Quality of care – Skills to save lives

“We had baby warmers [cots to keep the baby warm] in stock, but they were left unused as we did not know how to use them. We only learnt how they worked during the recent trainings we received on quality of care,” says Sheeba Mudaqiq, a doctor and quality of care mentor at the Community Health Centre (CHC) in Qadis, located three hours by car from the provincial capital of Qala-e-Naw, in Badghis province.

Badghis is a remote province in Western Afghanistan, on the border with Iran. The remoteness of the province impacts access to health services and social wellbeing for the people who live there. 

In September 2024, with support from the Asian Development Bank (ADB), UNICEF initiated a project to improve the quality of care for maternal and newborn health services as part of the High Impact Value Added (HIVA) project in Afghanistan. The HIVA project runs in 10 provinces with 50 health facilities that have high number of patients, assessed for selection by UNICEF’s implementing partner, Management Sciences for Health. The primary objective is to enhance the training capacity of health care providers at these facilities. To achieve this, 10 mini skills laboratories were established at selected provincial facilities, where mentors – all of whom are trained medical doctors or midwives – train local doctors and midwives at the health facilities imparting skills in maternal and newborn healthcare including quality antenatal care, care during childbirth, postnatal care, essential newborn care and family planning services. 

“In a 17-year career, this is the first time that I have learnt use this equipment,” says Sheeba. “Patients with complications were always referred to the provincial hospital. We never thought conducting ultrasounds, managing postpartum haemorrhage or essential newborn care were services that we could even provide.”

Bibi Gul (30), is a midwife at Qadis CHC. She received training in quality of care from the doctors who were trained by Sheeba. Bibi says, “I had never seen an anti-shock garment and was surprised to know that anything like this even exists. It is a lifesaving miracle.” Anti-shock garment is a specialised cloth belt that reduces the blood flow to the uterus and treats the shock. It can help keep the woman in labour alive for 48 hours, therefore providing a critical time window to provide essential lifesaving treatment to the patient.

“Use of a doppler [handheld device used for listening to the heartbeat of a foetus] is a game changer,” adds Bibi. “Before, we could not even tell if we were listening to the child’s heartbeat or the mother’s. Just last night, we had a pregnant mother whose unborn child had tachycardia [a heartbeat of over 100 beats per minute], so we immediately arranged for the child’s delivery. We managed to save both the mother and the baby.” 

“My first baby was born at the Qala-e-Naw provincial hospital. My second baby was born at home, and I had to be rushed to the hospital as I was bleeding, and the birth attendant could not handle it. Skipping the hours of travel to Qala-e-Naw and giving birth to my third child here, with a doctor taking care of everything, was my best experience.” 

Zahra (33), mother of three

“I felt supported and relaxed thanks to how well I was being taken care of here,” says Zahra (33), a mother of three, who gave birth to her youngest baby boy, Tayyab, at Qadis CHC about a month ago. “My first baby was born at the Qala-e-Naw provincial hospital. My second baby was born at home, and I had to be rushed to the hospital as I was bleeding, and the birth attendant could not handle it. Skipping the hours of travel to Qala-e-Naw and giving birth to my third child here, with a doctor taking care of everything, was my best experience.” 

“Thankfully, the birth was very smooth,” says Zahra’s mother-in-law Maryam (55), who is accompanying Zahra to the CHC for her routine postnatal check-up. “The staff kept Zahra comfortable, and everything was managed swiftly. I have told family in other villages about the facilities available here, too.” 

From September to December 2024, 20 clinical mentors and 120 provincial master trainers were trained under the HIVA quality of care initiative in 10 provinces of West, South and Central Afghanistan. In turn, these mentors have gone on to train 500 mentees from 50 health facilities – an average of 10 staff per facility. As approximately 33,000 women and children receive services in these facilities every month, in the course of a year, hundreds of thousands of mothers and newborns will benefit from improved maternal and child quality of care in the 10 provinces covered by the HIVA. 

Thanks to the continued support of ADB, this project will continue in the 10 provinces of Afghanistan until the end of June 2025, therefore providing quality healthcare to thousands of mothers and newborns in country. 

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This blog is also available on the UNICEF Afghanistan website.

All photo credits: UNICEF/Khan.