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 In addition, the outdated infrastructure, lack of critical amenities and facilities, and inadequate opportunities for medical training that are standard in most parts of Afghanistan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.

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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 the Future of the Bamiyan World Heritage Site

As one of Afghanistan’s two official World Heritage Sites, the Bamiyan Valley contains cultural and archaeological remains which make it a treasure to be safeguarded. Unfortunately, the site’s most famous cultural asset—the two colossal Buddha sculptures carved into the cliffs of the valley—was destroyed in 2001.

However, many efforts have been made since that time to preserve other aspects of the site. Today, an extensive rehabilitation plan, which includes the creation of a brand new cultural center, is currently in development.

The Site Remains Vulnerable

Despite these positive steps forward, the Bamiyan Valley remains vulnerable to threats such as environmental damage and security risks. This has resulted in its inclusion on a number of “at risk” lists, notably the list of World Heritage in Danger and the World Monuments Fund’s Watch List. Before the site can be removed from these lists, there is still a great deal of work to be done.

This question of what to do to ensure a safe and protected future for the Bamiyan Valley was the central focus of a recent three-day technical meeting. The event was organized jointly by UNESCO, the government of Afghanistan, and several other international partners. It was financially supported by the government of Japan.

Image by Johannes Zielcke | Flickr

International Efforts to Reinvigorate the Site

Held in December 2018, the meeting brought national and international experts together in Salah, Oman. The result was three productive days of dialogue and strategizing about the future of the Bamiyan World Heritage site.

Meeting participants also went on field visits to several Omani heritage properties, including the Land of Frankincense World Heritage site and the Al Baleed and Khor Rohri museums and interpretation centers. The purpose of these visits was to draw inspiration from these models and explore the elements of their management and operation plans that could be applicable to Bamiyan.

At the meeting, specific topics of discussion included:

The Current Status of the Bamiyan World Heritage Property

To improve communication and access to information, the meeting proposed that all of the technical information about the Bamiyan site (produced by UNESCO and other agencies and experts) be centralized into a single system. This could then be shared by Afghanistan’s Ministry of Information and Culture in order to facilitate better coordination among different stakeholders.

Such a system would make coordination around particular issues, such as illegal construction and land acquisition within the World Heritage property zone, much easier to implement. The meeting also recommended the establishment of a management plan and a relevant governance system for Bamiyan. Finally, conducting an inventory of Intangible Cultural Heritage that could then be integrated into national and local government databases was recommended.

Sustainable Development of the Bamiyan Valley

Much of the discussion on this topic focused on a few particular elements of a previously-created Bamiyan Strategic Master Plan, notably the traffic plan component and a bypass road. These developments are an important part of improving access to the site and increasing the quality of life for the local community.

In order to ensure that development will not interfere with future preservation and rehabilitation efforts, the meeting recommended that further technical, geological, and economic feasibility studies be undertaken. The meeting also stressed that future development plans in Bamiyan should be based on accurate GIS-based cultural mapping information, rather than on previous maps which are now outdated, but still occasionally in use.

Potential Rehabilitation of the Eastern Buddha Statue

At an earlier UNESCO meeting (held in Tokyo in September 2017), four technical proposals for the rehabilitation of one of the destroyed Buddha statues were presented. At the Oman meeting, participants supported the authorities’ decision to further investigate the suitability of these proposals. In the meantime, emphasis was placed on the importance of properly preserving the existing fragments of the Buddha.

Image by Regional Command East | Flickr

Opportunities and Challenges of Bamiyan Site Management

The meeting first recognized the recent efforts made by the government of Afghanistan to revise its 2004 National Law for the Protection of Cultural and Historical Properties to incorporate best practices based on international cultural conventions. The recommendation was made to accelerate the adoption of this revised law as well as to implement further regulations and guidelines as necessary to support the protection and promotion of Bamiyan.

There was also further discussion about how best to secure the proper financial and human resources to manage the site, and to implement proposed initiatives such as a museum and an archaeological park. Meeting participants encouraged the Afghan government to promote further outreach activities for an enhanced interpretation of the World Heritage site.

Donor Initiatives in Bamiyan

The Bamiyan World Heritage site, and its related preservation efforts and development activities, has received strong financial support from a wide variety of international donors. The meeting recognized and acknowledged the generosity of these donors.

The Italian Agency for Development Cooperation was a supporter of the project “Preservation and Promotion of the Bamiyan Valley through Culture-Oriented Sustainable Development.” The government of Japan was also recognized.

Featured Image by Johannes Zielcke | Flickr

This Afghan Village Is Famous for Its Amazing Pottery

The small Afghan village of Istalif lies about an hour’s drive north of Kabul. It is perched in the foothills of the Hindu Kush, whose tree-covered slopes rise sharply from the river below.

Istalif is not only a site of incredible natural beauty, it’s also home to a distinctive tradition of pottery-making that stretches back hundreds of years. Read on for a rare glimpse of the unique village of Istalif and its traditional ceramics.

Istalif was once an emperor’s favorite picnic spot.

With its blossoming trees, ancient gardens, and winding river, the village of Istalif has never been short of admirers. Perhaps the most famous of these was the great Mughal emperor Babur, a descendent of Genghis Khan, who captured Kabul in 1504 and ruled the region for decades afterward.

A man who spent much of his life on long and difficult campaigns, Babur was captivated by the peace and tranquility of Istalif. He bought a garden, the Bagh-i-Kalan, on the slopes above the river. This garden became his favorite place to come to recover from fighting and campaigning with picnicking and drinking parties. Later in life, Babur wrote of Istalif, “when the trees blossom, no place in the world equals it.”

According to legend, the potter’s community in Istalif was founded over 300 years ago.

While the history of pottery in Istalif has never been formally documented, local oral tradition has it that the village’s pottery tradition began more than 300 years ago. The founder of Istalifi pottery is said to be Sayed Mir Kolal. This potter from Bukhara (in present-day Uzbekistan) traveled to Afghanistan with his four sons in order to escape political upheaval.

When they reached Istalif and saw its rich clay deposits, abundance of water, beautiful surroundings, and easy proximity to the markets of Kabul, they knew they had found their new home. Today, Istalifi potters still believe that they are each descended from one of Mir Kolal’s four sons.

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Image by egerstner | Flickr

Pottery in Istalif is a family affair.

Given the story of its founding, it’s hardly surprising that the pottery tradition in Istalif is very much a family affair. The secrets of this art form have been passed down from father to son through many generations. From a young age, a family’s sons become potter’s apprentices, training daily with their fathers and uncles.

Every son is automatically considered part of the pottery clan. Even those that never master the art of throwing pots are still involved in the business (acting as salesmen for the family, for example), and are still considered to be “potters.”

The women of the family also take part, applying the glaze and engraving the intricate patterns on the shaped pieces. Today, there are around 50 or 60 families of potters in Istalif. For each of them, pottery is much more than just a profession: it is their very identity.

Istalifi ceramics are known for their distinctive glaze.

The most unique feature of Istalifi ceramics is the special turquoise glaze that is applied to the finished pieces. Made from ishkar, a type of mountain plant only found in certain provinces in northern Afghanistan, this glaze was central to the development of Istalif’s distinctive ceramic tradition.

To produce the glaze, the root of the ishkar plant is burned and the ash is ground into powder. This is then mixed with water and combined with quartz and copper oxide (both of which are easily sourced from the area around Istalif). The resulting mixture, a striking, sea-green glaze, is then used to cover the ceramics after firing.

Istalif was almost destroyed in the late 1990s.

Istalif’s status as a renowned center for ceramics is all the more incredible given the village’s tumultuous past. Istalif was destroyed (for the third time in its history) as a result of the conflict in the late 1990s.

The village itself was burned to the ground, and the residents were forced to flee. Before they left, however, many families secretly buried their pottery tools in the hopes that they would one day return to their homes and businesses.

The village is rebuilding itself and its arts and crafts traditions.

Happily, the renaissance that these exiled Istalifis hoped and planned for has indeed come to pass. Over the past 15 years, potters and their families have been slowly returning to Istalif and taking up their tools once more.

These resilient people have been helped in their efforts to rebuild their artisanal community by organizations like Turquoise Mountain. One of the most important NGOs focused on traditional arts and crafts in Afghanistan, Turquoise Mountain has worked closely with Istalifi potters to revive the village’s ceramic traditions, and to find new markets for its work.

Today, ceramics instruction is one of the main subjects at the Turquoise Mountain Institute. Faculty include Istalifi potters like Abdul Matin Malekzadah and Ustad Abdul Matin.