TRUST: Women’s Voices, Midwifery Leadership for Resilient Health

Under the project’s first outcome area, TRUST seeks to improve women’s and girls’ access to high-quality, respectful, and midwife-led maternal and newborn health services in targeted health facilities in Malawi and South Sudan. Results will be demonstrated through increased client satisfaction with ANC, delivery, and PNC services, reflecting both technical quality of care and women’s experiences of dignity, respect, and responsiveness. At the service delivery level, the project aims to ensure that a growing proportion of targeted facilities consistently offer the full continuum of ANC, delivery, and PNC services provided by qualified midwives. These access and quality improvements are expected to contribute to increased utilization of skilled birth attendance, antenatal visits, and postnatal care, particularly among marginalized groups, and to ultimately reduce preventable maternal morbidity and mortality. At the community level, community outreach and engagement activities will serve to improve knowledge of SRHR, promote more equitable decision-making around pregnancy and childbirth, and reduce social and cultural barriers to care seeking. In parallel, project-supported feedback and accountability mechanisms (such as community scorecards, dialogues, and other structured feedback channels) will enable women, girls, and communities to raise concerns about service quality and access, and support health facilities and duty-bearers to respond to these issues.

Under its second outcome area, the project aims to strengthen the system-level integration, sustainability, and influence of midwifery services within national and sub-national health systems. This includes increasing the availability of active and competent midwives in project-supported regions, helping to address critical workforce density gaps. In parallel, the project supports midwifery, gynecological, and obstetric associations to play a stronger leadership and advocacy role, resulting in concrete policy, legislative, or guideline changes that better integrate SRHR and midwifery into health systems. Through enhanced advocacy capacity, confidence, and collaboration at national and transnational levels, as well as the production of key knowledge products in parntership with academic institutions, midwifery associations are expected to contribute to durable structural changes (such as improved workforce policies, regulatory frameworks, and SRHR integration) that extend beyond the life of the project and reinforce long-term health system strengthening.