International Confederation of Midwives (ICM) 2020- 2023

Sida's contribution to ICM was initiated in August 2020, supporting the confederation during the last six months of their previous strategy and as they transition into their new strategy. Sida's core contribution to ICM is the first time the confederation receives such substantial core support to focus on the strengthening of their internal system and control, ensure an effective organization and a secretariat that is fit for purpose.  During the appraisal period an internal systems and control review was conducted by KPMG. This came at an opportune time given the strategy period, and allowed the organization to include some of the recommendations from the ISK report into the strategy process, identifying some of the institutional and structural shortcomings. The primary focus of Sida's core support is thus to strengthen the confederation, primarily focusing on the secretariat and the internal control, including a number of recruitment to strengthen core functions as well as to strengthen processes including results-based programme programme management, management of core funds, resource mobilization, monitoring, evaluation and learning. Thus far, ICM have recruited a number of core functions, enabled by Sida funding, including a controller function, an M&E specialist, a programme manager, a community engagement and management officer, among other things.  In August 2021, Sida's RBM support (additional to the financial contribution) was initiated to support ICM throughout an entire programme cycle (durating of 1 year). This will hopefully allow for MEL and RBM practices to be set up in a robust, sustainable and useful manner. The vision by the organization is to make RBM an intrinsic part of implementation and programme management. The Covid-19 pandemic have shifted ways of working as well as made some planned activities difficult to implement. For example, the ICM triennial conference was planned to take place in June 2020, this had to be postponed till June 2021 and took place virtually. The conference hosted more midwives from across the globe than ever before and allowed participants to continue to take part of the sessions for months after the conference. ICM have also issued a number of statements in relation to the importance of midwives in the Covid-19 response as well as the maintenance of maternity care and SRHR services in the pandemic. They have played a central role in advocating for the rights of midwives to have access to protective equipment as well as to support midwives throughout this challenging times in partnership with different agencies including UNFPA. As a result of dialogue with ICM during the strategy development process, a broader and more integrated SRHR scope was included in the new strategy, and ICM has increased their work in areas outside of maternity care. Highlights based on the 2022 reporting and 2023 annual meeting: The reporting has improved significantly over the agreement period, and incorporates aspect of institutional growth and strengthening of internal systems. While there has been a shift toward results-oriented reporting, this is still something that ICM can strenghten further. The most recent report for 2022 aligns well with the strategic objectives of the ICM triennial strategy, however is a bit of a patch work of different programmes and funding streams that ICM manages. This is, of course, a symptom of the problem of having small project/programme-based funding. Sida is the only core funder to ICM this far, however from next year BMGF have committed core funding to ICM. ICM exists in more than 120 countries, and thus cannot work across all countries given their limited capacity. ICM has therefore identified a few MAs to focus on particularly, this is also informed by funidng opportunties. Important to note, however, is that ICM always share learning, and use the country programmes to design and test programmes, tools, initiatives that can subsequently be streamlined across the membership. During 2022 ICM focused on the following countries: Bangladesh, Rwanda, Mexico, and Zambia. Noteworthy also their institutional work on JEDI (Justice, equity, diversity and inclusion) where ICM have taken a holistic and systematic approach to incorporating this across the board over the past few years. It will be important to think about how to capture the outcomes of this approach in the overarching work of the organization to have a dedicated reporting on the integration is good and should continue as relevant, however looking toward incorporating this approach also in the reporting of broader results would be the next step. ICM is constantly working to build capacity among their MAs, and have initiated a process to assess the readiness of MAs to receive funding. The tool has been co-developed with MAs in order for them to feel ownership and empowerment rather than being surveyed and controlled. The assessment tool will be important to review in the next appraisal process for the new agreement with ICM. While ICM were not particularly familiar with the HDP nexus as a concept when we initiated dialogue in 2021, their work and approach inherently makes them an excellent nexus actor. Since the initation of our dialogue in 2021, ICM have strengthend their role as a nexus actor. This is featured in their report for the first time and with a focus on Ukraine: "In March 2022, we conducted a preliminary assessment in partnership with the MAs in the Eastern Europe region to find out about their needs and their involvement in the Ukrainian crisis. Through these initial consultations, several urgent needs were identified in the Ukrainian neighbouring countries where MAs operate." "ICM has designed a rapid response grant process through which member associations (MAs) can request funds to support their work caring for Ukrainian refugees. MAs in countries near Ukraine have requested funds for translators, mental health providers, and other professionals as well as supplies such as hygiene and sanitary products, bedding, clothing, and funding for transportation fees." Summary of Key Results: Professional Framework for Midwifery: 1. Rolling out tools such as the Midwifery Services Framework (MSF) to strengthen member associations and support them to engage governments to reinforce midwifery as the heart of maternal, newborn, and child health (MNCH). 2. Reviewing and updating the ICM regulation standards, toolkit, and other resources that provide guidance to MAs to build relationships with Ministries of Health and midwife regulators 3. Disseminating education resources and guidance, developing guidance where needed, and facilitating the building of relationships between MAs, country midwife educators and Ministries of Education and Health. 4. Establishing the PUSH Campaign to promote midwifery as an autonomous profession, building a movement of supporters and allies, and facilitating partnerships between MAs, womens and reproductive rights organisations. We do all this work alongside member associations, key partners like UNFPA, and others who understand the importance of midwives. The MSF has been operationalized in Zambia during 2022, this has been a locally lead process using incountry experts and members of the Zambian MA. In just the first year of this work, there has been a lot of progress on advancing technical midwifery leadership within the MoH, which is a key aspect of integrating midwifery into the health system. The MoH are also discussing midwifery leadership at provincial and district levels to supplement the existing nursing officers. Another key outcome of this work has been closer working relationship between MoH and MAZ. For example, MAZ is now represented on the technical working group for the maternal, perinatal surveillance, and response team. Another outcome has been that MAZ has developed a strategic plan to ensure complementarity with government efforts and sharing it with stakeholders. The Young Midwife programme and the executive midwife programme: The YML programme serves to build the capacity of MAs, strengthen midwives and their community of practice, create mentorship and crosslearning relationships to share knowledge and experiences, and enhance training and advocacy for midwifery as a profession all critical elements that bolster midwives and their work ICM is a global partner on the WHO Strategic Directions for Nursing and Midwifery (SDNM) adopted at the World Health Assembly in 2022 and contributing to strategic discussions in countries. Midwives from Burundi, Bangladesh, South Sudan, and Liberia participate alongside ICM in the WHO-led ENAP/EPMM Advocacy and Accountability Working group, working to ensure that midwives in countries are actively engaged in country action planning and monitoring progress on maternal and newborn health targets and milestones through the Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality (EPMM). Through membership in the Partnership for Maternal, Newborn, and Child Health (PMNCH), we work alongside more than 1200 organisations across 10 constituencies. As a member of the Health Care Professionals constituency, we work closely with the International Federation of Gynaecology and Obstetrics (FIGO), the International Pediatric Association (IPA), the American Academy of Pediatrics (AAP), the International Council of Nurses (ICN), and the Council for International Neonatal Nurses (COINN). Current activity includes the development of a joint statement on respectful maternity care. The PUSH Campaign: The global communication campaign of PUSH focuses on shifting public perceptions of midwifery globally and driving the demand for midwives among women and families. The communications efforts work to reach across the gender equality space as well as the health space. A key element of the PUSH Campaign this year has focused on mobilising resources for midwives. This work involves crowding in traditional and non-traditional funders focused on reproductive justice and gender equality, elevating and aligning midwifery in donor priorities and funding decisions, and elevating the importance of midwifery in multilateral spaces, via policy, profile, and funding. To date, the Campaign has prioritised bilateral, multilateral, philanthropic, and private sector donors including Canada, the United States, France, Sweden, Germany, Japan, UAE and Global Financing Facility. PUSH is working with the Canadian Association of Midwives (CAM) to develop a collective advocacy strategy for funding. A donor engagement plan is underway, including key events, moments, and policy development opportunities. To date, PUSH has raised $1M of its $3M goal. Narrative Report 2023 - Highlights: Growing interest and global recognition of midwifery as an instrumental and sustainable approach to advancing health outcomes and SDG 3, focused on good health and well-being. This included UNESCO adding midwifery to the List of the Intangible Cultural Heritage of Humanity, which was driven by the collaborative efforts of MAs and ICM. International recognition also spotlighted the accomplishments of two ICM Young Midwife Leader Alumni. Neha Mankani of Pakistan was included on the BBC 100 Women List for her work in climate disaster relief in Pakistan while Ashu Martha Agbornyenty of Cameroon was awarded the 2023 Global Goalkeeper Change Maker Award by the Gates Foundation for her leadership and advocacy efforts to strengthen midwifery globally. 2023 marked the appointment of ICMs first Chief Midwife Jacqueline Dunkley-Bent ,and the appointments of Chief Midwives in Australia, New Zealand, Sweden, and Zambia. In-person ICM Congress held in Bali "Together again from Evidence to Reality" in June 2023 gathering 2475 delegates, including 841 (34%) from the Western Pacific; 640 (26%) from Europe; 391 (16%) from Southeast Asia; 375 (15%) from The Americas; 176 (7%) from Africa and 52 (2%) from Eastern Mediterranean. This was ICM's first in-person gathering since 2017. The Triennial Congress also marked the transition to a new board, signalling a strategic shift in governance. The 2020 2023 Board ended their term and the ICM Council elected a new Board for the 2023 2026 triennium. The new Board is the first to be assessed by the Independent Election Committee (IEC), concluding three years of governance changes led by the 2020 2023 Board. The new Board shows the competencies necessary for governing ICM and ensuring ICM's sustainability, including a commitment to equity with one regional Board Member for each of ICMs six regions. Notably, this Board includes a non-midwife for the first time, serving as treasurer, emphasising the importance of varied perspectives and leadership skills. Impact in numbers: - 28 MAs supported including for fundraising, advocacy support, organisational strengthening, twinning, project development and operations, refugee support (Ukraine crises). - USD 721,000 for MAs in emergency settings including in Ukraine where ICM have supported the establishment of a midwifery association for the first time, support in Turkiye's earthquake response, Malawi's flood response, Marroco's earthquake response, Afghan humanitarian response, Israel MA for support and response. - 15 resources developed or updated including MPath, MEAP, Learning Platform for ICM competencies, Facility readiness assessment tool, policy briefs. - Leadership support provided to 20 young midwives and executive midwives on MA Boards. - Much thanks to Sida's core support the secretariate team/ ICM team have succesfully recruited and expanded to a team of 28 staff from 17 different countries (8 of which from LMIC, however none of them in a leadership position).

ICMs vision is a world where every childbearing woman has access to a midwifes care for herself and her newborn. The mission is to strengthen Midwives Associations (MAs) and to advance the profession of midwifery globally by promoting autonomous midwives as the most appropriate caregivers for childbearing women and in keeping birth normal, in order to enhance the reproductive health of women and the health of their newborns and their families. Objectives for the Triennial Strategy 2017 - 2020 In the Strategy 2017 2020 ICM works around three interconnected strategic pillars - Quality, Equity and Leadership - and towards the following objectives: Quality - Demand an enabling environment through which midwives can provide quality midwifery services. - Deliver global standards, resources and tools for education, regulation and association to build the capacity, competence and professionalism of midwives - Deliver as the experts on midwives and midwifery, quality advice to stakeholders. Equity - Demand equitable access for midwives to midwifery education, regulation and continuing professional development. - Demand equitable access to midwife-led midwifery services for women. - Deliver equitable access to services and facilitate equitable opportunities for participation in ICM for Member Associations Leadership - Demand participation of midwives at the highest level of policy and decision making at global, regional and local levels. - Deliver effective midwifery leadership and expertise. During 2020, ICM embarked on a strategy development process for their forthcoming triennial strategi 2021-2023. The new strategy set the following priorities: Goal: Position ICM as an expert in creating, advising, influencing, and enabling the profession of midwifery globally. In their new strategy: 2021-2023 the strategic priorities have been slightly redefined and  Strategic Priority 1: Drive innovation and sustainability for the future of midwifery - Ensure a sustainable ICM, including human, social, economic, and environmental elements- Utilize and promote more digital and mobile tools and knowledge management resources to reach and support midwives and their associations (including at different stages of their professional development, and in different country contexts, digital access, and languages)- Facilitate an agile ICM that is constantly learning and responding to the needs of its members in new and improved ways- Foster and build the next generation of midwives while leveraging the knowledge and wisdom of older generations, fostering cross-generational learning Strategic Priority 2: Develop, strengthen, and support the roll-out of a new professional framework for midwifery - Promote midwifery as an autonomous profession with a distinct philosophy and approach to care- Facilitate an enabling environment for midwives- Strengthen midwifery education, regulation, associations, leadership, and model of care- Synthesise and drive research, evidence, and essential competencies for the profession of midwifery Strategic Priority 3: Foster a movement for midwifery, enabling and strengthening partnerships, advocacy, and communications for midwifery, with women's voices at the centre - Leverage advocacy and communications to influence and educate policy-makers and wider audiences on the impact of and need for midwives- Utilise effective and equitable relationships to build and support the profession of midwifery and expand the influence of ICM- Build up partnerships between women and midwives, from the individual level, to the community level, to the global level (womens rights and empowerment, woman-centered, respectful care, and gender equality)- Support partnerships between midwives (support for MAs, mentorship,strong regional support, twinning)- Strengthen partnerships between midwives and other stakeholders, including global and national policy-makers, other health professionals (obstetricians, pediatricians, nurses), traditional caregivers, other health workers and associations, and partners across sectors (SRHR, Womens Rights, UHC, etc.) Cross-cutting: Promote gender equality by employing a gender lens and prioritization across all elements of the strategic plan. .