This New Project Is Improving Health Care Quality in Afghanistan

As Afghanistan works to rebuild itself after many years of conflict, the country’s health care system remains an area of concern. Despite recent significant improvements, access to health care remains a challenge for many Afghans, particularly those living in remote or rural communities. In addition, the outdated infrastructure, lack of critical amenities and facilities, and inadequate opportunities for medical training that are standard in most parts of Afghanistan mean that it can be difficult for providers to deliver health care beyond the most basic services.

However, Afghanistan’s health care system is set to get a major boost over the next few years through the Sehatmandi Project, a large-scale program launched in the summer of 2018 that aims to improve access to and quality of health care services across the country. Here are four things you need to know about this important project.

It will cover the entire country.

Many of the development programs or initiatives that deal with health care in Afghanistan do so in very targeted areas, often concentrating either on Kabul or on rural areas in the north of the country. The Sehatmandi Project is exceptional in that its scope includes 31 of Afghanistan’s 34 provinces. This means that Afghans all around the country will be able to benefit from the cohesive and holistic improvements to Afghanistan’s health care system that the project aims to implement. In addition, some of the project’s key focus areas include offering underserved populations beneficial services such as nutrition management and family planning programs.

afghanistan

It is supported by a variety of national and international partners.

The Sehatmandi Project is a major, multi-year initiative with a budget to match: the total cost for the program’s three years of operation is estimated at US$600 million.

This cost will be covered by grants from three major funding entities:

The Afghanistan Reconstruction Trust Fund (ARTF)—Established in 2002, this multidonor trust fund is supported by 34 international donors under the overall management of the World Bank. It is one of the most important entities supporting Afghanistan’s ongoing rebuilding and development process.

The International Development Association (IDA)—Another arm of the World Bank, the IDA provides loans and grants to some of the world’s poorest countries, with the aim of boosting economic growth and lifting these nations out of poverty.

The Global Financing Facility (GFF)—This multi-stakeholder partnership helps governments of low- and lower-middle income countries to prioritize and finance their citizens’ health and nutrition.

In addition to these three major funders, the Sehatmandi Project involves many other administrative and operational partners, including Afghanistan’s Ministry of Public Health and Health Works, a global NGO based in the Netherlands.

It aims to build on the successes of a previous program.

The Sehatmandi Project is a follow-up to the System Enhancement for Health Action in Transition (SEHAT) program, another initiative operated by Afghanistan’s Ministry of Public Health and supported by IDA and ARTF.

Running from January 2014 to June 2018, SEHAT aimed to expand the scope, quality, and coverage of health care services provided to Afghans, especially vulnerable and underserved populations. A key goal of SEHAT was to allow health facilities across Afghanistan to deliver a basic package of health service (BPHS) and an essential package of hospital service (EPHS). The successes of the SEHAT program have laid an important foundation for the Sehatmandi Project, which can now pick up where the earlier program left off and take its accomplishments to the next level.

Some of the most important achievements of the SEHAT program include the following:

Better health services in Nangarhar province—SEHAT oversaw new health initiatives in each of Nangarhar province’s 22 districts. For example, with the support of the SEHAT program, personnel at the Kama District Hospital were able to upgrade their skills and provide better care to patients, and the hospital itself received a second ambulance and a power generator.

The Kabul Urban Health Project—The Rahman Mina Hospital, a Kabul hospital that serves hundreds of thousands of the city’s residents, benefited from extensive renovations and new equipment provided under SEHAT. In addition, the hospital was able to increase its supply of critical medicines, and hospital staff received training on a new health management information system, which improved the facility’s operational efficiency.

It now includes a pay-for-performance component.

In early 2019, Aga Khan Health Services (AKHS) took over the management of health care facilities in two Afghan provinces under the umbrella of the Sehatmandi Project. In this new role, AKHS will be responsible for two provincial hospitals, five district hospitals, 24 comprehensive health centers, 158 basic and primary health centers, and more than 1,000 village health posts in the provinces of Bamyan and Badakhshan.

Interestingly, AKHS plans to operate its portion of the health system using a pay-for-performance model, which will see health service providers compensated for meeting pre-established benchmarks, including numbers of antenatal and postnatal care visits, numbers of immunized infants, and quantity and quality of major surgeries.

A Look at 5 Charities That Aim to Help Afghans with Disabilities

A growing number of organizations are seeking to make life easier for Afghans with disabilities. Recognizing that Afghanistan is not the most easily accessible place for people with disabilities, these organizations aim to integrate these vulnerable individuals into Afghan society, which offers little in the way of infrastructure or systems to facilitate the daily lives of those with mobility difficulties or visual impairments. In addition, there are few services in Afghanistan that provide assistance and support to people with disabilities. However, the following organizations are seeking to ensure that Afghans with disabilities obtain the assistance that they need.

1. Humanity & Inclusion

Humanity and Inclusion

Formerly known as Handicap International (and still operating programs in Afghanistan under this name), Humanity & Inclusion (HI) has been working in Afghanistan for more than 30 years. Focused primarily on helping people injured by landmines, the organization accomplishes its mission in two ways. The first is through the direct provision of assistance and other support services. At its rehabilitation center in Kandahar, for example, HI offers physiotherapy sessions and produces support equipment such as prostheses and mobility aids. The second way is through extensive advocacy work: HI works with the government of Afghanistan and other national institutions to improve access to care for people with disabilities and to ensure that action plans based on the Convention on the Rights of Persons with Disabilities are properly coordinated. HI also supports local—often smaller—disability rights organizations by connecting them with potential partners and raising their concerns with local political leaders.

2. Tearfund

Tearfund

Based in the UK, Tearfund is a charity whose international work seeks to lift people out of poverty, overcome the effects of disasters, and deliver support to some of the world’s most vulnerable and marginalized populations. Since 1971, Tearfund has been supporting humanitarian work in Afghanistan. Active in 10 Afghan provinces, the charity partners with five local organizations to deliver its programming. One of its key focus areas is advocating for Afghans with disabilities. Through this work, Tearfund seeks to transform attitudes and end the stigma surrounding disabilities, as well as establish inclusive communities where people of different ability levels can live together on equal footing. In addition, the charity runs educational support programs and works with one of its local partners to help Afghanistan develop a more inclusive educational policy. As a result, more children with disabilities are now attending school than ever before.

3. Development and Ability Organization (DAO)

Development and Ability Organization

Founded in 2004, the Afghan-led DAO is one of the organizations recently certified by the Afghanistan Institute for Civil Society. A vocal advocate for disability rights, DAO aims to build a more inclusive society by increasing awareness of disability issues among the general public and the Afghan government. The organization’s current projects include physical rehabilitation activities, community dialogue initiatives, and the publication of a disability issues newsletter in three languages. In the future, DAO intends to expand its activities to include providing small support loans to people with disabilities and creating vocational training programs so that people vulnerable individuals can acquire vocational skills and earn an income.

4. Children in Crisis

Kids in Crisis

With the mission of bringing education, care, and protection to the world’s most vulnerable children, the UK nonprofit Children in Crisis has considerable experience working in remote regions. In Afghanistan, some of the “forgotten” children who are most in need are those with disabilities. Many families in Afghanistan simply don’t have the resources or knowledge to provide proper care and support to children with disabilities. As a result, it’s not uncommon for them to experience neglect, abuse, and even abandonment. In order to address this issue, Children in Crisis runs the In-Home Care Project, which aims to provide the families of children with disabilities with the resources and tools they need to become better caregivers. The program staff works with parents and family members to develop a personal care plan for each child and to provide initial medical care, physiotherapy, and materials. Ultimately, through the project’s training, families will be better equipped and capable of handling these responsibilities themselves.

5. Afghanistan International Foundation for the Blind (AIFB)

AFIB logo

Founded in 2009, AIFB is committed to its mission of improving and enhancing the lives of those Afghans in need affected by blindness. By collaborating and partnering with other international organizations, AIFB offers services and programs in the areas of education, health, rehabilitation, and community services for people affected by blindness and visual impairments. AIFB’s vision includes the use of Braille books and blind-based computer technologies in Afghan classrooms, services to help people with blindness to access employment and higher education, and support for prescriptions and health procedures.

Spotlight on the Swedish Committee for Afghanistan

The Swedish Committee for Afghanistan (SCA) has been in existence for more than 35 years. Its goal is to bring support and stability to Afghans who are struggling with the impact of war and violence on their country and their communities.

The organization is committed to maintaining operations in the country as long as necessary. The SCA currently serves as the second-largest channel for the development aid that is provided to Afghanistan by the Swedish government. Read on to learn more about the SCA and its activities in Afghanistan.

 

What is the SCA all about?

SCAlogoThe SCA was originally founded in response to the Soviet invasion of Afghanistan in 1979. In the early 1980s, the SCA was largely focused on raising funds for humanitarian support. It engaged in relief activities like providing essential health care and education to refugees and residents of occupied Afghanistan.

Over time, the SCA gradually expanded its work beyond the delivery of basic humanitarian services. It became a development organization with a much broader focus.

Today, the SCA’s vision is of an Afghanistan that is free from poverty, violence, and discrimination, where all citizens can live in dignity and enjoy equal opportunity and social justice. Supporting this vision are the SCA’s 12,000 members and individual donors in Sweden as well as the more than 6,000 Afghan employees who implement the SCA’s programs in 14 Afghan provinces.

 

What kinds of activities and programs does the SCA operate?

The organization aims to support some of Afghanistan’s most vulnerable groups, including children, people with disabilities, and rural and remote communities. The SCA operates programs and activities across four major focus areas:

 

  1. Healthcare

Access to healthcare and health outcomes in Afghanistan have improved in recent years. Despite this, the country’s health situation still remains a major challenge.

At present, the SCA is responsible for providing healthcare services and building healthcare capacity in Laghman province and Wardak province. In Afghanistan, it is typical for basic healthcare to be provided primarily by non-governmental organizations on a province-by-province basis.

Particular initiatives include conducting community-based health and hygiene education campaigns; training more health care providers, particularly midwives; and increasing health care access for people with disabilities.

Highlights from 2017 include: performing 2.6 million patient consultations; giving immunizations against diphtheria, tetanus, hepatitis b, and polio to 50,000 children under the age of 5; providing maternal care to more than 44,000 women; and establishing 31 more health clinics in the two provinces.

 

  1. Community Governance

In the Afghan countryside, many local communities have severely restricted opportunities for residents to effect change, make their voices heard, and assert their rights. This is the result of conflicts, corruption, and mismanagement at the municipal level.

To help empower these communities and their residents, the SCA works all around Afghanistan. It builds the capacity of local decision-making bodies and provides education and training to local authorities.

Highlights from 2017 include: providing support to nearly 370 community development councils, which in turn implemented 65 local projects; offering training in service delivery and community rights to members of local government; and conducting social audits of community projects in three provinces.

 

  1. Rural Livelihood

Rapid urbanization has taken place in Afghanistan over the last decade. Despite this, an estimated 75 percent of the country’s population still lives and works in rural areas. Unfortunately, many of these rural citizens, especially those in remote or isolated communities, are among Afghanistan’s most vulnerable people.

As a result of conflict, difficult environmental conditions, and natural disasters, poverty is endemic in most rural areas. As a result, the potential for long-term self-sufficiency is very limited.

To help rural citizens build secure livelihoods for themselves and their families and access new sources of income, the SCA facilitates the formation of self-help groups. These groups can save money together, develop business partnerships, and exchange knowledge and skills.

The SCA also provides practical, hands-on training in potentially income-generating activities such as poultry farming, vegetable farming, soap making, tailoring, and carpet weaving.

Highlights from 2017 include: forming over 200 new self-help groups; establishing 32 village-based saving and loan associations; granting micro-loans to more than 2,500 rural households; conducting an impact study revealing that previous loan recipients increased their household income by almost 29 percent.

 

  1. Education

Education is one of Afghanistan’s most important priorities. The SCA is just one of many organizations working to improve access to and quality of education for children all across the country. As a result of concerted efforts by these organizations and the government of Afghanistan, more Afghan children are attending school than ever. At present, nearly 70,000 children go to SCA-run schools.

Highlights from 2017 include: a 5 percent increase in the number of children enrolled in SCA primary schools; construction of seven new school buildings, 20 washrooms, and one resource center; the provision of special education to more than 1,600 children and adults with disabilities; and mainstream school inclusion for 600 children with physical disabilities and 2,000 children with intellectual and developmental disabilities.