FEATURE STORY October 23, 2017

Partnering to Improve Healthcare in Afghanistan

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Dr. Adam’s Clinic is one of 51 health centers in southern Kandahar province that provides basic package of health services since 2015. With support provided by the SEHAT Program, the clinic offers general check-ups, gynecology and obstetrics services, laboratory facilities, vaccination, and a pharmacy for about 200 out-patients on daily basis. 

Photo Credit: Rumi Consultancy/ World Bank


STORY HIGHLIGHTS

  • Performance-based partnership with the Ministry of Public Health have improved healthcare coverage and quality in Kandahar Province.
  • Non-governmental organizations are contracted to deliver basic healthcare and essential hospital services through the System Enhancement for Health Action in Transition (SEHAT) Program.
  • Medical staff can receive training, access peer-learning, and share best practices.

KANDAHAR CITY, Kandahar Province – The doctor gently places the diaphragm of his stethoscope on the child’s chest. The little girl looks at the stethoscope curiously but says nothing, while her mother, Sharifa, 50, holds her arm so that the doctor can easily examine her.

He completes the check-up and writes a prescription, telling Sharifa to administer the medication periodically to lower her daughter’s fever.

“Until recently, we did not visit a medical doctor and had always used home remedies,” says Sharifa. “But we switched to coming to the clinic when we learned that the doctors are from our community and their medications are good quality.”

The doctor, Sayed Massoom Nabizada, is the director of Dr. Adam’s Clinic in the ninth district of Kandahar city, the capital of Kandahar Province. Along with 17 colleagues, Dr. Nabizada provides daily health care services in the clinic from 8 am to 4 pm, seven days a week. The clinic serves a local population of 32,000 people, offering general check-ups, gynecology and obstetrics services, laboratory facilities, vaccination, malnutrition treatment, and a pharmacy. An average of 200 patients visit the clinic every day.

Dr. Adam’s Clinic is among a group of health centers that has come under the supervision of the Bu Ali Rehabilitation and Aid Network (BARAN) since July 1, 2015. BARAN provides health care services and monitoring oversight for 51 health centers in the 17 districts of Kandahar Province.  It is a non-governmental organization (NGO) that works in Kandahar to provide a basic package of health services, contracted by the Ministry of Public Health (MoPH) under the System Enhancement for Health Action in Transition (SEHAT) Program. The services are implemented through a performance-based partnership agreement between MoPH and BARAN.

SEHAT aims to expand the scope, quality, and coverage of health services provided to the population, particularly for the poor and is supported by the International Development Association (IDA), the World Bank Group’s fund for the poorest countries, and the Afghanistan Reconstruction Trust Fund (ARTF), in partnership with multiple donors.


"The rate of delivering quality health services for most of the organizations that implement the SEHAT program in the 34 provinces of Afghanistan is satisfactory and on-track."
Dr. Khwaja Mir Islam Saeed
Head of MoPH Grant and Services Contract Management Unit

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Quality and coverage of health services has increase significantly by providing basic package of health services and essential hospital services through performance-based partnerships between Ministry of Public Health and Non-governmental Organizations. 

Photo Credit: Rumi Consultancy/ World Bank


Under SEHAT, a package of basic health services and of essential hospital services have been made available across the country by contracting NGOs, like BARAN, to deliver the services defined in the package. The procurement and contract management for NGO services are carried out by the MoPH Service Procurement and Contract Management Directorate, and service provision is monitored through the regular health management information system and through facility and community surveys carried out by a third party.

“The rate of delivering quality health services for most of the organizations that implement the SEHAT program in the 34 provinces of Afghanistan is satisfactory and on-track. This would not have been possible without close coordination,” says Dr. Khwaja Mir Islam Saeed, Head of MoPH Grant and Services Contract Management Unit. “We can see that coordination at work in Kandahar too.”

Training Brings Benefits

As part of the SEHAT program, BARAN has provided training, supplied medications, paid staff salaries, and provided various other resources to Dr. Adam’s Clinic. Overall, BARAN has been conducting short-term training workshops for staff members in all 51 health centers in Kandahar Province. These trainings cover various topics, such as malnutrition management, vaccination, and tuberculosis prevention.

“Training always brings benefits,” says Dr. Nabizada. “Holding training workshops help doctors, nurses, and midwives learn about topics that they are less informed about.” Some of the training that is held in BARAN’s office in Kandahar city also enables peer-learning and sharing of best practices among health workers in different clinics.

 

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“Now that we have scored good achievements in the coverage of health services, our focus in the coming years will be on improving the quality of health care services,” says Dr. Miraz Khan Basharmal, head of the SEHAT program for BARAN in Kandahar. Photo Credit: Rumi Consultancy/ World Bank

A total of 28 women from Kandahar Province are currently undergoing training in the Community Midwifery Education (CME) program while 22 women are in the Community Health Nursing Education (CHNE) program. They will graduate by November 2017 and join the SEHAT program as professional midwives and nurses in Kandahar. “Recruiting midwives and nurses from the province will increase people’s trust in a health center,” says Dr. Miraz Khan Basharmal, head of the SEHAT program for BARAN in Kandahar.  “It will also provide employment opportunities for women. Since the midwives and nurses will be from the area, they will be easily accessible as well.”

Graduates from these education programs will help meet the need in many clinics in the province, where women often have to travel long distances for health care and delivery. “Before 2016, there was no midwife during the night in the health center and people had to travel more than 100 kilometers to reach a hospital in Kandahar city,” says Marzia, 28, a midwife in Haidera Comprehensive Health Center in Haidera village in Arghandab district.

Haidera village was one of the more conservative villages, where it was not common for women to work at night. However, people rallied support around the SEHAT program and BARAN hired a midwife for the night shift. “Since BARAN hired one more midwife in the health center, the midwifery section is open during the night too and the number of women who come here for childbirth has increased,” Marzia says.

After having achieved good coverage of health services, the focus will now be on improving the quality, according to Dr. Basharmal. “Now that we have scored good achievements in the coverage of health services, our focus in the coming years will be on improving the quality of health care services,” he says. 



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