Community Midwifery Education Program in Afghanistan
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.