10. CHALLENGES

The challenges we have faced while implementing the NPM programme include:

• Role Clarity - Lack of clear definition and positioning - Difficulty in integrating the cadre into the health system - Differential compensation

• Career Progression - Adequate mapping of career progression - Creation of a stack culminating in Chief Midwifery Officers at the state and central levels

• Legal and Regulatory - Accreditation of the programme - Legal framework required for midwives to work independently

• Training and Mentoring - Expensive skills required to train - Fungibility of skills - Infrastructure support - Leads to skill erosion