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Purpose
To improve the pre-service midwifery education program through identification of its strengths and weaknesses. Objectives To assess : How the program addressed the needs of Afghan women and their families for available quality maternal and newborn care. Estimate cost of schools and per midwife working. How program develops effective processes, for example, student recruitment. Increases the number of graduate midwives in Afghanistan and time estimated to reach national coverage with current output of midwife graduates. How program effect delivery of maternal health care services.
Methods
1. Review of midwifery education programs data: number of graduates and current students 2. Assessment of provincial level maternal health utilization: Analysis of HMIS data 3. Assessment of quality of care: Core competencies using training mannequins and simulations 4. Documentation of clinical practice of graduated midwives 5. Projection of number of midwives needed 6. Qualitative Interviews and FGDs
Deployed % 82 89 8
Currently working % 76 84 10
Proportional 9 Difference
Utilization of midwifery services Average ANC and SBA Use by Time and Treatment Group, 2003-2008
MROP
NBR
MVA
EC
PGR
SHK
8
Badakhshan Badghis Hirat Kabul Nangarhar Paktya Parwan Saripul
MROP
NB
SHK
MVA
EC
PGR
CME
IHS
Percent
30
40
50
60
70
80
90
100
30
40
50
60
70
80
90
100
Percent
10Percent
Percent
11
Actual situation Births per year 2012: 1,002,029 Number midwives needed: 5010 Number midwives: 3807 Gap: 1203
12
Economic Analyses
CME
7
26
25
22
19
(73%)
303295
11922
12201
13659
IHS
2
65
60
38
41
(63%)
285144
5256
5474
7687
13
Number of schools assessed Mean number of students enrolled Mean number of students graduated Mean number of students deployed Mean number of graduates working at the Eme of assessment Mean cost per batch (USD) Mean cost per enrollee Mean cost per graduate Mean cost per midwife deployed
Qualitative findings
Midwives, clients and authorities shows high general satisfaction from program Villagers refer to midwife as our own girl; she is one of the most respected women in the community and a role model for young Afghan girls. Women in the village are happy with midwives since they are female, because we cannot talk to male doctors about our problems. If we go and see a male doctor our men will kill us. These midwives are everything for us.
14
Qualitative findings
Challenges cited by most respondents:
Insecurity and cultural restrictions Transportation Inadequate supplies Discrimination by doctors CME Midwives that have studied less than 12 grade cannot attain full status as civil servants Inadequate refresher training and lack of professional development opportunities Inadequate supervision of midwives especially in remote areas Inadequate working hours at BHC and CHCs (5 hours per day) One midwife per BHC and two midwives per CHC are not enough Current curriculum does not address some technical needs of the 15 midwives (mental health, pharmaceuticals, etc.)
Recommendations
Hardship allowances and performance-based Incentives for remote, insecure areas, faculty & midwives Offer refresher training for midwives Supportive supervision Increase the number midwives in BHC/CHC Increase education level to 12th Grade for CME Enrich the curriculum with the lacking technical areas increasing the course length proportionally
Thank You!