Sabera Turkmani|Sheena Currie|Jaime Mungia|Nassim Assefi|Ahmed Javed Rahmanzai|Pashtun Azfar|Linda Bartlett
‘Midwives are the backbone of our health system’: Lessons from Afghanistan to guide expansion of midwifery in challenging settings
Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|Behavioral Tech Research, Inc.|New Leaders|United Nations Population Fund|Johns Hopkins University
last decade afghanistan made large investments scaling number midwives address access skilled care high burden maternal newborn mortalityat request ministry public health moph evaluation undertaken improve preservice midwifery education programme identification strengths weaknesses qualitative component evaluation specifically examined 1 programme strengths 2 programme weaknesses 3 perceptions programmes community impact 4 barriers provision care challenges impact 5 perceptions recently graduated midwifes field experience 6 recommendations programme improvementthe evaluation used mixed methods approach included qualitative quantitative components paper focuses qualitative components included indepth interviews 138 graduated midwives 20 key informants well 24 focus group discussions womeneight provinces afghanistan functioning accredited midwifery schools june 2008 november 2010midwives graduated one two national midwifery programmes institute health sciences community midwifery education key informants comprised stakeholders female residents midwives catchment areasmidwives described overall satisfaction quality education midwives stakeholders perceived women likely use maternal child health services communities midwives deployed strengths included evidencebased content standardised materials clinical training supportive learning environment selfreported aspects quality education respect midwives empowerment included feeling competent confident demonstrated respect shown coworkers weaknesses programme included perceived low educational requirement enter programme readiness programmes commence education insecurity geographical remoteness perceived challenges clients access care ability midwives make home visitsthe depth midwives contribution afghanistan increased maternal health care service utilisation changing communitys perceptions womens education professional independence overwhelmingly positive lessons learned serve model low resource postconflict settings striving increase workforce skilled providers