GHAZNI PUBLIC HEALTH

Afghanistan 's health system is in a state of near total disrepair. Standard health indices, including the infant mortality rate, the childhood mortality rate and the maternal mortality ratio, are among the worst in the world. As the new interim government re-establishes and slowly strengthens social services, it finds itself facing a multitude of technical, managerial and operational problems that need to be clarified before they can be solved. This report outlines the major issues currently facing the public health sector, discusses the roles of government, United Nations (UN) agencies, donors, and non-governmental organizations (NGOs), and makes recommendations for how some of the more pressing problems might be resolved.

Among the more glaring problems that continue to affect the ability of the Transitional Administration of Afghanistan to bring about rapid and lasting improvements in the health status of its population are:

  • a grossly deficient, even absent, infrastructure;
  • a health system that is top-heavy with doctors who are not trained to deal with priority, community-level problems, and who lack public health expertise;
  • poorly distributed resources;
  • health care delivered on a project basis by many distinct, relatively uncoordinated service providers, as opposed to health care delivered in accordance with a clear and coherent national health policy; and
  • lack of practical, useful and coordinated information systems for management decision making.

Despite these problems, there are positive factors that may allow the government and its partners to make reasonably rapid progress. These include a relatively high level of government commitment, donor interest (at least for the present), technical and financial assistance from the UN, a strong and committed community of NGOs and a (limited) record of successful implementation of public health programs in the form of mass poliomyelitis and measles vaccination campaigns.

An April 2002 Joint Donor Mission (JDM) to Afghanistan considered options for re-establishing and strengthening the country's public health services. Its principal recommendations were to develop a Basic Health Services Package that would form the essential content of the health system and to manage the delivery of those basic services through the development of performance based, contractual agreements with NGOs.

The Basic Health Services Package, currently under development by the Ministry of Public Health (MoPH) and its advisers, consists of seven major elements:

  • Maternal and newborn health
  • Child health and immunization
  • Public nutrition
  • Control of communicable diseases
  • Mental health
  • Disabilities
  • Essential drugs

At the time of this report, the cost of the proposed package had not yet been calculated. In addition, there are several outstanding issues regarding prioritization of the services in the package that should be explored further. For example, though mental health and disabilities are important sources of morbidity and are deserving of the attention of the public health community, they require a relatively high degree of specialization for intervention and make a small contribution to excess preventable mortality; they could, for these reasons, be considered as secondary priorities. Other issues include “vertical” versus “horizontal” programs, the level of implementation of various interventions and the need to pay adequate attention to particularly vulnerable populations.

Whatever the final composition of the Basic Health Services Package, there are a number of activities that are common to all of the proposed interventions and services. These include health education, training, operational research, information systems and program management. With particular regard to the latter, the performance-based partnership agreements (PPAs) are discussed in detail. Their perceived advantages

and disadvantages are reviewed, and recommendations are made in regard to their

eventual implementation. The implications of these PPAs for each of the major actors – the Ministry of Public Health (MoPH), the donors, the UN agencies involved in health and the NGOs are detailed.

Although it will be quite difficult to make rapid progress, this report concludes that there is reason to be cautiously optimistic about the future of Afghanistan 's public health system and its ability to improve the health status of its grossly underserved population. The key elements for a successful public health program in this post conflict environment include the establishment of realistic goals and objectives, the careful

prioritization of services and activities and the development of efficient and effective

management and information systems that allow for the close monitoring of progress – or lack of it – at every level, from the community through to secondary and tertiary care facilities. But one can only be optimistic if the most important prerequisites of all – a stable government, peace and security – are assured.

GHAZNI PUBLIC HEALTH INFRASTRUCTURE

There are four hospitals, ten clinics and a number of Basis Health Units (BHU) in Ghazni Province

.

 

Ghazni City

No. of Clinic:                              7
No. of Mobile Clinic:                   0
No. of Hospital:                          1
Nurses and Mid-wives               97

In addition to the above, there are an MSF TB center and private health clinics; however, these facilities do not meet the demand as people from surrounding districts come to the City for medical attention.

Ab Band District

The health sector is the first priority of the district with only one clinic operating. This clinic, located in Bazi Qullah (South of the district) is run by SCA, and currently employs:

  • 1 Mid Advanced medical student;
  •  1 pharmacist;
  •  1 health educator;
  •  1 community mobiliser;
  •  2 vaccinators (paid by NAC)

Basic drugs can only be found in this clinic, forcing people to go up to Moqur (20 km distant) or Ghazni city for specific drugs and treatment. The lack of specialised professional staff is putting at risk the life of the patients who cannot afford to pay the transportation expenses up to the above mentioned districts. Due to complete absence of female medical staff, women face acute difficulties during pregnancy and are compelled to seek the assistance of traditional midwives (most of the time old ladies). Should the case be too complicated, these traditional midwives would advise the ladies to go to Moqur or Ghazni, negotiating transportation means for them (up to 2000 Pak. Rupees). It is to be noted that villagers have explained that they could purchase drugs in Bazi village, South of the district.

Ajristan District

The health sector is in need of urgent support. There is only one clinic functioning in the district, which does not have a doctor and nurses. Two devoted Mid-advanced medical students run the clinic, one being in charge of OPD and the other one of pharmacy. The clinic employs a health educator (paid by WHO).

According to one of the Mid-advanced, the population in the district has no means to go for consultation in Sangar, and even if they go there, they rarely receive specific treatment for their diseases, due to lack of drugs.

Infant mortality rate is said to be high, and it is explained that complicated pregnancy cases often lead to the death of both mother & child.

There is no female medical staff in the district, and as a consequence, females have nearly no access to healthcare.

Main diseases affecting the population are:

  • pneumonia
  • anaemia
  • stomach diseases & child diarrhoea
  • tuberculosis

Most pressing needs for the medical sector are:

  • Female medical staff, notably obstetrician/gynecologist
  • Well supplied pharmacies
  • Qualified medical staff

However, any prevention and health education programme in the district is expected to meet resistance from an important part of the male population.

To be continued.....

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