Establishment of an accreditation system for midwifery education in Afghanistan: maintaining quality during national expansion.

OBJECTIVE: To establish a mechanism for ensuring and regulating quality of pre-service midwifery education in Afghanistan during a period of intense expansion. STUDY DESIGN: Case study of public health practice in health workforce development. METHODS: Afghanistan's high maternal mortality is due, in part, to a lack of competent skilled midwives. In post-conflict Afghanistan, 21 midwifery schools were re-opened or established between 2003 and 2007 in an atmosphere without proper regulatory mechanisms for ensuring educational quality. A national accreditation programme for midwifery education was developed with the following components: an appropriate policy foundation; educational standards and tools to assess achievement of these standards; technical support to programmes to identify gaps and solve problems; and a system of official recognition. RESULTS: All midwifery schools were mandated to achieve accreditation. Nineteen schools had been accredited by early 2007, with an average achievement of 91% of the agreed and mandated national standards for running a midwifery school. One school has been closed by the National Midwifery Education Accreditation Board due to inability to achieve the standards. CONCLUSION: Establishment of a national mechanism to accredit midwifery schools and ensure quality education can be achieved during a period of rapid expansion.