What happens when you set out with a mission and a goal and you find yourself at the end of a road with no outlet? This happens with projects. You know what you want to achieve but you hit an obstacle in the process and need to revamp your strategy.
The problem? Afghanistan has one of the highest maternal and infant mortality rates in the world. Almost all Afghan women deliver their babies at home with traditional birth attendants (TBAs) who are not educated, lack knowledge about hygiene and other personal health issues and believe in myths and superstitions which perpetuate unhealthy choices and cost lives and suffering. In addition, there were very few trained Afghan female nurses, midwives or health educators. AIL’s ultimate goal was to reduce the maternal and infant mortality rate.
What did AIL decide to do? Beginning in 1996 in the Pakistan refugee camps, AIL operated health clinics for women and gave all patients health education. AIL began training the traditional TBAs. AIL also started training female high school graduates as health educators. But this was not enough. AIL then developed a two-year, post-secondary course to train Afghan female high school graduates as nurses, midwives and health educators so that Afghan women would have highly trained females to go to for pre natal and post natal care and delivery. The course was excellent and graduates were immediately hired by the best refugee clinics and hospitals and women began going to have their babies delivered by the midwives and listen to their advice. When the Taliban were defeated and refugees began returning to Afghanistan, AIL continued training TBAs in villages, and AIL also opened another nurse/health educator/midwife course in Kabul. Again it was very successful.
The obstacles? As the Afghan government began to organize its various ministries, the health ministry first decided that no TBAs should be trained anymore because they were not educated, so AIL had to stop training TBAs. Next, the health ministry set up requirements for courses training midwives which cost hundreds of thousands of dollars for facilities. AIL didn’t have the funds and had to close the course in Afghanistan.
What was AIL now going to do to reduce maternal and infant mortality rates? Precluded from training TBAs and graduating highly qualified midwives, AIL decided to focus on educating the mothers directly by giving them the information on hygiene and nutrition that they needed and encouraging them to deliver at clinics or hospitals or with trained midwives. This had to be handled carefully as this is a highly personal issue for Afghans. AIL began offering a half day Expectant Mother class for expectant mothers and one care-giver (mother, sister or TBA) for women who came to AIL-operated clinics. Because AIL was trusted, AIL was able to hold two classes. The information was highly useful and the participants were also given reasons for why they should deliver at a health facility or with a trained person. Word spread about the usefulness of the classes and AIL now has a waiting list for the classes. What is most important are the results. Since 2010, over 1500 women have attended Expectant Mother classes. There have been no maternal deaths and only one still born and presently all women who attend the classes report that they have delivered in a clinic, hospital or with a trained midwife. In addition, class participants report that they have told many more women about what they learned in the class. Achieving the goal is an ongoing process, but what was learned here is that AIL did not give up on their mission. AIL overcame the barriers placed before them by stepping back and altering their format in a way that was successful and achievable within the constraints placed upon them.
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