Using task analysis to generate evidence for strengthening midwifery education, practice, and regulation in Ethiopia.
OBJECTIVE
Realizing aspirations for meeting the global reproductive, maternal, newborn, and child health goals depends not only on increasing the numbers but also on improving the capability of midwifery workforce. We conducted a task analysis study to identify the needs for strengthening the midwifery workforce in Ethiopia.


METHODS
We conducted a cross-sectional study of recently qualified midwives in Ethiopia. Purposively selected participants from representative geographic and practice settings completed a self-administered questionnaire, making judgments about the frequency of performance, criticality, competence, and location of training for a list of validated midwifery tasks. Using Statistical Package for the Social Sciences, Version 20, we computed the percentages and averages to describe participant and practice characteristics. We identified priority preservice education gaps by considering the tasks least frequently learned in preservice, most frequently mentioned for not being trained, and had the highest not capable response. Identification of top priorities for in-service training considered tasks with highest "not capable" and "never" done responses. We determined the licensing exam blueprint by weighing the composite mean scores for frequency and criticality variables and expert rating across practice categories.


RESULTS
One hundred and thirty-eight midwives participated in the study. The majority of respondents recognized the importance of midwifery tasks (89%), felt they were capable (91.8%), reported doing them frequently (63.9%), and learned them during preservice education (56.3%). We identified competence gaps in tasks related to obstetric complications, gynecology, public health, professional duties, and prevention of mother to child transmission of HIV. Moreover, our study helped to determine composition of the licensing exam for university graduates.


CONCLUSIONS
The task analysis indicates that midwives provide critical reproductive, maternal, newborn, and child health care services and supports continuing investment in this cadre. However, there were substantial competence gaps that limit their ability to accelerate progress toward health development goals. Moreover, basing the licensure exam on task analysis helped to ground it in national practice priorities.
Jhpiego, Addis Ababa, Ethiopia.
Tegbar
T
Yigzaw
Jhpiego, Washington DC, USA.
Catherine
C
Carr
Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands; Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Jelle
J
Stekelenburg
Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
Jos
J
van Roosmalen
Jhpiego, Addis Ababa, Ethiopia.
Hannah
H
Gibson
Jhpiego, Addis Ababa, Ethiopia.
Mintwab
M
Gelagay
Federal Ministry of Health, Addis Ababa, Ethiopia.
Azeb
A
Admassu
competence; frequency of performance; in-service training needs; licensing exam blueprint; midwife; perceived importance of tasks