Human Resources for Health in Maternal, Neonatal and - HRH ...

which was developed in 2002. This was finalised and approved in 2004 by the Ministry of
Public Health (MoPH) and accredited by the National Midwifery Education and
Accreditation Board in 2005. Currently 21 community midwifery training programmes are
being implemented by various NGOs in collaboration with MoPH. After an initial pilot was
completed in 2004, the first official training round was completed in 2006, tripling the
number of midwives to 1500. By 2009 Afghanistan had increased the number of CMWs to
2,300 still far short of the 5000 midwives required. CMWs play a pivotal role in the provision
of essential obstetric and newborn care and thereby reducing maternal and neonatal mortality.
According to the 2006 Household Survey, antenatal care increased from 4.6% in 2003 to
30.3%, skilled birth attendance increased from 6% in 2003 to 18.9 % and the contraceptive
prevalence rate from 5.1% in 2003 to 15.4%.
Another approach that has been utilised in order to improve the coverage of midwives has
been to encourage the retired workforce to return to practice. In Malawi the retired workforce
was encourage back into the public system (MoH Malawi 2004) while in Tanzania private
practice was initiated. Deregulation of midwifery practice in Tanzania allowed ‗new‘
workforce of ‗later life entrepreneurs‘ including retired government employed nursing
officers or those approaching retirement to establish their own facility-based services. (Rolfe
2008). In 2007 there were approximately 60 ‗maternity homes‘ located mainly in rural or
peri-urban areas. Despite bringing increased services to communities which was of
comparable quality to those provided by the government communities were reluctant to pay
for it. Private midwives also found the costs associated with start up, maintenance and
registration prohibitive. The authors suggest possible solutions such as on-going financing
arrangements such as micro-credit, contracting, vouchers and franchising models require
consideration.
One approach to supporting private midwifes to undertake a particular function is the
development of revolving loans. The Summa Foundation was created as part of USAID‘s
Promoting Financial Investments and Transfers (PROFIT) project (1991-1997) to facilitate
private sector involvement in family planning. In Indonesia. The project created a revolving
loan fund that provided loans to midwives for the expansion and establishment of their
private practices to provide family planning and reproductive services. The collaboration
between the public and private sector included the Indonesia Midwives Association (IBI),
Bank Rakyat Indonesia (BRI), and the National Family Planning Coordination Board
(BKKBN) (The Summa Foundation 2006). The programme was successful in sustain lending
to midwives and shift family planning clients from the public to private sector. However the
wide reach from national to community levels and the multiple partners involved in the
programme proved challenging. This approach may be transferable to other contexts to
support private HRH to increase MNRH care and services at community level.
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