Abstract
BackgroundFor over a decade, Afghanistan’s Ministry of Public Health and its international development partners have invested in strengthening the national health workforce and establishing a system of primary health care facilities and hospitals to reduce the high levels of maternal and child mortality that were documented shortly after the fall of the Taliban in 2001. Significant progress has been made, but many challenges remain. The objective of this study is to assess the availability and distribution of human resources for round-the-clock comprehensive emergency obstetric and newborn care service provision in secure areas of Afghanistan in order to inform policy and program planning.MethodsA cross-sectional assessment was conducted from December 2009 to February 2010 at the 78 accessible facilities designated to provide emergency obstetric and newborn care in Afghanistan. The availability of staff on call 24 hours a day, seven days a week; involvement of staff in essential clinical functions; turnover rates; and vacancies were documented at each facility. Descriptive statistics were used to summarize results.ResultsAll facilities assessed had at least one midwife on staff, but most did not meet the minimum staffing requirements set in national guidelines. Given that all facilities assessed are considered referral centers for lower-level clinics, the lack of doctors at 5% of facilities, lack of anesthetists at 10% of facilities and lack of obstetrician/gynecologists at 51% of facilities raises serious concerns about the capacity of the health system to respond with lifesaving care for women with obstetric complications.ConclusionsWhile the government continues its efforts to increase the number of qualified female health professionals in Afghanistan after decades with little female education, innovative strategies are needed to facilitate deployment, skill-development and retention of female healthcare providers in underserved areas.
Highlights
For over a decade, Afghanistan’s Ministry of Public Health and its international development partners have invested in strengthening the national health workforce and establishing a system of primary health care facilities and hospitals to reduce the high levels of maternal and child mortality that were documented shortly after the fall of the Taliban in 2001
In the recently published State of the Worlds Midwifery Report, the met need for reproductive, maternal, newborn, and child health services in Afghanistan was only 23% and there were only 400 staff classified as obstetricians/gynecologists [8]
A cross-sectional assessment of the availability and utilization of comprehensive emergency obstetric and newborn care (EmONC) (CEmONC) services in Afghanistan was conducted from December 2009 to February 2010
Summary
Afghanistan’s Ministry of Public Health and its international development partners have invested in strengthening the national health workforce and establishing a system of primary health care facilities and hospitals to reduce the high levels of maternal and child mortality that were documented shortly after the fall of the Taliban in 2001. In the recently published State of the Worlds Midwifery Report, the met need for reproductive, maternal, newborn, and child health services in Afghanistan was only 23% and there were only 400 staff classified as obstetricians/gynecologists [8]. Even with support from international donors to establish pre-service education programs to increase the midwifery workforce and in-service clinical refresher training programs for physicians and midwives, gaps in health service coverage remain. Current statistics indicate the number of certified midwives in Afghanistan has increased from 467 in 2003 to 3,807 in 2013 [9] This is still less than half of the projected number of midwives needed to serve the population, which is calculated as one midwife for every 175 births with a 15% attrition rate that is in line with international guidelines [10]
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