Gender Equity in Afghanistan Human Resources for Health 2002-2020: Midwives Versus Female Nurses and Physicians

Afghanistan experienced 23 years of crisis (1978-2001), severely depleting the healthcare workforce, particularly midwives, female nurses, and physicians, and limiting women's access to appropriate care. In this retrospective policy case study, we analyzed the Ministry of Public Health (MoPH) Human Resources for Health (HRH) policies by reviewing documents from the post-conflict period (2002-2020), focusing on government-sponsored initiatives that promoted women's workforce participation and gender equity in HRH policy. Overall, HRH policies effectively addressed reducing maternal mortality rates (MMR). During the reconstruction period, development agencies focused on Afghanistan and its MMR, creating a critical opportunity for innovative HRH initiatives, especially for midwives, to achieve the Millennium Development Goals. Key initiatives included early initiation and rapid expansion of the community midwifery program; flexible recruitment strategies; higher remuneration; and media promotion. This pro-midwifery stance helped achieve 30% of women in the workforce, positioned Afghanistan as a regional leader in midwifery, and highlighted its feminized health workforce. Contrarily, the Ministry's inability to prioritize women's healthcare beyond reproductive health hindered the promotion of female nurses and physicians. Chronic and non-communicable diseases became a priority in 2015. However, reduced interest in the HRH forums from international agencies and funding issues stalled implementation. At the same time, a lack of gender-sensitive targets for nursing and medicine, and poor stakeholder coordination, left these professions behind in achieving gender equity. Consequently, it limited women's access to healthcare beyond reproductive health. This case study offers key insights for national and international policymakers seeking reconstruction opportunities in post-conflict settings like Afghanistan. • Afghanistan's Human Resources for Health policies effectively reduced MMR in line with the Millennium Development Goals. • Innovative HRH initiatives targeted midwifery: expanding midwifery programs, raising pay, and promoting midwifery through the media. • The Ministry's inability to prioritize women's healthcare beyond reproductive health hindered the promotion of female nurses and physicians. • The pro-midwifery stance helped achieve 30% of women in the workforce and highlighted the feminization of the health workforce.