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

7/29/2019 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

Documents

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