Rural Hospital Saves Lives in Northern Afghanistan

KHOLM, Balkh Province – Pampered and propped on a blue silk embroidered pillow, baby Beheshta (meaning ‘Paradise’) looks ready to live up to her name.

She is just one day old, but little ‘Paradise,’ already has a circle of adoring admirers.

Her five-year-old brother, Mudaser, carefully waves a sea-green fan to cool her, while her grandmother, Del Jan, has drawn a thin black beauty mark between her eyes for extra blessings. A delicate veil is draped over her to ward off errant insects and her mother, Laila, 32, looks on satisfied, knowing Beheshta has arrived safely in the world, thanks to the doctors, nurses and midwives at Kholm District Hospital in Afghanistan’s Balkh province.

“She is our great gift,” says Laila. “We are very lucky to have her with us.” “My blood pressure was very high, and I was afraid of giving birth at home,” she explains. “I had lost one baby before and a neighbor suggested this place. She said it’s free, with very good people.” Ultimately, doctors had to deliver Beheshta by Caesarean section. “Now we are very happy. This is a very good place,” Laila says.

The 54-bed hospital, located about 60 kilometers east of Mazar-i-Sharif, serves a district of approximately 120,000 people. Originally a basic clinic, the Ministry of Public Health (MOPH) gradually upgraded the facility to a hospital since 2004 with support from the World Bank and the Afghanistan Reconstruction Trust Fund (ARTF)’s Strengthening Health Activities for the Rural Poor (SHARP) project and the System Enhancement for Health Action in Transition (SEHAT) program.

The programs’ objective is to expand the scope, quality and coverage of health services provided to the Afghan people, particularly the poor, women and children in 22 provinces, and to support the MOPH’s efforts at stewardship.

Widespread access to basic health services

Afghanistan has made impressive progress in the health sector during the past decade. Deaths of infants, children younger than five, and pregnancy-related mortalities have dropped dramatically. With World Bank support in 11 provinces, the number of health clinics has nearly tripled from 148 to 432, and 85 percent of the population now live in districts where basic health services are provided.

At the administrative level a clear separation of functions between service provision and its financing is one of the factors contributing to the success story.  This separation was made possible through contracting, of health services primary care services to NGOs by MOPH such that the latter assumed full responsibility for service delivery and the government “purchases” health services from the NGOs and exercises its stewardship functions over the sector.  The NGOs are selected on competitive basis and the provision of services by NGOs is monitored through the regular MOPH on quarterly basis and through facility assessment carried out by an independent third party on annual basis.

Before the hospital was upgraded at Kholm to offer emergency care, obstetrics, pediatrics, gynecology, basic surgeries and a range of other services, “sometimes people were dying because they had to go 60 kilometers for help in Mazar,” points out Himat Jalal, SHARP project supervisor for Balkh province.

Now at Kholm, SHARP pays the salaries for about 38 staff, and provides medical testing services such as X-ray imaging and ultrasound scanning, as well as vaccines and medicines.

In March 2013, the hospital treated about 3,700 outpatients and more were admitted for surgeries, baby delivery, and other care, says Jalal.

The Kholm hospital has become an essential feature in the area that for centuries was traversed by camel caravans following the ancient serais, or Silk Road trading routes between China, India, and Europe.

Emergency services save lives

Another new mother, Tahera, 20, fears she or her baby, Asma, would have died if their family had not rushed them to the hospital, or instead made a longer trek to the capital. “I was trying for more than two days with bad pain to deliver my child, but nothing,” recalls Tahera. “But I think the doctors here saved us.”

In a nearby recovery room for male patients, eight-year-old Shafiullah was sleeping off sedatives given for an emergency appendectomy by Dr. Zaheer Saber. Shafiullah’s mother brought him from a distant village when he came home from school with fever, nausea, and sore stomach, Saber says.

“Now, we are better able to help people with these emergencies, and can often save lives,” he says.

In charge of all these activities is Dr. Maliha Aziz. Despite her country’s conservative attitude toward women, Aziz says hospital staff chose her to be their chief medical officer.

“It is not difficult to be the boss as a woman in this place,” Aziz says. “When I come to work, I always feel part of the team. To me, being male or female is not important, and our staff respects each other a lot.”