External Evaluation of the Program Support to Hospital Midwifery Education in Afghanistan (2010-2014)

About the publication

  • Published: December 2014
  • Series: --
  • Type: NGO reviews
  • Carried out by: Vibeke Munk Petersen and Samay Hamed, Nordic Consulting Group (NCG), Denmark
  • Commissioned by: Forum for Women and Development (FOKUS)
  • Country: Afghanistan
  • Theme: Health
  • Pages: 65
  • Serial number: --
  • ISBN: --
  • ISSN: --
  • Organization: Forum for Women and Development (FOKUS) in collaboration with the Norwegian Afghanistan Committee (NAC) and the Norwegian Association of Midwives (DNJ)
  • Local partner: Institute of Health Science (IHS) in Nangarhar Province and the Afghan Midwives Association (AMA)
  • Project number: QZA-09/246-22
NB! The publication is ONLY available online and can not be ordered on paper.


FOKUS has supported various NAC projects in Afghanistan since the early 1990s. The education of midwives at the IHS in Nangarhar province has received support from FOKUS and back-donor Norad since 2002. FOKUS also provided financial support to a mother and child clinic (HEWAD) in the same province during the years 1997-2008, and a joint external evaluation of HEWAD and IHS was conducted in 2007.

In 2010, the midwives associations in Norway and Afghanistan were included as new program partners. It was thought that an inclusion of these two sister organizations would provide useful and strategic added-value to the overall goal of improving women’s reproductive health and rights in Afghanistan.


The purpose of the evaluation is to provide NAC, DNJ, partner organizations, and FOKUS with an assessment of the extent to which the objectives of the overall program in Afghanistan have been achieved and to inform future program development. Norad has decided that from 2015 onwards, FOKUS member organizations receiving grants from Norad in their own capacity shall no longer be entitled to financial support via FOKUS’ grant from Norad. Since NAC receives substantial funds from Norad/MFA for other projects, FOKUS will not be allowed to support IHS or AMA financially post 2014. NAC, however, will continue to give high priority to midwife education, and the evaluation will give directions for NAC’s future support to the training.

  1. The evaluation shall, in a structured manner, review impact and draw out lessons learned for the implementing organizations, NAC, DNJ and FOKUS.
  2. The evaluation shall provide information on the way forward for the program after the phasing out of support from FOKUS.
  3. The evaluation shall give recommendations and inform the future development of suitable objectives, achievable results and measurable indicators.


A combination of methods have been used to gather information used to triangulate information/data and thereby ensure their solidity. M&E data has been used in combination with other documentation and interviews/consultations with stakeholders. The evaluation focused on documenting impact/outcomes. The findings has formed the basis for the analysis of program performance vis-à-vis relevance, efficiency, effectiveness, impact, and participation - of methods and mechanisms established for the management of each component as well as compliance with program requirements and procedures.

Questionnaires were made to selected students in their final year and to graduated midwives in Jalalabad. The questionnaires were backed by focus discussion group interviews. Interviews were carried out with teachers and supportive staff at IHS, with head of AMA in Nangarhar, with the director of IHS at the Institute of Health Sciences in Jalalabad/Ministry of Public Health (MoPH). A short SWOT analysis was made with AMA and IHS in Jalalabad. In Kabul interviews were held with NAC director and other staffs, with AMA and with MoPH. Skype interviews were conducted with FOKUS, NAC Head Office in Norway and with DNJ.

Key findings

The program is overall assessed very positively by the external evaluation team, and as highly relevant in the Afghan context. The proposed objectives and outcomes are considered adequate.

The technical standard of the IHS staff and trainers has increased considerable during the program phase. Close to 100 percent of enrolled students graduated during 2010-14, and were employed as midwives at health facilities in Nangarhar district to provide health care for women and children in rural areas, besides ensuring economic income opportunities for themselves and their families. Working as a midwife has turned out to be one of the few professions open to women by most political and religious factions in conservative and traditional Afghan communities, not least because of the program partners’ persistent lobbying and advocacy through media and governmental organizations.

Further 28 midwives from Kabul and six provinces including Nangarhar have during the current program phase received an AMA leadership development training course. Recently, the Afghanistan Midwifery and Nursing Education Accreditation Board (AMNEAB), which is the highest organ for coordination of midwifery-related issues and standardisation of quality of midwifery education in Afghanistan, nominated the hospital midwifery education in Nangarhar under the program to have the best standard/quality in the country.

The program is characterized by a good and committed long-term cooperation between government institutions and NGOs, and the program has no doubt benefitted from a multi-donor approach, involving many partners with specific strengths and inputs. The established extracurricular activities in the education program (such as computer training, English lessons, women’s and human rights and peace training) have been highly commended and contributed to the empowerment of the students.


It is recommended to extend the program with another five years (two plus three), in order to ensure education of additional midwives, as the need for midwives in Afghanistan is estimated to be at least 5000 more than the present 3500.

The program has been carried out in line with NORAD/FOKUS/NAC’s criteria for funding. However, with a program approach unlike the former project approach, it is recommended to develop a joint program document for all involved partners in the next program phase. This document should comprise a joint program objective and implementation strategy as well as clear definition of responsibilities between the program partners. Each organization has its own monitoring system, and the program would benefit from a common approach.

It is recommended to particularly strengthen the AMA chapter in the Nangarhar province, and to work for the establishment of a bachelor degree for graduated midwives.

Comments from the organisation, if any

The recommendations from the external evaluation will be integrated into the larger NAC/DNJ program from 2015 onwards.

Published 09.09.2015
Last updated 09.09.2015