Community Midwifery Education School

Afghanistan had gone through 3 decades of war. During this period the health sector has been severely affected. Very slowly, the health sector is rebuilt. The life expectancy at birth is only 61 years for men and women. Afghanistan has 1 of the highest maternal mortality rates in the world: 327 per 100,000 life births (AMS 2010). It means that 9 women will die in childbirth during 24 hours. 81% of the pregnant women deliver at home without a skilled birth attendant.
The shortage of qualified midwives is a big problem, especially in the rural areas. Most widwives take jobs in the cities. This project recruits women that are going to be trained in midwifery and they are placed back in the rural communities where they come from.

A. Direct target group:
The students enrolled.
B. Indirect target group:
1. Pregnant women in Uruzgan (15,444per year).
2. The general population in Uruzgan (386,100 people).
3. The Ministry of Public Health and other stakeholders in health sector.

Current status

The current class of community midwife education was started in February 2012 with 19 students. Qualified teachers are supporting the students. It is competency based education using national standard curricula. In addition to the natinal standard curricula, intensive learning course is also conducted for the girls' who have been far from formal education for long period.
The trainers and school manager received Effective Teaching Skills and Emergency Obstetric and Newborn Care trainings. The School is accredited by the Afghanistan Midwifery and Nursing Education Accreditation Board.

Main activities are:
- Boost up CME inside the Tirinkote Hospital by completing/renewal of standard equipments and teaching materials
- Build capacity of the trainers (new curricula, effective teaching skills, EOC pratice) by enrolling in short training workshops
- Provide training modules for the students in local language
- Train all students according to the standard MoPH curricula and methodology
- Provide accommodation for the students
- Coordinate with other stakeholders as required for quality ensuring and accreditation of the program (MoPH, Ghazanfer Institute of Health Science, Urozgan Provincial Health Directorate and other health stakeholder)
- Perform internal assessment each 6 months (by AHDS; Cordaid may join the assessments).
- Facilitate any assessment/monitoring by AMNEAB

Curricula: it is to ensure competency based training to meet national standards. Implementation of standardized curricula and methods set by national IHS will ensure:
- Competency-based learning
- Skill focused
- Skill development on simulators (anatomic models) before going to clinical practice
- Clinical practice and skill development in hospital
- Problem-based approach to enable community midwives to manage problems and think more critically
- Knowledge, skills and attitudes that is necessary for providing the service

IHS curriculum for community midwifery was revised in Oct 2011 that extended from 18 months to 24 months education. It includes 35 training modules in 3 phases of training. The duration for each phase of training is 96 weeks:

Phase 1: Introductory Topics and Normal Pregnancy and Childbirth Care (32 weeks)
Phase 2: Complications of Pregnancy and Childbirth (32 weeks)
Phase 3: Family Planning and Other RH Topics (32 weeks)

Program update: AHDS as a member of IHS, hospital midwife, community midwife and reproductive health working groups has been responsible to review policies, strategies, procedures, curricula guidelines etc. Therefore, the program will be kept continuously up to date based on the outcomes of the working groups and approval of ANMEAB and other MoPH authorities.

Students: 19 students have started CME from 1st of February 2012. Most of them did not have 10 years schooling grade, therefore, eccelerated learning is also considered for them, besides the CME classes.

The official external assessment for the accreditation of the program by the AMNEAB will be done according to their annual plan.

In the past, AHDS had a six month accelerated learning course before admission of the students. Now, GIHS recommends that extra classes should be managed during the course of each semester to up grade educational level of the girls how are not graduated from 10 year schooling before entry to CME. This way the midwifery education and acceralerated learning courses will go parallelly. Hence the midwives can complete the course without any delay and can be in disposale of the target communities.

Overall objective is to contribute to human resources development in southwest region, especially female skilled attendants able to provide adequate maternal and newborn care including emergency obstetric care.

Specific objective:
1. Boost up CME of Urozgan Province
2. Train the students according to standard national curricula and methodology
3. Employ the community midwives in Urozgan health facilities

Goals

• 90% of the graduates deployed in Urozgan Province
• renewal of Accreditation for CME School each 2 years
• 19 trained community midwives

The graduated community midwives are going to work in rural areas where they come from. Access to skilled birth attendants for the communities in Urozgan Province will be increased that will contribute to reduction of morbidity and moratality among the women and children.

In addition, more women will work outdoor, with substantial income and status in the community.

The school will continue to train further midwives untill the local requirement is fulfilled.