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Supporting the Health System by Strengthening Midwifery in Afghanistan

Sabera Turkmani, President Afghanistan Midwives Association May 2012

Health Policies Scaling up community midwifery education and workforce planning approach Community involvement Midwifery pre-service evaluation results Professionalized midwifery Midwifery as womens empowerment Challenges Summary

Health Policy 2005: Addressing MDGs

To reduce maternal and newborn mortality To reduce under five mortality and improve child health To reduce incidence of communicable diseases To reduce malnutrition To develop the health system

Policy Environment
Development of Basic Package of Health Services Reproductive Health Strategy included improving coverage of midwives and an intrapartum care strategy The MOPH and international community demonstrated strong commitment and funding to prepare competent midwives, to work in underserved areas of Afghanistan

Scaling up community midwifery education

A job description based on all ICM essential competencies was developed A 18-month competency-based curricula and training materials developed in February 2004 and revised in 2010 to 24 months education program Knowledge and skills of teachers and clinical preceptors updated Midwifery Education Policy endorsed 2005 Midwifery education standards developed and endorsed by MoPH

Increase in recruitment and deployment of midwives 2000- 2011

Year 2000 2001 2002 2003 2004 2005 # recruited 26 23 95 311 509 360 #graduated 26 23 85 283 489 343 % deployed 92% 91% 82% 91% 83% 87%

2007 2008 2009 2010 2011 Total

336 485 704 425 546 4264

317 469 641 30 3140

85% 80% 89% NA NA 86%

Workforce planning approach

Recruit locally Selection based on national guidelines and facility needs for midwives Deploy to place of work Supervise and support to work effectively within enabling environment

The Community as a key actor

Local control increases local commitment:
Involve community in recruitment, selection and deployment of midwives Residential programs addressed cultural concerns about women being away from families

Quality Control: Accreditation & Supportive Supervision

Accreditation Board was established in 2005 after endorsement of accreditation policy to act as a national technical regulatory body to ensure: Sustainability of high quality midwifery Uniformity Establish certification process International equivalence Supportive supervision system was established to create a smooth transition for graduates from classroom to real practices in health facilities

Evaluation of the Pre-Service Midwifery Education Program 2010

Duration of the program was extended from 18 to 24 months 7 new modules were added to the curriculum to address competency gaps and the actual work being performed by midwives e.g. mental health Emphasis on increasing coordination between programs and clinical sites to allow students more practice eg. shock management Strengthening of Department of Nursing & Midwifery to improve advocacy, leadership and policy role of midwives

Professionalizing Midwifery through Association (2005)

Professional association, as an active partner in all deliberations that affect the profession and advocate for maternal health at policy level (2400 members from 34 provinces) Raising visibility and image of midwifery. AMA act as catalyst for education and regulatory system Technical body for education and professional development Lead organization for development of regulatory body

Key Initiatives of AMA

Initiated and lead development of professional regulation Initiated the concept of Safe motherhood Initiative (SMI) in the country. Initiated the concept of Mentorship Established mechanism for recognition of midwives who had significant contribution on maternal health

AMS 2010 Life expectancy Under five mortality Infant mortality Total fertility rate 62 97 77 5.1 AHS 2006 46 191 129 6.3

Deliveries attended by SBA

Maternal Mortality



Midwifery as womens empowerment

Womens participation in education programs Contribute to household economy Safeguard the health and well-being of families Women in leadership roles/positions Villagers in Shah Foladi refer to midwife Sadiqa as our own girl; she is one of the most respected women in the community and a role model for young Afghan girls.

Security Retention Midwifery career framework Conservative socio cultural context Improving quality of maternal and newborn care

Improved access to skilled midwifery care by: Training of many competent midwives Professionalization of midwifery Midwives working within an enabling environment association, supportive supervision

Sustained commitment and political leadership is necessary