1. Afghan Women Health Status Helsinki 10 November 2010 Presented by : Dr Wamta Shams 1 Afghan Women Health status Helsinki, 10 th November 2010 Prepared by: Dr Wamta Shams

2. Out line of presentation  Health status, indicators  Achievements  Barriers,challenges  Response & strategies ( suggestion/recommendation)

3. Mortality 2002 Maternal mortality ratio (per 100,000 live births) 1,600 Under-five mortality rate (per 1000 live births) 257 Infant mortality rate (per 1000 live births) 165 Life Expectancy46 The Bottom Line… ** National nutritional Survey 2004 ** Afghanistan Household Survey 2006 Nutritional Status2004 Under weight prevalence U535** Complementary feeding (6-9 months)20** Exclusive breastfeeding30**

4. Continue 4 Health services 2002 #of assisted delivery (SBA) 9% Delivery at home88.5% Contraceptive Prevalence rate13 Total Fertility rate6.6 Unmet demand32%

5. 5

6. Causes of Maternal Mortality (Globally) 6

7. Causes of maternal death in Afghanistan 7 Estimated 26,000 women dying from pregnancy related causes per year 1 woman dying every 27 minutes 78% of deaths are preventable

8. When Do Maternal Deaths Occur?

9. 6500 2200 800 400 Afghanistan MMR/100,000 #9#9

10. Where we are ?(achievement )  Health& Nutrition strategy  Commitment of Afghan government & MoPH  RH strategy & policy  Basic package of Health services (BPHS)& Essential package of Health Services (EPHS)  Substantial progress has been made in provision of health care services in rural Afghanistan  Competent Training guideline & curricula for community MWs  Establish community Based Health Care (CBHC)

11. Where we are? Coverage of Health facilities89% # of HF1241(2003) to 1586(2008) Family Planning service availability82.3 <5 mortality191 Infant mortality rate129 ANC coverage80.3 % of deliveries by SBA18.2% CPR36% # of Community Health worker20.000 # of Midwives467 to 1919

12. Millennium Development Goals (MDGs) –Reduce by 50%, between 2003 and 2015, the under-five mortality rate, and further reduce it to one third of the 2003 level by 2020 –Reduce by 50%, between 2002 and 2015, the maternal mortality ratio, and further reduce it to 25% of the 2002 level by 2020 –Have halted by 2020 and begun the reverse the spread of HIV/AIDS –Have halted by 2020 and begun to reverse the incidence of malaria and other major diseases ICPD Bench marks 60% of Primary Health Care centers should provide RH services by 2005 80% by 2010 and 100% by 2015 Afghanistan Compact Benchmark By end 2010, in line with Afghanistan’s MDGs, the Basic Package of Health Services will be extended to cover at least 90% of the population; maternal mortality will be reduced by 15%; and full immunization coverage for infants under 5 for vaccine preventable diseases will be achieved and their mortality rates reduced by 20% Health and Nutrition Sector,Goals: 12

13. Desired Results, New Health secretor Strategy MMR to be reduced by 21% - from an estimated 1600 deaths per 100,000 live births. Under 5 Mortality Rate (U5MR) to be reduced by 35% - from 257 deaths per 1000 live births Infant Mortality Rate (IMR) to be reduced by 30% - from 165 deaths per 1000 live births the ratio of Caesarian Sections per 100 deliveries carried out in district, provincial and regional hospitals –the HIV sero-prevalence rate in the general population will be maintained at less than 0.1%

14. 14 Remaining challenges

15. 15 Insecurity Coverage VS accessibility and utilization Sustainability – BPHS is a donor driven program Least budget allocation on RH activities Aligning strategies of BPHS NGOs toward achieving the MDGs. Geographical dispersal of population & remoteness. Challenges

16. 16 Challenges Insufficient Reproductive Health commodity security Cultural barrier ( knowledge & family prominence ) Insufficient /lack of SBA Insufficient quality of services Strengthening monitoring and evaluation to fill missing information Poorly motivated CHW Challenges

17. Suggestion/recommendation …. 1- Focus on equitable coverage for priority interventions. 2- Gender & Human right in MR 3- Proper HR planning 4- Strength government support,monitoring &evaluation on conducted locally driven implementation research 5- Government &Stakeholder Commitment Focus on Preventive, Primitive & Curative Services through integrated approach Increase accessibility and quality of services Promote Community Participation, strength gross root activity. Expansion of Services (BPHS & EPHS) Promote Innovative schemes Maternity waiting room Sufficient commodity security FP method provide 10% reduction in MMR Increase Demand for health services Performance based incentives Demand side financing Focus on Preventive, Primitive & Curative Services through integrated approach Increase accessibility and quality of services Promote Community Participation, strength gross root activity. Expansion of Services (BPHS & EPHS) Promote Innovative schemes Maternity waiting room Sufficient commodity security FP method provide 10% reduction in MMR Increase Demand for health services Performance based incentives Demand side financing

18. Suggestion/recommendation …. 1- Focus on equitable coverage for priority interventions. 2- Gender & Human right in MR 3- Proper HR planning 4- Strength government support,monitoring &evaluation on conducted locally driven implementation research 5- Government &Stakeholder Commitment  MM reduction is a matter of gender, sexual and reproductive rights, and social justice,  inequity, at the individual level, family level, community level, and institutional level lead to MMR. often, maternal death or disability are the result of gender-based violence. Promoting gender and RH rights is crucial.  MM reduction is a matter of gender, sexual and reproductive rights, and social justice,  inequity, at the individual level, family level, community level, and institutional level lead to MMR. often, maternal death or disability are the result of gender-based violence. Promoting gender and RH rights is crucial.

19. Suggestion/recommendation …. 1- Focus on equitable coverage for priority interventions. 2- Gender & Human right in MR 3- Proper HR planning 4- Strength government support,monitoring &evaluation on conducted locally driven implementation research 5- Government &Stakeholder Commitment  The most crucial constraint, or factor is lack of skilled & trained staff.  strenght gross root activity (CMW).The challenge is also to post (and keep) skilled and committed providers in basic EmOC facilities  Formulate/review national HR policies and stratégies.  To be included in the reform of health system, with multi-partner coordination, not only health. .  The most crucial constraint, or factor is lack of skilled & trained staff.  strenght gross root activity (CMW).The challenge is also to post (and keep) skilled and committed providers in basic EmOC facilities  Formulate/review national HR policies and stratégies.  To be included in the reform of health system, with multi-partner coordination, not only health. .

20. Suggestion/recommendation …. 1- Focus on equitable coverage for priority interventions. 2- Gender & Human right in MR 3- Proper HR planning 4- Strength government support,monitoring &evaluation on conducted locally driven implementation research 5- Government &Stakeholder Commitment Initiatives must focus on outcomes Timely and readily available data Allocate/generate resources for M&E Action on results Include on official document ( Misoporstol & Emergency contraceptive) Initiatives must focus on outcomes Timely and readily available data Allocate/generate resources for M&E Action on results Include on official document ( Misoporstol & Emergency contraceptive)

21. Suggestion/recommendation …. 1- Focus on equitable coverage for priority interventions. 2- Gender & Human right in MR 3- Proper HR planning 4- Strength government support,monitoring &evaluation on conducted locally driven implementation research 5- Government &Stakeholder Commitment Increase Inter-sectoral & ministerial collaborations Promoting Private-Public Partnership Ensure common vision and shared goals Ensure predictable long-term aid flow Donor commitment Increase Inter-sectoral & ministerial collaborations Promoting Private-Public Partnership Ensure common vision and shared goals Ensure predictable long-term aid flow Donor commitment

22. 22 Final Words “I am happy with the midwife. Previously there was no midwife in our village and women were suffering bleeding and their children were dying. Now thanks to God, we have got a midwife and since have not seen a pregnancy death.” “I am happy with the midwife. Previously there was no midwife in our village and women were suffering bleeding and their children were dying. Now thanks to God, we have got a midwife and since have not seen a pregnancy death.” “In the beginning, people thought that I might be a Dayea (traditional birth attendant) and would not be effective. At present, they know me as a women’s specialist and they respect me and say that I solve their women’s problems.”“In the beginning, people thought that I might be a Dayea (traditional birth attendant) and would not be effective. At present, they know me as a women’s specialist and they respect me and say that I solve their women’s problems.”

23. 23 Are Women Getting the Services they Need? “Before there was no midwife in our health center and we had to travel over one hour to the nearest town. I had all my babies at home before. But now Midwife Hadia is at the health centre and because of this more women are seeing a midwife. I will have my next baby with Hadia in this health center, she is very nice and makes me feel safe” Woman in Takhar province who was delivered by Midwife Hadia

24. Effective Interventions

25. Safe pregnancy and childbirth and a life of dignity for all women 25

26. 26 Health facility

27. 27 Community Health workers (CHW)

28. 28 SBA( Midwife)

29. 29 Community midwifes