Introduction
Reports have identified that strengthening midwifery is critical to improved maternal and newborn health, globally [1‐3]. However, poor quality midwifery care remains a major contributor to high maternal and neonatal death, especially in Low- and Middle-Income Countries (LMICs) [4, 5] despite evidence suggesting that 87% of the incidence of Maternal Mortality Ratio (MMR) (MMR) can be alleviated through quality midwifery care provided by midwives that have been educated, trained, regulated and licensed according to the International Confederation of Midwives (ICM ) global standards for midwifery education [6]. Recently, the world recorded a 34% (223/100,000 live birth) reduction in MMR. While this is appreciable, it is insignificant in terms of realizing the promising Sustainable Development Goal (SDG) which aims to achieve reduced maternal death to less than 70/100,000 live births by 2030 [7]. Progress in improving maternal health remains stalled in LMICs where almost 95% of all maternal deaths occur from preventable causes, 70% of which disturbing statistics is accounted for by sub-Saharan Africa [8]. Midwives played a pivotal role in achieving the millennium development goals and their efforts have continued to be recognised as the most cost-effective solution to meet SDG targets [2]. However, to enable midwives to contribute significantly, quality midwifery education has been identified as an important approach to promoting quality midwifery care [9, 10]. This approach involves improving the quality of midwifery education to international standards to prepare future midwives so that they are equipped with the appropriate competencies to enable the delivery of safe and high quality sexual and reproductive care required to achieve international SDG efforts [11].
The ICM with support from the World Health Organization (WHO) advocate the need to strengthen midwifery globally through the provision of standards for midwifery education and practice [12, 13]. The Confederation maintained this vision over the years by communicating these global Standards for Midwifery Education with an emphasis on Competency-Based Education (CBE) to ensure consistency in practice and education of midwives [14‐16]. However, nations are expected to interpret and adapt these global standards to midwifery educational programmes wherever these are located to prepare qualified midwives [16]. The title “qualified midwife” is appropriate for use by an individual who has been able to complete his/her midwifery education programme. And demonstrate competency in the practice of midwifery satisfactorily to earn a midwifery certificate and is registered and licensed to practice midwifery in the country where the education was obtained [17]. Midwives can acquire the specific knowledge and skills to become fully qualified midwives through three major educational pathways [18]. A direct-entry programme for midwifery, a post-nursing programme and a combined programme of Nursing and Midwifery [19]. However, regardless of the chosen pathways, it is expedient that countries meet the predetermined standards in CBE in midwifery curriculum to ensure the competency-based outcomes of midwifery education are equivalent [16, 20]. Unfortunately, several inconsistencies apply to the implementation and sustainability of CBE Midwifery education with most countries still following the Traditional Based Approach (TBA) [16] probably due to poor planning and implementation process especially in Africa.
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Competency-based education compared to Traditional-Based Approaches (TBA) continues to remain relevant, especially in professional healthcare education programmes including midwifery education [21, 22]. There are four basic principles distinguishing CBE from TBA highlighted by Frank and colleagues which are CBE’s focus on outcomes of education and training, the learner’s capabilities against predetermined standards [23]. Furthermore, CBE requires a flexible curriculum with reduced emphasis on time and promotion of learners-centeredness The increasing popularity of CBE and the paradigm shift were necessary in response to the dynamic labor market that requires flexible, adaptive, and competent employees that can respond swiftly to the ever-changing work environment [22, 24, 25]. CBE in the professional health care education programme has focused on health care professionals with adequate capabilities necessary to provide high-quality care and ability to meet the population’s health demands [26]. CBE prepares graduates by focusing on the competencies acquired during their educational experience that are assessed against knowledge, skills, attitude, and achievement standards as outcomes of the curriculum [21, 23].
Competency-based education is described as a curriculum or training program that provides comprehensive tasks to practice all the required competencies [26]. For the midwifery profession, competency-based education is an educational program of studies that is based on a complex combination of knowledge and skills acquisition, demonstration, values, and attitude in all aspects relating to the essential competencies required to become a qualified midwife [27]. The theory of CBE is an individualized programme, that aims to assess the theoretical and clinical competency of each midwifery student until competency proves satisfactory [27, 28]. Faculties, including educators and clinical preceptors, involved in the training and clinical experience of students ought to work harmoniously to sustain CBE for midwifery educational programs [29, 30]. Although proper implementation of CBE promises to realize the outcomes of education and training. However, studies have found that these expectations are difficult to achieve in reality due to inadequate knowledge of assessment of competency [31‐35]. Despite the proven benefits of CBE, little is known about the implementation of CBE, especially in Africa, where poor investment in quality midwifery education has been reported [36]. Hence, this study will review the existing literature concerning the implementation of competency-based education for midwifery programs and its sustainability in Africa.
Methods
The scoping methodology, as outlined by Arksey and O’Malley, was adopted to explore the extent of the literature concerning the implementation of CBE for midwifery programmes, and its sustainability in Africa [37]. The Arksey and O’Malley five-step framework for conducting scoping reviews was used, namely: (1) identify the research question; (2) identify relevant studies; (3) perform study selection; (4) extract and chart the data; and (5) collate, summarize, and report the results. This framework directed the scoping review methodology, with reference also to additional PRISMA-ScR guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [38].
Step 1: identify the Research question
This scoping review is guided by the following research questions:
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1.
What is the existing evidence of implementing CBE in midwifery education in Africa?
2.
How has CBE for midwifery education been sustained in Africa?
Inclusion and exclusion criteria
The inclusion of eligible studies in this scoping review was determined following the Participants, Concept, and Context (PCC) framework [39]. Inclusion and exclusion criteria are listed in Table 1. The review included literature published from January 2010 to April 2024 in the English language.
Table 1
Inclusion and exclusion criteria
Inclusion criteria | Exclusion criteria |
|---|---|
• Participants: midwifery students, midwifery educators, midwives, obstetric nurses, obstetrics and gynecology nurses and maternal and child health nursing staff in all matters relating to CBE for pre-service midwifery education programmes in Africa. • Concept: competency-based midwifery education, competency-based curriculum, teaching and learning approaches used for midwifery education and studies which include the ICM competency framework for midwifery practice, that is, pre-pregnancy, pregnancy, labor and childbirth, and the postpartum period. • Context: midwifery health care settings, midwifery educational institutions. • Studies conducted in Africa as per the World Bank classification in the English Language and published from 2010 to 2024. | • Literature on CBE for other health professions such as nursing, medicine, pharmacy, and allied health professions with no reference to midwifery was excluded. • Studies relating to in-service education for midwives were disapproved. • Studies conducted in high-income countries were excluded. • Studies not published in English were excluded. |
Step 2: identify relevant Studies
A comprehensive report identifying the relevant studies has been published previously [40]. Systematic and literature reviews which were considered relevant had their reference lists scrutinized manually for potential studies, however, the reviews were not considered for inclusion. This review considered English-only studies in Africa from 2010 to 2024. Reports published from 2010 which captured the International Confederation of Midwives (ICM) position statement on the implementation of CBE for midwifery programmes were equally considered [29].
Step 3: perform study selection
A total of 935 citations identified through database searching were imported into EndNote (v.21; Clarivate Analytics) and screened for duplicates. The remaining citations (n = 687) were uploaded into Rayyan review software (Qatar Computing Research Institute). The two independent reviewers (WBI and OA) conducted the initial screening to assess eligibility regarding the title and abstract and then conducted a full-text review using the PCC framework. Any disagreements during the selection process were resolved through discussion with the third senior reviewer (WBN).
Step 4: extract and chart the data
A data charting table was pre-developed to extract and chart relevant information from eligible studies. The reviewers conducted a pilot test on five included studies. Eligible studies were extracted by two independent reviewers (WBI and OA), while the third reviewer (WBN) validated the data extraction results. The data charting table, Table 2, was reviewed independently and compared for consistency by the team of reviewers following the PCC framework. The year of implementation of CBE was added to existing variables (the type of study, year, setting or context, aims, study population, research design, research techniques, and summary of findings). The data charting Table 2 showed a comprehensive report of relevant information of eligible literatures. Using an iterative approach, the two reviewers independently coded the content of the data using Nvivio, seven themes were generated. The report of the review is summarized in the Figure: 1, following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) format.
Step 5: collate, summarize, and report the results
Table 1 shows the complete list of extracted articles conducted across 17 African countries from 2010 to 2024, most of which were reported in South Africa (32%). Despite not limiting the search by language, the majority of the articles were in English, except for two in Arabic and French. The research consisted mainly of qualitative studies (n = 19); eighteen (18) studies used quantitative methodology while seventeen (17) were mixed methods. Other designs included surveys (n = 6), case studies (n = 8), multi-method research designs (n = 1) and field action reports (n = 2) and conference presentations (n = 1). Figure 1 shows the report of the scoping review findings following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) format.
Results
The 935 articles originally identified from electronic database were uploaded to Rayyan, from which 138 duplicate records were removed, while a further 110 duplicates were detected and removed by automation. Of the 528remaining, 456 were eliminated: 264 of these did not relate to the concept of the study; 133 were conducted outside African countries or regions; 30 were published before 2010; 21 consisted of the wrong population (i.e., the participants were mainly nurses and others without any connection to midwifery); 8 were the wrong publication type (e.g. editorial, commentary, literature reviews). Following the grey literature search, a further 26 reports were discovered. Finally, a total sample of 72 studies were included in this scoping review. Table 2 shows the data charting table of the result.
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Table 2
Data charting table for the scoping review on implementation of competency-based education for Quality Midwifery programmes in Africa
S/N | AUTHORS, PUBLICATION YEAR, COUNTRY, YEAR OF CBE IMPLEMENTATION | TITLE | STUDY AIM | METHODOLOGY/ PARTICIPANT | SUMMARY OF FINDINGS | |||||
|---|---|---|---|---|---|---|---|---|---|---|
1 | Ann-Beth Moller, Joanne Welsh, Elizabeth Ayebare, Effie Chipeta, Mechthild M. Gross, Gisele Houngbo, Hashim Hounkpatin et al., 2022 Benin – (TBA) Malawi-(CBE-2010) Tanzania-(CBE-2008) Uganda-(CBE-2006) | Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries—Benin, Malawi, Tanzania, and Uganda | This research sought to map midwifery pre-service training curricula in Benin, Malawi, Tanzania, and Uganda. | Methodology: multiple methods. phase 1, online interviews with the lead project midwives in the four study countries. Phase 2. Curricula were reviewed and mapped against the (ICM) Essential Competencies framework | Of the ten pre-service curricula assessed, findings revealed that all ICM competencies were not represented in the curricula. The pre-service training curricula were different within countries and midwifery care providers shared professional titles with other health providers. | |||||
2 | Dithole, K.S., Sandy, P.T. and Thupayagale-Tshweneagae, G., 2013. Bostwana - problem-based learning | Usefulness of problem-based learning in clinical nursing education: Experiences from the university of Bostwana | The study explores the usefulness of PBL in a nursing clinical setting from nursing students’ perspectives | Methodology: The phemenological research methodology. Participant - Nursing students (3rd year) at the University of Botswana. | Findings generated four themes: knowledge acquisition, skills development, theory-practice synergy, PBL though useful but cannot be used alone as a teaching strategy. | |||||
3. | F. Barchi, M. Kasimatis Singleton, M. Magama & S. Shaibu, 2014 Bostwana - problem-based learning | Building locally relevant ethics curricula for nursing education in Botswana | The goal of this multi-institutional collaboration was to develop an innovative, locally relevant ethics curriculum for nurses in Botswana. | Methodology: A pilot testing of curriculum, including cases set in local contexts, was performed with nursing faculty in Botswana in 2012 | Based on evaluation data, majority of the participant were willing to introduce the International Council of Nurses Code of Ethics in teaching, practice and mentoring due to the training. | |||||
4. | Malin Bogren, Britou Ndela, Carla Toko and Marie Berg, 2020 Democratic Republic of Congo (DRC)- (CBE-2013) | Midwifery education, regulation and association in the Democratic Republic of Congo (DRC)–current state and challenges | To explore the current state of the midwifery profession in the DRC and to suggest suitable strategies for increasing the quality and quantity of a highly competent midwifery health workforce in the DRC. | Methodology- mixed method participants- 17 stakeholders using three questionnaires developed by the International Confederation of Midwives, and three focus group discussions at a workshop. | The length of training for the programme is inadequate, poor qualifications of faculty, Lack of resources to deliver a quality midwifery education programme, The curriculum followed 60% theory and 40%clinical practice for each of the two educational programmes. | |||||
5. | Marie Berg, Ewa Carlsson Lalloo, Fatuma Kilongo Ngongo, Malin Bogren, 2023 DRC- (CBE-2013) | Contextual factors influencing implementation of a university-based midwifery education programme in Central Africa: A qualitative study | To investigate contextual factors and their influence on implementing a 90-credit midwifery education programme for nurses at a university in the eastern DRC. | Methodology: A qualitative study Participants: 22 participants involved in establishing the midwifery education programme. | The factors influencing the successful implementation of the new midwifery education programme in DRC were contextually classified into facilitating and hindering factors. . | |||||
6. | Sharon Brownie, Rachel Rossiter, Nabeel Al-Yateem, Mohamed H Gadallah, Rachel Rossiter 2018 Egypt – (CBE 2018) | Supporting the nationally mandated transition to competency-based nursing curricula in Egypt | conference presentation | In Egypt, the Government mandated transition to competency-based nursing curricula from bio-medical syllabi to competency-based curricula in 2018. | ||||||
7. | Temesgen Worku Gudayu, Marta Berta Badi, and Mengstu Melkamu Asaye 2015 Ethiopia (TBA) | Self-Efficacy, Learner Satisfaction, and Associated Factors of Simulation Based Education among Midwifery Students: A Cross-Sectional Study | To assess self-efficacy, learner satisfaction, and associated factors of simulation-based education among Midwifery students in Gondar University, 2015 | Methodology -Cross-sectional study Participants − 144 Midwifery students. | Participant reported that adequate supports from educators will contribute to increased satisfaction and confidence in simulation-based education which finding revealed to be average. | |||||
8. | Arif H. Jamie, Abdusemed A. Mohammed 2019 Ethiopia (TBA) | Satisfaction with simulation-based education among Bachelor of Midwifery students in public universities and colleges in Harar and Dire Dawa cities, Ethiopia | The aim of this study was to assess the students’ satisfaction with simulation-based education and associated factors. | Methodology: The cross-sectional study involving midwifery students. | Factors identified to facilitate satisfaction were teaches support during simulation, suitability of SBE to the students learning objectives and enough time allocation for SBE. | |||||
9. | Daniel Dejene, Jelle Stekelenburg, Marco Versluis, Firew Ayalew, Yohannes Molla, 2022 Ethiopia | Assessment of core teaching competency of health professional educators in Ethiopia: an institution-based cross-sectional study | This study aimed to assess the core teaching competency of nursing, midwifery and biomedical educators, and associated factors in Ethiopia. | Methodology: Cross-sectional study in colleges of health sciences (2) and student clinical sites (9) in Ethiopia. Participants: classroom instructors, clinical preceptors of nursing, technician training programmes for midwifery and biomedical, and all the final year students. | Nursing, midwifery, and biomedical educators lacked the skill and competency to use the various teaching methods especially active learning methods, performance assessment, feedback and digital learning needed to strengthening faculty. | |||||
10. | Judith T. Fullerton, Peter G. Johnson, Joyce B.Thompson,, Donna Vivio, 2011 Ethiopia, Ghana, Malawi Ethiopia- (TBA) Ghana- (TBA) Malawi- (2010) | Quality considerations in midwifery pre-service education: Exemplars from Africa | This paper uses findings from an assessment of pre-service education for midwives in Ethiopia, Ghana, and Malawi. | Methodology: a mixed qualitative and quantitative participatory assessment was conducted in three countries (Ethiopia, Ghana, and Malawi). participants included key stakeholders’, midwives and students in classroom, and midwives in clinical practice sites. | Curriculum development process in Ghana was done by education experts while Ghana and Malawi involved Nurses and midwifery councils. Theory/practice balance was the establish standard in all three countries. However, lack of accountability in adhering to the standard by schools due to notable challenges were reported. | |||||
11 | Martha Appiagyei, Alison Trump, Evans Danso, Alex Yeboah, Sarah Searle, Catherine Carr, 2015 Ghana- (TBA) | Case study: the role of e-learning in midiery preservice education in Ghana | this case study assesses the feasibility of using targeted supplementary e-learning modules in midwifery pre-service education. | Qualitative and quantitative methods participants- students and midwifery tutors with IT tutors, school principals and the MOH IT team | Findings highlighted Key success factors in feasibility of e-learning to include broad stakeholder supports, provision of material resources for e-learning by the government, the integration of eLearning into an already established curriculum, primary stakeholders’ enthusiasm about eLearning. Sustainability over the longer terms requires local capacity building | |||||
12 | Emmanuel Kusi Achampong, 2017 Ghana- (TBA) | Assessing the Current Curriculum of the Nursing and Midwifery Informatics Course at all Nursing and Midwifery Institutions in Ghana | To ascertain the preparedness of tutors for teaching the new nursing and midwifery informatics course as well as to compare the curriculum with other international recommendations | Two separate workshops were organized. Participants-tutors from nursing and midwifery training institutions in Ghana. | In 2015/2016 academic year, the nursing and midwifery informatics course was introduced. The time allocated for practical within course content was found to be inadequate. Tutors well poorly prepared to teach this new course. | |||||
13 | David Abdulai Salifu, Yolande Heymans 1 and Christmal Dela Christmals, 2022 GHANA- TBA | A Simulation-Based Clinical Nursing Education (SBCNE) Framework for a Low-Resource Setting: A Multimethod Study | This study sought to develop a context-specific framework to guide the design, implementation, and evaluation of SBCNE in a low-resource setting | Methodology- sequential multimethod design with participants- post-registration nurses and nursing students, and nurse educators | Context, planning, design, community of learning, and outcomes are the specific construct of the framework. The SBCNE framework is valuable in developing clinical competence especially in a low-resource setting. | |||||
14 | Duncan N Shikuku1, Joyce Jebet, Peter Nandikove, Edna Tallam, Evans Ogoti, Lucy Nyaga1, Hellen Mutsi, Issak Bashir, Dan Okoro, Sarah Bar Zeev and Charles Ameh 2022 Kenya (CBE-2021 midwifery educators in universities). | Improving midwifery educators’ capacity to teach emergency obstetrics and newborn care in Kenya universities: a pre-post study. | The objective of the study was to assess the capacity of university midwifery educators to deliver the updated competency-based curriculum after the capacity strengthening workshop in Kenya. | Methodology- Quasi-experimental (pre-post) design. Participants- Midwifery educators from 27 universities in Kenya. | The curriculum review aligns with the ICM’s 2018 updated definition and competencies of the midwives with focus on competency based EmONC.The workshop was found to improve the midwifery educator’s knowledge, competence, and confidence to deliver the updated curriculum. | |||||
15 | Duncan N. Shikuku, Edna Tallam, Ibrahim Wako, Agnes Mualuko, Lucy Waweru, Lucy Nyaga, Issak Bashir, Charles Ameh, 2022 Kenya (CBE-2021 midwifery educators in universities). | Evaluation of capacity to deliver emergency obstetrics and newborn care updated midwifery and reproductive health training curricula in Kenya: Before and after study | This paper measured change in confidence of pre-service midwifery/clinical medicine educators to deliver the updated competency-based curricula in Kenya. | Methodology-Cross-sectional online survey Participants- 51 diploma midwifery and clinical medicine (reproductive health specialty) educators from 35 Kenya Medical Training Colleges (KMTCs). | Educators’ confidence improved significantly on EmONC competency-based training and facilitation and improved confidence of educators to deliver the updated curricula. | |||||
16 | Tina Lavendera, Grace Omonib, Rose Laisserc, Linda McGowand, Sabina Wakasiakab, Gaynor Macleane, Angela Chimwazaf, 2019 Kenya-(CBE-2021 midwifery educators in universities). Malawi- (CBE-2010) Tanzania- (CBE-2008) | Evaluation of an educational board game to improve use of the partograph in sub-Saharan Africa: A quasi-experimental study. | This study explored the views, experiences and skill-development of midwives and student midwives on using educational board games to improve their labour-monitoring abilities | A quasi-experimental study. Participants- Midwives and student midwives from Malawi, Kenya, and Tanzania | Educational board games can support clinical practice and boost user confidence. This approach is cost -effective and impactful over the long-term basis. | |||||
17 | Champion N. Nyoni, Yvonne Botma, 2019 Lesotho- CBE- 2014 | Implementing a competency-based midwifery programme in Lesotho: A gap analysis | The study aims to explore the experience of administrators, educators and students on implementation of a competency-based midwifery programme through a gap analysis. | Qualitative descriptive research design. Participant: administrators’ facilitators and students in all the five (5) Nursing Education Institutions (NEIs). | The finding revealed wide disparities in the implementation of the CBC within the midwifery programme among NEIs in Lesotho. The major components of the Competency -based midwifery programme was not fully adopted to assimilate CBE. | |||||
18 | Champion N. Nyoni, Yvonne Botma, 2019 Lesotho: CBE- 2014 | A framework for implementing and sustaining a curricular innovation in a higher education midwifery programme. | To develop and validate a framework for implementing and sustaining a curricular innovation in a higher education midwifery programme. | Methodology- A multiple-methods research design Participants- students, educators, and administrators from all NEIs. | An evidence-based framework was developed to guide the implementation and sustainability of a curricular innovation in a higher education | |||||
19 | Champion N. Nyoni, Yvonne Botma, 2018 Lesotho: CBE- 2014 | Sustaining a newly implemented competence-based midwifery programme in Lesotho: Emerging issues | This article reports on issues that challenge the sustainability of a newly implemented CBC in Lesotho. | A qualitative descriptive study Participants: administrators, educators, clinical instructors, and students. | The finding revealed that poor support and monitoring system jeopardizes CBC sustainability. lack of accountability of a new curriculum. from implementers during classroom teaching. lack of expertise of the educators | |||||
20 | Champion N. Nyoni, Yvonne Botma, 2017 Lesotho: CBE- 2014 | Aligning summative clinical examination with competence-based Curriculum: Midwifery educators experiences in Lesotho | This study explored the experiences of midwifery educators who developed Objective Structured Clinical Examination(OSCE) through a phased approach that was aimed at aligning summative assessments with the competence-based midwifery programme. | Methodology- qualitative descriptive study, Participants: The midwifery educators from the four schools of nursing. | Their experience with the OSCE development process contributed to empowerment and building leadership skills. The midwifery educators were willing to implement and sustain the OSCE method of assessment. | |||||
21. | Mirriam Shawa Beloved Masava Pritchard Mutimbe Tawanda Nyoni Khantse Mokhele Mapoea Shale Eva Mukurunge Champion Nyoni2, 2023 Lesotho: CBE- 2014 | Fidelity of implementing a competency-based nursing programme during the COVID-19 pandemic: A case study | The study describes the fidelity of implementing a competency- based nursing education (CBNE) programme during the COVID-19 pandemic in a low- resource setting. | Methodology- A descriptive case study research design (integrating mixed methods and document analysis) Participants: educators, students and administrators of a nursing education institution and accessing institutional documents | The fidelity of implementing the CBNE programme was satisfactorily maintained according to the framework. However, sequenced progression and programmatic assessments were not aligned with a CBNE programme within the context of the COVID-19 pandemic. | |||||
22. | Pule S. Moabi1, Ntombifikile G. Mtshali, 2022 Lesotho: CBE- 2014 | Simulation-based education model for under-resourced nursing education institutions in Lesotho | This study aimed to develop a model that guides the implementation of simulation-based education (SBE) in under-resourced nursing education institutions in Lesotho. | Methodology- An explanatory sequential mixed methods design was adopted. Participants: students, nurse educators and principals in Four NEIs that are under the Christian Health Association of Lesotho (CHAL. | The model is supported by these major concepts: key stakeholders support, SBE policy, competent and skillful facilitators, and a well-equipped clinical skills laboratory. | |||||
23. | Pule S. Moabi1, Ntombifikile G. Mtshali, 2022 Lesotho: CBE- 2014 | Nurse educators and student nurses’ perspectives on ways to improve implementation of simulation-based education in Lesotho. | This study aimed to describe nurse educators and students’ perspectives on ways to improve implementation of simulation-based education in Lesotho | Method: A qualitative study was conducted . Participants: midwifery students, nurse educators including principal nurse educators in four private NEIs in Lesotho. | Resources to successfully implement SBE in Lesotho are inadequate, therefore, Nurse educators’ and students’ perspectives on ways to improve implementation of SBE in Lesotho includes increase the number of staffs, constructive feedback after each simulation exercise, adequate hours for simulation, easy access to the simulation laboratory. | |||||
24. | Pule Solomon Moabi Ntombifikile Gloria Mtshali 2021 Lesotho Lesotho: CBE- 2014 | Nursing Education Institutions’ Readiness to Fully Implement Simulation-Based Education in Lesotho | The aim of the study was to assess the readiness of the four private nursing education institutions in Lesotho to implement simulation-based education | Methodology- quantitative, descriptive research design. Population- nurse educators from the four private NEIs in Lesotho. | The study findings reveal that the institutions are moderately ready to implement simulation-based education. The successful implementation of SBE as a teaching methodology requires motivated staff, adequate funding, and managerial/administrative support as major facilitator to readiness to implement SBE. | |||||
25 | Fungai Muzeya Hester Julie 2020 Lesotho Lesotho: CBE- 2014 | Student midwives’ knowledge, skills and competency in relation to the active management of the third stage of labour: A correlational study | The knowledge and skills of final-year student nurse-midwives related to the active management of the third stage of labour were determined. | A quantitative, descriptive research design Population -student nurse-midwives in their final year of midwifery at the four schools of nursing | The component on the active management of the third stage of labour in the curriculum was adequate, however students had poor knowledge, skills, and competence of the management. . | |||||
26 | Ellemes Everret Phuma, 2015 (Dissertation) Malawi | Development of Neonatal Nursing Care Clinical Competency-Based Assessment Tool for Nurse-Midwife Technicians in CHAM Nursing Colleges, Malawi | The purpose of this study was to develop a neonatal nursing care clinical competency-based assessment tool to validate Nurse-Midwife Technicians (NMT) NMTs’ achievement of clinical competence in CHAM nursing colleges. | Methodology- sequential mixed method approach. The study was conducted in eight Christina Health Association of Malawi (CHAM) nursing colleges. Participants: midwifery clinical teachers and third year students, and midwifery clinical teachers. | The outcome of this study was the establishment of neonatal nursing clinical competencies, and development of a neonatal nursing care clinical competency-based assessment tool for the validation of NMT’s achievement of clinical competence. The tool provides a framework for neonatal nursing clinical teaching and assessments. | |||||
27 | Omaima Changuiti, Nawae Moustarhfir, Abdelghafour Marfak, Elmadani Saad, Abderraouf Hilali & Ibtissam Youlvouz-Marfak, 2021 Morocco- (CBE − 2013) | Simulation Based-Learning from Simple to Complicated Clinical Situations for Midwifery Students | his study aims at demonstrating the impact of simulation-based learning (SBL) experience on the learning of midwifery students | Methodology- experimental design. Participants- 28 midwifery students | These findings confirm that SBL creates an environment that is closer to reality thus offering the opportunity to learn in a safe environment. | |||||
28 | Said Abouzaj, 2019 Morocco- (CBE − 2013) | Competency-Based Approach in Training Nurses and Midwives in Morocco Demystify to Better Use | The purpose of this article is to present the competency-based approach in a simple way and to demystify the concept of competence | Review on Competency-Based Approach in Training Nurses and Midwives in Morocco Demystify to Better Use | In 2013 CBA (competency-based approach) was implemented and adopted to all training curricula for Nursing and Midwifery in Morocco. However, no notable changes have been observed as implementers continued with traditional method. | |||||
29. | Adetoro A.Adegoke, Safiyanu Mani, Aisha Abubakar, Nynke Van Den Broek 2013 Nigeria-(TBA) | Capacity building of skilled birth attendants: A review of pre-service education curricula | To assess the level, type and content of pre-service education curricula of health workers providing maternity services against the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. | A review of the quality and relevance of pre-service education curricula in nine training institutions in the three target states in Northern Nigeria using the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. | The findings revealed that all the four training curricula for the of four cadres of health-care providers (Nurses, Midwives, Community Health Extension Workers (CHEW) and Junior Community Health Extension Workers) did not meet the ICM global standards for Midwifery Education and practice. The curriculum is still traditional competency based | |||||
30. | Jean Pierre Ndayisenga, 2019 Rwanda (CBE − 2007) | Nurse and Midwife Educators’ Experiences of Translating Teaching Methodology Knowledge into Practice in Rwanda | explore nurse and midwife educators’ experiences of translating the knowledge and skills on teaching methodologies into their teaching practices in Rwanda. | A descriptive qualitative design. Participants - Educators | Educators’ competencies in teaching appreciated, but their opportunities to translate knowledge and skills were hindered by insufficient resources, such as teaching materials and equipment, and heavy workloads. | |||||
31 | Claudine Muraraneza, Ntombifikile Gloria Mtshali, 2020. Rwanda (CBE − 2007) | Drivers of transformation to competency-based nursing education in Rwanda | This article explores the drivers of transformation to competency-based nursing education in Rwanda. | Methodology- The Strauss and Corbin grounded theory approach was used. Participants- Educators, administrators, academic leaders, managers, and students. | Four categories of transformative factors emerged: (a) the political agenda of the country, (b) the transformation of higher education, (c) the transformation of the health care system and (d) the transformation of undergraduate nursing education. | |||||
32 | Claudine Muraraneza, Gloria Ntombifikile Mtshali, 2018, Rwanda. Rwanda (CBE − 2007) | Implementation of competency-based curriculum in pre-service nursing education: Middle range theory | To develop a middle range theory that guides the practice of competency-based curriculum in pre-service nursing education. | Qualitative design with the grounded theory of Corbin and Strauss was followed. Participants- educators, administrators, and academic leaders, students, and managers | A middle-range theory guides competency-based curriculum in pre-service nursing education. | |||||
33. | A. Harerimana J. de Beer,2013 Rwanda Rwanda (CBE- 2007). | Nurse educators’ utilisation of different teaching strategies in a competency-based approach in Rwanda | Explore nurse educators’ perceptions and knowledge on the competency-based approach used in nursing and midwifery education in Rwanda to facilitate the implementation of different teaching strategies | A quantitative, non-experimental descriptive study Participants: nurse educators from four Rwandan nursing schools. | Nurse/midwife educators have good knowledge and positive perception of effective implementation of CBE. However, nursing/ midwifery educators must contend with increased workload attributed to using active teaching strategies, and a lack of supports in using different teaching strategies. | |||||
34 | Andrew Mclellana, Abdi Adena, Antoine Lacroixb, Joan Shephardc, 2020 Sierra Leone: | Analysis of Bachelor of Science in Nursing Education in Sierra Leone: A look at program fidelity and student satisfaction | Examine BScN education with a program fidelity lens and report on student satisfaction with BScN education. | Guided by the organizing framework of the WHO’s Global Standards for the Initial Education of Professional Nurses and Midwives (2009) in combination with the Standards for Basic Nursing and Midwifery Education for Sierra Leone (2016) | The evaluation discovered students were unsatisfied with the BScN education due to poor learning environment at the universities and clinical sies. The clinical sites lack competent preceptors and supervisors, and the theoretical aspects of curriculum were underdelivered by educators. | |||||
35 | Moliehi Rosemary Mpeli and Yvonne Botma, 2015. South Africa (CBE-2001) | Abortion-related services: Value clarification through ‘Difficult Dialogues’ strategies | This article reports on the value clarification process and the views of preregistration midwifery students regarding abortion-related services before and after implementing the value clarification process. | The three-step method of value clarification as described by Lipe (n.d.) was used to elicit the views of preregistration midwifery students on abortion-related services. Participants: Nursing students in their final year of the preregistration nursing degree | The results demonstrate that the integration of the value clarification process into midwifery preregistration education promotes transformative learning and intellectual growth. Authors recommend active engagement of students in transformative learning activities that entail a process of value clarification. | |||||
36 | Johanna M. Mathibe-Neke, Taahira Mondell, 2017 South Africa (CBE-2001) | USING A NARRATIVE CASE STUDY TO FACILITATE A HOLISTIC MIDWIFERY CARE: A TEACHING STRATEGY | The aim was to use a case study as a teaching strategy in midwifery nursing education to ensure that students are responsive to a pregnant family by means of a holistic approach | A narrative case study design | The findings showed use a case study as a teaching strategy in midwifery nursing education create a platform for women empowerment such that woman gain more knowledge and self-care, self-control, self-healing, and self-actualization. | |||||
37. | Fiona Singh1 and Thembekile Masango, 2020 South Africa (CBE-2001) | Information Technology in Nursing Education: Perspectives of Student Nurses | To explain and describe the perspectives of student nurses at a private nursing education institution on the use of IT in nursing education | Methodology- A quantitative non-experimental, descriptive research design Participants- student nurses registered for basic and post-basic qualifications | The importance of IT in nursing education was acknowledged by participants. The challenges reported were inadequate training and poor internet connectivity, regular use IT, IT devices for personal use and work purposes, IT competence, positive attitudes to IT. | |||||
38. | Hafaza B. Amod, Petra Brysiewicz, 2019 South Africa (CBE-2001) | Promoting experiential learning through the use of high-fidelity human patient simulators in midwifery: A qualitative study | The aim of this study was to describe how HFHPS can promote experiential learning following the management of postpartum haemorrhage as a midwifery clinical emergency. | Methodology- Descriptive qualitative research approach was carried out in this study. The research setting was a local university in KwaZulu-Natal. Participants included 43 student midwives. | Four categories emerged from the data, namely HFHPS offers opportunity to manage complex real-life emergencies for student midwives ; promotes reflection learning, decisions making skills; experiential learning, and student confidence to try out what they learnt in a real-life situation. | |||||
39. | MARY SHAMANE SUBHAN, 2014 South Africa (CBE-2001) | Current pedagogical teaching strategies being used by educators at the KwaZulu natal college of nursing campuses across varied subjects and their views regarding innovative methodologies. | This study explore what current teaching strategies are being used to teach nursing students and their views on the use of more contemporary creative methodologies. | Methodology- quantitative cross-sectional descriptive research design Participants: Nurse educators at the KwaZulu Natal College of Nursing campuses were involved in the study | The study found that a major percentage of the respondents were using didactic teaching methods such as the lecture method and demonstration to teach across all subject areas. They however were receptive to supported to creative methodologies and need for further training on them | |||||
40. | Mahlasela Annah Rakhudu, 2017. South Africa (CBE-2001) | Experiences of North-west University Nursing Students in Problem Based Learning (PBL) | The purpose of this study was to explore and describe third- and fourth-year nursing students’ experiences of PBL at NWU | Methodology- A qualitative, descriptive, exploratory, and contextual research design, Participants: students | PBL fosters critical thinking, communication skills, and teamwork among students. However, the challenges encountered with PBL include problematic group cohesion and unfamiliarity with PBL, inadequate resources, insufficient time and workload and poor support. | |||||
41 | Judith C. Bruce, Melanie Lack, Nthabiseng M. Bomvana, Nomawethu Qamata-Mtshali, 2018 South Africa (CBE-2001) | Problem-based Learning: Nursing students’ attitude, self-reported competence, tutorial performance and self-directed learning readiness | The objectives were to ascertain Bachelor of Nursing (BN) students’ attitude towards the value of PBL as a learning strategy. | The study followed a descriptive and comparative survey design to collect the data. Participants were Bachelor of Nursing (BN) students | All BN students had positive attitude towards PBL, while a few students expressed being competent in the majority of the PBL processes. . | |||||
42 | Kabelo S. Bonokoane Jeanettte M. Sebaeng Seepaneng S. Moloko-Phiri, 2023 South Africa (CBE-2001) | Incorporation of Nurse Initiated Management of Antiretroviral Treatment course within the undergraduate nursing programme Northwest province. | To explore and describe nurse educators’ perceptions regarding the incorporation of NIMART course within the undergraduate nursing programme in NWP | Methodology- Phenomenography qualitative research design was followed. Participants: nurse educators at nursing education institutions of the NWP | The incorporation of the NIMART course into the undergraduate nursing programme was welcomed and endorsed by the Nurse educators. . | |||||
43 | Thembeka Maureen Sinqotho. 2015 South Africa (CBE-2001) | CASE BASED LEARNING IN THE UNDERGRADUATE NURSING PROGRAMME AT A UNIVERSITY OF TECHNOLOGY: A CASE STUDY | The purpose of this study was to evaluate the structure and the process in case-based learning at the University of Technology | Methodology: This study is qualitative. Participants: students | The study revealed that students had positive attitude towards CBL as it promotes group dynamics however working in groups as its demerits according to participants. The CBL processes and programme structures are adequate and supportive. | |||||
44. | Nomafrench Mbombo1 Million Bimerew, 2012 South Africa (CBE-2001) | Integrating Prevention of Mother to Child HIV Transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme | to describe teaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool | Methodology- A quantitative descriptive design. Participants: Students. | Integration of HIV competencies, including PMTC should be done theoretically and at service delivery to ensure nursing and midwifery competencies, including assessment strategies. Policies on supplies and distribution of antiretrovirals pose a barrier to successful implementation of PMTCT. | |||||
45. | Regis Rugira Marie Modeste, 2015 (dissertation) South Africa (CBE-2001) | Developing a model for integration of core competencies related to HIV and AIDS into undergraduate nursing curriculum at the University of the Western Cape Student | The purpose of this study was to develop a model for integration of HIV and AIDS nursing competencies into the undergraduate nursing programme at the University of the Western Cape. | Methodology: Intervention research: design and development approach. Participants: nurse educators, PLWHIV/AIDS, Clinical nurses, recent graduates, South African Nursing Council representatives. | The integration model developed was flexible, to allow adoption into other undergraduate nursing programmes, and may further assist in the systematic integration of HIV and AIDS into the nursing curriculum. | |||||
46. | Regis R. Marie Modeste; Oluyinka Adejumo, 2015 South Africa (CBE-2001) | Validation of the integration of HIV and AIDS related nursing competencies into the undergraduate nursing curriculum in South Africa | This article presents the validation process conducted to confirm the integration and mapping of the HIV and AIDS related nursing competencies into Nursing programme at a university in South Africa | Methodology: Qualitative approach, Participants: Nurse educators from selected universities, clinical nurses, recent graduates, people living with HIV/AIDs. | Each Competency and its expected outcomes were developed per year. Participants confirmed outcomes were complete and appropriateness feasibility and practicability for the mapping and integration of the HIV and AIDS related outcomes into the nursing curriculum. | |||||
47. | Joanne Rachel Naidoo, Silingene Ngcobo, Busisiwe Ncama, Petra Brysiewicz, 2017 South Africa (CBE-2001) | Experiences of nurse graduates of an integrated HIV curriculum from a Selected university in South africa | Experiences of the first cohort of student nurses exposed to the integration of HIV nursing competencies within a four-year Bachelor of Nursing programme | Methodology: A descriptive exploratory design Participants: first cohort of nurse graduates. | The results revealed a positive experience from all the participants evident by their ability to practice and fulfil a range of HIV-related nursing care independently. | |||||
48. | Wendy Augusta Phiri, 2017 (dissertaton) South Africa (CBE-2001) | The development of a framework to align theory and practice to improve midwifery education in the Western Cape | Thus, the purpose of this study was to develop a framework to align theory and practice for improved midwifery education in the Western Cape | Methodology: A qualitative exploratory, descriptive and theory Participants: community service practitioners, midwifery educators, (lecturers, and clinical facilitators) and professional nurses who were purposively sampled. | Theory synthesis – focused on the process of framework development. The context for which the framework was developed, and the assumptions of the framework were discussed. | |||||
49. | Siyabonga Ziqubu, 2019 (dissertation) South Africa (CBE-2001) | Examining the readiness of nurse educators to adopt technology-based education in a college of nursing within KwaZulu natal | The purpose of an investigation was to establish the preparedness of nurse educators to accept technology-centered training within a college of nursing in KZN | Methodology: A quantitative descriptive cross sectional survey research design was used. Participants: nurse educators and clinical facilitators. | the nurse educators showed readiness to adopt technology-based education. However, participants enlisted KZNCN support will improve the availability of resources and facilitating the conditions | |||||
50. | Million Bimerew and Nomafrench Mbombo 2014 South Africa (CBE-2001) | Adequacy and sustainability of undergraduate midwifery programmes training course materials. | The purpose of the study was to determine the adequacy and sustainability of Undergraduate midwifery programmes training course materials | Methodology: A quantitative survey method was employed Participants: lecturers and clinical supervisors and graduated professional nurses doing their community service. | The results of this study show that participants confirmed the adequacy of provision of PMTCT competency-based course materials to undergraduate midwifery students, further substantiating the course sustainability. | |||||
51. | Siyabonga Ziqubu and Penelope Margaret Orton, 2023 South Africa (CBE-2001) | Perspectives of Nurse Educators Towards Technology-based Education in Selected KwaZulu-Natal Nursing Colleges | The aim of this study was to describe nurse educators’ attitudes and forecasts towards technology-based education in KwaZulu-Natal | Methodology: A quantitative, descriptive, cross-sectional survey research design was used. Participants: nurse educators and clinical facilitators in College of Nursing campuses in KwaZulu-Natal. | Participants planned to use technology to support teaching and learning, in as much as access to such technology is adequately provided. | |||||
52. | Tebogo A. Tsimane, Charlene Downing, 2020 South Africa (CBE-2001) | A model to facilitate transformative learning in nursing education. | The purpose of this article is to describe a model to facilitate transformative learning in nursing education | Methodology: A qualitative, exploratory, descriptive and contextual design for theory generation. Participants: Nurse educators. | The six elements from which the theory was conceptualized; the context, agent, recipient, dynamic, process and procedure and outcome. | |||||
53. | Viola Janse van Vuuren, Daniel T. Goon and Eunice Seekoe 2018 South Africa (CBE-2001) | The perceptions of nurse educators regarding the use of high-fidelity simulation in nursing education | The aim of this study was to determine the perceptions of nurse educators regarding the use of high-fidelity simulation to at a South African private nursing college | Methodology: survey method Participants: Nurse educators and clinical training specialists. | The findings revealed the readiness of the participants to use HFS in nursing education. However, the participants expressed the need for more training to be adequately prepared to use simulation equipment. | |||||
54. | Sidwell Matlala, 2021 South Africa (CBE-2001) | Educators’ perceptions and views of problem-based learning through simulation | To explore the perceptions and views of healthcare educators on how problem-based learning can be facilitated through simulation. | Methodology: A qualitative research design was used. Participants: Educators from the Faculty of Health Sciences. | Problem-based learning through simulation promotes teamwork among students, which demonstrates a new technique to rendering a holistic patient care. | |||||
55. | Mauwane Rebecca Phaladi-Digamela, 2015 (dissertation) South Africa (CBE-2001) | A Competency-Based Curriculum Framework to Standardise Genetics Education in an Advanced Midwifery Programme | This study aims to develop a competency-based curriculum framework to standardize genetics education in an advanced midwifery programme | Methodology: Multimethod research approach Participants: Educators | To address the objective of this study, a curriculum framework to standardize genetics and education in the advanced midwifery programme was developed | |||||
56. | Felicity M. Daniels Lorraine P. Fakude, Ntombizodwa S. Linda1 Regis R. Marie Modeste, 2015 South Africa (CBE-2001) | Nurse educators’ experiences of case-based education in a South African nursing programme | The aim of the study was to explore nurse educators’ experiences, current practices, and possible improvements to inform the best practice of CBE at the nursing school in the Western Cape. | Methodology: A participatory action research method was applied in a two-day workshop conducted Participants: Nurse educators in the undergraduate nursing programmes | Participants reported various approaches employed in case-based education and the challenges encountered with the implementation at the nursing school in the Western Cape. | |||||
57. | Mahlasela A. Rakhudu1 Mashudu DavhanaMaselesele Ushonatefe Useh, 2017 South Africa (CBE-2001) | A model of collaboration for the implementation of problem-based learning in nursing education in South Africa | To develop a model of collaboration to facilitate the implementation of PBL in nursing education. | Methodology: An exploratory sequential design was used. Participant: nurse educators from three universities in South Africa offering PBL and nurse managers from all the three hospitals in Northwest Province | following the exploration of nursing students’ experiences and perceptions in 2008 for the need to strengthen PBL implementation through collaboration. A model of collaboration in implementing PBL in nursing education was developed. | |||||
58. | S. Mthembu, N. Mtshali, J. Frantz ,2014, south Africa South Africa (CBE-2001) | Contextual determinants for community-based learning programmes in nursing education in South Africa | aims to present the contextual determinants of CBL and to describe the causal conditions that led nursing education institutions (NEIs) to incorporate CBL into their curricula. | Methodology: A grounded theory research design Participants- nurse educators or lecturers, the head of department or deputy head of the NEIs, the programme director and coordinators and the facilitators (or lecturers), including clinical facilitators. | The contextual influence on implementation of CBL are transformation of higher education, healthcare system, and nursing education in South Africa. | |||||
59. | Hafaza Bibi Amod, Petra Brysiewicz, 2017 South Africa. South Africa (CBE-2001) | Developing, implementing, and evaluating a simulation learning package on post-partum haemorrhage for undergraduate midwifery students in KwaZulu-Natal | The aim of this study was to develop, implement and evaluate a simulation learning package (SLP) on post-partum haemorrhage for undergraduate midwifery students using high fidelity simulation | Methodology: An exploratory sequential mixed methodology was used in this study. Participants: students | The developed SLP on post-partum haemorrhage for undergraduate midwifery students was found suitable for undergraduate student-based approach | |||||
60. | Doreen Mloka, Edith Tarimo, Lillian Mselle, Stephen Mshana, Nathaniel Sirili, Jane Rogathi, Levina Msuya, et al., 2023 TANZANIA | The process of harmonizing competency-based curricula for medicine and nursing degree programmes.: a multi-institutional and multi-professional experience | This paper describes how three health professions training universities in Tanzania and their two long-standing United States partners embarked on developing harmonized CBC for undergraduate medicine and nursing degrees | The main goal of the activity was to develop templates to harmonize curricula that would support graduates to acquire mandatory national Graduate Minimum Essential Competencies (GMEC) irrespective of the institution of their training | The paper describes the processes of engaging multiple institutions and interprofessional collaborations to develop a mandatory, harmonized national curriculum for teaching medicine and nursing. | |||||
61 | Mmari Vumilia Bettuel, Mselle Lillian Teddy, Kibusi, Stephen Mathew & Osaki Kalafunja Mlang’a, 2020 Tanzania(CBE- 2008). | Implementation Dosage of Competency-Based Curriculum for Nursing and Midwifery Programme among Nurse Educators in Tanzania | The aim of this study to assess implementation dosage of the nursing and midwifery CBET (Competency-Based Education and Training) curriculum among nurse educators in Tanzania. | Methodology: Descriptive cross-sectional study design using a partial convergent mixed methods research approach. Participants- Nurse educators from nursing and midwifery schools. | Inability of the educators to deliver the intended dosage as stipulated by the nursing and midwifery CBET curriculum was observed. Contributing factors identified were insufficient time for teaching and learning, poor understanding and interpretation of the CBC, workload, and shortage of educators. | |||||
62. | Mmari Vumilia, Mselle Lilian, Kibusi Stephen and Osaki Kalafunja, 2020 Tanzania (CBE- 2008). | Experiences of Nurse Educators on the Implementation of the Competency-Based Curriculum for Nursing and Midwifery Programmes in Tanzania: A mixed methods study | This study describes experiences of nurse educators in implementing the CBET for nursing and midwifery programmes in Tanzania. | Methodology: A descriptive cross-sectional study design using concurrent, partial mixed methods. Participants: Nurse educators in selected nursing and midwifery training schools across Tanzania. | This study revealed that educators had difficulty in interpreting the curriculum inevitably impacting the proper implementation of nursing and midwifery Competency Based Education and Training curriculum (CBET) curriculum. | |||||
63. | Sima Ferdnard ,2021. Tanzania (CBE- 2008) | Assessment of Competency Based Education and Training (CBET) curriculum. in improving quality of training in school of nursing, Lake zone Tanzania. | The purpose of the study was to assess the execution of CBET curriculum in nursing and midwifery training institutions in Tanzania. | Methodology: A mixed method approach. Participants: Nurse educators of school of nursing and midwifery involved in classroom and practicum sites teaching of students utilizing CBET curriculum | The study revealed that clinical nurse educators were not involved during the training on the implementation of CBE curriculum evident by poor preparation and orientation on the use of CBET curriculum. The classroom nurse educators despite good knowledge failed to use OSCE to assess student during exams. | |||||
64. | Stembile Mugore, Mercy Mwanja, Vumilia Mmari, Alphonce Kalulad, 2018 Tazania (CBE- 2008) Uganda (CBE- 2006) | Adaptation of the training resource package to strengthen preservice family planning training for nurses and midwives in Tanzania and Uganda, 2018 | workshops to adapt modules of the Training Resource Package for Family Planning (TRP) using CB- training methods to improve the quality of preservice family planning education for nurses and midwives. | Methodology: Field action reports Participants comprises of policy makers, program managers, educators from nursing and midwifery training institutions, and representatives from professional association from both countries. | Participants had difficulty in integrating competency-based-based teaching methods into their curricula because of their poor knowledge and interpretation of such approaches. Thus affecting their ability to adjust the comprehensive TRP content to fit into the limited time allotted family planning in preservice education . | |||||
65. | June Patrick Bigirwa, Stephen Ndawula Esther Frances Naluwemba 2020 Uganda (CBE- 2006) | E-learning adoption: Does the instructional design model matter? An explanatory sequential study on midwifery schools in Uganda | This research intended to ascertain to ascertain whether instruction design was relevant to e-learning adoption and the essential instruction design traits to be implemented by midwifery schools. | Methodology: This study used an explanatory sequential mixed methods design. Participants: Ten midwifery schools were sampled with 224 participants | The result of the analysis showed that instructional design had a significant influence on e-learning adoption. Instructional design accounted for 38.7% of the variance in e-learning adoption, a moderate positive relationship and its six key salient traits. | |||||
66. | June Patrick Bigirwa, Stephen Ndawula, and Esther Frances Naluwemba, 2022 Uganda (CBE- 2006) | Technology Leadership Practices of End Users and the Adoption of E-Learning in Midwifery Institutions in Uganda | The study intended to ascertain if technology leadership practices were significant to e-learning adoption and sketch core practices | Methodology: This study used an explanatory sequential mixed method. Participants: Students on the e-learning programme and the tutors in twelve midwifery institutions offering e-learning programme in Uganda | Technology leadership practices had positive influence on adoption. Six (6) Core technology leadership practices were highlighted | |||||
67. | Michelle Telfer, Rachel Zaslow, Rose Chalo Nabirye, Scovia Nalugo Mbalinda 2021 Uganda (CBE- 2006) | Review of midwifery education in Uganda: Toward a framework for integrated learning and midwifery model of care | To examine the current approach to midwifery education and deployment in Uganda against the backdrop of the evidence presented in the Lancet Series on Midwifery and the International Confederation of Midwives Global Standards for Midwifery Education. | A review of government reports and published literature regarding nursing and midwifery education. | Finding showed that nursing and midwifery education in Uganda are too numerous with ambiguous path to educational advancement. Wide gap exists in curricula in comparism to International Confederation of Midwives standards. Graduates lack competencies in midwifery model of care making them synonymous to staff nurses in the maternity units. | |||||
68. | Milly M. Kabanga1*, Christopher B. Mugimu1 and Joseph Oonyu 2018. Uganda (CBE- 2006). | Appropriateness of curriculum content in competence –based education training programs of nurses and midwives in Uganda. | The aim of this study was to investigate the perception of professionals regarding appropriateness of the CBE curriculum content in terms of organization, clarity, relevance, and suitability in training programs of nurses and midwives of Uganda. | Methodology: The study used concurrent mixed methods. Participants: school principals, tutors, nurse/midwives, hospital administrators/consultants, officials at both Uganda Nursing and Midwifery Examination Board (UNMEB) and Uganda Nurses and Midwives Council (UNMC), Ministry of Education and Sports (MoES) and Ministry of Health officials. | The curriculum content was considered appropriate in terms of clarity, relevance, and suitability to prepare competent midwives. However, some shortcomings were identified, for example, (a) poor adaptation of CBE by stakeholders and implementers evident by wide disparities in the implementation of curriculum content/subject areas to different cohorts of students. (b) inadequate numbers of tutors and clinical supervisors. | |||||
69. | Milly M. Kabanga, Christopher B. Mugimu, Joseph Oonyu, 2018 Uganda (CBE-2006) | Exploring the Pedagogical Practices used in Competence Based Education Training of Nurses and Midwives in Uganda | The purpose of this study was to explore the suitability of pedagogical practices utilized in the CBE training programs in Uganda | Methodology: Concurrent mixed method Participant - School principals, nursing and midwifery tutors, hospital administrators, officials at Uganda nursing and midwifery examination board and council | The pedagogical approaches in CBE were found suitable for training competent nurses and midwives. However, some notable challenges were identified in institutionalizing it which includes inadequate material resources, and insufficient support to students largely due to shortage of staff. | |||||
70. | Dan Kaye, Andrew Mwanika, Gilbert Burnham, Larry W Chang, Scovia N Mbalinda, Isaac Okullo, Rose C Nabirye, Wilson Muhwezi, Hussein Oria, Stephen Kijjambu, Lynn Atuyambe, Warren Aryeija, 2021 Uganda (CBE-2006) | The organization and implementation of community-based education programs for health worker training institutions in Uganda | This study was undertaken to assess the scope and nature of community-based education for various health worker cadres in Uganda. | Methodology: This was a cross-sectional study. Participants: In-depth and key informant interviews were conducted with people involved in managing CBE in twenty-two selected training institutions, as well as stakeholders from the community, Ministry of Health, Ministry of Education, civil society organizations and local government. | The planning and implementation of CBE curriculum findings revealed major Strengths to include providing hands-on experience, knowledge and skills generation and the linking learners to the communities. The challenges mostly mentioned are poor human resource, financial, and material constraints. | |||||
71. | Martha Mbewe, Natalia Mbewe, Catherine M. Ngoma, 2020 Zambia: (CBE-2013) | Factors contributing to students’ satisfaction with direct observation of procedural skills in the school of nursing sciences at the University of Zambia | This study investigated factors influencing student satisfaction with direct observation of procedural skills to get students’ views on this assessment tool. | Methodology: A cross sectional quantitative survey participants: final year undergraduate nursing students | Direct observation of procedural skills remains an appropriate tool to assess student clinical competence. In conclusion, the major factors that influenced student satisfaction included clinical environment which was not conducive for assessments as it lacked many essential medical surgical supplies and unavailability clinical facilitators. | |||||
72. | Lynda Tyer-Viola, Beatrice Zulu, Margaret Maimbolwa and and Anthony Guarino, 2012 Zambia: (CBE-2013) | Evaluation of the use of Simulation with Student Midwives in Zambia | This study evaluated the use of simulation with midwifery students in Zambia | Methodology: pre and post-test quasi experimental design Participants-midwifery students. | Students’ satisfaction with simulation were influenced by participation in the procedure. | |||||
Fig. 1
PRISMA- ScR
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Reporting of the scoping review findings follows the PRISMA- ScR flow chart format(Fig. 1) Subsequent content analysis using Graneheim and Lundman approach identified seven (7) themes from the literature and a narrative report presented [41] as follows; (a) midwifery curriculum (b) competency-based education curriculum implementation process (c) pedagogical approaches in CBE (d) Benefits of CBE (e) sustainability of CBE (f) facilitators of CBE implementation (g) challenges to CBE implementation.
Theme 1: midwifery curriculum
Midwifery curriculum generated two sub-themes comprising the types of midwifery curriculum implemented and the content of the midwifery curriculum.
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Sub-theme1: Type of midwifery curriculum implemented
A thorough search of the published literature in Africa on midwifery education found 17 countries 11 of which are implementing CBE (South Africa, Rwanda, Tanzania, Uganda, Lesotho, Kenya, Egypt, Morocco, Malawi, Democratic Republic of Congo, Zambia), while 5 countries (Nigeria, Ethiopia, Ghana, Benin, Sierra Leone) are using Traditional-Based Approaches. Problem-Based Learning (PBL) is the main teaching pedagogy used in Botswana.
Sub-theme 2: Content of the Curriculla. (wide disparities within and across the countries)
The findings showed that the content of the curriculum differs appreciably among training institutions within African countries. Comparing the content of the curriculum to ICM global, essential competencies for midwifery practice revealed that a wide gap exists within institutions in a nation and across the African continent. A study assessing the curriculum in four countries found that, out of the ten pre-service curricula assessed, none of the curricula included all the ICM competencies [42]. In Nigeria, of the2 institutions in the 3 selected northern states providing pre-service education for midwives, 23 competencies were found not to align with the ICM standards [43]. Similarly, in Uganda, wide disparities were noticeable in curricula compared to the ICM standards, midwives synonymous with general nurses working in the maternity unit because graduates lack competencies in the midwifery mode of professional care [44].
In an undergraduate midwifery programme in South Africa, the content of the curriculum revealed that some topics were integrated into the existing curriculum using CBE approaches. For instance, a study showed that the competency-based course materials on Prevention of Mother to Child Transmission (PMTCT) of HIV/AIDS were adequate, and that the course was found to be sustainable for undergraduate midwifery students [45]. In a similar study, PMTCT including HIV and AIDS related outcomes was recommended to be fully integrated into classroom teaching and at SDP (Service Delivery Points) for nursing and midwifery competencies, including assessment strategies [46, 47]. This study concludes that incorporation of the Nurse Initiated Management of Anti-Retroviral Treatment (NIMART) course into the undergraduate nursing programme was supported by nurse educators who expressed that the NIMART course will benefit the student nurses, the NEIs and the communities at large [48]. The Simulation Learning Package (SLP) on PPH (Post-Partum Hemorrhage) developed for undergraduate midwifery students was also found suitable [49]. In South Africa, a competency-based Curriculum Framework was found to be necessary and was developed to standardize genetics education in an Advanced Midwifery Programme [50]. In Tanzania and Uganda, Training Resource Packages (TRPs) to Strengthen Pre-service Family Planning Training for Nurses and Midwives was integrated into the pre-service curriculum using CBE approaches [51]. In Kenya, in 2021, the Nursing Council of Kenya (NCK) in collaboration with the Liverpool School of Tropical Medicine (LSTM) and multiple stakeholders reviewed and updated the nursing and midwifery degree programme focusing on strengthening the quality of training of the pre-service faculty and clinical instructors on pedagogy skills and capacity-building for the provision of competency-based Emergency Obstetrics and Newborn Care (EmONC) [52]. The study established that the curriculum component concerning the active management of the third stage of labour aspect in the curriculum was adequate [53].
Theme 2: The CBE curriculum implementation process generated five (5) sub-themes which are (a) contextual factors for curriculum reform (b) stakeholders’ engagement (c) roles of stakeholders. (d) opinion of stakeholders on CBE (e) development of intervention tool informing the model /framework
Sub-theme 1: Contextual factors for curriculum reform
This review identified the contextual factors for curriculum reform in various countries. The most prominent factor for the transition to CBE was the need to prepare competent midwives through the improvement of the quality of pre-service midwifery education to address the high burden of maternal and newborn mortality, especially in Africa, where the rates are high [52, 54, 55]. In South Africa and Rwanda, curriculum reform was borne from a demand for competent graduates, the political agenda of the countries to respond to population health, the transformation of higher education, the health care systems and undergraduate nursing education [56, 57].
Sub-theme 2: Stakeholders’ engagement
The stakeholders identified are policy makers (national governments), ministries of health, ministries of education, professional regulatory bodies of the countries, commissions for the universities, institution administrators, heads of nursing and midwifery programmes, faculties (which include nurse and midwifery educators, clinical instructors and clinical staff, clinical supervisors and clinical preceptors), students’ interprofessional collaborations and partnerships [56, 58‐60]. In Ethiopia, the stakeholders involved in the midwifery curriculum process were primarily education experts with minimal contributions from professional bodies, classroom educators and clinical preceptors, which reflected in the content lacking midwifery clinical practice [51]. While it was evident that the curricula in Ghana and Malawi received input from their professional bodies since the content comprised information on midwifery clinical practice [61]. A part of highlighting effective curriculum development processes is a focus on interprofessional collaborations within and between universities, both local and international partnerships [52, 58, 62, 63]. For instance, in Kenya, the Nursing Council of Kenya (NCK), in collaboration with an international body developed a competency-based curriculum integrating EMNOC [64]. In 2012, the Global Nurse Capacity Building Programme (GNCBP) through the Nursing Education Partnership Initiative (NEPI), was instrumental in the development of the maiden competency-based curriculum (CBC) for the post-basic Diploma in Midwifery programme in Lesotho, across all of the Nursing Education Institutions (NEIs) [65]. The NEPI further collaborated and partnered with nursing and midwifery education institutions and national health departments in other African countries such as the Democratic Republic of Congo, Ethiopia, Lesotho, Malawi, South Africa, and Zambia [63]. An exploration of nursing students’ experiences and perceptions at the school of nursing sciences in South Africa (SA) revealed that students recommended the need for inter- and intra- collaborative partnerships between professionals in the universities and clinical practice settings [66].
Sub-theme 3: Roles of the stakeholders in curriculum process
Implementation of competency-based education requires engaging all stakeholders so that they discharge their roles in the review, development and adoption of a CBE curriculum to create a national standard for teaching and learning in a particular country [55, 63, 64]. The government of the country is expected to exert its political will by making the implementation of the curriculum a policy, and ensuring compliance by all stakeholders/policy makers. Governments are expected to provide an enabling environment through capacity-building of faculties and provision of financial, human and material resources for the proper implementation of CBE [58, 62]. The role of regulatory bodies, which include professional bodies and university commissions, is to ensure that schools adopt and adapt the curriculum. With support from government and partners, Stakeholders/policy makers t should facilitate the training and retraining of faculties and distribute supplies and resources for the implementation of CBE [58, 62]. Stakeholders/policy makers should also monitor and evaluate the curriculum through consultation with other stakeholders to update the curriculum regularly [59]. The role of faculties is to adopt and integrate the CBE into the teaching and learning of students, maximizing the available support, and being committed to in-service training/retraining on CBE, including that of new faculties [67]. The students provide feedback on the CBE curriculum [66, 68].
Sub-theme 4: Opinions of stakeholders regarding CBE
The study assessed the readiness to adopt, appropriateness, feasibility and practicability, fidelity, implementation, attitude, perception, positive attitude, satisfaction, adequacy, suitability, acceptability to elicit the opinions of stakeholders on CBE. For example, in South Africa, the nurse educators showed a readiness to adopt technology-based education when asked, and participants showed a willingness to adopt it [69]. The findings in another study in South Africa confirmed that nurse educators were ready to use technology-based education (High Fidelity Simulation (HFS) but stressed that readiness does not translate to the utilization of HFS [70], while a further study found that institutions were moderately prepared to integrate simulation-based education into teaching and learning [71]. Educators established the appropriateness, feasibility, and practicability of integrating HIV/Aids into the nursing curriculum [47]. The suitability of the pedagogical approaches in CBE were explored and the study confirmed the suitability of the approach for training of nurses and midwives [72]. The appropriateness of the curriculum content was assessed for clarity, relevance, and suitability in preparing competent midwives. The findings showed that it was appropriate across all the variables of assessment [73]. While in Rwanda, findings revealed that nurses/midwife educators had good knowledge which was evident in their mastery and utilization of different teaching strategies in a CBE approach and a positive perception toward effective implementation of CBE [74].
The educators acknowledged the positive influence of IT in nursing education and showed a good attitude toward IT use [75] (Singh and Masango, 2020). A study concluded that nurse educators perceived the incorporation of the NIMART course into the undergraduate nursing programme as a good idea and approved its incorporation [48]. A study on the fidelity of implementing the Community-Based Nursing Education (CBNE) programme during the COVID-19 pandemic found that the nurse educators satisfactorily maintained the fidelity of implementing the CBNE framework within the context of COVID-19 [76]. In Uganda, the implementation of CBE by educators in institutions was explored, and the literature indicated that the CBE curriculum had been analytically planned and implemented, which was evident in major similarities amongst institutions in the country [77]. Study results highlighted that nurse educators in KwaZulu-Natal have positive attitudes toward utilizing technology to support teaching and learning, provided that the technology is readily accessible [78].
Other studies assessed students’ opinions on CBE implementation. A study conducted on case-based learning (CBL) showed that students had positive perceptions of and supported CBL, while they highlighted the importance of group dynamics as a key success factor to successful implementation [79]. Concerning Problem-Based learning (PBL), the majority of the students had a positive perception of PBL, with a few students feeling confident in utilizing most of the PBL processes [80]. In this experimental study, students who participated found simulation method more satisfactory than students who did not participate [81]. In a study by Gudayu, it was discovered that students’ satisfaction and confidence was average in the use of simulation among midwifery students [82]. In South Africa, students expressed that educator supported the use of creative pedagogical approaches but would appreciate further training and support to equip them to use and gain mastery of a range of creative teaching strategies [67].
Sub-theme 5: Development of a framework/model/theory
The development of the model or framework was identified as critical for CBE curriculum implementation. In Lesotho, following two years of integration of CBE, implementers had difficulty implementing and sustaining CBE. This called development of an evidenced-based framework to direct the implementation and sustainability of a competency-based curriculum for higher education in midwifery [83]. An integration model for including HIV and AIDS into the nursing curriculum was developed by Modeste [84]. The model proved useful in enhancing the competencies of nurses in the provision of HIV and AIDS-related care and management [84]. A framework was developed to enhance the incorporation of simulation in nursing education and the development of clinical competence in a low resource setting [85, 86]. A model to facilitate transformative learning in nursing education was developed and found to be adaptable to all settings of clinical practice, research, and education [87]. Phaladi-Digamela (2015) developed a curriculum framework to standardize genetics’ education in the advanced midwifery programme [50]. Rakhudu and colleagues developed a model of collaboration to implement PBL in nursing education [66]. In Rwanda, a middle-range theory was developed to guide the implementation of a competency-based curriculum in pre-service nursing education [88]. A framework to guide the assessment of clinical competence and to track student clinical experience in neonatal nursing clinical teaching was developed [89].
Theme 3: Pedagogical approaches in CBE
The pedagogical approaches identified in CBE include the use of IT in nursing education [75] and other forms of IT, such as e-learning [90, 91] and nursing and midwifery informatics [92]. Educational board games [93], narrative case studies [94], value clarification through ‘Difficult Dialogues’ strategies [95] are also some of the approaches discussed including technology-based education [69, 78] such as Simulation Based-Learning [81, 82, 96] and High-Fidelity Simulation [70]. Other approaches mentioned are case-based learning which includes group work, reflection, and student presentation [79, 97] and problem-based learning [66, 80, 98, 100], as well as direct observation of procedural skills as an appropriate tool to assess student clinical competence [101]. The OSCE method was mentioned as a popular assessment tool to evaluate the clinical competence of students [102, 103].
Theme 4: benefits of CBE
Some of the literature reviewed expressed the outcomes of CBE as including educators’ increased competencies and confidence in teaching [52, 64, 104]. The literature further revealed that orientation on all teaching strategies increased knowledge, thus informing the importance of using a variety of teaching strategies by faculties [105]. A study on the value clarification process concerning abortion-related services in South Africa reports that CBE promotes transformative learning and improves intellectual growth among learners [95]. Midwifery educators described their experiences with the OSCE development process as an exercise that equips them with leadership skills and knowledge which is critical to the midwifery practice and education [102]. The use of educational board games was found to be cost-effective and to assist in translating knowledge to care provision [93]. The results of a study on PMTCT competency-based course materials showed that it promotes higher-order thinking, improves communication skills, teamwork and learning among students [98]. A study on High Fidelity Simulation infers that it promotes experiential and contextual learning, encourages self-directed learning and reflective learning [99, 106]. These findings further confirm that Simulation-Based Learning develops student skills and confidence to manage complex real-life emergencies because it offers an opportunity for learners to be immersed in an environment that is closer to reality [96]. Problem-based learning through simulation also promotes teamwork among students and the ability to render holistic nursing care to patients [100]. The developed simulation learning package (SLP) on PPH was found suitable for undergraduate nursing students, as it also encourages active learning, collaboration, and multiple teaching techniques, feedback, critical thinking, self-confidence, and satisfaction [49].
Theme 5: Sustainability of CBE curriculum
Only two literature sources categorically discussed the sustainability of CBE [83, 107]. Other literature sources report on the issues challenging the implementation of CBE. In Lesotho, inadequate support and monitoring of a newly implemented CBC within the midwifery programme threatened its sustainability among NEIs in the country [59]. In the Democratic Republic of Congo, despite CBE being widely promoted by the Ministry of Public Health, an insufficient budget and inadequate educators trained in CBA methodology were highlighted as major factors accounting for the continued use of the traditional approach (Ministry of Public Health [108]. The same was reported for Morocco and South Africa despite the necessary support and training in CBE, implementers continue to implement TBA such as the lecture method and demonstration in teaching across all subject areas [55, 67].
Theme 6: facilitators of CBE implementation
Sub-theme 1: Broad stakeholder support
Much Emphasis is placed on broad stakeholder support both locally (local capacity building) and internationally, which should be intentional and sustained for longer periods. Broad stakeholder support has been stressed as an important facilitator to CBE implementation. This includes governmental support of the nursing and midwifery council through capacity building of faculties and supply of equipment [70, 91] as well as established and functional interprofessional collaborations, both locally and internationally [91, 109]. Students also need adequate educator support in terms of being exposed to more practical sessions, as such practices boost competency, satisfaction, and confidence [53, 82].
Sub-theme 2: Functional monitoring system:
A functional monitoring system was identified as a notable facilitator which involves extensive coordination among all stakeholders to promote strong ownership and acceptability of the CBE project [91]. This study found that poor support and a weak monitoring system, especially in relation to professional regulatory councils, jeopardizes CBC sustainability. The previous literature on sustaining the implementation of a competency -based midwifery programme revealed a lack of accountability for the new curriculum from implementers during classroom teaching, throughout the programme. This was traceable to the lack of expertise of the educators which resulted in them returning to the traditional method [107].
Sub-theme 3: Availability of Guidelines Informing the Frameworks /Models
The availability of guidelines that inform frameworks or models that communicate nationally or globally, is recognised as a facilitator to the implementation and sustainability of CBE [107]. A framework for implementing and sustaining a competency-based curriculum was developed in Lesotho to serve as guide [83].
Sub-theme 4: Motivation and Recognition:
The need for motivated staff students, tutors and other stakeholders was also mentioned to sustain the enthusiasm and interest for CBE programme implementation [91, 109]. Further factors are the awareness that midwives are able to deliver quality midwifery care if educated and motivated, and women’s demand for quality maternity care from highly competent and motivated midwives [109].
Theme 7: Challenges Concerning the Implementation of CBE
Sub-theme 1: Poor Knowledge of CBE
The findings showed that educators and clinical preceptors involved in the training and clinical facilitations have sub-optimal knowledge of active learning methods of the various pedagogical approaches which have been identified for implementing CBE which inevitably challenges the proper implementation of a nursing and midwifery CBE curriculum [97, 110]. In Tanzania, educators were unable to deliver the prescribed allocations of the nursing and midwifery CBET curriculum due to poor understanding and interpretation of the CBC [111]. In Ethiopia, the majority of the classroom educators and clinical preceptors had low teaching competency in CBE especially in relation to student-centered learning, e-learning and gender studies [112]. In another study, both staff and clinical preceptors reported that they were poorly oriented regarding the implementation of a competency-based curriculum in supervision and evaluation of midwifery students [61]. Some educators claimed they were unfamiliar with the Problem-Based Learning (PBL) approach [98]. In a study on integrating a Training Package for Family Planning using competency-based teaching methods into their curricula, the educators from nursing and midwifery training institutions were unable to integrate the training packages successfully, because they were not familiar with the incorporation process for such approaches [51]. In a study conducted by Milly and others, the stakeholders within and NEIs had challenges integrating CBE into teaching and learning which was reflected in the wide disparities in implementation of curriculum content/subject areas in the various institutions [73].
Sub-theme 2: Inadequate Human and Material Resources
Other major challenges in institutionalizing CBE were reported to be human resources, financial, and material constraints [72, 73, 77, 113]. The facilitation of the training of these students requires a well- resourced clinical environment with essential medical supplies, a conducive environment, adequate faculty members for effective guidance and supervision and feedback to the students are often grossly insufficient [100, 103]. In Lesotho, over-dependence on improvision of equipment and supplies during simulation, some faulty high-fidelity simulators and inadequate staffing impacted negatively on the successful implementation of SBE [114]. In a study on the integration of NIMART into the curriculum, it was discovered that state policies on distribution of antiretroviral commodities limited the availability of antiretrovirals, thus hampering the opportunities for students to learn the practice of PMTCT competently [46], while others found the course content to be inadequate with the tutors not adequately prepared which constituted a notable challenge [92]. Another study observed that regarding the CBE approaches that require the use of the internet, such as PBL, e-learning, participants reported resources in the library and computer laboratories, internet connectivity, insufficient training, qualifications of the faculty and class sizes to be inadequate [75, 98]. The persistent shortage of qualified staff and competent clinical preceptors in the clinical settings, coupled with the lack of teaching and training resources and increased workload impacted on the quality of midwifery education [61, 111, 115, 116]. Students often need to contend with the demand for clinical experience as the midwifery student population continues to increase, exceeding the institutional capacity [51, 105].
Sub-theme 3: Lack of Motivation and Support
Lack of continuous support in using the different teaching approaches was highlighted among the challenges in implementing CBE. Nursing/midwifery educators reported that using active teaching strategies contributes to an increased workload, hence the need for continuous support [74]. Students reported that insufficient support was largely due to shortage of staff as they lacked an adequate number of tutors and clinical supervisor/preceptors, and the competent clinical preceptors necessary to support clinical and theoretical learning [72, 98]. Students further expressed a need for support in terms of constructive criticism, for educators to be patient, and correct them respectfully, as well as easy access to the simulation lab [114]. Proper implementation of CBE requires staff to be motivated; availability of funds and managerial/administrative support [71]. Staff should be supported to attain higher educational levels; teaching materials and good working conditions should be provided [109].
Sub-theme 4: Insufficient time
Insufficient time was noted by educators and students as being another major challenge [97, 111]. The educators experienced problems integrating the TRP content using CBE to include it in the family planning curriculum because the time available was insufficient, even before training began [51]. Students complained about time constraints as a challenge, since they feel pressured by the timing for delivery combined with the increased workload experienced with the implementation of CBE [97, 98]. In another study, students stated that a great amount of content in the curriculum was not covered because the curriculum was too heavily loaded and the time allocated was insufficient [115]. Insufficient hours being allotted for clinical training and teaching was another factor mentioned [114].
Discussion
This study showed that of the 54 African countries according to the World Bank classification, the literature on CBE for midwifery programmes only spanned 17 African countries at the time of this report. South Africa, Rwanda, Tanzania, Uganda, Lesotho, Kenya, Egypt, Malawi, Democratic Republic of Congo Morocco, and Zambia were among the countries implementing CBE. However, in Botswana, Problem-based learning was integrated into its curriculum with little success recorded following the implementation. Needless to say, where CBE was claimed to be implemented, the implementation appeared questionable. This may also imply that there is limited support for the proper implementation of CBE where it is practiced, for example, in the Democratic Republic of Congo, CBE has been widely promoted by the Ministry of Public Health, yet 81% of the country’s nursing education institutions continue to use a traditional approach due to an insufficient budget and a paucity of educators trained in the competency-based approach [108]. In Lesotho, wide disparities exist in the implementation of the CBC within the midwifery programme among NEIs in Lesotho. The major components of the Competency-based midwifery programme were not fully adopted to assimilate CBE [59]. Despite the adoption of CBE since 2013 with support for implementation in Morocco, TBA continues to be the mainstay for teaching and learning [55]. These findings are similar to those of other studies which reported inconsistences in the type and nature of midwifery education despite ICM standards [117].
Anzeige
The findings showed that the content of the curriculum differs appreciably from ICM standards among training institutions within the various nations, while new topics integrated into existing curricula employed CBE approaches These findings build on existing evidence showing that discrepancies in the nature and content of midwifery education programmes prevail globally [14, 16, 20]. The integration of new topics using CBE approaches may suggest that faculties need more training on the various CBE approaches It could also denote that the appropriate pedagogical approach(es) for each topic/course should be properly integrated so that instructional design aligns with the competency-based curriculum to ensure utilization and accountability.
This review revealed that for successful implementation of CBE, the following CBE curriculum implementation process must be strictly observed: identify contextual factors for curriculum reform, stakeholders’ engagement, roles of stakeholders, opinion of stakeholders of CBE and the development of intervention tools to informs the model /framework. The identified contextual factors in this review include the need for competent midwifery graduates to provide high-quality sexual and reproductive health care to combat SDG-3 goals in reducing the high burden of maternal and newborn mortality, especially in Africa, where the burden is alarming [52,54,55,]. Other factors are the transformation of higher education, the health care system and undergraduate nursing education programmes [56, 57]. This suggests that countries should critically self-examine and analyze themselves to justify the need for curriculum reform. This will serve as a motivator for planning curriculum reform, implementation, and sustainability across nations. This concurs well with similar studies on curriculum reform conducted in the United States [118, 119]. The study highlighted broad stakeholders’ involvement in the CBE implementation process and, while this is commendable, the engagement of stakeholders is presently grossly inconsistent. For example, in Tanzania, multiple stakeholders include the Tanzanian commission comprised of university, faculty, interprofessional collaborations and international partners. In Ethiopia, education experts were mainly involved in the CBE curriculum process. In Ghana and Malawi, professional organizations were the major contributors. This review further showed the relevance of identified stakeholders in the curriculum planning and implementation process by highlighting their roles and involvement in the success of the CBE implementation. This report is similar to findings from previous authors on stakeholders’ involvement in the implementation of curriculum [120‐122]. Also, the development of an intervention tool which informs the model /framework will serve as a guide and a national template for implementers enabling them the maintenance of standards. This conforms with findings from study conducted by Dragoo and colleague on Implementing competency-based education [123]. It is hoped that proper adherence to the curriculum implementation process will promote accountability and acceptability of CBE for all stakeholders.
The study highlighted the numerous pedagogical approaches employed in the implementation of CBE. This implies that multiple approaches should be utilized in the teaching and training of midwifery students so that the approaches complement one another to achieve the best result. This is consistent with similar study on CBE [72]. All stakeholders should be cognizant and trained to utilize the various teaching methodologies, while a functioning system should be put in place to ensure accountability and sustainability of all pedagogical approaches [118]. The study revealed that the implementation of CBE offers several benefits to students, faculties, nations and the communities it serves. Hence its implementation should be widely encouraged and supported by all stakeholders to prepare competent midwifery students. This finding is in agreement with another study where the benefits of CBE were mentioned [118].
There is a paucity of literature on the sustainability of CBE, however most of the literature reported challenges with the implementation of CBE. Evidence from the literature confirmed that CBE has not been sustained in Africa. It remains a struggle to fully integrate the major components of the Competency-based midwifery programme due to inadequate support and lack of a monitoring system which challenges its implementation and sustainability.
Much emphasis has been placed on broad stakeholder support, both locally (local capacity building) and internationally, which should be intentional and sustained for longer periods. A functioning monitoring system, the availability of guidelines informing frameworks or models, adequate supervision and support for students coupled with a highly motivated and educated faculty, clinical staff, students, and other stakeholders are requirements [91]. The awareness that women demand quality maternity services from competent and highly educated midwives, and thus that the planned CBE programme is appealing and interesting was highlighted [109].
Poor knowledge of the various pedagogical approaches for implementing CBE was reported by implementers as jeopardizing the proper implementation of the nursing and midwifery CBE curriculum. Other major challenges identified in implementing and sustaining CBE were inadequate human resources, both in quality and quantity and financial and material constraints. Participants complained of insufficient time being allocated for teaching and learning, high workloads and a shortage of educators [111], while lack of motivation and support, and poor accountability on the part of the student were also cited. This finding is in line with previous authors on challenges on implementation of CBE [22, 35, 118, 123, 124].
Strengths and limitations
The study methodology involves a rigorous and contemporary search of the published literature on competency-based education for midwifery education and practice. The PRISMA-ScR extension guided this scoping review. The review was limited to studies conducted in the English language, however only three studies were found to be conducted in other languages (two in French, one in Arabic). The review included conference proceedings to obtain country representation on the subject area.
Conclusion
Competency-based education is a proven approach to preparing competent and confident graduates. The implementation and sustainability of CBE is just emerging in Africa. It is expedient that CBE implementation should be planned concurrently with its sustainability in order for it to be effective especially in Africa where resources are scarce.
Acknowledgements
We wish to appreciate the College of Health Sciences of the University of KwaZulu-Natal for providing financial support for publication and all researchers whose articles were used in this scoping review study.
Declarations
Ethical approval and consent to participate
Not Applicable.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
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