Competency-based education in midwifery: A comprehensive review of implementation strategies and outcomes in developing regions

Prima Kusrini, Ari Indra Susanti

Abstract


Competency-based education (CBE) is increasingly adopted as a reformative approach in midwifery education, particularly within developing regions such as Africa and South-East Asia. It aims to improve the preparedness of midwives to address complex maternal and newborn health challenges. This literature review employed a comprehensive analysis of 14 peer-reviewed studies, utilizing qualitative and mixed-method research designs. The studies included systematic reviews, gap analyses, and interview-based investigations across diverse educational settings. The review identified that CBE significantly enhances clinical competencies, theoretical knowledge, and professional self-confidence among midwifery students. Practical implementation strategies included the integration of simulation-based learning, continuous assessment, and mentorship models. However, significant barriers included inadequate institutional resources, faculty training, and resistance to pedagogical change. CBE offers a structured and outcomes-driven educational model that aligns theoretical instruction with practical skills acquisition. Its adoption addresses persistent gaps in midwifery training and contributes to workforce readiness in resource-limited settings. The findings suggest that CBE can serve as a transformative framework for midwifery education in developing regions. Policy support, investment in educator training, and curriculum reform are essential to realize its potential and improve reproductive health outcomes fully.

 

Abstrak

Model pendidikan berbasis kompetensi (CBE) kini semakin diadopsi dalam program pendidikan kebidanan di negara-negara berkembang sebagai upaya untuk meningkatkan kesiapan mahasiswa dalam praktik klinis serta menjawab kekurangan tenaga profesional di bidang kesehatan ibu dan bayi. Kajian literatur ini melibatkan analisis terhadap 14 artikel ilmiah yang telah melalui proses peer-review. Pendekatan yang digunakan meliputi metode kualitatif dan campuran, mencakup tinjauan sistematis, analisis kesenjangan, serta studi wawancara yang dilakukan di berbagai institusi pendidikan di kawasan Afrika dan Asia Tenggara. Studi-studi yang dikaji menunjukkan bahwa penerapan CBE secara signifikan memperkuat keterampilan praktik, pemahaman konseptual, dan rasa percaya diri mahasiswa kebidanan. Pendekatan yang paling efektif mencakup penggunaan simulasi dalam pembelajaran, pendampingan akademik, dan penerapan alat evaluasi berbasis kompetensi. Kendati demikian, implementasi CBE masih menghadapi hambatan, seperti keterbatasan sumber daya institusional, kurangnya pelatihan bagi tenaga pengajar, dan resistensi terhadap perubahan kurikulum. CBE berperan penting dalam menjembatani teori dan praktik, serta menawarkan pendekatan sistematis untuk meningkatkan mutu pendidikan kebidanan. Fokusnya pada pencapaian hasil memungkinkan pembentukan tenaga profesional yang lebih siap menghadapi tantangan di lapangan. Penerapan CBE memiliki potensi besar dalam meningkatkan kualitas pendidikan kebidanan di wilayah dengan sumber daya terbatas. Untuk mencapai dampak yang berkelanjutan, diperlukan dukungan berupa pelatihan tenaga pengajar, pembaruan kebijakan pendidikan, serta penguatan infrastruktur institusi. Keberhasilan implementasi model ini berkontribusi pada peningkatan layanan kesehatan ibu dan bayi serta penguatan kapasitas tenaga kesehatan di negara-negara berkembang..

Kata Kunci: kebidanan; pendidikan berbasis kompetensi ; pendidikan tenaga kesehatan; strategi implementasi


Keywords


competency-based education; healthcare education; implementation strategies; midwifery

References


Abouzaj, S. (2019). Competency-based approach in training nurses and midwives in Morocco demystifies the better use. Advances in Medical Education and Practice, 10(1), 1069-1079.

Adnani, Q. E. S., Gilkison, A., & McAra-Couper, J. (2022). Strengthening midwifery education through clinical experience: Findings from a qualitative study in Indonesia. Women and Birth, 35(1), 87-95.

Adnani, Q. E. S., Gilkison, A., & McAra-Couper, J. (2023). A historical narrative of the development of midwifery education in Indonesia. Women and Birth, 36(1), 175-178.

Agyeman-Manu, K., Ghebreyesus, T. A., Maait, M., Rafila, A., Tom, L., Lima, N. T., & Wangmo, D. (2023). Prioritising the health and care workforce shortage: Protect, invest, together. The Lancet Global Health, 11(8), 1162-1164.

Ahmed, S., & Fullerton, J. (2019). Challenges of reducing maternal and neonatal mortality in Indonesia: Ways forward. International Journal of Gynecology & Obstetrics, 144(1), 1-3.

Aldridge, J. M., & McLure, F. I. (2024). Preparing schools for educational change: Barriers and supports–a systematic literature review. Leadership and Policy in schools, 23(3), 486-511.

Anderson, L. (2018). Competency-based education: Recent policy trends. The Journal of Competency-Based Education, 3(1), 1-5.

Bharj, K. K., Luyben, A., Avery, M. D., Johnson, P. G., Barger, M. K., & Bick, D. (2016). An agenda for midwifery education: Advancing the state of the world׳ s midwifery. Midwifery, 33(1), 3-6.

Bogren, M., Alesö, A., Teklemariam, M., Sjöblom, H., Hammarbäck, L., & Erlandsson, K. (2022). Facilitators of and barriers to providing high-quality midwifery education in South-East Asia—An integrative review. Women and Birth, 35(3), 199-210.

Bogren, M., Grahn, M., Kaboru, B. B., & Berg, M. (2020). Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo-an interview study. Human Resources for Health, 18(1), 1-10.

Bogren, M., Kaboru, B. B., & Berg, M. (2021). Barriers to delivering quality midwifery education programmes in the Democratic Republic of Congo — An interview study with educators and clinical preceptors. Women and Birth, 34(1), 67-75.

Butler, M. M., Fullerton, J. T., & Aman, C. (2018). Competence for basic midwifery practice: Updating the ICM essential competencies. Midwifery, 66(2), 168-175.

Capper, T. S., Williamson, M., & Chee, R. (2023). How is cultural safety understood and translated into midwifery practice? A scoping review and thematic analysis. Nurse Education in Practice, 66(6), 1-12.

Chen, A. M. H., Kleppinger, E. L., Churchwell, M. D., & Rhoney, D. H. (2024). Examining competency-based education through the lens of implementation science: A scoping review. American Journal of Pharmaceutical Education, 88(2), 1-20.

Curry, L., & Docherty, M. (2017). Implementing competency-based education. Collected Essays on Learning and Teaching, 10(4), 61-73.

Daneman, D., & Benatar, S. (2019). Dynamic tensions following new pedagogy in undergraduate medical education. Academic Medicine: Journal of the Association of American Medical Colleges, 94(12), 1873-1877.

Firoozehchian, F., Zareiyan, A., Geranmayeh, M., & Behboodi Moghadam, Z. (2022). Domains of competence in midwifery students: a basis for developing a competence assessment tool for Iranian undergraduate midwifery students. BMC Medical Education, 22(1), 1-15.

Gcawu, S. N., & van Rooyen, D. (2022). Clinical teaching practices of nurse educators: An integrative literature review. Health SA-SA Gesondheid, 27(1), 1-9.

Gholamian, S., Alidoosti, K., Zolala, S., & Sabzevari, S. (2022). The effect of implementing the competency-based education model on the clinicai skills among midwifery students. Strides in Development of Medical Education Journal, 19(1), 91-100.

Gruppen, L. D., Irby, D. M., Durning, S. J., & Maggio, L. A. (2019). Conceptualizing learning environments in the health professions. Academic Medicine, 94(7), 969-974.

Hakimi, M., Kheirkhah, M., Abolghasemi, J., & Hakimi, R. (2021). The effects of competency-based education on midwifery students’ knowledge, skills, and self-confidence for postpartum hemorrhage management. Nursing and Midwifery Studies, 10(3), 137-144.

Hunter, B., Thomas, G., Wilhelmová, R., Trendafilova, P., Blaževičienė, A., Lynch, L., & Jokinen, M. (2022). Strengthening global midwifery education to improve quality maternity care: Co-designing the world health organization Midwifery Assessment Tool for Education (MATE). Nurse Education in Practice, 1(1), 63, 1-8.

Ige, W. B., Ngcobo, W. B., & Afolabi, O. (2023). Implementation of competency-based education for quality midwifery programs in Africa: Protocol for a scoping review. JMIR research protocols, 12(1), 1-6.

Irfanullah, E. A., Chandra, A., Solaiman, R. H., Siems, C., Chethan, S., Belani, K., & Harmon, J. (2023). Simulation training in a lower middle-income country: Supporting a new center and developing low-cost models for critical skill acquisition. Cureus, 15(6), 1-8.

Jefford, E., Alonso, C., & Stevens, J. R. (2019). Call us midwives: Critical comparison of what is a midwife and what is midwifery. International Journal of Childbirth, 9(1), 39-50.

Johnson, K., Tuzzio, L., Renz, A., Baldwin, L. M., & Parchman, M. (2016). Decision-to-implement worksheet for evidencebased interventions: From the WWAMI region practice and research network. Journal of the American Board of Family Medicine, 29(5), 553-562.

Lawrence, E. R., Klein, T. J., & Beyuo, T. K. (2022). Maternal Mortality in low and middle-income countries. Obstetrics and Gynecology Clinics of North America, 49(4), 713-733.

Lewis, L. S., Rebeschi, L. M., & Hunt, E. (2022). Nursing education practice update 2022: Competency-based education in nursing. SAGE Open Nursing, 8(1), 1-6.

Lu, Y. Y., Ching-Hui, L., & Lee, C. H. (2021, November). Strategic alliances in institutions of higher education to promote sustainable development goals: A case study of two universities in taiwan. Annual SEAAIR conference proceedings. SEAAIR (South East Asian Association for Institutional Research), 1(1), 187-196.

Luyben, A., Barger, M., Avery, M., Bharj, K. K., O’Connell, R., Fleming, V., ... & Sherratt, D. (2017). Exploring global recognition of quality midwifery education: vision or fiction?. Women and Birth, 30(3), 184-192.

Matlala, S. (2021). Educators’ perceptions and views of problem-based learning through simulation. Curationis, 44(1), 1-7.

Mmari, V., Stephen, K., Lilian, M., & Osaki, K. (2019). The implementation fidelity of competency based curriculum for nursing and midwifery programme in Tanzania: A protocol for a mixed methods. Nurs Prim Care, 3(2), 1-6.

Moller, A. B., Welsh, J., Ayebare, E., Chipeta, E., Gross, M. M., Houngbo, G., Hounkpatin, H., Kandeya, B., Mwilike, B., Nalwadda, G., Petzold, M., Sognonvi, A., & Hanson, C. (2022). Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries—Benin, Malawi, Tanzania, and Uganda. PLOS Global Public Health, 2(9), 1-16.

Muraraneza, C., & Mtshali, G. N. (2018). Implementation of competency based curriculum in pre-service nursing education: Middle range theory. International Journal of Africa Nursing Sciences, 8(1), 53-58.

Muraraneza, C., & Mtshali, G. N. (2021). Planning reform to competency based curricula in undergraduate nursing and midwifery education: A qualitative study. Nurse Education Today, 106, 1-6.

Naciri, A., Hajji, M. E., Radid, M., Kharbach, A., & Chemsi, G. (2022). Exploring student motivation and performance in the flipped classroom: A case study of nursing students. Electronic Journal of General Medicine, 19(3), 1-5.

Neal, S., Nove, A., Bar-Zeev, S., Pairman, S., Ryan, E., ten Hoope-Bender, P., & Homer, C. S. (2023). An analysis of the global diversity of midwifery pre-service education pathways. Women and Birth, 36(5), 439-445.

Nyoni, C. N., & Botma, Y. (2019). Implementing a competency-based midwifery programme in Lesotho: A gap analysis. Nurse education in practice, 34, 72-78.

Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—a web and mobile app for systematic reviews. Systematic Reviews, 5(1), 1-10.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Research Methods and Reporting, 372(1), 1-9.

Renfrew, M. J., & Malata, A. M. (2021). Scaling up care by midwives must now be a global priority. The Lancet Global Health, 9(1), 2-3.

Superieure, E. N. (2024). Exploration of pedagogical practices in competency-based education for midwifery students in Morocco. The International Journal of Science Didactics and Educational Engineering, 1(3). 298-306.

Susanti, A. I., Mandiri, A., & Gumilang, L. (2025). Are midwifery students ready for interprofessional education with project-based learning?. Inovasi Kurikulum, 22(2), 873-856.

Thacharodi, A., Singh, P., Meenatchi, R., Tawfeeq Ahmed, Z. H., Kumar, R. R. S., V, N., Kavish, S., Maqbool, M., & Hassan, S. (2024). Revolutionizing healthcare and medicine: The impact of modern technologies for a healthier future-A comprehensive review. Health Care Science, 3(5), 329-349.

Toll, K., Sharp, T., Reynolds, K., & Bradfield, Z. (2024). Advanced midwifery practice: A scoping review. Women and Birth: Journal of the Australian College of Midwives, 37(1), 106-117.

Viswanathan, M., Middleton, J. C., Stuebe, A., Berkman, N., Goulding, A. N., McLaurin-Jiang, S., ... & Gaynes, B. N. (2021). Maternal, fetal, and child outcomes of mental health treatments in women: A systematic review of perinatal pharmacologic interventions. AHRQ Comparative Effectiveness Reviews, 236(1), 1-10.

Warren, N., Gresh, A., Mkhonta, N. R., Kazembe, A., Engelbrecht, S., Feraud, J., ... & Johnson, P. (2023). Pre-service midwifery education in sub-Saharan Africa: A scoping review. Nurse Education in Practice, 71(1), 1-36.

Westphaln, K. K., Regoeczi, W., Masotya, M., Vazquez-Westphaln, B., Lounsbury, K., McDavid, L., ... & Ronis, S. D. (2021). From Arksey and O’Malley and Beyond: Customizations to enhance a team-based, mixed approach to scoping review methodology. MethodsX, 8(1), 1-14.




DOI: https://doi.org/10.17509/jik.v22i2.83661

Refbacks

  • There are currently no refbacks.


Copyright (c) 2025 Prima Kusrini, Ari Indra Susanti

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.


Inovasi Kurikulum
Published by Himpunan Pengembang Kurikulum Indonesia (HIPKIN)
in collaboration with Curriculum Development Study Program
Faculty of Education - Universitas Pendidikan Indonesia
Gedung FIP UPI Lt. 9 Jl. Dr. Setiabudhi Bandung 40154


Indexed By:

SINTA   GARUDA   Crossref      DOAJ DIMENSIONS BASE   ROAD

Google Scholar

Google Scholar p. ISSN 1829-6750 | Google Scholar e. ISSN 2798-1363