Evaluation of the Midwifery Training Project

Jul 2018

The global scenario of maternal health has seen an unprecedented growth, however, conflict zones like Afghanistan still bear the brunt of challenges. There is no doubt that some significant progress has been made but there is a long way to go. Within the context of improving yet still insufficient maternal healthcare provision, Action for Development in collaboration with the Haute école de santé de Genève designed and developed a short-term capacity building training course for qualified midwives in Afghanistan.  

The course provided two weeks of comprehensive training for midwives in order to top-up their basic training and included 5 modules ranging from care of the newborn to post-partum haemorrhage. AfD has been significantly contributing to the professional training of certified midwives in rural areas of the country over the past 4 years.

The report of this evaluation (2014-2017) by Mary Kirkbride with Olena Kuzyakiv sheds some light on the current status of the program, the achievements unlocked and vision for the future. According to the data collected the overall project objective was partially achieved. Maternal and infant mortality rates in most of the rural areas of Afghanistan where the project was rolled-out remained constant despite an increase in the numbers of complex cases.  The majority of the specific project objectives were achieved. In the areas covered by the project, there was an increase in the proportion of pregnant women who receive ante-natal care; an increase in the proportion of births attended by qualified midwives and an improvement in the management and treatment of the most common complications during pregnancy and birth.

When it comes to participant satisfaction, over 90% of the midwives were satisfied with the training. All of the Master Trainers felt competent and confident in teaching within the curriculum. The effectiveness of the course and its implementation is one of the most important stepping stones towards the success of the program. 100% of trained midwives and master trainers felt that overall the quality of the capacity building training course was sufficient. The majority of midwives, master trainers and ministry of public health officials wish to see an increase in the duration and frequency of the training and an expansion of the number of topics covered by the training. A challenging aspect of the course implementation was that some rural health facilities lacked the necessary equipment and medication and had poor infrastructure and insufficient staff capacity for the training to be carried out as effectively as possible.

Seeing the success of the project, the continuing need for more and better-qualified midwives in Afghanistan is the continued vision of the future. Some initial recommendations include improving the medical ethics aspect of the training, increase in the frequency and duration, expansion of the topics covered under the module and ensuring financial backing in order to sustain the projects and the modules within.

Whilst the idea for what’s next shapes up, it is also important to ascertain certain contingency risks that may follow. Under-investment in healthcare which means that in some cases health centres lack the facilities and staff capacity the midwives require to operate effectively and for the trainers to carry out the training in the best possible way. The specific reality in the health centres where AfD trained midwives are already operating and where the statistics have shown a lack of progress should be investigated further to identify and address any as yet unknown restrictions to the future success of the project. Insecurity caused by the ongoing conflict in Afghanistan has been well managed by AfD to date but it remains an ongoing threat to all development projects in the country.

Overall, the project has been a success and well managed. It has responded significantly to challenges such as budgetary constraints and security concerns. However, funding continues to be a battle to ensure that the policies and programs see the reality of the ground.

To see the full report, check out: https://bit.ly/2LucoIv

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