Quality Health Care Reaches Villages in Afghanistan’s Mountainous Daykundi Province

NILI DISTRICT, Daykundi Province – Malika, 40, sits on the chair beside the doctor, describing a problem she’s been having with her lungs. Her breaths are labored and she speaks slowly. It is early morning and the Shish Basic Health Center (BHC) is still quiet, the corridor empty.

Today, Malika has walked two hours to reach the health center. The doctor writes her a prescription and advises her to exercise every day and to eat fruit and vegetables. “I have had a problem with my lungs for two years,” says Malika, a resident of Jan Mohammad village. “The quality of medicine that I receive from this health center is much better than other medicines that are sold in pharmacies in the market.”

As there are widespread quality control problems with domestically produced pharmaceutical drugs in Afghanistan, the health center imports medicines from the Netherlands to ensure patients have access to high quality prescription drugs.

The whitewashed health center is the only concrete building in Shish village, which lies in Nili district in Daykundi in central Afghanistan. It was founded in 2006 and operates with a staff of seven, including nurse, midwife, vaccinators, cleaner, and guard, from 8 am to 4 pm daily. Shish BHC covers an area of nearly 20,000 people, most of whom earn their income through agriculture.

Health services at Shish BHC is provided by Première Urgence-Aide Médicale Internationale (PU-AMI), a French nongovernmental organization (NGO), which has been contracted by the Ministry of Public Heath (MoPH). The contract is one of several performance-based partnership agreements between MoPH and NGOs to deliver a defined packages of basic health services and essential hospital services under the ministry’s System Enhancement for Health Action in Transition (SEHAT) Program. The provision of services by NGOs is monitored through the regular health management information system, and a third party.

SEHAT aims to expand the scope, quality, and coverage of health services provided to the population, particularly for the poor. It 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.

Strong coordination

Before the implementation of SEHAT in Daykundi in 2014, health centers faced many challenges, including shortage of medication and properly trained staff. A mountainous province, Daykundi faced especial difficulties in transporting medication to health centers during the winter. In some parts of the province, transportation problems affected delivery of adequate medicines for urgent health cases in specialized centers from the provincial capital, Nili.

Many of these problems have been resolved since under SEHAT. Through SEHAT, PU-AMI delivers medication every six months to health centers that lie far from Nili and face a potential shortage during the winter months.

“The coordination between health centers and the organization that provides health facilities has become much better than it was in the past,” says Dr. Ahmad Fahim in Daykundi. “We hold meetings regularly with doctors, the MoPH directorate, and the local people. It helps us to deliver high quality health services successfully across the province.”

Community engagement raises awareness

Since the implementation of SEHAT in Shish village, the health center has worked to establish a health-minded community, engaging locals on health issues and educating them about diseases and other health-related risks. Every month, health center staff hold meetings with the villagers, and the health center hosts regular seminars and workshops.

These programs are an opportunity for villagers to interact with each other, discuss health issues and take information home to share with their families. “We learn a lot from workshops and meetings,” says Safar a member of the Health Community Council (HCC). “We are satisfied with the health center services, most of our health problems are addressed at the center and we do not need to walk as far as we did.”

The center also has 15 health “posts” in nearby villages, where a male and female volunteer engage in community outreach and give basic medical advice. “Our health posts work closely with the villagers,” says Dr. Ghulam, 34, a medical officer. “People’s awareness of health issues is much better than five years ago. Villagers refer their health issues to the health center and the rate of disease is low.”

The health posts work to raise public awareness through public outreach campaigns, which include health campaigns in mosques and door-to-door visits to distribute health-related information. The work of the health centers has contributed to an increasing trust in institutional health services in the province. “Many years ago it was a big shame for a woman to come to a health center for childbirth or family planning,” says Monwar, 35, a vaccinator. “Now, most of the births are delivered in the health center and people’s health awareness has improved.”