Guiding the way forward

The 50,000 Happy Birthdays project gave an unique opportunity to strengthen country leadership and build on previous success using HMS and HBS educational programs.

The impact of midwifery-led care is highlighted in the December 2020 publication in the Lancet Global Health journal (Nove et al, 2020). Andrea Nove and colleagues estimated that 67% of maternal deaths, 64% of neonatal deaths, and 65% of stillbirths could be averted. The solution? Universal provision of care by competent and skilled midwives who meet international standards and are well integrated into health systems in the context of multidisciplinary teams.

The 50,000 Happy Birthdays project has contributed to the positive impact that an increase in midwife-delivered interventions has on women and families.

The project countries are committed to increasing and diversifying national coverage of life-saving skills training


Prompted by the project, EMwA reached out to other professional associations to establish formal partnerships. As a result, EMwA, the Obstetrics and Gynaecology Society and the Pediatric Association  of Ethiopia now have a memorandum of understanding and collaborative working agreement to scale training and the development of competencies among midwives and other maternal and newborn health care workers.

These three health professional associations are joining Saving Little Lives at Birth — a partnership that was awarded the Global Financing Facility, (GFF) grant for a collaborative project which will continue to improve newborn health outcomes in Ethiopia.

Saving Little Lives is a package of synergistic neonatal survival interventions, which will be scaled up at 290 target health facilities. The project, starting in 2020, will cover four districts with a population of 37 million and an estimated 2,5m births in the project’s period.


More Happy Birthdays is a Latter-day Saint Charities (LDSC) funded project which builds on the success of the 50,000 and 10,000 Happy Birthdays projects. Maternity Foundation, Novametrics, LDSC and ICM will join the RAM national team to train up to 2000 additional providers from more than 100 new health facilities. The Safe Delivery App has been added to the HMS and HBS modules to improve provider’s knowledge and skills retention. At the request of the Rwanda Ministry of Health, digital tools for monitoring and evaluation have been introduced which will allow the team to demonstrate greater impact.


Haydom Lutheran Hospital will scale up its “Safer Births Bundle” funded by the 2020 GFF grant. The project includes low-dose high-frequency training programs, associated state-of-the-art simulators, and tools to assist health workers in decision making and delivery of care at birth. The scale up will be expanded to 30 hospitals in six regions of Tanzania, accounting for one-third of national maternal and neonatal mortality. TAMA 50kHB Master Trainers will play a vital role in this scale-up and will also continue training providers in HMS and HBS under the Safe Motherhood project with the Canadian Association of Midwives

COVID-19 pandemic and beyond

The 50,000 Happy Birthday project ended just before the outbreak of the COVID-19 pandemic. At the time of the release of this report, it is known that multiple challenges caused by the pandemic will have a negative impact on maternal and newborn survival (ICM, 2020).

ICM and partners strongly believe that well-trained and competent providers, continuously practicing in their facilities, and well supported by a strong professional association, will be able to provide quality care to meet the population’s needs during the time of COVID-19 (WHO, 2020).

In time of crises such as the COVID-19 pandemic, the Midwives’ Associations in Ethiopia, Rwanda and Tanzania continue to train midwives and other health providers beyond the 50,000 Happy Birthdays project. They admirably continue to serve women and their families and thereby save lives despite challenging circumstances. For this, they all must be highly commended.