H4+ High Burden Countries Initiative National Assessment of Midwifery Workforce in Afghanistan

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H4+ High Burden Countries Initiative

National Assessment of Midwifery

Workforce in Afghanistan

Sabera Turkmani

Jhpiego/Afghan Midwives Association

H4+HBCI

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Acknowledgements:

Dr. Sadia Ayub Directorate Reproductive Health Dr. Ishan Shahir Directorate Human Resources Core Group members - MoPH, H4+, AMA, Jhpiego Lead researchers - Partamin Manaly, Sabera Turkmani MoPH and other government institutions H4+ and other development partners AMA and AFSOG Study participants Expert participants HBCI Secretariat and Technical Working Group USAID for supporting the cofounding

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Overviewofthepresenta9on

MaternalhealthinAfghanistan HBCIprocess-overview Researchtasks Workforcereten9on Skillsassessment AMAreflec9on Summary

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MaternalhealthinAfghanistan

MaternalMortalityRa9oin2002was1,600/100,000

Only467midwivesavailablein2003

Lessthen10%birthswereaQendedbySBAs(MICS2003)

Majorpolicyini9a9vewastotrainanddeploymidwivesin

thecommunity

Abasicpackageofhealthservicescontractedoutto

NGOs

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OverviewoftheHBCIprocessinAfghanistan

Secondarydatareviewthrough2012 PreliminaryvisitbyHBCIsecretariatinMay2012tomeetwithstakeholdersandintroduceHBCI

Gapsinassessmentframeworkiden9fiedandagreed SteeringGroupestablishedledbyMOPH(H4+,HRH,professionalassocia9ons&Jhpiego)

Collabora9onJhpiegoandtheAfghanMidwivesAssocia9ontoundertakeprimarydatacollec7on

Stakeholdermee9ngSeptember2012withTechnicalConsensusStatement

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RESEARCHTASKS

(approvedbyAfghanIRBandSteeringGroup)

Indica9velyes9matethedistribu9onofmidwiferyworkforceinpublicandprivatesectoramongAfghanMidwivesAssocia9on(AMA)andAfghanSocietyofObstetricians&Gynaecologists(AFSOG)members

Indica9velyes9matemagnitudeanddistribu9onofprivateprovidersofmidwiferyservices

Indica7velyes7mateworkforcereten7onratesforpublichealthfacili7es Skillsassessmentofasampleofprivatelyeducatedmidwivesand

doctors

In-depthinterviewwithkeyinformantsonthepolicyenvironmentformidwiferyservices

Analy9cSeminarbyMoPHandotherstakeholderrepresenta9vesonthepolicyenvironmentformidwiferyservices.

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SampleandresponseratesDatacollectioncomponents Desired Actual Remark

Private/publicworkdistribution-midwives 82 73 Goodresponse

Private/publicworkdistribution-doctors 71 55

Privatefacilities - 74 Firsttime

estimation

Turnoverrate-BHC 66 91 Somefacilitiesdid

notcooperatetoprovidethedataon

turnoverforthe

samplefacilities.

Thisshouldbekept

inmindwhen

interpretingtheresults

Turnoverrate-CHC 61 70Turnoverrate-DH 34 8

Turnoverrate-PH 21 7

Turnoverrate-RH 5 0

Turnoverrate-SH 17 0

Turnoverrate-SHC 62 48Turnoverrate-MHT - 7

Skills-midwives 25 25 Highresponseand

goodcooperationSkills-doctors 10 8

In-depthinterview 5-10 5

Analyticseminar 7-10 9

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Reten9onindicators Turnoverrate:#staffleinpast12months/Average#staffforbeginningandendofthe12

monthsperiod*100 Stabilityindex:#currentstaffworkingfor12ormoremonths/#ofstaff12monthsago*100

Survivalrate:#staffrecruited12ormoremonthsagoleavingtheirpost/#staffrecruited

12ormoremonthsago*100

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Posi7on

Turnoverrate

2011

Turnoverrate

2012

Stabilityindex

2011

Stabilityindex

2012

Survivalrate

2011

Survivalrate

2012

Survivalhalf-life

months

Anesthe9st 0% 36% 1.00 0.43 0% 57% FMD 13% 36% 0.80 0.40 20% 60% 62

FN % 17% 0.88 0.70 13% 30% 60

Lab 11% 20% 0.83 0.74 17% 26% 0

MMD 8% 33% 0.0 0.56 10% 44% 3

MN 8% 22% 0.88 0.66 12% 34% 63

MW 2% 26% 0.8 0.71 2% 2% 116

Paed 0% 60% 1.00 0.40 0% 60% -

Pharmacist 11% 34% 0.86 0.54 14% 46% 52

Surgeon 0% 48% 1.00 0.38 0% 63% 7

WorkforceReten9on

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Reten9on-somepoints

Turnover:midwivesrange2%-26%

Turnover:Medicaldoctor(female)13%-36%

Turnover:MedicalDoctor(male)8%-33%

Survival:Insomecaseslessthan1in3health

workersremaininpost

aer12months

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Skillsassessment

Doctor Midwife GrandTotal

N 8 25 33

Delivery 64.0% 70.2% 68.7%

ManualRemovalOfPlacenta 73.8% 79.2% 77.8%

ManualVacuumAspiration 50.0% 50.0% 50.0%

VacuumExtraction 50.0% 50.0% 50.0%

NewBornResuscitation 81.4% 76.5% 77.7%

Pre-eclampsia/Eclampsia 98.0% 60.8% 70.1%

Partograph 76.3% 44.0% 51.8%

Allskills 64.6% 61.6% 62.3%

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AfghanMidwivesAssocia9onreflec9on

RecognizeAMA,asanac9vepartnerwithH4+indelibera9onsthataffectandadvocateformaternalhealth

Organiza9onalcapacitybuildinginleadership&research

Encouragingprofessionaldevelopmentandgrowththroughengagementof25+membersinopera9onalresearch

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Summary

The interpretation of the results will be incorporated intothe final MOPH/ HBCI report

Many challenges in getting to the real data informationscattered

Large investments in educating the midwifery workforce,less investments in human resource information systems

Strengthened professional association as potentialrecipient research