Despite significant progress in improving maternal and child health since 2002, Afghanistan remains one of the most dangerous places on earth to become pregnant – or be born.
High maternal and child mortality and morbidity rates make maternal, newborn and child health (MNCH) a pressing public health issue in the country. In the province of Badakhshan, the maternal mortality ratio is 2,200 deaths per 100,000 live births, one of the highest rates in the world.
But by tackling poverty from multiple angles, the Aga Khan Development Network (AKDN) sees good prospects for improving MNCH in Afghanistan, says Dr. Ahmad Fawad Akbari, Deputy Director of Aga Khan Foundation (Afghanistan)'s Rural Development Program, which includes specific MNCH and public health programming.
On November 6, AKFC was pleased to welcome Dr. Akbari to Ottawa to share his on-the-ground experiences delivering MNCH and rural development interventions in Afghanistan. Almost 60 guests attended his presentation at the Delegation of the Ismaili Imamat, which highlighted the AKDN's achievements in improving health prospects for mothers and children in Afghanistan.
Dr. Akbari's remarks were followed by a discussion panel, exploring current challenges and future directions in MNCH around the world. In addition to Dr. Fawad, the panel featured Chris Rosene, Director of International Development Programs at the Canadian Red Cross, and Dr. Vyta Senikas, Acting Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada.
During the panel, moderated by AKFC Program Manager Tanya Salewski, Dr. Senikas emphasized the importance of developing adequate numbers of skilled and capable human resources to provide necessary services, and recognized the importance of engaging with traditional birth attendants, to bring them into the process of reforming birthing practice in rural areas.
Mr. Rosene shared the experience of the Red Cross in Central America, using community health workers and volunteers to educate and mobilize communities, including approaches for involving men in addressing maternal and child health issues.
A photo exhibit featuring scenes from the Faizabad hospital's maternal and neonatal ward – photographed in September 2012 by Leslie Knott – were also on display. View the gallery.
Q&A with Dr. Fawad Akbari
Dr. Akbari is the Deputy Director of Aga Khan Foundation (Afghanistan)'s Rural Development Program. Born and raised in Afghanistan, he studied at the Kabul Medical University with a specialization in Pediatrics Internal Medicine and completed his masters in International Public Health from the University of Liverpool.
Afghanistan is often said to be one of the worst places on earth to be a mother, due to high maternal mortality and morbidity rates. What are the main challenges to improving maternal, newborn and child health (MNCH) in Afghanistan?
Dr. Akbari: One of the biggest challenges we are trying to address is cultural and traditional barriers that do not allow female members of the household to have access to family planning and related health care services. Almost 67 percent of births in Afghanistan take place at home without a trained medical professional – this is partly due to transportation challenges and geography, but also because of the cultural barriers which prevent women from going to health care facilities to see a doctor or midwife.
Poverty is another challenge we are facing in Afghanistan, meaning a lack of livelihood opportunities, a lack of income, food insecurity and poor nutrition – all of which lead to poor health.
These are the main challenges we are trying to address. There are other challenges beyond our control, such as poor security, climate, and a lack of large infrastructure projects like roads and electricity generation.
What is the Aga Khan Development Network's (AKDN) approach to changing cultural and traditional barriers to improving MNCH?
Dr. Akbari: Through different approaches, the AKDN is trying to intervene and improve the situation. Our community development programs work with local councils to increase their awareness about gender and women's rights. At the same time, our community health promoters also work to improve awareness of reproductive health rights, about women's rights and men's rights in the household and in the community – and educate them about the benefits of family planning and related health care.There is terminology we use called "KAP" – which stands for "Knowledge, Attitude and Practice." We design our programs in a way that we address all of them: we provide the knowledge, we work with them to change their attitudes, and then we provide them opportunities to practice their new knowledge and attitudes.
How do you tackle the challenge of poverty?
Dr. Akbari: Poverty is not a simple concept – so we intervene through a multi-sectoral approach, which we call MIAD, or Multi-Input Area Development. We know that the elements of poverty are complex and interconnected, so to improve the health status of Afghans we have to work in other areas like education, community development, agriculture and market development.For example, if we have a malnourished child, they come to the health facility when they have complications – traditionally, only the immediate symptoms are addressed, and when they go back home they don't have food and their families don't have income opportunities, so the problem occurs again. We address the immediate problem - such as providing micronutrient supplements and therapeutic food in health facilities - but we also work with households and communities to reduce the problem over the long term, such as improving food production and access to food, or providing vocational training and opportunities to save money through community-based savings groups.
What role does new technology play in the AKDN's health programming?
Dr. Akbari: The introduction of E-health, also called telehealth or telemedicine, is unique to the AKDN. Since 2009, we have been using specially-designed video links to connect smaller provincial hospitals to bigger hubs of health care in Kabul and Karachi (Pakistan). So a doctor who works in Kabul can use the technology to directly see and talk to a patient in a more remote area, make a diagnosis and advise appropriate treatment while otherwise the same patient would spend hundreds of dollars and several days of travel to Kabul and seek the same services.
We are also introducing new equipment that allows the doctor to do more than just consult with individual patients – like a special stethoscope which sends the heartbeat in real time over a video link.This technology is important for Afghans, because geography and weather often make it difficult to travel long distances to reach large hubs of health care – not to mention that it is very expensive to do so, and many Afghans can't afford it.
Are there any individual stories that stand out, of Afghans who have benefitted from AKDN programming?
Dr. Akbari: I heard a story of a sixteen year old girl in one of the most isolated districts of Badakhshan (a northeastern province in Afghanistan). She went into labour but when the delivery didn't happen normally at home, she and her husband walked for two days to reach a health facility – the only hope they had. Luckily, the AKDN had upgraded the health centre to have an emergency obstetric care unit.
At the facility were a female doctor and a midwife who was trained by our community midwifery school. Immediately after the first check-up, they found out that it was an obstructed labour because she was having twins – and she needed a caesarean section. The staff had the equipment and had been trained to use it properly, so they were able to save the lives of the mother and her twins.
It seems like a simple story, but the lives of three people were saved. Had we not had services in that facility, they would have died. And this is just an example – hundreds of such cases have happened.