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Healthy People, Healthy Community - COMMUNITY MIDWIFERY EDUCATION PROGRAM IN AFGHANISTAN

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by Maryam Safi

(THE COMPLETE DOCUMENT IS AVAILABLE FOR DOWNLOAD IN THE ATTACHMENT BELOW)

Vision:

The program’s vision is to see the realization and development of a vibrant and vital civil society in Afghanistan where the interest, concerns, and dignity of the civilians, the citizen, and the common man are taken seriously and more people have access to resources and power over choices.

Mission:

The program will contribute to bring about and support genuine and coherent development practice among people, organizations, and institutions working for the development of Afghan Nation through civil society development, capacity building, service delivery and research.  The program is committed to achieve its mission through transparent, equitable, professional, ethical and gender sensitive services with dignity to human being. Sustainable development is bringing desired positive changes in a community through enabling and capacitating the target communities to identify and respond to their perceived needs. This is the only way of bringing about a true sustainable and manageable Afghanistan-oriented development. Sustainable development is not something that could be (and neither should be) attained overnight, but extreme caution should be exercised to maintain provision of basic assistance to the community, while gradually introducing community-oriented developmental practices and disciplines.

Overview:

The program intends to contribute to the reduction of maternal and newborn mortality by increasing the quality of clinical services in the maternity wards of the regional hospitals in the country.   

The program is committed to achieve the above mentioned goal by graduating ‘20’ Community midwives in each province  from a competency-based midwifery-training course that adheres to the Ministry of Public Health (MoPH) training program over the Eighteen (18) months period. In the process of offering this training, the program expects to build the capacity of Midwifery Accreditation Board /MoPH as a training institution by improving the instructional and clinical supervision skills of Midwifery Accreditation Board instructors, the quality of the Midwifery Accreditation Board training facilities and Midwifery Accreditation Board / MoPH management systems.  Further, the program expects to assist the clinical facilities in the region in providing quality supervision and guidance to the trainees by offering “refresher training” programs to medical staff members. Finally, it expects to work with local partners, including health committees, NGOs and MoPH employees to identify and select trainees and to ensure that they are successfully deployed in appropriate clinical settings after the completion of the training period in their own origins.

Goal of the Project:

The goal of CME is to assist high quality community midwife training programs that will prepare skilled rural providers of maternal and newborn health services, and support the midwife/midwifery student in the classroom, hospital and community.

General Objective:

To train and graduate ‘20’ competent community midwives who are selected from remote and rural areas of the provinces over ‘24’ months period.

(DOWNLOAD COMPLETE DOCUMENT - SEE ATTACHMENT BELOW)

 


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Introduction The following case study is developed to show audience/readers how Wazir Ahmad Kheil’s tribes in Khogyani District, Afghanistan collectively managed to follow their problems and finally construct girls and boys schools there in spite of internal and external pressure and risky time this community have had during different government’s periods including Taliban’s (anti-state elements). This case study also indicates how community initiated resiliencies and used them for the welfare of their children’s future. Because of community interest to their children’s education they used to share their views and standpoint to every then rulers/government to show them their fond interest. Looking at communities’ stance during different governments’ period is a sign of traditional local leadership resilience. It is seen that interest for education created a sense of cooperation among this community’s three tribes in the form of revitalizing the idea of collective work that have added to their cohesion for development and peace building in the area as well. Through, in this story the narrator of the case study has tried to show audiences how these trends gradually resulted in creating positive deviant strategies among the tribes for the welfare of this society in the area as a whole. Situation Analysis (background) Wazir Ahmad Kheil community is topographically plain and is located southeast, 9-10 km from Kaga Bazaar center city of Khogyani District in Ningarhar Province. It is one of the biggest villages of Wazir Ahmad Kheil area, where security is, sometimes, good in comparison to other villages in this location. It has agriculture land; therefore some residents are busy working on their land. During a visit from the area some Positive Deviance project’s researchers were told by community individuals that their people have been famous for collective work, fond of education attainment and health services provision to their people, but due to unexpected worsened political situation at different time periods they did not succeed. Never the less, they continued launching efforts to engage their resilience to achieve their goals. “Still they keep their efforts to, at least, do something for their community and try to encourage both Taliban and the government listen to their voice and assist them in achieving their goals…..” community individuals responded. Positive Deviant Initiative: In Pashto (national language) there is saying, ‘Don’t kill illiterate, you kill his /her illiteracy’. Illiteracy is the phenomenon if overcomes over human being, it makes him/ her blind as someone, who strolls on the way. And if it spreads out in an area, then both darkness and blindness get to gather and make the status tenser. So is said to have been Wazir Ahmad Kheil area in the past, where illiteracy had presence over the entire community. Study revealed that community people have been intending to change situation and, therefore used to try their best to initiate negotiations among and outside the community to meet their need and resolve their problems. Despite the tense situation and increasing insecurity around the community people kept joining hands to work collectively in order to create enabling environment so that community leadership through that find ways to get their intended results. Community history shows, on many occasions, that community has been able to resolve their problems by themselves. One of their top priorities was school formation that they hoped to follow on. Research also showed that community ability to take care of their own issues was well proved to community people. Such practices were shown for instance when it was learned that the school comes under Taliban threat, it was negotiated. After school started functioning it was heard that school will be burned by Taliban as they are against it. As soon as the rumor spread community communicated with Taliban and made them change their mind. At the end Taliban were motivated to change their mind and therefore did not burn the school. The school is still safe and is functioning. Casual Analysis As indirectly cited above the idea of collective work or Ashar existed among people since long ago, but with the recent war (socio-political change) it has been diminishing in the culture of most communities. Few people of particular traditions have managed to initiate and benefit using such behaviors. For most it was hard due to rapidly changing environment. People by having and supporting the idea ‘Ashar’ believed that by doing things collectively they can rehabilitate their irrigation system (canals), mosque, hospital and school. The idea also existed that through Ashar people can do what they need to do for their community welfare. They see it as a net to bringing different strata and traditions in one circle to make them join hands not only for development, but also for social change as well. Having experience with conflict they also believed ‘Initiating negotiations with conflicting parties (community, Taliban, neighbor community and the government..) also relates to having such collective ideas (negotiating with conflicting sides) and work that plays role in changing community socio-economic status….’. Moreover, community’s long term experience in negotiations with different types of local power holders made community leadership wise and proactive, therefore the community learned more how to resolve their problems through negotiations by themselves. Functional Analysis It is said that Wazir Ahmad Kheil area did not have educational facilities because of inexistence of school due to government and NGOs’ ignorance. Community had great interest to school. Since school did not exist, families sent children to Mosques to obtain religious education. During late president Daud Khan’s government ministry of education decided to build school for the community in the area, but there was no land to construct on. Since community was so enthusiastic to their children’s education they decided to provide land. The three tribes of Wazir like Ahmad Kheil, Pera Kheil and Khowaza Kheil agreed to provide land to school building; therefore, they bought four Jeribz of land in a location accessible to all tribes. The tribes based on the allocated portion paid their contribution. Finally, school was constructed for the first time and girls and boys went to school. Since this was a middle school, students needed to complete their 12 grade education, thus, students after graduation took admission in district’s central Lycee called Malik Yar Hotak High School so that they complete their higher grade education. Considering community’s deviant move in terms of strategy application analysis takes us to other community efforts to look at that boosted social change action. Malik Noor Mohammad, a chief of the community in confirmation to this work says, “Collective work has brought big change in our life. Our agriculture got improved. Water streams and intakes got better. Our product was not good before, now with the Bless of Allah it is good because of this work. Our community pathways became improved as a result of this work and transportation takes place easily.” “ Khpla Lasa Gula Lasa,” he is reminding a Pashtu proverb, a very common one in Afghani culture, meaning ‘Things done by our own hands makes them look better like flowers’. Noor Mohammad continues, “Whenever there is any natural disaster or flood or any other socio-affecting incidents every one rushes to help the family. Even if there is death or marriage ceremony of any family we reach and assist that family.” When Russian soldiers entered Afghanistan and conflict began in the area the school was burned and destroyed by armed groups. Education again stopped. When Mujahidin took power in the country the three tribes again decided to reconstruct this school. Community people came to gather and decided to construct the school collectively. School construction restarted. Youth laid bricks. Community’s masons started construction work and people brought wood from mountains to use them for rooftop, windows and doors. As a result, school building was constructed again and children of each family started going to school. As part of community Ashar and a sign of local governance each community member tried to donate something. Engineer Mahmood, a prominent commander of the area provided floor cover. In addition, he paid salary of four teachers for sometimes. At the time of President Burhanuddin Rabani (former/second Muhiddin’s president) the school again suffered financially. Mr. Mohammad Shakir school principal of the time motivated community to lend their hands to pay teachers’ salary. Community agreed to pay in crop each harvesting season to teachers. Thus, teachers’ salary was given. When Mr. Karzai became president, Provincial Reconstruction Teams (PRT) started developmental activities in most provinces in the country, especially schools and hospitals’ construction. As part of its plan PRT also constructed this school in two stories. When the boys school was constructed community decided to collect money and buy land for girls school as well. Therefore, they bought land close to their Health Clinic, where the boys school was constructed with the financial assistance of an international organization. Study of Ahmad Kheil’s community in connection to positive social change and the role of local leadership under the umbrella of Ashar and fond interest to development indicate that this community has deployed its role over issues between and among conflicting sides, too. Community tendency of Ashar toward development paved ways to establish linkages with key players of the existing context, as well. The idea behind this development was also based on their past experience that community had communication with all sides involved in social change and development such as local government, Taliban and sometimes armed men in the area. To make the point clear Mr. Malik Noor Mohammad tribal chief of the community describes this as “ …… we depend on government and government depend on us, …and about Taliban we cannot stay away from them, too. We have to keep link with Taliban as well, sometimes, in the form of secret session or meeting and often through mobile phone with them in one way or another. When there is a problem we communicate with them. It also happens that they send us word through third party. We do this when we see the matter is for the benefit of community …..that is why no one has created obstacle in front of our community development work.” Sustainability Analysis Looking at some stated points above community has developed a system of cooperation (collective work) on the basis of local traditions that has strengthened community internal and external relations. This has given upper hand to leadership to open negotiations with any local power holders in case any issue emerges between or among community. This is gradually progressing; improving and is getting momentum. Let me give you an example of such empowerment and external relations formation. Wazir Juhadi Schools are good examples. Wazir Jihadi boys’ school right now has 2894 boys students. Wazir Jihadi girls’ school has 1220 girl students. Schools’ head of Taliban had a visit recently from girls and boys schools in Wazir village to how this school is functioning. During this visit school principal was assured that no potential threat will be expected from Taliban’s side. This assurance is a vivid example of security and the education system continuation in the area. This strategy that the community has applied shows a change in community behavior that other communities around have not been able to adapt and apply. Collective work, as part of community’s preferred and useful tradition, is another inducement to have contributed to peaceful strategy application as a means of obtaining community common goal. As a result people have traditionally initiated a system for problems’ solutions and if community encounter at any particular period. During recent presidential election both schools were centers for voters. Boy’s school was voting center for male voters and Wazir Ahmad Kheil clinic was voting center for women voters. This example and what some respondents during interviews said shows that people have had the idea and ability of creating a peaceful environment, where community forms and support local governance. The two instruments; community ability and enabling environment seem to have had role in raising community voice when there is any issue from local power holders’ side. Conclusion Study of long history of conflicts and community initiatives in Wazir main village in the light of above description and project’s variables is concluded as follows. Security: In terms of security the case study shows that direct violence has not been felt so far. Physical & emotional threats against community members from external forces are minimized. Clear sign of peaceful environment is that Taliban’s education director visits the school and assures education staff and leaving girl’s school operational in the area. Peace building: School becomes the voting center during presidential election in 2009. There was no treat to community members (male or female) during the voting period. State of relationship: Relations within and between communities and external actors in which difference are resolve through negotiation have improved. This has minimized security threat between conflicting sides and instead has established good communication, improving security in the area. This is a clear indication of good leadership of this community. Development work: As per this variable of the case study…….Sharing of money & resources by the three stated tribes (Ahmad Khel, Pera Khel & Khwaza Khel) for purchasing land and the construction….Collection of crops & vegetable seasonally to provide teachers’ remuneration are all signs of support to community interest for their welfare and development. Local Governance Initiatives: In terms of local traditional administration and leadership communication system for community developed is established. This gives way to timely communicate with chiefs following any problem’s emergence. Peace initiatives creation between Taliban and the government through community mediation slowly improved. As an example, government soldiers were once released from Taliban’s clutches at the end of community talks with Taliban groups that had captured soldiers. This minimized threat that was feared before. Results: All such efforts and initiatives indicate that the role community is playing in resolving conflict or violence is seen effective than any other party involved. As research indicates---Establishing indirect relationship between Taliban and government by local community council had great role in minimizing all types’ disputes and issues. Role of community involvement in problems’ solution is perceived as 20% dispute resolution has taken place through government, 30% through Taliban and 50% through local council (from slide presentation).

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