trained in Mission Schools, not in the educational environment described above. This description gives the reader an idea of what the teaching environment of the highest level of nursing education looks like. The KCN campus looks very simple compared to the COM campus, a few 100 meters further along the road. Here there are separate buildings for every specialism; each with several stories, there is an athletic arena and a well furnished canteen where food is served. Then there is a separate library, there are colourful gardens, well kept grass fields between the buildings and a paved road connecting the buildings. The COM campus also contains a research section. Still, with an output of 100 midwives per year, the KCN outnumber the output of the COM, who train 60 per year (Dovlo 2004). Looking at the training institutions, one can see a bias towards the COM in the budget for the educational environment of these two professions. In response to the critical shortage of midwives, policy makers (government and international donor organizations together) have agreed that more nurses and midwives need to be trained urgently (Palmer 2006). The KCN Blantyre campus did not look like it had the capacity to double the intake, let alone tripling or quadrupling it. KCN would need to seriously improve the infrastructure in terms of classroom and dormitory expansions according to Dorothy Ngoma from NONM. But sufficient infrastructure alone is not a guarantee for (quality) training of midwives according to a KCN lecturer. In this chapter, the question is raised what good education is and what could or should be improved according to the respondents. First, the different cadres and training opportunities will be explained. Second, I will discuss what the characteristics of a good midwife are, both ideally and within the circumstances the midwives have to deal with daily. Finally, I will discuss in-service education, which plays an important part in sustaining and improving quality of care, through an investment in skills and knowledge improvement for those already working in the field.
Nursing and midwifery education Courses, cadres and possible career paths I explained in chapter one that if NMTs want to upgrade to a diploma RNM, they can follow a two year upgrading program at the MCHS or at KCN. The entry requirements for this program are an ordinary pass in Mathematics and four credits (score of 75% or higher): in Biology, Physical Sciences, English and one in any other subject. But many midwives wanted to be a degree RNM. They could go from NMT to degree RNM via two routes, the “Mature entry” program or the “Generic” program. The first “Mature Entry” option is a two year program in which one can enrol after completion of the formerly mentioned upgrading program and two years of work experience as a diploma RNM. The midwives in this study did not prefer this route though, because it takes many years. In an informal conversation, the father of an NMT told me his daughter wants to go for her degree, but if she wants to go for this “Mature Entry” program she would need two years of working experience before she can enter. He said he was worried that by then she would already be married and pregnant. Two respondents indeed got pregnant during their NMT training and had to drop-out of school, but they re-enrolled a later year to finish their study. The second of the two routes is preferred by the majority: qualifying for the four years “Generic Program” at KCN to get their bachelor’s degree at once. This requires higher grades in high school: six credits in Physical Science, Biology, Mathematics, English and two other subjects. Additionally, they need an acceptable score in the University Entry Exam. NMT are saying that this is one of the reasons they are so happy with their job in the government hospital: the government pays for these high school fees, so they can obtain their credits in the subjects they still need. 50