Rwanda like many other Sub Saharan African countries is faced with a gross shortage of midwives that has contributed to a high maternal mortality rate. There are approximately midwives 1100 graduated and licensed to practice in the country as of Feb 2015 which is far below the projected numbers needed within the country. As a result, of low rates of midwifery service coverage, many nurses work in maternity wards with limited midwifery skills and only basic obstetrical training. This places additional stressors on midwifery mangers many of who have not been trained in management skills and increased risk of mismanagement of maternity cases due to lack of experience and supportive supervision by the bedside care providers. There has been a significant increase in incident reporting to the Rwanda National Council for Nurses and Midwives (NCNM) over the last two years. The vast majority of these cases reported fall under the domain of misconduct in Maternity Care. Investigations by the NCNM and Rwanda Association of Midwives (RAM) into cases have identified several clusters of clinical practice sites with poor practice and key areas identified for additional in-service educational offerings. The areas that have led to alleged misconduct by midwives center around issues of labor management and poor documentation to support clinical actions taken or not taken. The Rwanda Association of Midwives (RAM) under the sponsorship of Africa Medical Research Foundation (AMREF) was invited to participate in a Leadership, Management, and Governance (LMG) training designed to addresses the needs of midwifery service managers in Feb 2015. The Rwanda Association of Midwives sent two of its Senior Midwives and executive members of the Association to the regional training is based upon the AMREF and MSF Training course for Midwives in Leadership Governance and Management written with the support of USAID. In order to complete the training Certification, the 2 Midwives are required to complete a training of additional trainers to scale up LGM practices. Certification for this training is subject to successful completion of the 6 months quality improvement training and project. Upon presentation after the AMREF training the RAM texecutive committed to utilizing the required quality improvement package to support the RAM national agenda items to have a greater impact on overall Midwifery practice and leadership in the country. With the knowledge that evidence based practice cannot be implemented without good leadership skills, the RAM decided to combine objectives of leadership strengthening and training to address clinical deficiencies found in the community. The main challenges identified by the RAM in terms of midwifery clinical practice focus around proper and consistent use of the parto-graph, labor management skills and documentation

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