Factors influencing the retention of midwives in the public sector in Afghanistan: a qualitative assessment of midwives in eight provinces.
OBJECTIVE
to examine factors that affect retention of public sector midwives throughout their career in Afghanistan.


METHODS
qualitative assessment using semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs).


METHODS
health clinics in eight provinces in Afghanistan, midwifery education schools in three provinces, and stakeholder organisations in Kabul.


METHODS
purposively sampled midwifery profession stakeholders in Kabul (n=14 IDIs); purposively selected community midwifery students in Kabul (n=3 FGDs), Parwan (n=1 FGD) and Wardak (n=1 FGD) provinces (six participants per FGD); public sector midwives, health facility managers, and community health workers from randomly selected clinics in eight provinces (n=48 IDIs); midwives who had left the public sector midwifery service (n=5 IDIs).


RESULTS
several factors affect a midwife throughout her career in the public sector, including her selection as a trainee, the training itself, deployment to her pre-assigned post, and working in clinics. Overall, appropriate selection is the key to ensuring deployment and retention later on in a midwife's career. Other factors that affect retention of midwives include civil security concerns in rural areas, support of family and community, salary levels, professional development opportunities and workplace support, and inefficient human resources planning in the public sector.


CONCLUSIONS
Factors affecting midwife retention are linked to problems within the community midwifery education (CME) programme and those reflecting the wider Afghan context. Civil insecurity and traditional attitudes towards women were major factors identified that negatively affect midwifery retention.


CONCLUSIONS
Factors such as civil insecurity and traditional attitudes towards women require a multisectoral response and innovative strategies to reduce their impact. However, factors inherent to midwife career development also impact retention and may be more readily modified.
Health Protection and Research Organisation, House P860, Street 4 Taimany, District 10, Kabul, Afghanistan. Electronic address: mollywood@hotmail.com.
Molly E
ME
Wood
G Farooq
GF
Mansoor
Pashton
P
Hashemy
Emily
E
Namey
Fatima
F
Gohar
Saadia Fayeq
SF
Ayoubi
Catherine S
CS
Todd
D000328:Adult; D000346:Afghanistan; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008880:Midwifery / Q000706:statistics & numerical data*; D020380:Needs Assessment; D009721:Nurse Midwives / Q000193:education / Q000523:psychology; D010559:Personnel Management / Q000379:methods / Q000592:standards; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data; D012938:Social Perception; D066252:Sociological Factors; D011795:Surveys and Questionnaires
Afghanistan; Employee retention; Midwifery