Peer-reviewed article
Evaluation of a strategy developed to revise the scope of practice to recognize midwife specialists' competencies in South Africa.
Tukisi KP, Jacobs W, Rensburg ZJV ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluated a proposed strategy to expand the scope of practice for midwife specialists in South Africa to better recognize their advanced training and competencies. Maternal and neonatal mortality remain high in South Africa, and the current regulations do not fully allow midwife specialists to practise to their full capability. Experts assessed the proposed strategy as clear and clinically significant but identified implementation challenges, particularly resistance from regulatory bodies and obstetricians. The researchers concluded that successful implementation would require collaborative effort among stakeholders.
Key points
- Current South African regulations do not fully recognize midwife specialists' expanded roles and advanced competencies despite their postgraduate training
- The proposed strategy was evaluated as clear, simple, generalizable, accessible, and clinically significant
- Experts identified anticipated resistance from regulatory bodies and obstetricians as a major implementation challenge
- The strategy could grant midwife specialists formal professional autonomy to contribute more effectively to maternal and neonatal health
- Successful implementation requires collaborative effort among stakeholders in the health system
Limitations
This study evaluated a proposed strategy using expert opinion rather than testing its actual implementation or measuring real-world outcomes on maternal and neonatal health. It does not provide evidence about whether expanded midwife specialist roles actually improve health outcomes or patient safety.
Abstract
Background Maternal and neonatal morbidity and mortality remain major global public health challenges, even in South Africa. These challenges have necessitated the expansion of midwives' knowledge and skill through postgraduate training, preparing them as midwife specialists. Despite their advanced training and competencies, current scope of practice regulations does not fully recognize South African midwife specialists' expanded roles and capabilities. This regulatory gap limits their ability to practise to the full extent of their expertise and constrains their potential contribution to improving maternal and neonatal health outcomes. Objective To evaluate a strategy to revise the scope of practice to recognize midwife specialists' competencies in South Africa. Methods This study employed a qualitative research design using an expert review methodology to evaluate a strategy aimed at revising the scope of practice to recognize midwife specialists' knowledge and skills in South Africa. A purposive sampling strategy followed by a snowball sampling method was used to identify 19 experts to evaluate the strategies guided by Chinn, Kramer and Sitzman's theory evaluation framework via an online platform. Results The strategy to revise the scope of practice was found to be clear, simple, generalizable, accessible, and clinically significant within midwife specialists' practice. While the strategy was generally considered relevant, experts highlighted potential implementation challenges, including anticipated resistance from regulatory bodies and obstetricians. Conclusions Although the proposed strategy to revise the scope of practice for midwife specialists was found relevant to the midwifery field, experts emphasized that its successful implementation requires collaborative effort. The strategy may grant midwife specialists formal professional autonomy, enhancing their ability to contribute optimally to clinical practice and improve maternal and neonatal health outcomes.