Questions/Answers

While Afghanistan has some of the poorest maternal health indicators in the world, Iran is one of the few countries to have reached MDG 5A. I. R. of Iran pays special attention to the status of the health of refugees including afghans for the matter of improving the public health within the country and the region and also for the matter of humanitarian issues.Due to several conflicts in the region and the matter of displaced people.Iran is witnessing a huge number of refugees entering into the country with many health related problem. one solution was providing the basic and supplement health insurance to legal refugees inhibiting in Iran with the help of International organizations like UNHCR .On the other hand for the matter of humanitarian assistance Iran tries to provide free of charge health services even to illegal refugees for the matter of improving and supporting the health of Iranian and the people of the region. for this overall aim I.R. of Iran is going to expand south-south collaborations. One aspects is improving the maternal health of Afghan refugees residing in Iran that is generally lower than that of Iranians. Against this background, and based on a request from the Ministry of Higher Education of Afghanistan,I. R. of Iran with the help of UNFPA Iran and afghanistan have designed a project to improve the maternal health situation in Afghanistan and of Afghan refugees residing in Iran. The project has been developed in close coordination with UNFPA Afghanistan, IOM Afghanistan and Ministry of Health and Medical education of Iran, and UNHCR Iran, taking into account the maternal health needs in Afghanistan and Iran. It is part of round two of the Solutions Strategy for Afghan Refugees.

To achieve the overall objective, the project is made up of three complementary and interlinked outputs. 1. Improving maternal health in Afghanistan through an Afghan-Iranian academic collaboration which will build the capacity of the midwifery department at Kabul Medical University (KMU). 2. Improving maternal health for Afghan refugees in Iran by developing an Afghan-friendly maternity ward at a South Tehran hospital 3. Qualifying 50 Afghan refugee women as diploma-level midwives using the Afghan midwifery curriculum to enhance repatriation and reintegration prospects in Afghanistan.

Iran hosts one of the largest refugee populations in the world. Approximately 1 million of these predominantly Afghan refugees are registered, with up to 2 million unregistered. Only 300,000 of these refugees have access to free primary health care. The predominant part of Iran’s refugees – up to 97% - live in urban areas. An estimated 463,190 refugees are residing in Tehran province alone, not counting unregistered refugees. The current economic situation in Iran is putting pressure on the refugee community, as living costs have significantly increased due to inflation, while job opportunities have been reduced. There is a lack of data on the delivery situation of Afghan refugee women in Iran. However, existing data shows that in certain refugee settlements up to 48% of pregnant refugee women were delivering at home, without skilled attendance. Financial constrains and access to the services are main reasons for delivering at home. In order to address this issues, the project was aimed to establish maternity ward in Shahid Akbar-Abadi hospital –the hospital which has the most afghan visitor- in order to increase access to the Maternal Healthcare for Afghan Refugees.

the initiative comprise of three interlinked objectives which one of them is development of Afghan-friendly maternity ward. in line with this objective maternity ward was established and necessary equipment was procured for this ward. this ward mostly will provide maternal health services for Afghan refugees in order to increase their health and well-being (contribution to SDG3)

as mentioned earlier, Iran host one of the biggest refugees community around the world and these refugees don't have appropriate access to the health services. the target of this initiative is Afghan women those who refer to Akbar-Abadi hospital for maternal health services and those who are being trained on midwifery under this project in order to return to Afghanistan and provide services for women there.

This project is aimed to improve maternal health of Afghan refugees - Those who are living in Iran through increasing their access to maternal health services by establishment of maternaty ward in Shahid Akbar-Abadi Hospital - Those who are living in Afghanistan through training of midwifery students in associate and master level in Iran in order to go back to Afghanistan to provide services for Afghan women and also collaborate with Kabul Medical University

SDG 3 and SDG 17 were emphasized in this project since the focus of this project is on health and well-being of Afghan women and also it is South-South collaboration which contribute to partnership goals of SDG. for implementation of this project, Ministry of Health and Medical Education, Iran University of Medical Sciences, UNFPA Iran Country Office, UNFPA Afghanistan country Office, IOM Afghanistan and Iran, and UNHCR Iran were involved.

Although this project is south-south project but this initiative belong to the country and it is not adaptation from other context. The commencement of project was based on the health problems of Afghan Refugees. three different types objectives were defined for this project. the training of Afghan students is tailor made training since Iran does not have associate degree midwifery program and it was tailored only for these afghan students.

The total budget of the project, which is being funded by the Government of Italy, is USD 1,017,724 over a period of three years. First year: 264,081 Second year: 552,962 Third year: 200,681

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The project is adaptable to other context but as first step, it was decided to finalize the implementation of this project, Evaluate the results and after that and based on lessons learned of this project, it will be adapted to other context.

one of the tools which grantee the sustainability of this project is the MOU which was signed between Ministry of Health and Medical Education of Iran and Ministry of Public Health of Afghanistan. in this MoU It has been mentioned that providing job opportunities for midwifery graduates, approval of their certificate, and so on. Also in order to make students interested to go back to Afghanistan and provide services there, it was planned to conduct three week internship in Afghanistan after completion of their theoretical training in Iran. Ministry of Public Health of Afghanistan is responsible to facilitate this three week internship in Afghanistan

The project is three year project and Italian Embassy financially support this project. the allocation of each year budget is released after receiving progress report and completion of planned activities for each year. this procedure grantee the implementation of planned activities for each year in terms of time and budget.

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this project was developed with collaboration of different stackholders as follow: Overall Stakeholders: • Ministry of Foreign Affairs • Ministry of Health o Department of International Relations – o Deputy for Health –  Department for Population, Family and School Health –  Center for Communicable Diseases Control – o Deputy for Curative Affairs –  Office of Midwifery – • Ministry of Interior o BAFIA (Bureau for Aliens and Foreign Immigrants Affairs) • UNFPA Iran • UNHCR • UNFPA Afghanistan a) Iranian-Afghan Academic Collaboration on Midwifery Iranian Stakeholders: • Deputy for Education of the MOHME • Board of Midwifery • Iran Medical University Afghan Stakeholders: • Nursing and Midwifery Department of Kabul Medical University • Ministry of Higher Education • Iran University of Medical Sciences • Midwifery Office of MOHME • Shahid Akbarabadi Hospital • IOM Iran Afghan Stakeholders: • Nursing and Midwifery Department of Kabul Medical University • Ministry of Public Health • Institute of Health Sciences • IOM Afghanistan

Main Lesson learned: - Although all students knew about the ultimate objective of project which was repatriation of Afghan refugees to Afghanistan, but providing incentives for repatriation of Afghan refugees is one the most important challenges which had to be considered in development of any project. - Since the students were selected among Afghan refugees in Iran, and most of them had never been in Afghanistan, they would need an orientation about Afghanistan and its health system. Therefore, a 3-week internship in Afghanistan was proposed to be conducted at the end of the training. The internship will familiarize them with the health system in Afghanistan and the type of services that they can provide upon completion of their training and return to Afghanistan.