h4+ high burden countries initiative national assessment of midwifery workforce in afghanistan
TRANSCRIPT
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H4+ High Burden Countries Initiative
National Assessment of Midwifery
Workforce in Afghanistan
Sabera Turkmani
Jhpiego/Afghan Midwives Association
H4+HBCI
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Acknowledgements:
Dr. Sadia Ayub Directorate Reproductive Health Dr. Ishan Shahir Directorate Human Resources Core Group members - MoPH, H4+, AMA, Jhpiego Lead researchers - Partamin Manaly, Sabera Turkmani MoPH and other government institutions H4+ and other development partners AMA and AFSOG Study participants Expert participants HBCI Secretariat and Technical Working Group USAID for supporting the cofounding
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Overviewofthepresenta9on
MaternalhealthinAfghanistan HBCIprocess-overview Researchtasks Workforcereten9on Skillsassessment AMAreflec9on Summary
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MaternalhealthinAfghanistan
MaternalMortalityRa9oin2002was1,600/100,000
Only467midwivesavailablein2003
Lessthen10%birthswereaQendedbySBAs(MICS2003)
Majorpolicyini9a9vewastotrainanddeploymidwivesin
thecommunity
Abasicpackageofhealthservicescontractedoutto
NGOs
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OverviewoftheHBCIprocessinAfghanistan
Secondarydatareviewthrough2012 PreliminaryvisitbyHBCIsecretariatinMay2012tomeetwithstakeholdersandintroduceHBCI
Gapsinassessmentframeworkiden9fiedandagreed SteeringGroupestablishedledbyMOPH(H4+,HRH,professionalassocia9ons&Jhpiego)
Collabora9onJhpiegoandtheAfghanMidwivesAssocia9ontoundertakeprimarydatacollec7on
Stakeholdermee9ngSeptember2012withTechnicalConsensusStatement
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RESEARCHTASKS
(approvedbyAfghanIRBandSteeringGroup)
Indica9velyes9matethedistribu9onofmidwiferyworkforceinpublicandprivatesectoramongAfghanMidwivesAssocia9on(AMA)andAfghanSocietyofObstetricians&Gynaecologists(AFSOG)members
Indica9velyes9matemagnitudeanddistribu9onofprivateprovidersofmidwiferyservices
Indica7velyes7mateworkforcereten7onratesforpublichealthfacili7es Skillsassessmentofasampleofprivatelyeducatedmidwivesand
doctors
In-depthinterviewwithkeyinformantsonthepolicyenvironmentformidwiferyservices
Analy9cSeminarbyMoPHandotherstakeholderrepresenta9vesonthepolicyenvironmentformidwiferyservices.
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SampleandresponseratesDatacollectioncomponents Desired Actual Remark
Private/publicworkdistribution-midwives 82 73 Goodresponse
Private/publicworkdistribution-doctors 71 55
Privatefacilities - 74 Firsttime
estimation
Turnoverrate-BHC 66 91 Somefacilitiesdid
notcooperatetoprovidethedataon
turnoverforthe
samplefacilities.
Thisshouldbekept
inmindwhen
interpretingtheresults
Turnoverrate-CHC 61 70Turnoverrate-DH 34 8
Turnoverrate-PH 21 7
Turnoverrate-RH 5 0
Turnoverrate-SH 17 0
Turnoverrate-SHC 62 48Turnoverrate-MHT - 7
Skills-midwives 25 25 Highresponseand
goodcooperationSkills-doctors 10 8
In-depthinterview 5-10 5
Analyticseminar 7-10 9
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Reten9onindicators Turnoverrate:#staffleinpast12months/Average#staffforbeginningandendofthe12
monthsperiod*100 Stabilityindex:#currentstaffworkingfor12ormoremonths/#ofstaff12monthsago*100
Survivalrate:#staffrecruited12ormoremonthsagoleavingtheirpost/#staffrecruited
12ormoremonthsago*100
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Posi7on
Turnoverrate
2011
Turnoverrate
2012
Stabilityindex
2011
Stabilityindex
2012
Survivalrate
2011
Survivalrate
2012
Survivalhalf-life
months
Anesthe9st 0% 36% 1.00 0.43 0% 57% FMD 13% 36% 0.80 0.40 20% 60% 62
FN % 17% 0.88 0.70 13% 30% 60
Lab 11% 20% 0.83 0.74 17% 26% 0
MMD 8% 33% 0.0 0.56 10% 44% 3
MN 8% 22% 0.88 0.66 12% 34% 63
MW 2% 26% 0.8 0.71 2% 2% 116
Paed 0% 60% 1.00 0.40 0% 60% -
Pharmacist 11% 34% 0.86 0.54 14% 46% 52
Surgeon 0% 48% 1.00 0.38 0% 63% 7
WorkforceReten9on
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Reten9on-somepoints
Turnover:midwivesrange2%-26%
Turnover:Medicaldoctor(female)13%-36%
Turnover:MedicalDoctor(male)8%-33%
Survival:Insomecaseslessthan1in3health
workersremaininpost
aer12months
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Skillsassessment
Doctor Midwife GrandTotal
N 8 25 33
Delivery 64.0% 70.2% 68.7%
ManualRemovalOfPlacenta 73.8% 79.2% 77.8%
ManualVacuumAspiration 50.0% 50.0% 50.0%
VacuumExtraction 50.0% 50.0% 50.0%
NewBornResuscitation 81.4% 76.5% 77.7%
Pre-eclampsia/Eclampsia 98.0% 60.8% 70.1%
Partograph 76.3% 44.0% 51.8%
Allskills 64.6% 61.6% 62.3%
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AfghanMidwivesAssocia9onreflec9on
RecognizeAMA,asanac9vepartnerwithH4+indelibera9onsthataffectandadvocateformaternalhealth
Organiza9onalcapacitybuildinginleadership&research
Encouragingprofessionaldevelopmentandgrowththroughengagementof25+membersinopera9onalresearch
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Summary
The interpretation of the results will be incorporated intothe final MOPH/ HBCI report
Many challenges in getting to the real data informationscattered
Large investments in educating the midwifery workforce,less investments in human resource information systems
Strengthened professional association as potentialrecipient research