BACKGROUND:
The MIDWIZE leadership program—a collaborative initiative funded by the Swedish Institute—seeks to strengthen maternal and newborn health through midwife-led quality improvement (QI). The program includes leadership training, quality improvement skills and a practical project. Central to the practical project are four evidence-based practices: dynamic birthing positions, presence of birth companions, immediate skin-to-skin care, and perineal protection. Operating since 2020 across Ethiopia, Kenya, and Uganda, MIDWIZE uses a train-the-trainer model: trained "MIDWIZE ambassadors" from earlier cohorts cascade skills and knowledge to their peers and facilities

OBJECTIVES:
To evaluate the effectiveness of scaling four evidence-based midwifery practices—dynamic birth positions, birth companions, immediate skin-to-skin care, and perineal protection—across public health facilities in Kenya, Ethiopia, and Uganda, and to identify context-specific barriers to their sustained adoption.

METHODS:
Over five years, the program engaged health leaders in structured capacity-building—remote and on-site trainings, mentoring, and QI coaching. Participation has exceeded 100 leaders across the countries . Ambassadors used peer-led workshops and social media groups to foster continued facility-level implementation Pre- and post-intervention observational audits tracked practice uptake.

RESULTS:
In Kenya and Ethiopia, implementation fidelity was high: all four evidence-based practices showed statistically significant improvements, alongside supportive institutional policy changes. Preliminary results indicate enhanced respectful care outcomes and reduced perineal trauma. However, in Uganda two practices declined: birth companion presence and skin-to-skin contact lasting longer than five minutes. Facility size, high staff turnover, and rotation emerged as likely systemic barriers to sustainability.

CONCLUSIONS:
MIDWIZE effectively scaled evidence-based midwifery practices in Kenya and Ethiopia through a sustainable ambassador-led QI approach. Uganda’s mixed results underscore the need for context-specific strategies. Tailored interventions should address institutional infrastructure and workforce stability to sustain key practices.

KEY MESSAGE:
These findings confirm the value of midwife-led QI models, while also illustrating the complexity of institutionalizing respectful, evidence-based maternity care in varying health system contexts. Education - student experience 1 (including three-minute presentation competition)