The Midwifery Services Framework (MSF) – what, why and how

The Midwifery Services Framework (MSF) for Developing Sexual, Reproductive, Maternal and Newborn Health (SRMNH) Services by Midwives is a tool developed by International Confederation of Midwives (ICM) and partners [1] to support the development and strengthening of midwifery services across all countries focusing on a quality midwifery workforce.

The ICM supports a midwifery strengthening approach using the MSF: The framework provides health system developers and planners, maternal and newborn health experts, policy makers and other stakeholders such as midwives, educators, regulators and professional associations with an evidence-based tool from which to develop new or strengthen existing effective and efficient midwifery services. The MSF supports the implementation of the midwife-led model of care, which has proven to be an effective and desirable model of care provision for women and their families.

1.    What is the MSF?

The MSF is designed to ‘scale up’ and/or strengthen midwifery programmes to deliver SRMNH services at the national level and to integrate midwifery in the national Human Resources for Health (HRH) agenda through effective programme development and advocacy. It spells out what needs to be considered to set up or strengthen midwifery services and the tools that can help countries do that. It helps governments and stakeholders assess their current situation, what needs to be improved and the tools available to achieve the desired changes in SRMNH services.

It explains key midwifery concepts, outlines a step-by-step approach on how to set up or strengthen midwifery services through discussion of the quality care that women and newborn need, education, regulation, and effective management of the workforce and builds the ongoing monitoring and evaluation of the process.

The approach helps identify next steps for strengthening or improvement through the use of decision trees that lead to a selection of the available tools from ICM and partner organisations including: The WHO Midwifery Strengthening Toolkit, Jhpiego/MCHIP Pre-Service Education Toolkit for Midwives and UNFPA/WHO/Intel/Jhpiego e-learning modules on essential maternal and newborn life-saving skills.

The components of the framework can be used in sequence, or separately to develop or strengthen certain parts of a country’s midwifery services, or to evaluate their efficiency.


2.    Why is a MSF is required?

Many countries have identified the need to strengthen SRMNH services and understand the value of setting up or improving their midwifery services. Many global and national development partners are also interested in inserting midwifery care into national health systems to increase the survival, health and wellbeing of women, children and families. In many cases, however, the question remains – how do you develop or strengthen midwifery.

The MSF offers a systemic approach to tackling the wider issue of health system strengthening and improvement of the quality of sexual and reproductive health care. Quality maternal and newborn health services can be improved by the integration of midwifery services across the health system.

3.    How does the MSF work?

Working with the MSF is initiated by a national government and starts with a meeting with ICM experts to identify exactly what kind of support is needed, who would be involved and what the potential timeline for MSF assessment and implementation would be. A workshop with national stakeholders in SRMNH services to work through the steps of the MSF (Box 1) is then organised and facilitated by ICM experts. This generates a set of actions to be undertaken nationally, using the tools that are linked to the steps of the MSF. ICM provides support in setting up the working groups for the next steps and is available for further guidance during one year after the conclusion of the national MSF workshop.  Additional support within the working groups and beyond the one-year window can also be discussed and agreed.


Watch MSF Journey film 


4.    Contact details

For further information, please contact the International Confederation of Midwives at, visit or call +31 70 3060520. 

The Midwifery Services Framework, Guidelines for developing SRMNAH services by midwives is available for download in English here. As well as the MSF Flyer  and the MSF FAQ
Le Cadre pour les Services de Pratique sage-femme est aussi disponible en Francais, ainsi que le Flyer MSF et le FAQ MSF
Marco de Servicios de Parteria esta disponible en Espanol, asi que el Flyer MSF y el FAQ MSF.

[1] UNFPA, WHO, Jhpiego, ICS Integrare and various midwifery, obstetrics, health systems and health workforce experts

Keeping you in touch

  • Facebook
  • Twitter
  • Youtube
  • LinkedIn
  • Flickr
  • Pinterest