Reframing Midwifery Education and Leadership: A Comparative Meta-Synthesis of Filipino, ASEAN, and Middle Eastern Curricula and Policy Roles

This study, conceptualized and led by Dr. Fernan Torreno in collaboration with Francia Ganituen, Frincess Flores, and Famiela Torreno, presents a comparative meta-synthesis of midwifery education and leadership in the Philippines, ASEAN, and Middle Eastern regions. Midwives are vital to maternal and newborn health, yet their education and leadership pathways remain uneven and fragmented despite international frameworks from WHO, UNFPA, and ICM advocating competency-based, policy-engaged training.

Drawing on 500 studies published between 2000 and 2025, including CHED and DOH reports, ASEAN and Gulf regulatory frameworks, university theses, institutional audits, and peer-reviewed literature, the team applied PRISMA screening, thematic coding, and GRADE-CERQual confidence assessment. Six recurring domains were identified:
1. Curriculum misalignment – Philippine curricula remain clinically focused with minimal leadership content, ASEAN shows partial harmonization through MRAs, while Gulf systems emphasize hospital-based training.
2. Leadership role ambiguity – Midwives report low confidence in leadership roles, especially in hierarchical Gulf systems.
3. Educator competency gaps – Educators juggle clinical and teaching duties with limited pedagogical preparation, though ASEAN has begun adopting WHO and ICM frameworks.
4. Mobility and benchmarking barriers – Filipino midwives face restricted mobility due to incomplete CHED alignment, while Gulf countries lack cross-border recognition.
5. Policy engagement deficits – Midwives rarely participate in policy formulation, with emerging advocacy roles seen mainly in select ASEAN countries.
6. Quality assurance fragmentation – QA systems are fragmented in the Philippines, uneven in ASEAN, and centralized but physician-dominated in the Gulf.

The findings highlight a persistent gap between global advocacy and national implementation. However, the study also provides a policy roadmap: the Philippines should embed leadership and policy modules, expand educator training, and align CHED curricula with ASEAN benchmarks; ASEAN must strengthen enforcement of MRAs and QA systems; and Gulf countries should transition toward academic-led midwifery models with inclusive policy engagement.

By situating midwives not only as clinical providers but also as educators, advocates, and leaders, the authors argue for reforms that prepare the workforce to shape equitable, resilient health systems. Comparative tables, coding matrices, CERQual ratings, and a PRISMA flow diagram ensure methodological transparency and compliance with PRISMA 2020, ENTREQ, and GRADE-CERQual standards.

The collaboration of Dr. Fernan Torreno, Francia Ganituen, Frincess Flores, and Famiela Torreno ensures both scholarly rigor and practical policy relevance. This research advances global discourse on midwifery education by offering region-specific strategies for curriculum reform, leadership integration, and quality assurance harmonization.

本研究由Fernan Torreno博士构思并主导，联合Francia Ganituen、Frincess Flores与Famiela Torreno共同开展，针对菲律宾（Philippines）、东盟（ASEAN）及中东地区（Middle Eastern regions）的助产士教育（midwifery education）与领导力现状开展比较性元综合研究（comparative meta-synthesis）。助产士是孕产妇与新生儿健康的核心保障力量，但尽管世界卫生组织（WHO）、联合国人口基金（UNFPA）与国际助产士联合会（ICM）均倡导以胜任力为核心、融入政策实践的培训体系，助产士的教育与职业晋升路径仍存在不均衡且碎片化的问题。

研究团队检索了2000年至2025年间发表的500项研究，涵盖菲律宾高等教育委员会（CHED）与菲律宾卫生部（DOH）报告、东盟及海湾地区监管框架、大学学位论文、机构审计报告及同行评议文献，并采用PRISMA筛选流程（PRISMA）、主题编码法及GRADE-CERQual置信度评估（GRADE-CERQual）方法开展分析。最终确定了六大核心主题领域：
1. 课程适配偏差：菲律宾助产士课程仍以临床实践为核心，领导力相关内容占比极低；东盟地区通过区域互认协议（MRAs）实现了部分协调统一；海湾地区则强调以医院为基础的培训模式。
2. 领导力角色模糊：助产士普遍对自身领导力角色缺乏信心，在层级制显著的海湾地区尤为突出。
3. 教育者胜任力缺口：教育者同时承担临床工作与教学任务，且教学法相关培训储备不足；不过东盟地区已开始逐步采用世界卫生组织（WHO）与国际助产士联合会（ICM）制定的框架。
4. 流动与基准对标障碍：菲律宾助产士因菲律宾高等教育委员会（CHED）课程未实现统一适配，跨境流动受到严格限制；海湾国家则普遍缺乏跨境执业认可机制。
5. 政策参与不足：助产士极少参与政策制定工作，仅部分东盟国家出现了助产士参与政策倡导的新兴趋势。
6. 质量保障碎片化：菲律宾的质量保障体系呈现碎片化特征，东盟地区质量保障水平参差不齐，海湾地区虽实行集中化管理，但由医师主导质量评估工作。

研究结果显示，全球倡导的助产士发展框架与各国实际落地情况之间仍存在长期存在的差距。不过本研究同时提出了针对性的政策路线图：菲律宾应将领导力与政策模块嵌入课程体系，扩大教育者培训规模，并推动菲律宾高等教育委员会（CHED）课程与东盟基准实现对齐；东盟需强化区域互认协议（MRAs）与质量保障体系的执行力度；海湾国家则应逐步转向以学术机构为主导的助产士发展模式，并推动政策参与的包容性建设。

研究团队提出，助产士不仅应作为临床照护提供者，更应承担教育者、倡导者与领导者的角色，呼吁通过改革打造能够助力构建公平且韧性更强的卫生系统的助产士队伍。本研究附带的比较分析表格、编码矩阵、GRADE-CERQual评级结果及PRISMA流程图，确保了研究方法的透明度，并符合PRISMA 2020、ENTREQ及GRADE-CERQual标准。

由Fernan Torreno博士、Francia Ganituen、Frincess Flores与Famiela Torreno组成的研究团队保障了研究的学术严谨性与政策实践相关性。本研究通过提出针对不同区域的课程改革、领导力整合及质量保障协调策略，推动了全球助产士教育领域的学术讨论。