Tahera Hussaini is a midwife in the Hesar Robat village of Miramor district of Daikundi, one of Afghanistan’s most remote provinces in the central highlands region. As one of 80 midwives trained by the United Nations Population Fund (UNFPA) under a pilot project set up to ensure that women have access to reproductive health services, Ms. Hussaini takes pride in serving the women of her village by providing reproductive, maternal and child health services.

In 2009, UNFPA conceived the model project—a community-based health structure designed to serve 1,500 to 4,000 people in remote villages—to provide midwifery services to Afghanistan’s most underserved and marginalized women in remote areas.

The need for the programme is clear. Despite significant progress in maternal health in Afghanistan, which has shown a fourfold decrease in maternal mortality during the last 15 years, one in every 50 women in Afghanistan dies from a pregnancy-related condition.

So far, the UNFPA pilot project has successfully contributed to women’s health in three provinces: Bamyan, Daikundi and Faryab. To date, UNFPA has established 80 facilities in remote villages where trained midwives provide maternal health services.

All of the midwives in the project have graduated from a UNFPA-supported training course. The comprehensive, -26month course includes midwifery skills and treatment of basic illness.

“The beauty of this particular model is that the midwife actually serves in the community and women do not need to go to a major health centre unless there is a complication,” said Annette Robertson, UNFPA’s Country Representative in Afghanistan.

The success of the programme relies on an integrated sense of ownership among the communities. Midwives are nominated and supported by residents, and selected for training through a competitive examination. In addition, there is a financial buy-in, as communities contribute one-third the cost of setting up one of these maternal facilities in their respective areas.

According to UNFPA, the services are cost-efficient and have been accepted by the communities where they are offered. Once trained, the midwives return to their villages with life-saving skills, along with a sense of status and empowerment. Afghans have great respect for their services and some communities have come up with their own name for the midwives: angels.

Given the success of the programme so far, UNFPA officials have scheduled to extend the project to other provinces, and incorporate the programme in the Afghan Ministry of Public Health’s Basic Package of Health Services (BPHS).

“We are getting positive feedback from the Ministry of Public Health,” said Ms. Robertson, who expressed satisfaction that the Ministry has taken an interest in ensuring that rural, disadvantaged and underserved populations are reached with maternal services.

While the UNFPA-supported programme is making a significant contribution to maternal health in Afghanistan, there is still a long way to go before the country will achieve maternal health targets. Currently, about 23 per cent of maternal needs are being met. If the country as a whole continues with the current rate of progress, however, the positive trend will reverse, as only eight per cent of the needs in maternal and child health are expected to be met by 2030.