Public Private Partnerships Program for Improvement of Maternal Health in Afghanistan

Purpose
The overall objective of the programme is to improve the existing health systems through further strengthening human resources development and introducing evidence based innovative approaches which will contribute to the reduction of maternal, neonatal and infant mortality rates in Afghanistan.
The purpose of the programme is to strengthen collaboration of stakeholders in the health sector through stimulating Public Private Partnerships in reproductive health and safe motherhood.

Partners within the project
The Afghanistan consortium exists of the following organizations: Cordaid, Afghan Health & Development Services (AHDS), Afghan Midwives Association (AMA), Ministry of Public Health Afghanistan, HealthNet TPO, Midwifery Academy Amsterdam, Midwifery Academy Groningen, Royal Tropical Institute (KIT), Public Health Consultants in Action (PHC), Royal Dutch Organization of Midwives (KNOV), International Confederation of Midwives (ICM) and COS Noord-Holland. All of the organizations have unique qualities and this diverse mix of traditional and non-traditional partners have an added value for collaboration.
Information on the partners can be found under the Partners page of this website.

Results
The expected results (divided by objective) after four years are:

1. Strengthening existing health systems:
a. By the end of the first year training schools for midwives will be in the position to receive larger numbers of students, will have better facilities for the students and sufficient female students will have the academic qualifications of entry into the training;
b. In the course of the second year different assessments/mappings will be made to help co-ordination of HRD, management of HRD including retention of staff and development of a curriculum for nurses;
c. By the end of the programme period due to extra outreach efforts Afghan Health and Development Services (one of the Afghan partners) and Health Net TPO will have trained at least 60 extra midwives and at least 15 extra male nurses and 15 extra female nurses in KIHS in Kandahar and at least 10 extra community midwives in the CME in Nangarhar. They will be employed by organizations in the country. This is an expansion of the current programme of midwifery training, community midwifery and nurses’ training;
d. By the end of the programme period a standard curriculum for nurse training will be in place in the country, which is culturally appropriate for the Afghan situation.

2. Research on cultural dimension:
a. By the end of the programme evidence based strategies and interventions for the improvement of community health services will be developed, based on a one year exploratory study and two-year action research.

3. Strengthening professional organizations:
a. By the end of the programme period a vibrant association of midwives will be in place, which play a role in quality improvement of health care and which can represent these cadres in national and international forums.

4. Raising awareness in Afghanistan and the Netherlands on maternal health;
a. Raised awareness among general public in Afghanistan and the Netherlands;
b. Raised awareness among health professionals and development workers in Afghanistan and the Netherlands;
c. Raised awareness among decision-makers in Afghanistan and the Netherlands.

Activities
In order to achieve these results, the PPP Afghanistan will undertake the following activities (by objective):

1. Strengthening existing health system:
a. Extra outreach efforts to recruit new students in remote areas and provide them a ‘preparatory training’;
b. Improvement of facilities in the Kandahar Institute of Health Sciences (KIHS) and the Community Midwife Education (CME) in Nangarhar (like library, educational materials, etc.);
c. Inventory of training schools and training programmes in the country, which can be involved in the training programmes, besides the Institute of Health Sciences in Kandahar, and assess their possibilities of contributing to training of extra numbers of qualified staff;
d. Standardization of curricula and examinations and collaboration between training schools;
e. Employment and retention of personnel: mapping of retention strategies, investigation incentive packages, piloting.

2. Research on cultural dimension:
a. Pilot research on the cultural dimensions of the high maternal mortality rate in year 1;
b. Action research following up the pilot research including (1) an analysis of the (gendered) causes of high maternal mortality at different levels, (2) investigation of the identity, role and practices of ‘traditional birth attendants’ and strategies to link them to the formal health system, (3) bringing the voices and knowledge of rural women and representing organizations into the evidence base and (4) exploring how maternal health links to women’s health in general and in particular to gender based violence.

3. Strengthening professional organizations:
a. Exploring the needs and possibilities of strengthening the Afghan Midwives Association in year 1;
b. Follow-up activities depend on results of the exploration in the first year. Activities could be: advocacy skills and leadership skills strengthening, participation in international midwifery conferences, working visit KNOV in The Netherlands.

4. Raising awareness in Afghanistan and the Netherlands:
a. Articles for websites, newsletters and also approach of media to raise awareness;
b. Public events.