This document summarizes lessons learned from the National CMW Training Project in Yemen from 1998-2003. Some of the key lessons included that training community midwives is an effective strategy for introducing reproductive health services to rural areas, continuity in training is possible to meet national targets, and ongoing education is important for graduates. The project was highly praised for meeting its targets of training over 400 people across 20 governorates. Standardizing training quality assurance remains a challenge but indicators developed by the project can help.

1. Amanah/Final Evaluation: National CMWTP
By May Haddad MD.MPH 1
25 lessons learnt
for sustainability:
CMWTP final evaluation
CMW Training Project-1
It is indeed outstanding that all target groups (over
400 people) addressed in this final evaluation highly
praise and acknowledge the national CMW Training
project. The targets include a wide variety of people in
Yemen: general public, community leaders, service
providers, mothers from beneficiary families, CMW
graduates, CMW trainers and TOT graduates, researchers,
members of Steering Committee, Project’s staff 1998-
2003, officials from UNFPA, the Dutch embassy, the
government, the UN and international agencies.
CMW Training Project-2
CMW Training Project is described as “vital, noble
and fulfilling a dream”.
“It is one of the most successful MOPH and P Projects
conducted in Yemen. CMWTP is not a typical Project: It
has excellent objectives, the trainees are committed girls
and women who are concerned about their communities
and CMW trainers are qualified with high standards. It has
set standards in quality training including curricula
development, resources publications and setting criteria
for optimal training conditions”.

2. Amanah/Final Evaluation: National CMWTP
By May Haddad MD.MPH 2
CMW Training Project-3
CMWTP 1998-2003 has met its’ targets:
National coverage: 20 governates
Activating 61 training sites
Renovating 75% of target centers
Achieving 80.1% of target graduates
Achieving 77.6% of target CMWs graduates
Achieving 89-100% of TOT CMW trainers graduate
Developing quality criteria for training
Organizing 65 main training classes
Developing five training curricula and modules
Developing variant educational materials by graduates
CMW Training Project-4
Potential Yearly Impact of all CMWTP Project’s CMWs
graduates 1998-2003 in Yemen:
640, 20 deliveries
847, 392 TT injections to mothers
1,331616 pregnant mother examination
1,210560 counseling in FP
544,752 contraceptive-delivery
1,028976 child-vaccination
121,056 children treated with ORT
907920 HE session
181,584 home visits
lesson one: the strategy
Training CMWs is a successful strategy in introducing RH
services to rural and remote deprived areas in Yemen. The
national CMW training Project 1998-2003 has
demonstrated impact and success in meeting its’ targets.
lesson 2: continuity
It is possible to continue training and graduating a big
number of CMW in Yemen in order to meet national
targets of training CMW in remote underserved areas.
Although the time allocated for CMWTP implementation
1998-2003 has been longer than expected, the next phase
for training a similar number (or bigger number) of CMW is
estimated to be less.
lesson 3: ongoing education
Planning for refresher workshops, upgrade and
continuing education is integral in training programs; and
in addressing CMW graduate demands in updating and
gaining new skills. This phase of the training Project
demonstrated the need for further programming of
ongoing education for Project’s graduates 1998-2003.
lesson 4: opportunities
There are several opportunities that are to be
considered while planning a new Project phase including:
political will, decentralization policies, funders interests,
partnership with the directorate officials and local
councils, coordinating with women groups at the
communities level (includes CMWs themselves), Project’s
experience, the current Proposal draft, communities
acceptance etc.
lesson 5: concepts & principles
The national CMW Training Project has demonstrated
essential working concepts and principles that are to be
emphasized in similar CMW Training Projects’
development or current national Project’s renewal.

3. Amanah/Final Evaluation: National CMWTP
By May Haddad MD.MPH 3
Concepts and principles
“Amanah” (honesty), measurable objectives, quality
assurance of training, documentation, curriculum and
resources development, capacity building, coordination
between variant stakeholders, community participation,
building on resources and experiences of training CMWs in
Yemen, decentralization, fighting corruption, transparency,
setting criteria for replication, extension and expansion etc.
lesson 6: qualitative training
CMWTP developed indicators for qualitative CMW
training in Yemen.
Among the indicators:
Indicators: qualitative training-1
Number of CMW graduates/MHW upgrade per
course/class is 17-20
Two trainers per CMW/MHW upgrade class
Indicators: qualitative training-2
Standard checklist of materials,
Selected publications /resources /materials provided to
each trainee
Indicators: qualitative training-3
Competent and motivated CMW trainers make a
difference. TOT curriculum is an effective module in
enhancing the training skills of trainers
Indicators: qualitative training-4
Practicum time and outputs are crucial in the training
curriculum (example each CMW trainee must deliver 20
women in labor in order to graduate)
Indicators: qualitative training-5
Operational research, documentation and educational
materials development are components of the training
curriculum
Indicators: qualitative training-6
Home visits are essential both in the training
curriculum and tasks of CMW graduate
lesson 7: training curricula-1
The three training curricula (CMW training, MHW
upgrade, TOT: CMW trainers) developed by the Project
are to continue with modifications and revised
publications production.
The two recently developed curricula of CMW
supervision and refresher short term training are highly
significant in developing further a supervision module
(that is of utmost need) and an approach in organizing
appropriate refresher courses.
lesson 8: training curricula-2
Despite the fact that the CMW training curriculum,
agenda and resources are replicable, the need to
introduce modifications based on reflective experience is
a priority in preparing for training continuity.

4. Amanah/Final Evaluation: National CMWTP
By May Haddad MD.MPH 4
lesson 9: standardization in Yemen
Standardization of training quality assurance in Yemen
remains a challenge to be addressed. Project’s training
indicators and standards are of great significance.
lesson 10: making links
The need to make stronger links and networks among
the different NGOs (international and local), UN agencies
and governmental bodies who are delivering CMW training
in Yemen is to be addressed.
lesson 11: CMW organization
Developing an independent CMW structure is ripening in
Yemen. The structure is to address rights and duties of
CMW, establish CMW legal rights and protection, enhance
networks etc.
lesson 12: CMWTP
The current structure of the Project (with selected
modifications) is the most competent structure to
organize a national new phase of CMW training in
Yemen.
Other Project’s objectives may include ongoing
education to graduates 1998-2003, developing further the
supervision curriculum, quality assurance of all CMW
training in Yemen etc.
lesson 13: transition period
The transition period between CMWTP 1998-2003 phase
and the potential new phase is to addresses the following
priorities:
Protecting the current capital assets of the Project
1998-2003,
Developing a realistic user-friendly Project document
that builds on the current experience,
Modifying CMW, MHW upgrade curricula and publishing
new modified resources based on the current experience
Documenting CMW supervision training curricula draft
Documenting the process of refresher one- week
workshops
Modifying the criteria for CMW selection etc.
lesson 14: criteria CMW selection
Criteria of CMW selection is to be revised in accordance
to the educational level available in the target area,
avoiding bias and interferences, inclusion of mothers,
married women, pregnant women and women older than
25 and protecting the chances of MHW to be selected etc.
lesson 15: integrating MHW
Integrating Murshidat Health Workers in the CMW
training curriculum is an investment that “pays off”.
Several biases against MHW integration are to be
addressed including criteria of selection, education level,
and modifications in the training curriculum itself.
lesson 16: links with the health facilities
CMW are empowered when they are linked to the
health facilities. All efforts of enhancing the link (includes
employment) are to continue. It is to note that the level
of engagement of the local council and health directorate
affects employment.
lesson 17: site of CMW work

5. Amanah/Final Evaluation: National CMWTP
By May Haddad MD.MPH 5
There are advantages when CMW graduates work in
either communities and /or health facilities. CMW often
work in both.
Some reported that preference of CMW site of work is
to be given to health facilities (when existing) till
saturation level is reached.
The establishment of CMW health posts at the
community level has been demonstrated as a possible
means for site of work in the community.
lesson 18: CMW job description
CMW demonstrated understanding of job description
and application of skills learnt during training.
Additionally, they demonstrated that new tasks could be
introduced (not always linked to health) such as
addressing iron deficiency anemia, HIV/AIDS prevention,
school health activities, community organization and
mobilization etc.
lesson 19: beneficiary families
Beneficiary families highly appreciate CMW services
(health services, “CMW are women like us”, economic and
social reasons) and have requested that CMW insert IUD.
They also appreciate home visits and have encouraged the
organization of health education sessions in the
community
lesson 20: training sites
Renovating training sites at the directorate levels and
in villages is a good investment particularly when health
directors and other people in charge intend continuing
training activities.
lesson 21: role of HMIs
Health Manpower Institutes in Yemen are to take
charge at a later stage when they have enhanced their
capacity in leading wide scale outreach CMW training
programs, better supervision and internal working
mechanisms.
lesson 22: project staff
Recruiting Project staff from the MOPH and P is a good
strategy in capacity building. However, the original jobs
(and promotion) of those who have been recruited or
seconded to the Project (particularly CMW trainers) are to
be protected.
lesson 23: role of zones
The role of zones 1998-2003 is to be revisited with
more supervision delegated at the directorates and local
levels instead of that of the zones. The number of zones is
to be re-assessed.
lesson 24: local councils
The readiness of directorates and local councils in
recruiting CMW, providing training and residence sites,
and determining CMW “future” employment and site of
work is crucial.
lesson 25: dispersing funds
The need to develop clear mechanisms to ensure that
all stakeholders disperse the funds on a timely matter at
all levels of Project implementation is vital.