Training Midwives in Afghanistan

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

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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

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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:

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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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When the mother of a newborn infant dies, the child has only one chance in four of surviving until its first birthday (UNICEF).

More than 50 percent of pregnant women in Afghanistan do not receive any antenatal care, and just 31 percent of deliveries are attended by a skilled professional (MoPH, Afghanistan).

The situation is particularly alarming for those living in poorer, rural areas, where as little as 3% of deliveries have been reported as having a skilled professional in attendance (Bartlett et al, 2017).

In rural Afghanistan, villages often remain cut off from the centre during the winter months, which hinders their access to health services. It is therefore critical to have a health provider in these villages, who is knowledgeable and capable of recognising and treating health problems.

This is why Action for Development (AfD) remains committed to training midwives in deprived areas of rural Afghanistan, and ultimately reducing the incidence of death and illness amongst mothers and infants.

In November 2017, AfD conducted the first round of its midwives capacity building programme in the province of Panjsher, a mountainous region in northeastern Afghanistan, which had only one maternal health doctor in 2009 (UNICEF). Residents live in villages that are largely inaccessible by roads, and extreme weather frequently obstructs the few available transportation paths. Some women have to walk for hours, even days, to reach a clinic, and it can be difficult to transport emergency cases.

Twenty midwives from different districts of the province were brought together to the centre of Panjsher where they could enhance their knowledge on specific pregnancy and birth-related issues, including Eclampsia, Pre-eclampsia, managing third-stage labour, and newborn care.

The twenty midwives, who will be trained to become trainers in the following month, will pass on their new knowledge to eighty further midwives and community midwives.

We would like to thank you once again for supporting our project. Your support saves lives.

Best wishes,

The team at AfD

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Organization Information

Action for Development (AfD)

Location: Geneva - Switzerland
Website:
Facebook: Facebook Page
Twitter: @afd_swiss
Project Leader:
Zuhra Dadgar-Shafiq
Geneva, Geneva Switzerland
$5,230 raised of $22,000 goal
 
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