For almost 40 years and in over 150 countries Jhpiego has worked to prevent the needless death of women and their families. Jhpiego,an affiliate of Johns Hopkins University designs innovative, effective and low-cost solutions to ensure high-quality health care for the worlds most vulnerable populations. Working in HIV/AIDS, family planning and reproductive health, maternal and newborn health care, infection prevention and control and malaria - Jhpiego helps countries care for themselves.
May 22, 2013

On the Frontlines, Health Worker Ozara Husseini

Community health worker discusses family planning.
Community health worker discusses family planning.

In the tiny village of Katasank in central Afghanistan, Ozara Husseini is a lifeline for pregnant women and mothers. She is neither a doctor nor a midwife. And yet, Ozara is often the first person to whom women turn when they have a question about their health. A community health worker who is studying to be a teacher, Ozara knows the importance of education and gives women in her village of  200 the information they need to safely space their pregnancies.

"I really believe in family planning,” says the 20-something who has been a community health worker since she was a young teen. “It is the only thing that is going to improve the economic situation of women throughout Afghanistan. Most women I visit in this community are very willing to accept family planning and want to use it -- either to not have any more children or to be able to have space between their children.”

As a maternal health issue, postpartum family planning is crucial because pregnancies during the first year after childbirth hold the greatest risk for the mother and her baby. Healthy birth spacing allows women to properly care for themselves, their babies and family, helping to reduce maternal and newborn deaths.

Community health workers are often the first contact for information on hygiene, nutrition, safe birthing practices and family planning methods. Ozara visits women in their homes, using illustrated flipcharts to educate women on family health issues. She explains that spacing pregnancies three years apart benefits both mother and newborn.

When patients are ill or in need of specialized maternal health services, she refers them to the Community Health Center in the nearby town of Foladi where two midwives work.

“Women get married very young here,” says Ozara. “Some women will have up to three children before they are 20 years old. There are a lot of cultural barriers here to using family planning - a lot of people believe that the birth of children is the will of God and we shouldn't interfere with this. Some decision makers of the family don't allow the women to use birth control - but often the women will do it in secret because they know that it is the only way that they are going to be able to look after their existing children properly. I explain all types of family planning - the (intrauterine device), pill, condoms and an injection that the women have to go to the health center for. It is up to families to decide for themselves.

“I have noticed,” she added, “an improvement in the economic situation of families who are able to decide when they will have their next child because they can plan for it.”

Community health workers are an integral part of the Afghan government’s community-based  health system. In partnership with the Ministry of Public Health and with the support of U.S. Agnecy for International Development, Jhpiego has worked to ensure women and families gain access to quality health services.

A rebuilt midwifery education system has graduated 3,000 skilled midwives who are working in communities throughout the country. In addition, Jhpiego has helped educate and train community health workers like Ozara in delivering basic health information, family planning counseling, gender equity issues and prevention of postpartum hemorrhage in women who can’t reach a health facility and must give birth at home. Postpartum hemorrhage or severe bleeding after birth -- is leading cause of maternal deaths worldwide.

Community health workers like Ozara have educated more than 10,000 pregnant women living in remote areas on self-administration of misoprostol, a potentially lifesaving drug to prevent postpartum hemorrhage when giving birth at home.









Feb 19, 2013

Sharbanoo - An Afghan Midwife

Shahrbanoo, a young midwife working in Bamyan Province in Afghanistan, is a graduate of the community midwifery education system, which was established by the Afghan government with support from USAID and Jhpiego. More than 3,000 skilled midwives have graduated from accredited schools in this system and are working today to save the lives of mothers and newborns. A significant reduction in maternal deaths in Afghanistan reported in 2010 has been attributed to these new midwives who bring skilled care to women where they live. Midwifery school graduates have an education and a job to help them provide for their families.


Nov 27, 2012

Afghan Midwifery Workforce

The number of midwives delivering skilled health care to women in Afghanistan has more than tripled under programs supported by Jhpiego and partners, leading to significantly more women surviving childbirth.
Jhpiego, an international health non-profit and affiliate of Johns Hopkins University, has been at the forefront of efforts to prevent childbirth-related deaths in Afghanistan since 2002. In partnership with the Afghan government and funded by the U.S. Agency for International Development, Jhpiego helped revitalize the Afghan midwifery workforce by developing a national education system to train midwives to provide competent skilled care to women during childbirth.

At the time the USAID-funded work began in 2003, Afghanistan’s maternal death rate was the second highest in the world. There were only 467 midwives in a country of 20 million, less than 8 percent of pregnant women gave birth with a skilled provider at her side, and only one province offered midwifery education.

Today, as a result of  the USAID-funded Health Services Support Project (HSSP) and prior programs, the state of midwifery in Afghanistan is vastly improved:

•    More than 3,000 new midwives have graduated from a network of government-accredited schools whose curriculums and competency-based training were developed by Jhpiego in collaboration with the Afghan Ministry of Public Health and other partners;
•    The percentage of women giving birth in a health facility has increased from 19 percent in 2005 to 32.4 percent in 2011;
•    Midwifery programs have increased from 1 in 2002 to 30 today;
•    86 percent of  graduates of  community midwifery schools received jobs;
•    A professional organization of midwives was organized and supported with the help of USAID; the association  has more than 2,000 members across 33 out of 34 provinces;
    The Afghanistan Mortality Study (AMS), which was released last year by the government, showed a significant reduction in women dying in childbirth. The study found that 327 Afghan women die for every 100,000 births. That compares to the World Health Organization rate of 1,400 for 100,000 births in 2008.

Dr. Leslie Mancuso, Jhpiego President and Chief Executive Officer, said Jhpiego’s innovative strategies to build the capacity of  Afghan midwives and strengthen health facilities throughout the country have resulted in improved health services for women.

“The fact that more Afghan women are surviving childbirth is a testament to the newly-educated midwives who are working in their communities to prevent the needless deaths of women and families,” said Dr. Mancuso. “Jhpiego’s focus on skilled care and innovative strategies to prevent the deaths of women shows that continued investment in strengthening the Afghan health system will save lives.”

Training in infection prevention
Training in infection prevention