Community Midwifery Education Program in Afghanistan
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World Bank, Washington, DC
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In the immediate post conflict period,
Afghanistan's health services were in a deplorable and
chaotic state. Access and utilization of reproductive health
services and skilled care during pregnancy, childbirth, and
the first month after delivery are key to saving those women
at risk of dying due to pregnancy and childbirth
complications. In a society where women seek care only from
female providers, one barrier to expansion of services was
the lack of qualified female health workers who could be
deployed to remote health facilities. Very few midwives who
had trained in Kabul or other big cities were willing to
work in rural areas, and there were no education facilities
and too few female school graduates who could be trained in
the provinces. As maternal health was one of the top
priorities of the health sector, the shortage of midwives to
provide reproductive health services had to be tackled
urgently. Hence the Community Midwifery Education (CME)
Program was created. The program aimed not only to train
more midwives, but also to ensure both their initial
deployment in remote health facilities as well as good
retention rates. These aims were realized through the
creation of a new health cadre known as "community
midwives," along with new competency-based curricula;
establishment of CME schools in each province; relaxation of
the admission criteria for students; and establishment of a
strong accreditation board to ensure qualified midwives were
trained by the program. The program's success is
attributed to stakeholder strong engagement, equity, and
strengthened human resource for health. The program should
be expanded to address the continuing shortage of midwives.
The Mnistry of Public Health considers the program a
successful intervention and believes that there is great
potential to replicate this model to train other health
professionals and tackle the shortage of other human
resources for health.
Palabras clave
ABORTION, ACCESS TO HEALTH SERVICES, ACCESS TO REPRODUCTIVE HEALTH SERVICES, ANTENATAL CARE, BABIES, BABY, BASIC HEALTH SERVICES, BASIC REPRODUCTIVE HEALTH, BASIC REPRODUCTIVE HEALTH SERVICES, BEHAVIOR CHANGE, BIG CITIES, BIRTH ATTENDANT, BIRTH ATTENDANTS, CARE DURING PREGNANCY, CHILD CARE, CHILD HEALTH, CHILD HEALTH SERVICES, CHILDBIRTH, CHILDBIRTH COMPLICATIONS, CHILDBIRTHS, CLINICS, COMMUNITY HEALTH, COMPLICATIONS OF PREGNANCY, COMPREHENSIVE CARE, CULTURAL PRACTICES, CULTURAL REALITIES, DELIVERY CARE, DISEASE, DOCTOR, DOCTORS, DYING, EDUCATION FOR GIRLS, EDUCATION OF WOMEN, EMERGENCY CARE, EMERGENCY OBSTETRIC CARE, EQUAL ACCESS, EQUAL RIGHTS, FAMILIES, FAMILY CARE, FAMILY CARE INTERNATIONAL, FAMILY PLANNING, FAMILY SUPPORT, FATHER, FEMALE, FEMALE PROVIDERS, FOCUS GROUP DISCUSSIONS, FORMS OF DISCRIMINATION, GENDER, GENDER ISSUES, GENDER MAINSTREAMING, GENDER SENSITIVITY, GYNECOLOGY, HEALTH CARE, HEALTH CARE PROVIDERS, HEALTH CARE SERVICES, HEALTH CARE SYSTEM, HEALTH CARE WORKERS, HEALTH CENTERS, HEALTH COMMITTEES, HEALTH FACILITIES, HEALTH INDICATORS, HEALTH MANAGEMENT, HEALTH OF MOTHERS, HEALTH OF WOMEN, HEALTH POLICY, HEALTH PROBLEMS, HEALTH PROFESSIONALS, HEALTH PROMOTION, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE PROVIDERS, HEALTH SERVICES, HEALTH SPECIALIST, HEALTH STRATEGY, HEALTH SYSTEM, HEALTH TARGETS, HEALTH WORKERS, HEALTH WORKFORCE, HEALTH-SEEKING BEHAVIOR, HOSPITAL, HOSPITALS, HUMAN DEVELOPMENT, HUMAN DIGNITY, HUMAN RESOURCES, HUMAN RIGHTS, HUMAN RIGHTS STANDARDS, HUSBANDS, INFANT, INFANT HEALTH, INFECTION PREVENTION, INFORMATION SYSTEM, INTERNATIONAL CONFEDERATION OF MIDWIVES, INTERNATIONAL JOURNAL OF GYNECOLOGY, INTERNATIONAL ORGANIZATIONS, INTERVENTION, JOB OPPORTUNITIES, JOURNAL OF WOMEN, LEVELS OF EDUCATION, LIVE BIRTH, LIVE BIRTHS, LOCAL COMMUNITIES, MALE HEALTH, MARRIED WOMEN, MATERNAL CARE, MATERNAL DEATH, MATERNAL DEATHS, MATERNAL HEALTH, MATERNAL MORBIDITY, MATERNAL MORTALITY, MATERNAL MORTALITY RATIO, MEDICAL BULLETIN, MEDICINE, MIDWIFE, MIDWIFERY, MIDWIFES, MIDWIVES, MILLENNIUM DECLARATION, MILLENNIUM DEVELOPMENT GOALS, MINISTRY OF EDUCATION, MINISTRY OF HEALTH, MORBIDITY, MORTALITY, MORTALITY RATE, MOTHER, NATIONAL HEALTH POLICY, NATIONAL HEALTH SYSTEM, NATIONAL LEVEL, NATIONAL POLICY, NEONATAL HEALTH, NEONATAL MORTALITY, NEWBORN, NEWBORN CARE, NEWBORN HEALTH, NEWBORNS, NUMBER OF PEOPLE, NURSE, NURSES, NURSING, NUTRITION, OBSTETRIC SERVICES, OBSTETRICS, OPPORTUNITIES FOR WOMEN, OUTREACH ACTIVITIES, PATIENT, PATIENTS, PERSONAL BEHAVIOR, PHYSICIAN, PHYSIOTHERAPISTS, POLICY LEVEL, POLICY MAKERS, POLICY-MAKING PROCESS, POPULATION DISCUSSION, POSTNATAL CARE, PREGNANCIES, PREGNANCY, PREGNANCY COMPLICATIONS, PREGNANCY-RELATED CAUSES, PREGNANT WOMAN, PRIMARY HEALTH CARE, PRIMARY HEALTH FACILITIES, PRIMARY HEALTH SERVICES, PROGNOSIS, PROGRESS, PROVINCIAL HOSPITAL, PROVINCIAL HOSPITALS, PROVISION OF SERVICES, PUBLIC HEALTH, PUBLIC HEALTH OFFICIALS, QUALITY OF CARE, QUALITY OF EDUCATION, QUALITY OF SERVICES, RELIGIOUS LEADERS, REPRODUCTIVE AGE, REPRODUCTIVE AGE MORTALITY, REPRODUCTIVE HEALTH, REPRODUCTIVE HEALTH SERVICES, REPRODUCTIVE HEALTHCARE, RESPECT, RURAL AREAS, RURAL COMMUNITIES, SAFE MOTHERHOOD, SCIENTIFIC EVIDENCE, SERVICE DELIVERY, SERVICE PROVIDER, SERVICE PROVIDERS, SERVICE PROVISION, SERVICES TO WOMEN, SEX, SEXUALITY, SKILLED ATTENDANCE, SKILLED ATTENDANTS, SKILLED BIRTH ATTENDANCE, SKILLED BIRTH ATTENDANTS, SKILLED CARE, SOCIAL COMMISSION, SOCIAL MARKETING, SOCIAL STATUS, SPECIALIST, SPECIALISTS, TECHNICAL ASSISTANCE, TECHNICAL CAPACITY, TRADITIONAL BIRTH ATTENDANTS, TRADITIONAL HEALERS, UNFPA, UNITED NATIONS POPULATION FUND, UNSAFE ABORTION, URBAN POPULATIONS, VULNERABILITY, WOMAN, WOMEN'S HEALTH, WORKERS, WORKFORCE, WORKING CONDITIONS, WORLD HEALTH ORGANIZATION