Afghanistan Residents Benefit from Improved Quality Healthcare in Balkh Province

KHULM DISTRICT, Balkh Province – Winter announces itself with a soft snowfall. The sidewalks are empty but some people walk across the yard of a hospital. Inside the hospital, one can hear whispers of congratulations—it is a special day for Bibi Sediqa, she has just become a grandmother.

“Luckily for the first time my daughter’s child survived. She had always lost her child immediately after birth. I just thank God for having a good hospital and doctors,” the beaming grandmother says. Bibi, 60, is one of many happy faces in the Khulm District Hospital (DH). She came with her daughter from Balkh Province.

A bukhari (wood-fueled heater) warms the neonatal and obstetrics section, which houses new mothers and women in labor. Bibi Sediqa sits close to her daughter’s bed as the doctor checks her daughter’s documents and provides counsel on neonatal childcare.

Khulm DH is a 50-bed hospital, located in Khulm district, 60 kilometers from Mazar-e-Sharif city in Balkh. Founded nearly half a century ago as a small health center, Khulm DH is one of 90 health facilities in the province. The hospital provides free health services through the System Enhancement for Health Action in Transition (SEHAT) program for more than 75,000 people in the district.

The hospital has been receiving support under the SEHAT program since January 2014. It has expanded capacity since 2002 and employs 41 healthcare professionals, including doctors, vaccinators, midwives, a dentist, a physiotherapist, laboratory technicians, and support staff. 

SEHAT, under the umbrella of the Ministry of Public Health (MoPH), 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. 

SEHAT supports the provision of Basic Package of Health Service (BPHS) and Essential Package of Hospital Services (EPHS) to the entire country. The services are implemented through performance-based partnership agreements between MoPH and nongovernmental organizations (NGOs), which deliver health services as defined in these packages. The health services at Khulm DH and the other 89 health facilities in Balkh Province are implemented by an NGO named Bakhtar Development Network (BDN) contracted by MoPH. 

Holistic approach to healthcare

SEHAT seeks to develop the overall healthcare ecosystem and is a holistic program. In addition to supporting the health facilities, SEHAT has set up 814 health posts in Balkh Province. “Through the health posts, we have raised health awareness among people, especially the poorest of the poor,” says Dr. Abdul in Balkh Province. “One could say that health posts act as a bridge between health centers and the people.”

Each health post is manned by two volunteers —a man and a woman. They work on the ground to raise awareness of diseases and preventive actions, such as vaccinations, and act as the first point of contact to treat simple diseases and administer emergency first aid. They are also the main points of patient referral to health centers. “The volunteers are the ones who go in to the villages and represent us,” says Dr. Abdul. “We support all of our staff, especially the volunteers in the health posts because they are the ones strengthening the connection between the community and health centers. Now most people access quality health care by visiting the health centers.”

Under SEHAT, the quality of healthcare has been raised with the help of more modern medical equipment. “One of the main benefits of SEHAT support has been the modernization of medical equipment in the hospital,” says Dr. Maliha. The hospital has been equipped with an anesthetic machine, an incubator, surgical sets, an electrocardiogram, and dental equipment.

In addition to equipment, SEHAT has also extended service support, such as insulating the X-ray room. These facilities have had a visible impact on the quality of services and delivery of care in the hospital. The hospital’s emergency wing is also equipped to handle accidents from the Kabul–Mazar-e-Sharif highway. On a daily basis, the hospital provides health services to an average of 180 patients. 

Saifurahman, 50, who has come to Khulm DH with his wife for her antenatal examination, expresses his satisfaction with the quality of service.  “All the women from my village come to the hospital for childbirth, vaccination, family planning, and other health issues, especially in recent years. This was not so in the past,” he says. “The doctors treat us well, the medicines are good and we are content. We are very happy to see our hospital is getting better day by day.”

Dr. Maliha points out that even people from other districts are coming to the hospital because of the quality of healthcare, “As people are being treated effectively and they find the hospital equipped, we are receiving patients from adjacent districts, such as Sholgar and Balkh, as well as from nearby areas of Samangan Province.”