Afghanistan Mortality Survey 2010 - Measure DHS

MATERNAL HEALTH 4Afghanistan is committed to achieving Millennium Development Goal 5 which targets areduction in the maternal mortality ratio (MMR) by 50 percent between 2002 and 2015, and furtherreduction to 25 percent of the 2002 level by 2020 (UNDP/GIRoA, 2008). To this end, the Ministry ofPublic Health (MoPH) has been working closely with the United Nations, USAID, other developmentpartners and NGOs for the improvement of maternal and newborn health in Afghanistan. The MoPH hasundertaken a number of other major interventions to strengthen maternal and neonatal health care, such asdeveloping standards and guidelines for maternal care, training midwives and doctors, strengthening thehealth infrastructure, providing supplies and equipment, developing information materials, conductingcampaigns, and conducting surveys related to the implementation of pilot projects and initiatives inmaternal and newborn health.A key concern in the policies and strategies that the MoPH has adopted is broadening access tomaternal care. One element of this effort has been directed toward ensuring that basic health services andemergency obstetric care (EMOC) are available at basic health centers (BHCs) and that more comprehensivecare is offered at comprehensive health centers (CHCs), district hospitals (DHs), and specializedmaternity hospitals, which are known as centers of excellence for maternal care provision.With regard to access to care, improvements in the availability of skilled staff have been animportant element. In this regard, in 2003 the MoPH reported a severe shortage of skilled birth attendants(SBAs) and midwives in the country. In response, donors including the USAID, the Dutch government,the World Bank and the European Commission assisted the MoPH to establish two programs to train andgraduate new midwives: the Institutes of Health Sciences (IHS) program designed to train midwives topractice at the provincial, regional and national/specialty hospitals; and the Community MidwiferyEducation (CME) outreach program for community-based care. Between 2002 and 2011, 34 schools (4IHS and 30 CME) were established in 31 provinces to serve women in all 34 provinces and there has beena seven-fold increase in the number of midwives trained from 467 to 3,275 (AMNEAB, 2011). Accordingto the newly released State of the World’s Midwifery (SOWM) report, there were 2,331 midwives,nurse/midwives and nurses with midwifery competencies and an additional 254 auxiliary midwives andauxiliary nurse/midwives in the labor force in 2008 (UNFPA, 2011).There is evidence that the effort to expand access to health care is succeeding. For example, theNRVA 2007/8 estimated that in 2008, the large majority of the Afghan population (85 percent) waswithin one hour’s distance of a public health facility by any means of transport (ICON-INSTITUTE,2009). Assessment of health services in 2008 using the Balanced Score Card (BSC) approach found thatwomen were more likely than men to access services (JHUBSPH and IIHMR, 2009). The study alsofound that the proportion of BPHS facilities providing antenatal care on a routine basis had increasedsteadily from 2004 to 2008 and was at an all time high of 95 percent. Although the score for provision ofdelivery care in health facilities was lower than for antenatal care, the national median proportion offacilities providing delivery care according to the BPHS standards, increased by 18 percent in one year,from 60 percent in 2007 to 71 percent in 2008.This chapter reviews information collected in the AMS 2010 on antenatal, delivery, and postnatalcare, as well as on problems in accessing health care. These data are useful both in the continuing effort toassess the progress Afghanistan is making in improving the coverage of maternal health services and inplanning for future improvements in maternal care.Maternal Health | 63