Strong, basic clinical education systems are akin to preventive medicine, saving precious time and resources by producing competent graduates. ACNM works to strengthen pre-service midwifery education programs through an integrated approach that focuses on creating continuity between three main learning environments: 1) Theoretical learning in the classroom 2) Practice of skills prior to direct patient care in a skills lab and 3) Clinical practice in the actual clinical setting. For each environment, standards, curricula and teaching materials are reviewed, created, and implemented; teacher and clinical preceptor clinical, teaching and management skills are improved; and adequate infrastructure, equipment, and supplies are procured. ACNM is currently evaluating specific components and activities within this integrated approach in Ghana to identify the components with the highest transformative potential. At times ACNM works with schools, nursing and midwifery councils, ministries of health, health development partners and donors to address specific components of the integrated approach described above. For instance, under the USAID funded ACCESS program, ACNM provided technical assistance to develop a Basic Emergency Obstetric and Newborn Care curriculum and implement faculty training in Ghana, Ethiopia, Malawi, and Tanzania. In our current USAID funded project in Zambia pre-service strengthening focuses specifically on strengthening environment, standards, curricula, and teaching materials for the existing midwifery school skills labs. ACNM is adept at tailoring integrated pre-service strengthening to the needs of the specific country.  For additional information on DGO's approach to pre-service training please click here.