H4+

HBCI

H4+ High Burden Countries Initiative National Assessment of Midwifery Workforce in Afghanistan
Sabera Turkmani Jhpiego/Afghan Midwives Association

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

Overview of the presenta9on

Maternal health in Afghanistan HBCI process - overview Research tasks Workforce reten9on Skills assessment AMA reec9on Summary
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 Maternal health in Afghanistan

Maternal Mortality Ra9o in 2002 was 1,600/100,000 Only 467 midwives available in 2003 Less then 10% births were aQended by SBAs (MICS 2003) Major policy ini9a9ve was to train and deploy midwives in the community A basic package of health services contracted out to NGOs

Overview of the HBCI process in Afghanistan

Secondary data review through 2012 Preliminary visit by HBCI secretariat in May 2012 to meet with stakeholders and introduce HBCI Gaps in assessment framework iden9ed and agreed Steering Group established led by MOPH (H4+, HRH, professional associa9ons & Jhpiego) Collabora9on Jhpiego and the Afghan Midwives Associa9on to undertake primary data collec7on Stakeholder mee9ng September 2012 with Technical Consensus Statement
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RESEARCH TASKS (approved by Afghan IRB and Steering Group)

Indica9vely es9mate the distribu9on of midwifery workforce in public and private sector among Afghan Midwives Associa9on (AMA) and Afghan Society of Obstetricians & Gynaecologists (AFSOG) members Indica9vely es9mate magnitude and distribu9on of private providers of midwifery services Indica7vely es7mate workforce reten7on rates for public health facili7es Skills assessment of a sample of privately educated midwives and doctors In-depth interview with key informants on the policy environment for midwifery services Analy9c Seminar by MoPH and other stakeholder representa9ves on the policy environment for midwifery services.
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Sample and response rates

Data collection components Private/public work distribution- midwives Private/public work distribution- doctors Private facilities Turnover rate-BHC Turnover rate-CHC Turnover rate-DH Turnover rate-PH Turnover rate-RH Turnover rate-SH Turnover rate-SHC Turnover rate-MHT Skills-midwives Skills-doctors In-depth interview Analytic seminar Desired 82 71 - 66 61 34 21 5 17 62 - 25 10 5-10 7-10 Actual 73 55 74 91 70 8 7 0 0 48 7 25 8 5 9 Remark Good response First time estimation Some facilities did not cooperate to provide the data on turnover for the sample facilities. This should be kept in mind when interpreting the results High response and good cooperation

Reten9on indicators
Turnover rate: # sta lef in past 12 months/ Average # sta for beginning and end of the 12 months period* 100 Stability index: # current sta working for 12 or more months/# of sta 12 months ago*100 Survival rate: # sta recruited 12 or more months ago leaving their post/# sta recruited 12 or more months ago*100
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Workforce Reten9on
Survival rate 2011 Survival rate 2012 57% 60% 30% 26% 44% 34% 29% 60% 46% 63% Survival half-life months 9 62 60 90 39 63 116 - 52 7
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Stability index 2011 1.00 0.80 0.88 0.83 0.90 0.88 0.98 1.00 0.86 1.00

Anesthe9st FMD FN Lab MMD MN MW Paed Pharmacist Surgeon

0% 13% 9% 11% 8% 8% 2% 0% 11% 0%

36% 36% 17% 20% 33% 22% 26% 60% 34% 48%

Stability index 2012 0.43 0.40 0.70 0.74 0.56 0.66 0.71 0.40 0.54 0.38

Turnover rate 2011

Turnover rate 2012

Posi7on

0% 20% 13% 17% 10% 12% 2% 0% 14% 0%

Reten9on - some points

Turnover: midwives range 2% - 26% Turnover: Medical doctor (female) 13% - 36% Turnover: Medical Doctor (male) 8% - 33% Survival: In some cases less than 1 in 3 health workers remain in post afer 12 months
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Skills assessment
N Delivery Doctor 8 64.0% Midwife 25 70.2% 79.2% 50.0% 50.0% 76.5% 60.8% 44.0% 61.6% Grand Total 33 68.7% 77.8% 50.0% 50.0% 77.7% 70.1% 51.8% 62.3%
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Manual Removal Of Placenta 73.8% Manual Vacuum Aspiration Vacuum Extraction New Born Resuscitation Pre-eclampsia /Eclampsia Partograph All skills 50.0% 50.0% 81.4% 98.0% 76.3% 64.6%

Afghan Midwives Associa9on reec9on

Recognize AMA, as an ac9ve partner with H4+ in delibera9ons that aect and advocate for maternal health Organiza9onal capacity building in leadership & research Encouraging professional development and growth through engagement of 25+ members in opera9onal research
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 Summary
The interpretation of the results will be incorporated into the final MOPH/ HBCI report Many challenges in getting to the real data information scattered Large investments in educating the midwifery workforce, less investments in human resource information systems Strengthened professional association as potential recipient research

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