---

A student midwife during simulation training at Kathmandu University School of Medical Sciences, Nepal @GIZ

Midwives can deliver up to 90% of essential maternal and newborn health services. GIZ’s support in Malawi, Nepal, and Sierra Leone highlights how investing in midwifery—through regulation, education, and mentorship—can save lives, expand access to services, and strengthen health systems.

Midwives play a pivotal role in global efforts to reduce maternal and newborn mortality. According to the WHO, achieving universal coverage of midwives could avert 67% of maternal deaths, 64% of newborn deaths, and 65% of stillbirths – potentially saving 4.3 million lives by 2035[1]. Midwifery-led care is known for placing women at the center, reducing unnecessary medical interventions, and improving women’s experiences of birth. Furthermore, well-trained and supported midwives can provide up to 90% of essential services for maternal, child, adolescent health – including family planning, immunization, nutrition, and adolescent health services. Midwives are a cornerstone of well-functioning primary health care systems, especially in rural and underserved areas, where they are often the main providers of care. In addition to improved health outcomes for women and newborns, the shorter educational duration compared to obstetricians and reduced healthcare costs during pregnancy and childbirth because of fewer interventions contribute to why midwifery-led care is especially cost-effective. In fact, according to the United Nations Population Fund (UNFPA), every dollar invested in midwifery has a return of 16 dollars[2].

• [1] https://iris.who.int/bitstream/handle/10665/379236/9789240098268-eng.pdf?sequence=1
• [2]The Midwifery Accelerator: expanding health care for women and newborns | The United Nations sexual and reproductive health agency

Supporting the midwifery workforce is an important part of German development cooperation in the health sector, as experiences in Malawi, Nepal and Sierra Leone demonstrate.

National mentorship program supports midwives in Malawi

The GIZ-implemented Health Systems Strengthening with a Focus on Reproductive Health programme in Malawi has long been supporting midwifery in Malawi through a comprehensive approach. Strategic investments in skills building for the midwifery workforce have supported long-term improvements in quality of care. The program has fostered the development and implementation of a national mentorship program for midwives, producing standardized materials, checklists, and establishing skills labs in district and later rural hospitals. A key factor for the success of the program was that the mentorship was harmonized across all implementing partners to ensure consistency and sustainability. GIZ also contributed to policy and regulatory frameworks by working closely with the Nurses and Midwives Council of Malawi, streamlining licensing processes and fully integrating them into the continuous professional development (CPD) program, which is now standardized nationwide. Health Systems Strengthening with a focus on Reproductive Health

May 5th marks International Day of the Midwife, honoring midwives and their essential work worldwide. For more info :
https://internationalmidwives.org/theme-idm-2026-one-million-more-midwives/
https://www.unfpa.org/events/international-day-midwife

The strength of the GIZ approach is that we work across all levels—from policy to implementation.

says Dorah Mbeya, program advisor for GIZ Malawi and herself a midwife.

In its current phase, the health program in Malawi is supporting the Ministry of Health to develop online CPD courses in adolescent sexual and reproductive health, respectful maternity care, and rights-based approaches. Midwifery continues to be central to the program’s activities, including support for the capacity building of Community Midwifery Assistants who serve in remote areas.

Standardizing midwifery education in Nepal

In Nepal, GIZ has contributed to enhancing midwifery education by strengthening the regulatory environment, improving educational systems, and reinforcing professional networks. Working closely with the Ministry of Health and Population (MoHP), GIZ supported capacity building for midwifery educators and has contributed to national strategies and guidelines for midwifery services.

In Nepal, woman-centered midwifery care is still new. At Dhulikhel Hospital, which is one of the first hospitals in Nepal having established a midwife-led birthing unit, many women ask for “the nurse in pink” – the midwives – because they associate them with respectful and compassionate care.

notes Sami Pande, Health Advisor, GIZ Nepal.

Through the introduction of simulation labs, curriculum development for certificate-level training and bridging programs, and dedicated faculty support, GIZ has helped improve the quality of midwifery education and prepare competent, confident practitioners. In partnership with the Midwifery Society of Nepal, GIZ also supported the creation of a strong educator network, promoting continuous advocacy and professional growth across the sector.
Since 2024, GIZ has complemented these efforts by supporting Nepal’s ambitious Gender and Social Inclusion strategy which aims at reducing access barriers to the health services.

Enhancing Emergency Obstetric and Newborn Care in Sierra Leone

Sierra Leone has one of the highest maternal mortality rates in the world. A protracted civil war lasting until the early 2000s severely weakened the country’s health infrastructure and workforce, challenges that were further exacerbated by the West African Ebola epidemic.

The GIZ project Health Systems Strengthening and Epidemic Prevention partners with the Ministry of Health and builds on previous experiences and proven approaches in midwifery capacity development as a key strategy to improve quality of care and maternal and newborn health outcomes. The project supports 33 healthcare facilities across the three districts of Kambia, Kailahun, and Pujehun. Through mentorship and targeted in-service training, it strengthens the capacity of midwives to deliver high-quality emergency care for women and newborns.

In collaboration with three midwifery schools, the project has established skills labs to enhance the clinical competencies and confidence of midwives and other maternal and newborn care providers. A structured continuing education program enables midwives from community-level facilities to undertake placements at district hospitals, while hospital-based midwives are deployed to peripheral facilities. This reciprocal approach ensures continuity of service delivery while promoting peer learning and knowledge exchange across levels of care.

Attending the EmONC training has truly been a blessing. It has improved my skills in delivery and antenatal care, and I am inspired to put everything I have learned into practice. Heartfelt thanks to all the donors and facilitators who made this wonderful experience possible.

Health worker participant in emergency obstetric and newborn care training, Sierra Leone.  

In parallel, the development of standard operating procedures (SOPs) contributes to strengthening referral systems by systematically addressing identified gaps, particularly delays in the timely referral of complicated pregnancies. Furthermore, the project supports the Ministry of Health in conducting Integrated Supportive Supervision Visits across all public health facilities in Kailahun District and Pujehun District, thereby reinforcing quality of care in a comprehensive and system-oriented manner.

Further information

Natalia Wiik
May 2026