Transitioning to midwifery models of care: Implementation insights from focus groups with Health leaders in two African countries

Abstract

Background: Midwifery models of care, endorsed by the World Health Organization (WHO), offer rights-based, person-centred care with proven benefits for safer maternal and newborn care worldwide. Despite these demonstrated benefits, the successful adoption of midwifery models of care depends on context-specific factors, making it essential to understand how healthcare leaders perceive and approach such transitions.
Aim: To examine healthcare leaders’ perceptions of transitioning to midwifery models of care in Ethiopia and The Gambia, and to identify key barriers and facilitators influencing implementation.
Setting: The study was conducted in Ethiopia and The Gambia within their respective maternal health system contexts, focusing on national and sub-national leadership perspectives.
Methods: A qualitative study using open-ended, semi-structured interviews. An inductive thematic analysis was applied to explore leaders’ insights on midwifery models of care and system readiness for transition.
Results: Facilitators included midwives’ active advocacy for women’s rights and strong community engagement in maternal health decision-making. Common barriers across both countries were workforce shortages, limited health system infrastructure, donor dependency, and persistent gaps in access for rural populations. Additional barriers included inadequate transport networks, geographic inaccessibility, financial challenges limiting women’s ability to reach skilled care, hierarchical governance structures that restrict midwives’ professional autonomy, insufficient facility readiness, and cultural resistance to evidence-based midwifery practices.
Conclusion: Transitioning to midwifery-led models of care requires context-specific strategies aligned with the World Health Organization implementation guidance, with particular attention to strengthening infrastructure, financing, and workforce capacity.
Contribution: The study underscores the need to integrate midwives more fully into policy and governance structures. Strengthening their leadership and advocacy roles may enhance the visibility, influence, and overall contribution of the midwifery profession within national health systems.