Speakman Elizabeth M, Shafi Ahmad, Sondorp Egbert, Atta Nooria, Howard Natasha
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), Tavistock Place, London, UK.
BMC Womens Health. 2014 Sep 15;14:111. doi: 10.1186/1472-6874-14-111.
Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants--particularly in rural areas--hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005.
This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson's policy triangle framework.
The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society.
CME is considered by stakeholders to be a positive model for promoting women's education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan.
阿富汗的政治过渡推动了被摧毁的卫生系统的重建。由于政治意愿和历史上极高的死亡率，孕产妇健康被列为优先事项。然而，熟练接生员的严重短缺——尤其是在农村地区——阻碍了安全孕产倡议的实施。社区助产士教育（CME）项目于2002年开始培训农村助产士，并于2005年在全国范围内扩大规模。
本案例研究分析了CME的发展和实施情况，以帮助确定其成功之处和面临的挑战。通过文献回顾和关键信息提供者访谈收集数据。内容分析以沃尔特和吉尔森的政策三角框架为依据。
CME项目带来了持续积极的指标，包括自2002年以来孕产妇死亡率每10万例最多降低1273例、熟练接生率最多提高28%，以及合格助产士数量增加了六倍。CME最初是一个小型试点项目，现已获得国际捐助者、阿富汗政府和民间社会的支持。
利益相关者认为CME是促进妇女教育、就业和健康的积极典范。然而，其未来受到不安全、腐败、缺乏监管和资金不确定性的威胁。需要进行战略规划和资源调动，以使其发挥改变阿富汗孕产妇保健状况的潜力。
