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
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