Digitally strengthened, midwife-led intervention to reach the unreached mothers across ten conflict-prone provinces of Afghanistan during humanitarian crisis

Coronavirus disease 2019 (COVID-19) pandemic had significant negative impact on sexual and reproductive health (SRH) with devastating impact on pregnant women in resource constrain humanitarian settings. This paper provides detailed account of a community midwife-led intervention in ten humanitarian settings of Afghanistan using world health organization (WHO) emergency disaster risk management (EDRM) framework. The project is aimed at increasing access to Integrated Package of Essential SRH Services and Minimal Initial Service Package (MISP) with a specific focus on prevention of Postpartum Haemorrhage (PPH) and screening and management of preeclampsia and eclampsia. The project was implemented through 150 Community outreach midwives (COMs). Each midwife served 300 households; mentored by gynaecologists and supervisors. Midwives were trained through a digitally enabled, simulation based training and equipped with a set of off-the shelf devices and kits. During COVID-19 pandemic and in absence of health care services during crisis, this intervention has played as a lifesaving intervention for the community in Afghanistan. Variable digital literacy, sociocultural barriers, reluctance in adapting to digital platforms, security and uncertainties were some of the challenges faced. Adaptation of outreach methods integrated high impactful digital technologies has been the most appropriate strategy "to reach the unreached". Through this model, national and global stakeholders were engaged even during the crisis in Afghanistan. It also provided vital inputs for the donors, governments, civil society organizations and other stakeholders for sustaining and advancing the delivery of quality SRH services in humanitarian settings.