculum.

Rationale for Bachelor‑Level Midwifery Education

Global evidence demonstrates that midwives educated to international standards can deliver the majority of essential maternal, newborn, and reproductive health interventions across the continuum of care. The World Health Organization (WHO) and the International Confederation of Midwives (ICM) emphasize that strengthening midwifery education is among the most cost‑effective strategies for reducing preventable maternal and neonatal mortality and improving quality of care(7).

National health indicators further reinforce this need. In settings where maternal mortality ratios remain high, newborn mortality rates are elevated, and coverage of skilled birth attendance is limited, the capacity of the midwifery workforce is a key determinant of service quality and outcomes. Diploma‑level training alone has increasingly been recognized as insufficient to meet the growing complexity of service delivery, referral systems, quality improvement, and leadership demands within modern health systems(8,9).

Evidence‑Informed Curriculum Development

The BSM curriculum was informed by a national needs assessment and stakeholder consultations involving institutions responsible for health, higher education, regulation, and service delivery, as well as practicing midwives and educators. These consultations consistently highlighted strong demand for upgrading midwifery education to degree level, particularly in advanced emergency obstetric and newborn care, leadership and supervision, research skills, and evidence‑based practice.

The curriculum development approach aligns with WHO guidance on transforming and scaling up health professionals’ education, which emphasizes evidence‑based design, stakeholder engagement, and alignment with national workforce needs(2). Institutional experience derived from prior national curriculum initiatives, such as nursing education reform, further supported a structured and methodologically sound development

Alignment with National and Global Frameworks

A central principle guiding the curriculum was alignment with national development and sectoral frameworks, including health sector strategic plans, national midwifery strategies, and higher education accreditation requirements(5,6). Such alignment ensures coherence between educational outputs, workforce planning, regulation, and service delivery priorities.

At the global level, the curriculum was benchmarked against:

• WHO standards for health professional education
• ICM Essential Competencies and Global Standards for Midwifery Education
• Sustainable Development Goals (SDGs), particularly targets 3.1 and 3.2 related to maternal and newborn mortality reduction

This standards‑based approach supports quality assurance, professional recognition, and comparability across institutions and national contexts(10).

Curriculum Structure and Implementation Considerations

The validated Bachelor of Science in Midwifery curriculum follows a progressive, multi‑year structure integrating theoretical instruction with extensive supervised clinical practice, reflecting international standards for midwifery education(4,7). The curriculum encompasses foundational studies, comprehensive midwifery care, advanced clinical competencies, leadership and management, research methodology, and community‑based practice.

Clinical training spans antenatal, intrapartum, postnatal, neonatal, and sexual and reproductive health services, with exposure to referral‑level care and health facility management. Consistent with WHO recommendations, attention was also given to institutional readiness, including faculty capacity, infrastructure, clinical placement sites, and regulatory oversight mechanisms, recognizing that curriculum quality depends on effective implementation environments(2).

Validation Process and Stakeholder Engagement

The curriculum validation process adopted a participatory and transparent approach, bringing together stakeholders from government institutions, regulatory authorities, higher education institutions, professional bodies, and technical experts. Through structured group discussions and plenary sessions, participants reviewed curriculum objectives, content relevance, assessment strategies, feasibility, and regulatory alignment.

The validation process resulted in broad consensus that the curriculum is academically sound, contextually appropriate, and aligned with national workforce needs. Stakeholder recommendations were incorporated to strengthen clarity, feasibility, and quality assurance mechanisms. Inclusive validation processes of this nature are widely regarded as critical for national ownership and sustainability of health professions education reforms (2,6).

Conclusion and Broader Relevance

The development and validation of a national Bachelor of Science in Midwifery curriculum illustrates how institution‑commissioned, evidence‑informed, and standards‑based approaches can contribute to strengthening health professional education systems. Institutional experience gained through prior national curriculum initiatives, such as nursing education reform, can enhance continuity, technical rigor, and stakeholder trust.

The approach documented here offers transferable lessons for other institutions and countries seeking to modernize midwifery education through inclusive stakeholder engagement, regulatory alignment, and adherence to international quality standards. Well‑designed bachelor‑level midwifery programs have the potential to significantly improve maternal and newborn health outcomes, professional development, and overall health system resilience.