Afganistan

Reducing maternal and newborn deaths in Charharkint District Northern Afghanistan

Maternal mortality in Afghanistan is the second highest in the world, and with an average of 7.2 babies per woman, is the leading cause of death in women of reproductive age. Bakhtar Development Network, which delivered the basic health service in Balkh Province, asked HealthProm to improve uptake by village women of maternity services and newborn care. All births were meant to take place in the health centres it had set up or the hospital, but in rural areas 90% were still in villages, with no skilled care. This is largely because women and their families fail to recognise early enough the need for the midwife at the centre and access in mountainous areas is poor. Also, the women and girls who benefit have hitherto often had little say even in decisions on their own health.

The project is raising awareness of risks of delay in seeking care, facilitating villagers' self-help and improving quality of care. The project facilitators, trained in participatory methods, encourage women and men to devise steps to help solve their own formidable health problems. First they set up "safe motherhood groups" in the first then villages in 2009.

Heads of safe motherhood groups meet monthly with the local project administrator, Dr Hussain Ali Jahid, in the building the project erected in the district's central village. He provides them with components from which they make up clean birth kits for all the women in their villages in the last three months of pregnancy. We also provide them with blankets, which they make into baby blankets, as hypothermia is a main cause of death of newborn babies in this cold area.

The project is gradually expanding to work with a population of 10,000 very poor villagers, recruiting and training new facilitators, husband and wife couples, from among the literate people in the villages already covered, to work in the next group of ten villages. We provide the facilitators with motorbikes to get to villages.

We will provide an antenna to any village which does not have mobile phone reception so they can call for help in an emergency. However, villagers realise that the project vehicle will not always be able to reach all villages. With the help of the International Federation for Rural Transport Development we put to villagers options on low-cost transport from villages to the road. They chose stretchers with a single wheel and Transaid is working up a design. We aim for the stretchers to be made as near as possible to the point of use and by local people from local materials to the extent possible.

NGOs in Afghanistan traditionally provide some small non-monetary reward for project work of villagers. We will give cheap hand sewing machines for collective use of participating villages. This will enable women to earn, and when they earn, they also gain the respect from the men. Such work is difficult in the long winter evenings with only kerosene lamps, so we will provide low-cost solar lighting units from India to leaders of village safe motherhood groups as reward for their work. We are also seeking to interest non-profit organisations working in the province in extending their work to the district as improved nutrition, literacy or family income would all impact on health.

The project will work to develop motivating factors for midwives, who feel unappreciated by villagers. We will show DVDs of their work, including delivering public health education in villages, to the Provincial Directorate of Public Health, so clinic staff will realise that they are not forgotten. With their agreement we are appointing an experienced midwife from the provincial capital, Mazar-e Sharif, for one week per month to provide in-service further training.

We provide essential equipment and supplies to the city hospital's maternity department so they are equipped to treat the increasing number of referrals. To combat hypothermia in a very cold hospital, we will also buy the new low-cost Embrace baby warmer from India for when 'Kangaroo Mother Care' is not possible.

The project is supported by Hilden Charitable Fund, The Funding Network, Trusthouse Charitable Foundation, the WF Southall Trust and the Overseas Aid Commission of Guernsey, the Karl Mayer Foundation, Quaker Peace and Social Witness and other donors.