Saving new lives
Equipping neonatal care units for mothers and babies in Afghanistan
By Ariel Higgins-Steele with reporting by Malalai Naziri
QALA-i-NAW, Afghanistan, 21 August 2017 — When Nasiba* gave birth to her eighth child, a baby girl named Abeda, it was the first time she had delivered in a maternity ward. All her other children had been born at home.
“Because it was my eighth child I thought I would be very weak,” Nasiba said. “I heard from relatives in my village that the risk of death was high during delivery and that it was better to go to a health facility,” she added softly, as she recovered at the Badghis provincial hospital in the town of Qala-i-Naw.
In the mostly rural western province of Badghis, rates of skilled birth attendance are among the lowest in the country, at just six per cent, compared to the national average of 50 per cent. This makes it critical to get the message out to women that they should give birth in a health facility to reduce maternal and newborn deaths.
Spreading the word
There are critical windows of opportunity for mothers and babies to receive maternal and neonatal health care. They include four recommended intermittent visits during pregnancy, giving birth attended by a medical professional, and at least two post-natal care visits. These are so health care providers can check on the health of the mother and infant, as well as pass along critical messages on healthy behaviours and danger signs.
But in the remote expanses of provinces like Badghis, it can be hard for women to access care during pregnancy and childbirth. Health facilities may be far away and difficult to reach, or women and families may not be fully aware of the risks of giving birth at home.
In some areas it can be traditions and beliefs that are barriers to women accessing health facilities — for example if there is no male family member available to accompany a woman to the health centre.
The Ministry of Public Health, and departments at provincial and district levels, are working closely with UNICEF and partners to increase awareness and knowledge about the importance of having a skilled attendant present when giving birth. Community health workers–volunteers who live in villages and are trained in basic health information and care–are instrumental in spreading the word on healthy behaviours and when it is important to seek care.
That’s how Ghoncha Gul, a 25-year-old farmer’s wife, and her family were convinced to plan ahead and have her deliver her sixth child in a hospital. When her baby boy became sick ten days later, she knew it was important to return for post-natal care.
“My baby was very sick,” Ghoncha said. “He was suffering from diarrhoea and his body temperature was cold. We made the long journey to the health facility for him because we were worried he would not survive,” said Gul, who lives in the remote Gharghaeto village in the Qala-i-Naw district of Badghis province, two hours’ walk from the provincial hospital and about half an hour by car.
When Ghoncha arrived at the hospital with her baby, she was admitted to the neonatal unit where the health worker on duty gave her antibiotics and advised Ghoncha to continue breastfeeding exclusively.
“He has been getting better since the morning,” Ghoncha said, as she continued breastfeeding. “He is now taking breast milk.”
Improving conditions at health facilities
The lack of awareness about the importance of skilled-birth attendance is often compounded by budget shortages for procurement, maintenance and servicing of equipment and supplies for the so-called Essential and Basic Packages of Health Services.
So even when the messages reach the right people, the low quality of available health services remain a challenge. Clients prefer to use private health services, but this results in high out-of-pocket expenditure that few can afford.
Since 2015, UNICEF has been conducting assessments of hospitals in 10 provinces across Afghanistan to introduce specialized newborn care units. Working with national and provincial health authorities, they renovate and upgrade rooms, incubators and heaters to ensure that provincial hospitals are equipped to give quality care to all newborns, especially those who are born underweight or with complications.
A holistic approach
Being able to access good quality health services depends directly on the skills and knowledge of health care providers and the availability of equipment, supplies and standards. Most health facilities experience high staff turnover, as wages are low and there is limited job security. This leads to understaffing, with posts being vacant for long periods of time, as well as recruitment of untrained new staff.
In addition, a lack of female care providers and 24/7 health services at health facilities seriously affects women’s ability to use health services, while a lack of community transport and high costs associated with getting to a health facility add to the burden.
To address these challenges beyond providing newly equipped neonatal units and spreading the message on healthy behaviours, UNICEF and the Ministry of Public Health are working to deliver maternal and child health services through different channels in Badghis province.
Mobile health teams comprising a nurse, midwife and vaccinator visit areas that are two hours from fixed health facilities to deliver services and important messages. Meanwhile, an innovative approach to reduce out-of-pocket expenditure is being piloted, giving women who have their baby in a health facility financial incentive to cover the cost of transport.
About newborn care units
In close cooperation with the Ministry of Public Health and organizations responsible for implementing the Basic Package of Health Services in Afghanistan, UNICEF currently supports newborn care units in 10 provinces. The newborn care units are supported by generous donations from the Government of Japan.
*Names changed for anonymity