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Mother and Child Health Care, MCHC

Afghanistan’s population estimated at 22, 5 Million is faced with major health challenges as shown by its high mortality ratio, low life expectancy and high child mortality rate. At the end of 23 years of war, Afghanistan had one of highest maternal mortality ratios in the world, estimated at 1600/100,000 live births meaning that on average 1 in 9 Afghan women will die in childbirth.

Life expectancy is only 46 years and under-five mortality rate is 230/1000. A low contraceptive prevalence rate (6%) contributes to a high fertility rate (average of 6.6 children per woman).

Ministry of Public Health

In line with the National Health Policy, the vision of the National Reproductive Health Policy is the highest achievable standard of reproductive health for the families of Afghanistan.

The mission of the MoPH, therefore, is commitment to ensuring the accelerated implementation of quality health care for all people of Afghanistan, through targeting resources especially to women and children and to under served areas of the country, and through working effectively with communities and other development partners.

The goal of this strategy is to develop the health sector to improve the health of the people of Afghanistan, especially women and children, through implementing the basic package of health services (BPHS) and the essential package of hospital services (EPHS) as the standard, agreed-upon minimum of health care to be provided at each level of the health system.

Swedish Committee for Afghanistan, SCA

SCA will continue its engagement with the Afghan government in implementing health service delivery according to the BPHS strategy. BPHS embraces both service delivery and capacity development. Mean while, as SCA didn’t find the components of reproductive health and family planning sufficiently addressed within the package, it added on such component. SCA train community midwives and runs Mother and Child Health Centers.
Implementing MCH activities on top of BPHS represents much added value to BPHS projects as its impact extends beyond the MCH services to positively influencing the quality of the whole package. Swedish International Development Agency (SIDA) funding remains invaluable to enable SCA in filling the gaps related to women and child health as identified through three years of BPHS.

MCH project

The Mother and Child Health Care (MCHC) project was designed in 2005 to address the unmet needs and out-of-focus areas of RH. The areas to be strengthened and focused are training of more Community Midwives to staff the health facilities with more skilled and professional birth attendants which contributed to make MCH services more accessible, available and acceptable.

The hard ware component of project (rehabilitation and construction of delivery rooms) helped the BPHS projects to have enough and proper space to provide MCH services addressing all those cultural barriers, hampering the utilization of services. Having sufficient number of well constructed and equipped delivery rooms will improve further the privacy, quality of services and to increase the utilization and satisfaction of both beneficiaries and service providers.

Family planning components of the MCH at the facility and community levels and the demand-creation for utilization of RH services through conducting Learning for Healthy Life (LHL) courses. The implementation of this project through the last two years revealed that project had significant impact on the performances of health projects and improving the health indicators. Interest of community for more LHL classes is found, improved medical supplies, especially of family planning helped to increase the number of FP clients.

The target population addressed through this project is women and children in Wardak and Paktika, where SCA implements BPHS projects, in Nuristan and Kunduz where SCA continues HIV/AIDS and LHL components of MCHC project.
SCA started the implementation Wardak BPHS in March 2004 and is now contracted for a second period. The population of the province, covered by the project, is around 517,200 people. RH and CH services are provided through a network of 23 BHCs, nine CHCs and two hospitals.

SCA started the Paktika BPHS in July 2006 on a 24-month contract with MoPH. SCA provides basic health services to the population of six districts, with a population estimated at 108,500. The MCH services will be provided through a network of six health facilities.

Midwifery Training Course

The training of Community Midwives (CMW) is a long term solution for sustainability of RH services and decreased maternal mortality in Afghanistan. It is an important aspect of RH services as it improves the capacity of CMW to provide quality RH services. CMWs are skilled birth attendants who serve women and babies in the remote and rural areas. The competency based curriculum has been approved by MoPH in 2004 for national expansion. SCA is running one CMW school in Wardak (with students also from Paktika). Two batches of CMWs have already graduated and are deployed in the health facilities. One new batch of 24 students started their 18 months training in early 2007.

The MCHC project is supported by HTU (Health Technical Unit) at SCA Kabul Office. The present projects are funded by the World Bank and SIDA.