title: Availability and distribution of human resources for provision of comprehensive emergency obstetric and newborn care in Afghanistan: a cross-sectional study.
abstract: BACKGROUND
  For over a decade, Afghanistan's Ministry of Public Health and its international development partners have invested in strengthening the national health workforce and establishing a system of primary health care facilities and hospitals to reduce the high levels of maternal and child mortality that were documented shortly after the fall of the Taliban in 2001. Significant progress has been made, but many challenges remain. The objective of this study is to assess the availability and distribution of human resources for round-the-clock comprehensive emergency obstetric and newborn care service provision in secure areas of Afghanistan in order to inform policy and program planning.
  
  
  METHODS
  A cross-sectional assessment was conducted from December 2009 to February 2010 at the 78 accessible facilities designated to provide emergency obstetric and newborn care in Afghanistan. The availability of staff on call 24 hours a day, seven days a week; involvement of staff in essential clinical functions; turnover rates; and vacancies were documented at each facility. Descriptive statistics were used to summarize results.
  
  
  RESULTS
  All facilities assessed had at least one midwife on staff, but most did not meet the minimum staffing requirements set in national guidelines. Given that all facilities assessed are considered referral centers for lower-level clinics, the lack of doctors at 5% of facilities, lack of anesthetists at 10% of facilities and lack of obstetrician/gynecologists at 51% of facilities raises serious concerns about the capacity of the health system to respond with lifesaving care for women with obstetric complications.
  
  
  CONCLUSIONS
  While the government continues its efforts to increase the number of qualified female health professionals in Afghanistan after decades with little female education, innovative strategies are needed to facilitate deployment, skill-development and retention of female healthcare providers in underserved areas.
authors.affiliation: International Rescue Committee, 3 Bloomsbury Place, London, WC1A 2QL UK.
authors.forename: Manizha
authors.initials: M
authors.lastname: Faqir
authors.affiliation: Jhpiego/Afghanistan, an affiliate of Johns Hopkins University, Shar-e-Naw, Street 3, House 265, Kabul, Afghanistan.
authors.forename: Partamin
authors.initials: P
authors.lastname: Zainullah
authors.affiliation: Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames St., Baltimore, MD USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Tappis
authors.affiliation: Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames St., Baltimore, MD USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Mungia
authors.affiliation: Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames St., Baltimore, MD USA.
authors.forename: Sheena
authors.initials: S
authors.lastname: Currie
authors.affiliation: Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames St., Baltimore, MD USA.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Kim
keywords: Afghanistan; Emergency obstetric care; Health services; Human resources; Maternal health; Neonatal health
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