Village Clinic in Northern Afghanistan Provides Frontline Health Care

ULGATO VILLAGE, Balkh Province – In this tiny Afghan village, people seeking medical help find it behind a delicate lace curtain decorated with peacocks. Draped over the door of a traditional dome-roofed, mud-baked home, the decorative white curtain is Dr. Ahmed Seyarr Rahimi’s way of welcoming patients from the village of Ulgato to his clinic. Outside, harsh desert-like conditions create a stark contrast.

“It is a difficult life for people here,” says Rahimi, 30. “Many are very poor and coping with big problems. I just want them to know we’re here to help.” Rahimi and his sister-in-law Nooria, a midwife, are the only staff at Ulgato’s sub-medical clinic, which opened six years ago. Together they serve a population of about 4,300 people, generally treating about 35 patients every day, says Rahimi.

“People really like us because we try to work hard for them, and they come here just as they would come to a house, not a clinic,” says Nooria.

The sub-clinic, Ulgato Village clinic, is located down a winding desert lane about 45 kilometers east of Mazar-i-Sharif in Afghanistan’s northern Balkh province. The small clinic is operated by the Afghan NGO - Coordination of Humanitarian Assistance (CHA) contracted by the Ministry of Public Health (MoPH) with support from the World Bank and 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.

Afghanistan has made impressive progress in the health sector in the past decade. Deaths of infants, children younger than five, and pregnancy-related mortalities have already 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, primarily, 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.

Care and counselling

The Ulgato sub-clinic is the first link in the chain of medical care available in Kholm district.

Each day, Rahimi and his sister-in-law commute from Mazar-i-Sharif to run the little clinic out of two small rooms embellished with straw and mud in the traditional way. There is no electricity at the facility. Medical equipment must be battery operated.

Under the clinic’s low curved ceilings, the pair offers basic medical care: injections, medicine, birth control counseling, and help and advice for mothers with babies.

“This is the first step for them,” explains Rahimi. “We are doing all the small things for people, not operations. We are explaining everything about different diseases and if we can solve the problem, we do. But if they need to go to the district hospital, we send them there.”

Nooria, a trained midwife, delivers babies and works with women who are not allowed to seek treatment from a man. Many people in the village eke out a living by harvesting clumps of fragrant cactus brush from the nearby mountains, or have relatives working in places like Iran. Poverty is a fact of life here that also gives rise to a range of health problems, says Rahimi.

Often, people will come in complaining of headache, stress, or an inability to sleep, but after other potential causes are ruled out, Rahimi provides psychological counseling to help them. “Here, stress is caused by so many things,” he explains. “It could be living in a big family, or having so many babies, or husbands going away to Iran to work. Maybe there is a marriage that’s not wanted, or everyone is sleeping in one room.” The ongoing threat of violence in Afghanistan after 30 years of war is also frequently an issue, he adds. “Definitely everybody worries about security, even those who have a good life.”

Rahimi says he really enjoys the range of medical challenges that the patients present. “I do like this work. We are helping so many poor people who really need us the most.”