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Training Midwives in Afghanistan

by Action for Development (AfD)
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan

Reducing maternal and neonatal mortality in Afghanistan

In today’s Afghanistan, women still face different challenges that prevent them from receiving adequate pre/post-natal health care, general insecurity being one of them. Most of the population also lives away from health facilities: in 2008, about 60% of the Afghan population lived at least two hours (by foot) away from a health care centre. Furthermore, because of cultural reasons, women cannot undergo consultations with male medical personnel. This is particularly problematic since female health providers are not available in every health facility. As a result, maternal and neonatal mortality are still widespread: the neonatal mortality rate is of 35 deaths for 1.000 live births, and the maternal mortality rate is 396/100.000.

To improve this alarming situation, in 2018 AfD collaborated with the Haute École de Santé of Geneva to train 21 midwives from the Takhar Province of Northern Afghanistan, whom in turn trained 128 additional midwives coming from different health facilities, in order for them to receive and develop the knowledge and skills necessary to improving the quality of care provided to pregnant women and young mothers. In total, 149 midwives benefited from the training last year. As a result of this training, not only mothers and newborns living in remote areas of the country were able to receive a better quality of care, but also the community was made aware of the importance of medical care for women and children.

In addition to the midwifery training, AfD was able to provide medical supplies for a particularly deprived health facility in Panjshir, located in the northeastern part of the country. As a result, this medical facility was able to provide standard basic healthcare to about 50.000 people. 

Cascade training trainees, District hospital
Cascade training trainees, District hospital

259 midwives and nurses receive skills-gap training in Panjsher and Takhar Provinces to provide better services to mothers and newborns!

 

Giving birth in Afghanistan is still a dangerous ordeal that many women are risking their lives for, especially in rural regions. The country has one of the highest infant and maternal mortality rates in the world and 25% of children die before their 5th birthday (UNICEF). Most maternal deaths (80%) are preventable however, as the health-care solutions to prevent or manage complications are well known. In spite of this, women in Afghanistan have a 1 in 52 chance of dying from pregnancy related causes, compared to 1 in 4900 in developed and 1 in 180 in developing countries. This highlights the consequences of breakdowns in health systems in fragile states like Afghanistan as well as the importance of all births being attended by skilled health professionals, as timely management and treatment can make the difference between life and death for both the mother and the baby.

Since 2014, AfD has been working to reduce infant and maternal mortality by providing midwifery skills-gap training to midwives in rural Afghanistan. AfD’s program focusses on the major complications that account for nearly 75% of all maternal deaths (pre-eclampsia, eclampsia, complications from delivery as well as severe bleeding after birth). From 2019, five new training modules will also be available.

Current Modules

New modules, 2019 onwards

1. Care of the Newborn

 6. Family Planning

2. Pre-Eclampsia

 7. Nutrition

3. Eclampsia

 8. Manual Vacuum Aspiration

4. Management of 3rd Stage of Labour

 9. Vacuum Extraction

5. Postpartum Hemorrhage

10. Sepsis

These modules were developed in partnership with the Geneva Midwifery School (Haute École de Santé de Genève, HEdS).  They have been adapted for the country needs, aligned with Afghan government regulations and translated into local language. 

In 2017/18, AfD conducted training for 259 midwives in the Panjsher and Takhar provinces. These provinces were chosen due to an acceptable security level, the available infrastructure (availability of training centers, hospitals, accommodation etc) and a sufficient transport network. 

The training was conducted in two stages. In the first stage, 41 midwives were trained as master midwife trainers. These trainers then returned to their local health centers where, overseen by the Ministry of Public Health, they shared their new knowledge through cascade training of midwives and nurses in their local geographical area.  As a result, the professional skills and knowledge of 218 more healthcare workers in the two provinces was enhanced. 

In rural areas such as Panjsher and Takhar, where gynecologists are rarely available, the services midwives provide for women during their pregnancy, the birth and the postpartum period is vital. AfD’s collaboration with HEdS has enabled midwives in rural areas of Afghanistan to benefit from continued professional development, allowing them to increase their practical skills and knowledge in vital and life-saving areas, increasing their professional competence and confidence.

Now AfD is seeking funding to use the same methodology to train an additional 800 midwives in 4 other rural provinces; Kapisa, Laghman, Nangarhar and Parwan in 2019 and 2020.

We would like to thank you again for supporting our midwifery project. If you would like more information about the project and our latest project evaluation, please visit our website.

Please share our project details with friends and family. With further support, we will be able to save more lives.

 

Kind regards,

 

The team at AfD

Midwives save lives. Approximately two thirds of all maternal and neonatal deaths could be prevented by implementing quality midwifery services. But in Afghanistan, more than 50% of births take place without a skilled birth attendant. The country is still considered as one of the most dangerous places for a woman to give birth. Mothers and infants in poor and underserved communities are at greatest risk.

It is within this context that our midwifery project remains committed to training midwives in provinces where access to healthcare is particularly limited. This year, we trained midwives in Panjsher. In October, we will train midwives in the province of Takhar.

Four new training modules (based on the newest methods and latest research) are currently being developed by the Haute École de Santé in Geneva using funding from the Conservation, Food and Health Foundation. We also hope to develop a module on maternal and infant nutrition, pending funding.

We would like to thank you once again for supporting us in our quest to improve access to quality healthcare in Afghanistan, and ultimately to reduce maternal and infant deaths. Please share our project details with friends and family, so we can continue to save lives.

Warm wishes,

The team at AfD

Links:

Afghanistan still has one of the highest maternal mortality rates in the world. Major contributing factors are a lack of access to primary health care and conservative traditions that make it hard for women to see a male doctor. Most rural areas have few trained midwives and women have no choice but to rely on birth attendants with little medical knowledge.

Training schemes for midwives play a key role in the reduction of maternal and infant mortality rates. Our training scheme has already trained 331midwives in the provinces of Herat, Kabul, Parwan, Kapisa, Bamyan and Panshjer. We have recently received funding from the Conservation Food and Health Foundation, which will allow us to launch the training in Takhar province, and to develop new training modules for the second phase of midwifery training.

Regular training updates based on the newest methods and medical research is vital to ensure quality care for mothers and infants. We will add five new modules to the training; these were based on an evaluation of our previous training and include: nutrition during pregnancy and early childhood, manual vacuum aspiration (a safe and effective treatment option for women undergoing early pregnancy loss), vacuum extraction (a common form of assisted natural delivery, used when labor is not progressing and/or when there are health concerns for the infant/mother), family planning, and maternal and neonatal sepsis (a leading cause of death for women and newborns that can be treated if caught early). Quality of care will be applied throughout the training process.

We would like to thank you again for supporting our midwifery project. Please share our project details with friends and family. With further support, we will be able to extend our care to more mothers and infants in Afghanistan, and save more lives.

Kind regards,

The team at AfD

Links:

Afghanistan remains one of the most dangerous places to give birth. There are an estimated 396 maternal deaths for every 100,000 live births there. A major contributing factor is that two out of every three deliveries take place at home, without a skilled birth attendant. Mothers and infants at heightened risk are those in rural areas, where access to healthcare is extremely limited.

Over the past four years, our midwifery project has been significantly contributing to the professional training of certified midwives in rural areas of Afghanistan. So far, we have trained 330 midwives. The course provides two weeks of comprehensive training for midwives to enhance their 18-month basic training so that they can provide quality health care to mothers and infants. Selected midwives are intensively trained to become midwife trainers. Each trainer passes on their knowledge to five other community midwives; a cost-effective approach to knowledge-sharing.

We now have the results from the project evaluation. Interviews with trained midwives, Ministry of Public Health representatives (MoPH), master trainers, and patients revealed that, overall, the training was well-received, and resulted in improvements in the professional capacity of midwives. Suggestions included having a longer, more intense training period, and adding new training topics. These suggestions will be incorporated into our future training programs.

Examination of regional statistics pre- and post-training showed an increase in the number of pregnancy-related consultations, pre- and post-natal visits, deliveries in health facilities, and family planning consultations. Maternal and infant mortality rates were constant throughout this period. Taken together, these findings indicate that our midwifery program is effective at improving the capacity of midwives, and, with continuation, has the potential to contribute to a reduction in maternal and infant mortality rates in Afghanistan. For those who are interested, the evaluation report will soon be available on our website.

We would like to thank you for the support you have given to this project. With further support, we can continue to improve the care that mothers and infants receive in Afghanistan, and give them a chance to survive and thrive.

Kind regards,

The team at AfD

Links:

 

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Organization Information

Action for Development (AfD)

Project Leader:
Zuhra Dadgar-Shafiq
Geneva, Geneva Switzerland
$3,926 raised of $50,000 goal
 
14 donations
$46,074 to go
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