The Afghan Midwives Association: Mentoring Midwives in Remote Areas to Improve Maternal and Newborn Care

Session: Supporting Midwives through Education, Mentoring and Partnerships

Presenter: Sheena Currie, USAID’s Maternal and Child Survival Program/Jhpiego

Background: Despite many efforts to rebuild Afghanistan’s health workforce, recent evidence highlights that gaps remain in availability, distribution and capacity of clinicians needed to provide lifesaving maternal and newborn health (MNH) services.  To address this, the Afghan Midwives Association (AMA) developed an innovative mentorship program to ensure continued practice opportunities after graduation to aid skill retention in midwives working in remote facilities.

Methods: AMA’s mentorship model trains experienced midwives to mentor recent graduates posted at periphery health facilities and supports them to conduct: 1. Needs assessment of mentee skills. 2. Routine visits (at least six per year) for onsite coaching. 3. Assessment of mentee skill retention using national quality performance standards for antenatal care (ANC), normal and complicated labor and delivery, and postnatal care (PNC).  4. Assessment of facility infrastructure, supplies, equipment and management support for MNH services.

Results: The program was piloted in 28 health facilities in six provinces in 2011. During the first year of implementation, participating facilities improved performance in ANC performance from 20% to 88%, labor/delivery performance from 19% to 85%, complicated labor/delivery performance from 15% to 94% and PNC performance from 16% to 94%. Average scores for MNH service support increased from 38% to 81% over the same period. In the second and third years of implementation, additional facilities were included, with average scores improving from similarly low levels to more than 70%.

Conclusion: To date, the program has successfully supported more than 80 midwives to mentor nearly 200 colleagues, resulting in improvements in staff competency and working environments in nine provinces of Afghanistan. The program is ongoing with 27 experienced volunteers mentoring approximately 70 less experienced peers at 30 facilities in three provinces, and plans are underway to expand the program to at least 20 additional facilities in 2015.