Roya, a midwife at a district basic health centre in Kabul Province doing a pre-natal check up for Pashtoon, who is 8 months pregnant. Credit: Lalage Snow/Save the Children.

Roya has been a midwife for 16 years. She says “I really like this profession and I really want to serve women.”

“There are many problems for mothers and babies here in Afghanistan because of a lack of awareness. Most women give birth at home; many have never seen a hospital. There are lots of misunderstandings and cultural obstacles to mums getting proper healthcare when they’re pregnant.

The lack of midwives is a big problem in Afghanistan. However, in the last few years the community midwives here have been doing a great job explaining the risks of pregnancy to women in the communities and educating them to understand what to do if there are complications. They also make sure that pregnant women know they need to be well nourished, that they should leave a gap between children, and that girls under 18 shouldn’t get pregnant.

Community midwives stop women dying. They raise awareness of what mums and families need to do, they uncover any risks to the mother or baby and they do all the necessary checks.”

Neonatal mortality rate  (per 1,000 live births) (2011) 35
Under-five mortality rate (per 1,000 live births) (2011) 101
Maternal mortality ratio (per 100,000 live births) (2010) 460
Number of doctors, nurses and midwives per 10,000 people (2010) 2.7
Births attended by skilled personnel (2011) 36.3%
Total expenditure on health as a percentage of gross domestic product (2011) 9.6%
General government expenditure on health as a percentage of total expenditure on health (2011) 15.6%

Whilst Afghanistan continues to bear a high burden of maternal, newborn and child deaths, there has been significant progress in the reduction of child and maternal mortality in recent years. Much of this can be credited to improvements in the health system, particularly the introduction and expansion of the Basic Package of Health Services (BPHS), which has brought health care closer to communities. Central to this achievement is an increase in the number and capacity of skilled health workers. It is estimated community health workers treat about 40 per cent of all sick children.

Approximately 57% of the Afghan population now has access to basic health care, although coverage is much lower in hard-to-reach areas. Out-of-pocket expenses account for up to 79% of total health expenditure, despite the 2008 abolition of formal user fees in public health facilities.

The availability of doctors, nurses and midwives is low, and mechanisms for accreditation, regulation and licensing require improvement. HRH planning has therefore been a priority for the government, with the development of multiple policies and collaborative fora, but effective implementation is a challenge. Although the planned development of a five-year HRH Strategy is a positive sign, and its effective implementation will require clear resource commitments.

The EVERY ONE campaign in Afghanistan is calling for the Government of Afghanistan, supported by international donors and non-governmental organisations to take a number of actions, including:

  • Train an additional 6,300 midwives and attain 95 per cent coverage of skilled birth attendance by 2016.
  • Increase the number of Community Health Supervisors from one
    per health facility to two per health facility (one male, one female)

Read our policy brief Investing in health workers to save children’s lives: Bringing care closer to communities in Afghanistan to find out more.

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