Improving Care of Pregnant Women and Newborns in Afghanistan

How midwives and community health workers are changing maternal health across the country

Nasratullah AnsariTechnical Director, HSSPJhpiego

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Jhpiego: Innovating to Save Lives

Jhpiego prevents the needless deaths

of women and their families.

Founded in 1973 Affiliate of Johns Hopkins University Currently working in 54 countries Experience working in 154 countries Over 700 employees worldwide

Jhpiego’s Approach

Jhpiego saves lives by: Building local human resource

capacity Working in partnerships with

government, nongovernmental organizations, universities, professional associations and communities

Strengthening health care systems Developing evidence-based

innovations and sharing best practices

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Saving Lives, Increasing Access and Quality of Services

Strengthen the health system and increase use of services: Establish national midwifery education policy, schools and

accreditation system Develop reproductive and maternal and newborn health

guidelines and policies that reflect best practices Build a corps of competent community midwives and health

workers Scale up innovative health care interventions:

Equip providers with facility-based techniques to prevent post-birth bleeding and improve quality of care

Prevention of post-partum hemorrhage through education of trained health workers and the distribution of misoprostol.

Health Workforce Planning Recruit locally Select based on national

guidelines and facility needs for midwives

Educate them in the skills, interventions

Deploy to place of work Supervise and support to

work effectively

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The Community as an Active Partner Local control increases

local commitment: Involve community in

recruitment, selection and deployment of midwives

Train community health workers in delivering postpartum family planning services at the household level

Sadiqa: A Community Midwife in Bamyan

Villagers in Shah Foladi refer to midwife Sadiqa as “our own girl”; she is one of the most respected women in the community and a role model for young Afghan girls

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Results 2002 – 2009 Midwifery workforce grew

1961 new midwives 86% working as midwives

Health centers staffed with 1+ midwife: <10% 61%

Misoprostol taken by 96% of women in intervention area in pilot project to protect against postpartum bleeding

8,500 community health workers trained and are delivering postpartum family planning services in communities

Midwifery programs increased from one to 34 schools

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The Work Continues

Vibrant maternal health/reproductive health workforce must be composed substantially of midwives

Midwives must be empowered professionally and deployed rationally

Success of community midwife program has created demand

Community must be engaged as active partner Health systems strengthening is imperative to deliver

high-quality, sustainable maternal and newborn health services