ARTF RESULTS STORIES 2016 PROVIDING QUALITY HEALTH SERVICES IN AFGHANISTAN Afghanistan Reconstruction Trust Fund
PROVIDING QUALITY HEALTH SERVICES IN AFGHANISTAN The System Enhancement for Health Action in Transition (SEHAT) Program implemented by the Ministry of Public Health aims to expand the scope, quality, and coverage of health services to the population, particularly the poor, across Afghanistan. The program, estimated at a total value of $654 million, is jointly supported by the Government of Afghanistan with $30 million, IDA Grant $100 million, Health Results Innovation Trust Fund $7 million, and ARTF $517 million. The SEHAT Program, which supports the provision of basic health services and essential hospital services in the entire country, was approved on June 17, 2013, for a period of five years of funding. The closing date for the project is June 30, 2018. CHALLENGE THE AFGHAN HEALTH SYSTEM has made considerable progress over the period of 2002 2012 due to Ministry of Public Health (MoPH) leadership, sound public health policies, innovative service delivery, careful program monitoring and evaluation, and development assistance. The number of functioning health facilities increased from 496 in 2002 to more than 2,000 in 2012. Data from household surveys (between 2003 and 2011) show significant improvement in the coverage of reproductive and child health services as well as a drop in maternal and child mortality. However, despite the aforementioned progress, the country faces significant challenges in the sector. Afghanistan s infant and under-five mortality rates are still higher than the average for other low-income countries. Afghanistan also has one of the highest levels of child malnutrition in the world. About 41 percent of children under-five suffer from chronic malnutrition, and women and children suffer from high levels of vitamin and mineral deficiencies. 2 ARTF Results Stories 2
APPROACH THE HEALTH SECTOR has experienced a significant turnover since the establishment of a new administration in 2002. The government has given the utmost importance to addressing the high maternal and child mortality, especially in rural areas. MoPH undertook a series of critical and strategic steps: it defined a Basic Package of Health Services (BPHS) and later an Essential Package of Hospital Services (EPHS); and it established a system for contracting on a large scale with international and national nongovernmental organizations (NGOs) for delivery of these services. The SEHAT Program aims to expand the scope, quality, and coverage of health services provided to the population, particularly the poor, across the country, and to enhance MoPH stewardship functions. The program supports the provision of BPHS and EPHS in both rural and urban areas. It is strengthening the national health system and MoPH s capacity at central and provincial levels to effectively perform its stewardship functions. RESULTS Maternal and child health services: Health Management Information System (HMIS) data show an increase in the utilization of key maternal and child health services during the first six months of 2014 as compared to the same period in 2013. Health facilities: Since the start of SEHAT in June 2013, 35 new health facilities have been established, 14 health facilities have been upgraded, and around 1,000 health facilities have been equipped to provide health services in the target areas. Children: More children have benefited from project outcomes since SEHAT began. According to HMIS data, the proportion of children under-five with severe acute malnutrition who have been treated has reached almost one third (32 percent). Service delivery: In the large majority of provinces, BPHS and EPHS are delivered by NGOs under a contracting mechanism. As key components of the project, 27 NGOs have been contracted and properly managed to deliver health services in the target areas. The SEHAT Program has increased the efficiency and quick delivery of health services for communities across Bamyan Province. Hussain Ali Khalili, director, Bu Ali Rehabilitation and Aid Network 3 ARTF Results Stories 3
Health Centre Brings Vital Health Care to Isolated Villages Farmer Mohammad Baqir Ali, 62, is having his blood pressure checked by a doctor at the Koprok Basic Health Center (BHC). He has a periodic cough and has come to the clinic to seek medical advice and treatment. The BHC, located in Koprok village in Yakawlang district, 60 km from Bamyan city, provides free basic health services to over 6,000 residents in 11 neighboring villages and is the only health facility in this mountainous area. The villagers are mostly farmers, cultivating crops on the slopes of the rain-fed mountains, with hardly a plain or arable land in sight in this difficult terrain. Baqir Ali is thankful to have the health center in the village: Koprok BHC has helped us a lot. In the past when our access to Bamyan Provincial Hospital was blocked during winter, many women from our village would lose their lives during labor. But this has changed and many of our health problems are treated here. The clinic s services have brought about significant improvements in health in the villages. Before its establishment, various illnesses remained untreated, children did not receive the requisite vaccinations, and the mortality rate among mothers and children was high. Villagers lacked basic health care awareness and did not know what to do in emergency health situations. Koprok BHC was established over 11 years ago and has been receiving financial support from the SEHAT Program since January 2014. SEHAT supplies quality medicine to the health center, which is given free to patients. It also provides staff salaries and helps with capacity building programs as well as equipment repair. Koprok Health Center has saved the lives of so many villagers. Before this clinic was built, patients would die on the way to hospital during the winter season because of road blockage. Sayed Habibullah, resident, Koprok village Quick delivery of health services A medical doctor and four nurses and midwives provide vaccinations, obstetrics and gynecology, and emergency services at the health center. It has a laboratory for the diagnosis of tuberculosis because of the high prevalence of the disease in Bamyan Province. Koprok Health Center has saved the lives of so many villagers, says Sayed Habibullah, 65, an elder from Koprok village. Before this clinic was built, patients would die on the way to hospital during the winter season because of road blockage. Koprok BHC has 12 health posts where 24 male and female volunteers work to raise villagers awareness of health care issues. As a result, villagers pay more attention to their health now. Women who previously delivered their babies at home are now visiting the clinic. Villagers now bring their under-fiveyear-old children for regular vaccinations. 4 ARTF Results Stories 4
CONTACT INFO World Bank Kabul Office Street 15, House 19 Wazir Akbar Khan Kabul, Islamic Republic of Afghanistan Telephone: +93 (0) 701 133 328 Wezi Msisha ARTF Coordinator wmsisha@worldbank.org All documents are available on http://www.artf.af 5 ARTF Results Stories 5