Due to the high maternal and neonatal mortality in Afghanistan, which was rated the highest in the world in 2002 at 1,600 per 100,000 live births for maternal mortality and 60 deaths per 1,000 live births for neonatal mortality, and the obvious need for skilled midwives especially in rural areas where 77% of Afghan population reside, two pre-services education programs were developed to train new midwives namely: the institute of health sciences (IHS) program which was designed for midwives who practice largely in provincial, regional and national/specialty hospitals; the CME program which was aimed at developing community midwives for deployment within rural communities; and the supportive supervision system which provided an enabling and supportive work environment for newly graduated midwives. These efforts increased the number of midwives in Afghanistan from 467 in 2002 [1] to 4,600 in 2014 [2]. Yet, according to the State of World Midwifery Report 2011, to attain 95% skilled birth attendance, Afghanistan should have an additional 7,359 professional midwives by 2015. Another gap still existed, especially the fact that midwives in remote facilities had little or no opportunity to receive technical training from certified midwife trainers (mentors). In response to this need, AMA implemented a Swedish Committee for Afghanistan (SCA)-funded midwives’ mentorship project, which was initially funded through Forum Syd with an overall budget of 16,641,743 AFN until 2015, when SCA funded it through a Sida grant.

To close this gap, the Afghan Midwives Association (AMA), in line with its mandate of supporting midwives, designed a novel field-based mentorship program in which certified national midwifery trainers (mentors) were tasked with traveling to rural health facilities and providing mentorship services to the midwives (mentees) working there. The mentorship project was launched in 2010, and implementation started in 2011 in three provinces: Maidan Wardak, Samangan, and Sar-e-Pol. By 2012, the project had been extended to three more provinces: Parwan, Kapisa, and Laghman. The project prepared 57 mentors and 86 mentees in 86 HFs in six pilot provinces (Lagman, Samangan, Wardak, Kapitsa, Parwin, and Sar-e Pul) with an average of 30% HF coverage in targeted provinces during 2011–2014. In 2014, the program was condensed to 3 provinces: Wardak, Samangan, and Laghman, covering 28 centers and 30 newly graduated midwives. Two mentors and one focal point trained on High Impact Interventions (HIIs), Postpartum Hemorrhage (PPH), and Pre-Eclampsia and Eclampsia (PE/E) prevention, detection, and management, and Helping Babies Survive (HBS) key skills and post-abortion care were to visit 10 health facilities per province. They were also oriented on family planning methods and on using the mentorship tools for the mentorship program to identify gaps in mentees performance and Respectful Maternity Care (RMC). In 2015, a formative evaluation was carried out, and it was found that the Mentorship project greatly contributed to: strengthening the professional capacity of the midwives in the provision of quality and safe maternal and newborn care services; improving clinical work settings; and increasing acknowledgment of the midwifery profession among health workers as well as community acceptance of midwifery services. However, the mentorship program needed to be improved before it could be considered a successful model for in-service education and consequently scaled up on a national level. Therefore, various recommendations were made that were implemented in the program.

Between 2015 and 2019, the program prepared 16 mentors and 146 mentees in 137 health facilities, totaling 73 mentors, 232 mentees, and 223 HFs between 2011 and 2019. This evaluation aims to assess the efficiency and effectiveness of the mentorship project in capacitating midwives and improving the quality of midwifery services in the targeted area since implementation started in 2011–2019.