| Issue/Objective |
In fragile and conflict-affected settings such as the Democratic Republic of Congo and South Sudan, women face systemic barriers to accessing respectful, high-quality maternity care. The GAC-funded SMART-RMC project (2022-2025), led by the Canadian Association of Midwives and co-implemented with the Société congolaise de la pratique sage-femme and South Sudan Nurses and Midwives Association, aimed to institutionalize Respectful Maternity Care (RMC) through a rights-based approach. Midwife-led Quality Improvement Plans (QIPs) were implemented as both a clinical and social accountability mechanism, generating measurable improvements in quality of care and catalyzing grassroots advocacy. |
| Methodology/Approach |
The project was implemented across 40 health facilities (30 in DRC, 10 in South Sudan). QIPs were designed and led by midwives through participatory processes involving inter-professional health teams and community stakeholders. Data sources include baseline, midline, and endline quantitative indicators (e.g., client satisfaction, provider competency levels, RMC uptake and delivery, service utilization) and qualitative insights generated from exchanges with midwives and clients, testimonials, and case studies featured in activity reports. The implementation period for QIPs spanned 18 months. |
| Results |
By endline, 100% of targeted facilities in both countries were implementing QIPs, compared to 0% at baseline. Significant improvements were observed in women's reported positive care experiences (DRC: 8.7% to 100%; South Sudan: 55% to 75.3%) and in facility-level readiness to deliver RMC across key infrastructural and procedural domains (DRC: 31.2% to 58.8%; South Sudan: 30.9% to 82.7%). Qualitatively, midwife-led QIP processes enabled frontline providers to drive tangible "small wins," including reorganizing maternity wards to ensure privacy (e.g., installation of curtains/partitions), introducing birth companionship practices, improving cleanliness through locally mobilized resources, and initiating dialogue with leadership to procure essential clinical equipment and gain better recognition for midwives. These actions strengthened accountability to clients while reinforcing midwife motivation and community trust. |
| Discussion/Conclusion |
Embedding midwife-led QIPs within a rights-based RMC framework enabled context-specific solutions that enhanced the enabling environment for the delivery of respectful care and for the promotion of better working conditions for midwives themselves. In uncertain and resource-constrained environments, this approach demonstrates how collective, facility-level action, anchored in midwifery leadership, can promote the profession, restore accountability and advance health equity. |
| Presenters and Affiliations |
Kariane St-Denis Canadian Association of Midwives |
