Improving Care of Pregnant Women and Newborns in Afghanistan How midwives and community health workers are changing maternal health across the country Nasratullah Ansari Technical Director, HSSP Jhpiego

2 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

4 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

6 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

8 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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10 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