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.