Afghanistan: more midwives are future hope for women's and children's health: Scottish midwife Sheena Currie is in Afghanistan as the co-ordinator of HealthNet International's auxiliary midwife training programme.

After seeing an advertisement on the ICM website, I successfully applied for the post of Training Co-ordinator for the Auxiliary Midwife Training programme (AMT) in Afghanistan. This project was earlier reported in International Midwifery by Dineke Mol and Mary Gibson (IM 2002; 15(6): 6-8). My main role here is monitoring, co-ordinating and evaluating the AMT as well as trying to improve quality of care within the obstetrics and gynaecology unit at the University Hospital in Jalalabad. My background has been lecturing in midwifery in the UK-mostly Scotland--and now I will be here with HealthNet International for a year, something completely different and an exalting challenge.

Focus on reproductive health in Afghanistan

In their ongoing commitment to the reconstruction of health care in Afghanistan the Interim Government has identified a National Health Policy in which maternal and child health are top priorities. The current situation of high maternal and infant mortality is embedded in years of crisis and a complex chain of causes many of which problems remain unresolved. Undoubtedly women and children remain the most vulnerable members of the polulation. The Ministry of Health (MOH) in Kabul has endorsed the ultimate goals of lowering maternity mortality and morbidity in women and children. The key performance indicators will be:

* Maternal mortality rate

* Infant mortality rate

* Under-5 mortality rate

* Adequate nutritional status

* Total fertility rate

To work towards achieving this, a Basic Package of Health Services (BPHS) has been developed. With financial support and technical assistance from donors, NGOs and other implementing agencies, the BPHS will provide a minimum range of primary, care services to which everyone should have equal access. One problem in achieving this is how to address the lack of female staff. In Afghanistan gender-linked inequality continues to be an obstacle to the improvement of the position and health of women.

Strategies for Safe Motherhood

With the support of UNICEF, the annual workshop for the Safe Motherhood Initiative was held in Kabul in April 2003, just one of the many activities taking place. Three main strategies were identified:

* To improve coverage, utilisation and quality of emergency obstetric care (EOC)

* To improve the coverage of skilled attendance at birth

* To ensure effective antenatal care

With reference to quality, UNICEF has initiated the development of five centres of excellence...