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Investing in midwifery and nursing to build a stronger health system

Once reliant on foreign nurses and midwives, Libya is now strengthening its healthcare system by investing in local talent. By providing more modern and practice-oriented education, the country is equipping midwives and nurses with the skills to deliver quality care – ensuring better health outcomes based on capacity building.

Shortages, Underinvestment, and an Unprepared Workforce

Years of conflict have left Libya’s healthcare system fragmented and severely underfunded. According to the United Nations Population Fund (UNFPA), chronic underinvestment and poor maintenance have led to acute shortages of medical staff, supplies, and equipment. More than a million people lack access to essential care, while many hospitals and clinics remain damaged or non-functional.

Before 2011, Libya depended on foreign midwives and nurses to support its healthcare sector. In recent years, the numbers of locally trained professionals have increased, yet many enter the workforce without sufficient training or qualifications. Weak regulations, outdated curricula, and limited career development opportunities continue to undermine their effectiveness, directly affecting patient care.

Challenges in Midwifery and Nursing

Midwives and nurses are essential for maternal and reproductive health, but they face many challenges that limit their professional development and scope of work. While nursing staff is available, there are major discrepancies in terms of regional distribution, job descriptions and pre-service qualification, which lacks standardisation and practice-orientation. Midwives are scarce in Libya and in addition face similar challenges as nurses.

Mrs. Najia Nwigi, president of the Libyan Midwifery Association, says: “In Tripoli, the concern is that doctors take all of midwives’ responsibilities and assistance, thereby limiting opportunities for midwives’ professional development. Outside of Tripoli, in regions such as Ghadames, a contrasting scenario emerges. Characterised by the absence of readily available medical doctors, midwives assume all the responsibility, revealing certain deficiencies.”

These disparities have led to significant gaps in maternal and newborn care, particularly in rural regions, further deepening inequalities in healthcare access. Addressing these challenges requires strengthening regulatory frameworks, improving training standards, and providing enhanced support for healthcare professionals across all regions.

The Urban-Rural Divide

Healthcare access and professional challenges differ significantly between Libya’s urban centres and remote areas. In the bigger cities, midwives and nurses often work in well-equipped hospitals but remain overshadowed by doctors, limiting their autonomy and career progression. Despite better infrastructure, their roles are undervalued, and their decision-making power is restricted.

Conversely, in remote areas, midwives and nurses play a more central role in patient care due to the lack of doctors and specialised medical services. They often serve as the primary healthcare providers, handling childbirth and emergency cases with minimal support. However, these professionals face significant resource shortages, outdated facilities, and inadequate training for complex medical situations.

This stark contrast between the urban and rural areas highlights the urgent need for targeted training programmes and resource distribution to ensure quality healthcare across all regions in Libya. It also shows the need for better-trained healthcare professionals, as well as for a change in work culture.

Enhancing Education, Regulation, and Workforce Recognition

To address these challenges, Libya is taking steps to standardise midwifery and nursing education, reinforce governance, and improve working conditions. Efforts are underway to develop a robust regulatory framework, strengthen faculty training, and modernise curricula to meet international standards.

On midwifery education, the president of the Libyan Midwifery Association adds: “The curriculum lacks some of the tasks performed by midwives according to the required competencies and standards of the International Confederation of Midwives. Additionally, there is a severe shortage of teachers and trainers […]. Existing trainers are not qualified enough to teach and conduct trainings”.

Given the shortage of midwives, specialised nurses in maternal and newborn health are being introduced at the primary healthcare level to help close critical care gaps. Despite these advancements, significant hurdles remain. The healthcare system continues to suffer from fragmentation, financial constraints, and deep-rooted societal norms that discourage women—particularly married women—from working night shifts. Overcoming these barriers requires targeted policy reforms and public awareness campaigns to ensure midwives and nurses receive the recognition, training, and support necessary to provide quality care across Libya.

Investing in Training and Capacity Building

As part of these reforms, the ‘Strengthening the Health System and Pandemic Response’ (SHSPR) project has partnered with educational institutions at both the technical and university levels. Since the end of 2023, the initiative has focused on qualifying more than 400 teaching staff at nursing and midwifery departments and faculties in applying more modern teaching methodologies. Some modules have also taught soft skills related to patient-centred care, ensuring that future midwives and nurses are better equipped to meet healthcare demands.

One of the SHSPR training participants summarised: “The training provided valuable insights into how a nursing field teacher can significantly enhance her effectiveness in educating future health workers. It emphasized the importance of adapting and improving teaching styles through the incorporation of innovative educational methods.”

Raising awareness about the importance of midwifery has been another key area of work. Awareness days and workshops have engaged students and youth, highlighting the vital role midwives play in women’s health and community well-being. These events have provided a platform for practicing midwives to share experiences, inspiring the next generation to consider midwifery as a career. By addressing misconceptions and fostering dialogue on career opportunities, these initiatives aim to elevate the profession and attract more young people into the field.

Hands-on Training for Practical Solutions

The SHSPR project has also implemented training sessions focused on applying simulation as teaching method. Through realistic scenarios, simulation offers a practical approach to skill development and ensures that future nurses and midwives are well prepared for the real patients in the healthcare setting. The hands-on training enabled the participants to develop practical solutions to real maternal and newborn health challenges they encounter in their daily work. Beyond technical expertise, the sessions emphasised respectful maternity care, patient-centred communication, and the ability to handle complex cases with confidence.
This comprehensive approach enhanced both their technical skills and interpersonal competencies, ensuring that the current and future nurses and midwives can provide compassionate, effective care to women and newborns.

Empowering Midwives and Nurses for Lasting Change

Empowering midwives and nurses goes beyond training—it is about transforming healthcare for future generations. By strengthening the skills of healthcare workers for women, addressing misconceptions, and improving working conditions, Libya is laying the foundation for a more resilient healthcare system. The goal is to ensure that every mother and newborn receives the care they deserve.

Further information

• Improving Libya’s health system and its pandemic response – giz.de
• UNFPA Libya | Midwives: The unsung heroes of reproductive health response in Libya

Valerie Broch Alvarez, Eya Miniaoui, Ann-Kristin Atwi
March 2024