In Eastern Afghanistan, Thousands Enjoy Better Healthcare

from World Bank
Published on 03 Dec 2018 View Original


  • Thousands of Afghans in Nangarhar province have benefited from better health services and facilities under the SEHAT program.

  • Implemented in the Kama District Hospital, the program provided a package of basic health services to patients and helped health personnel upgrade their skills.

  • The Kama District Hospital is one of 100 health facilities that provided health services in sometimes challenging circumstances.

KAMA DISTRICT, Nangarhar Province – Gulab Zarin had come to the Kama District Hospital for her monthly routine check-up. Her last visit to the health center was very different. “While cooking in the kitchen, I stopped breathing and my vision went dark. When I woke up, I was on a hospital bed,” says Zarin, 41, who has asthma.

On this day, the mother of five was sitting on a bed in a quiet, warm room with walls covered with informational health posters. A female doctor gently adjusted the blood pressure monitor on her arm. “Every time I come here, doctors are so respectful and care about us. My neighbors and I are so pleased.” said Zarin, while taking a prescription from her doctor.

As the day progressed, more and more patients arrived by foot, car, and motorcycle to Kama District Hospital. The hospital serves a population of more than 80,000 in Kama district, Nangarhar province, in eastern Afghanistan. The different sections of the 50-bed hospital provide services for emergencies, surgery, outpatients, nutrition, midwifery, and vaccinations, among other services. The 56-strong staff delivers health services to 700 patients daily. On average, 400 newborns are delivered, and more than 170 minor operations are carried out each month.

Kama District Hospital, established in 2009, was one of over 100 health facilities in Nangarhar province that provides a Basic Package of Health Services (BPHS) under the Ministry of Public Health’s (MoPH) System Enhancement for Health Action in Transition(SEHAT) program. From January 2014 – June 2018, the Agency for Assistance and Development of Afghanistan (AADA), a nongovernmental organization, implemented the SEHAT program in the 22 districts of Nangarhar province under the overall stewardship of the MoPH.

Closed in June 2018, SEHAT aimed to expand the scope, quality, and coverage of health services provided to the population, particularly vulnerable groups. It was supported by the International Development Association (IDA), the World Bank Group’s fund for the poorest countries, and the Afghanistan Reconstruction Trust Fund (ARTF), administered by the World Bank on behalf of 34 donors.

The improvement in delivery of BPHS and EPHS will continue under MoPH’s Afghanistan Sehatmandi Project, which came into effect in July 2018. The project aims to increase the utilization and quality of health, nutrition, and family planning services across the country. It works to strengthen the health system and its performance, as well as to increase demand and community accountability for key health services. The project is supported by the ARTF, IDA, and the Global Financing Facility (GFF), a multi-stakeholder partnership that prioritizes high impact but underinvested areas of health.

Update Knowledge and Skills

The implementation of SEHAT in Nangarhar benefited both the community served by the hospital as well as its medical staff. Dr. Mohammad Mashal Stanekzai, head of Kama District Hospital, was among those who benefited from the trainings provided by SEHAT. He says the trainings equipped health center staff with updated knowledge and skills. “For instance, the doctors in Kama District Hospital did not know much about Leishmania parasites [spread by sandflies] and how to treat them.” Dr. Stanekzai explained. “Since doctors received a five-day training on it through the SEHAT program, they have learned about it and treated more than 100 cases of leishmaniasis in the district.”

Midwife Halima, 24, agrees that SEHAT training has been invaluable: “Although I underwent Community Midwifery Education, I faced cases that I did not have enough information for when I started working in the hospital. Working with other midwives and particularly receiving on-the-job training from SEHAT taught me a lot.”

Through SEHAT, MOPH also provided Kama District Hospital with another ambulance, thus making two ambulances available 24 hours a day. In addition, the center received a power generator, producing enough electricity for devices, such as incubators and laboratory and other equipment. “The facilities are very good and help us so much in delivering quality health services to people,” says Dr. Stanekzai.

Amnuallah, 51, attested to the good hospital care and service shortly after undergoing a successful operation on his throat. “It is five days that I am here in hospital and I have had a very good experience,” said the father of 13. “I appreciate the hospital’s management system. There are so many patients, but the doctors are always doing their best.”

Challenging Environment

Providing health services to the population in Nangarhar province, however, is not always easy for health workers. Since 2014, the security situation in some parts of the province has worsened, making the work for health care staff challenging. “Unfortunately, insecurity is a real threat to health center personnel in Nangarhar,” says Dr. Khawani, who works in another health center in the province. He says doctors employ a range of measures to ensure health services are provided to the people. “Due to insecurity, we sometimes change our working schedule. Sometimes we even work from different places to make sure health services are delivered.”

For example, after the Momand Basic Health Center in Achin district closed due to conflict, AADA opened another center in the neighboring village of Asif Khail. The same scenario has been repeated for many other health centers. “We use several ways and try our best to provide health services to people. Hopefully we’ll be successful in our service with the community’s support,” says Shafiqullah Shafaq, BPHS Program Manager in Nangarhar province.