’The situation in the country, it really prevents the profession and the activities of the SRHR from progressing. For example, as soon as there is instability, we see changes in government. For example, the government that was there may be well, well, well involved in the midwifery project, well involved in the midwifery strategy. But when you take that from the government, from we're going to come with another government, we're back to zero. You could say that there’s not really any continuity in the things of the state.’ (KI #1, translated from French)

’They have to do this in an environment where those midwives and those nurses are not getting paid, and when and if they get paid, they get paid probably like $15.00 per month. So, even the salary they do receive it, it’s not enough for them to survive.’ (KI #24)

’This is a really important point, and above all, with the number of midwives in the country, there are many midwives so far who don't have a job yet. That is to say, there are midwives who are qualified and who are in the country, but who are not working. So, this is a really negative problem for the reduction of maternal mortality.’ (KI #7, translated from French)

‘I could also say in terms of policies, if we had something to do for the association, we should have an accreditation for the profession. Without accreditation, you can't have a strong profession. You have to have terms of renewal of licence, up-to-date training diplomas, continuing education.’ (KI #1, translated from French)

’I think the involvement of doctors themselves in designing and implementing development across the world in global health and outside of it, because a contextual piece is just that a lot of the development practitioners that I met in Uganda or South Sudan too, they're medical doctors who actually in some better paid positions. They're in humanitarian relief. They're in this. They're in government. They're medical doctors.’ (KI #13) (quote relates to authority and leadership being primarily medical model and male-dominated)

’They had an office space, a small office space that was paid through CAM with other funds, but they didn't actually have staff. This is what we've been working on basically for the past year, so now we have - there’s a team, a project officer, a finance person, a secretary, an administrative assistant, security guards, and they moved into a bigger space. That was all at the beginning of last year basically where we had hired the team, and then when you hire a team, you have to put in place all the procedures, like admin, human resources.’ (KI #21)

’And above all, learn to decentralise. Get everyone involved. Get everyone involved in the management of the association. So that everyone can feel concerned in their own corner. You are a sectionalist, but you should feel that you are… it concerns you. And also to organise elections from time to time. Organise elections. Organising elections like this allows people to improve. It allows people to improve things and it allows everyone to make a contribution to the organisation.’ (KI #2, translated from French)

’The mentoring I liked, first of all, is how to manage a professional association. Another thing, we didn't have a plan. We were working, but we didn't have an annual plan that showed the midwife’s activities. We were shown how to make a plan of activities and how to manage projects as well. It was a reinforcement.’ (KI #2, translated from French)

’People with association-strengthening expertise in Canada have an assumption of a democratic landscape and is not applicable for our partners in non-democratic situations.’ (KI #31)

’Before the training, the association was authoritarian, a hierarchy. Now, the dynamics have changed, and the leaders are now also the care providers.’ (Focus group participant, translated from French)

’The association has not yet reached the level of financial autonomy. They depend on partners; they have no sources of income. The contributions are lower and that’s it. They are not yet free enough. We need to support them, but by targeting the area of support that is really essential for their maturity.’ (KI #4, translated from French)

’So now we are trained to make sure that we bring up young, young, young midwives to love the association, to work for the association. When we are stepping down, there are young midwives who can take over, who knows they are succession, and so on.’ (KI #6)

’I manage the social media accounts [for the association], so I see how - midwives reach out constantly to me every day asking for, "Hey, how do I join? How do I, this, and this? What do you guys offer? Are there learning opportunities?” People are eager for knowledge. They really are.’ (KI #15)

’Work is work, and people (midwife association members) should be paid for work, and then choosing to engage yourself in building your profession and building your association because you believe in it, that could be voluntary, but - making sure the people are compensated, especially in global south context, because they're so under compensated.’ (KI #7) (quote captures pay inequity related to gender)

’This is across the board - consultants found this when they went, that it was totally observed, it’s been reported, that because [the association] was going out in the regions in the rural areas and delivering training to midwives, a whole bunch of district health officers and regional health bureaucrats and doctors gained understanding of what [the association] was and what midwives were and [the association’s] own kind of capacity to influence things and capacity to support their members grew as an unintended benefit of those clinical skills trainings.’ (KI #19)

’Once you build a strong association, then that association is going to keep advocating for its members. It’s going to keep advocating for the profession. It’s going to keep advocating for women and children and their rights.’ (KI #17)

‘First of all, to strengthen the leadership of management - the executive leadership committees, as well as the national and provincial leadership committees. And above all, learn to decentralize. Get everyone involved. Involve everyone in the management of the association. So that everyone can feel concerned in his or her own corner.’ (KI #2, translated from French)

’It used to be the doctor who trained others in EmONC and now it is the midwives who are called by the government. Midwifery trainers have been able to advocate for the presence of midwives in EmONC trainings and even to include traditional birth attendants in rural areas.’ (Focus group participant, translated from French)

’For example, in the north, we had a screening day for cervical cancer. And at the same time, we did the treatment for women who have precancerous lesions and at that time, we promoted the profession.’ (KI #7)

’But also developing their own monitoring and evaluation tools so that it may fit within (the) context. And with the sustainability. So, (the association) is able to apply certain tools in the next five to ten years, so that’s what I think capacity building for the association will be necessary to move forward.’ (KI #7)

’They are constantly, constantly building that capacity and another good example of - and this is actually a success story for that - is that they are building the capacity to write proposals. So, now they get funding directly (…), we have a local fund, and now they have funding.’ (KI #24)

’I think it’s very important. You have so much capacity already, but if you're thinking of sustainability, it’s how do you move on? How do you get that proposal writing capacity, research, dissemination?’ (KI #23)

’Because when we see what others in other countries are doing, it helps us, so that we can work much more at the level of our institutions, at the level of the country to help women in our work.’ (KI #7, translated from French)

’It started off as just the three of them - three or four, and now they've grown, and they're definitely - yeah, everything that they do, and the connections that they have. I think they're super well placed. Just today, talking about, let’s reach out to the Department of Gender and the Ministry of Health. Those are key connections to have.’ (KI #19)

‘Now we can go and talk, even within the Ministry (…) I presented with confidence (…) I can come up with the funding and convincing people this is the reality. This is also the result of this relationship.’ (KI #16)

’I was trying to think whether there is a gender framework or model to capture specifically the impact of the [midwifery] association on gender equality (…) the only one that comes to mind is the gender at work framework (…) and I think in theory it is possible to take a framework, operationalize it with specific metrics (…) and use it to measure if the association has impacted gender equality.’ (KI #25) (quote captures how midwifery associations can measure gender equity with relation to programme activities)

‘When you have disempowered midwives, you don't have good quality care. You really just don't, and you don't have any opportunity to input into national programs or local programs because there is not a respect for the midwives who would like to have their voices heard at those tables.’ (KI #22)