Afghanistan

Guest post by Dr. Ahmad Masoud Rahmani

Dr. Ahmad Masoud Rahmani is the National Director of the Afghanistan National Blood Safety and Transfusion Services Directorate, in Kabul, Afghanistan. Dr. Masoud was a participant in the MSH Leadership Development Program offered by the USAID-funded Technical Support to the Central and Provincial Ministry of Public Health project (Tech-Serve) in Afghanistan last year. 

The National Blood Transfusion service in Afghanistan has the responsibility for ensuring that a safe and adequate blood supply is available for all people who need it. This is a free service to all citizens of Afghanistan as mandated by our parliament. Yet to us the costs of providing one pint of blood is very high, about $30 per unit. This includes the cost of consumables, testing of blood, refreshments to blood donors, and the cost of supporting staff and services. For Afghanistan, a country devastated by internal strife and war, this is a very high burden to carry by the Ministry of Public Health.

That point was made often by the Honorable Dr. Walter T. Gwenigale, Minister of Health and Social Welfare of the Republic of Liberia (also widely known as Dr. G in Liberia) at a conference, co-sponsored by MSH on June 9 and 10 at the US Institute of Peace. The event, Health in Post-Conflict and Fragile States: Challenges for the Next Decade was organized by Leonard Rubenstein, Chair of the USIP Health and Peacebuilding Working Group, and Stephen Commins, of International Medical Corps.

The two-day discussion explored the unique characteristics of health service delivery in fragile and conflict-affected states, making the point that “yes, it can be done,” but there is still a long way to go to get it right and find the balance between short-term interventions and long-term development. Speakers shared lessons learned in reconstructing health systems, especially in Afghanistan and Southern Sudan. They also took a look at human rights, governance, and vulnerable populations, particularly women. Dr. Gwenigale and Deputy Administrator of USAID, Ambassador Donald K. Steinberg provided keynotes.

The Ministry of Public Health’s (MOPH) Pharmaceutical Enterprises operates 53 pharmacy stores located near government hospitals nationwide, managed by 118 pharmacists. With 1 million US dollars in capital, pharmaceuticals are purchased, stored, and then distributed to the Afghan people through these government-owned pharmacies.

Dr. Mirza Mohammed Ayoobi, the Deputy Director of Pharmaceutical Enterprises says, “Majority of our government-employed pharmacists have over 15 years of experience, but have not kept pace with the changing landscape of pharmacy practice. They need training on medication counseling, rational use, and good dispensing practices.”

In response, the Strengthening Pharmaceutical Systems Program-Afghanistan team organized and facilitated the first of a series of training programs to upgrade the pharmacist’s knowledge and skills on dispensing and rational use of medicines.

After a training program, MSH interviewed Mr. Mohammad Hasham, a pharmacist in Khairkhana, about the importance and value of this training course.

Blog post updated Dec. 27, 2011.

Taj Bibi learns how to use zinc and oral rehydration salts to treat her child. Photo credit: BASICS/Afghanistan, MSH.

Taj Bibi sits nursing her 5-month-old baby in the kitchen of her home in the village of Sartal in Takhar province in Afghanistan’s north. The room is dark; the only natural light comes from the doorway to the dusty courtyard outside. The sound of her children playing echoes across the small family compound.

Bibi’s first two children died -- one of them from severe diarrhea -- because the family could not afford to take them to the doctor. “Now, if our children get diarrhea or any other illness, I take them to the community health worker,” she said.

Community health workers (CHWs) are the building blocks of the Afghan health system, bringing basic health services to villages across the country.

Providing immunizations to children in Afghanistan.

Many children in Afghanistan can be spared of communicable diseases that can make them ill and even cause death, if they receive routine vaccinations. But in a country of more than 25 million people in a country the size of Texas, where over 80% of the population lives in rural areas, immunizing every child against measles, diphtheria, pertusis (whooping cough), tetanus, and polio is very challenging.

Large scale immunization campaigns have proved helpful, but have been unable to significantly increase and maintain high immunization rates throughout the country.

The US Agency for International Development’s BASICS project (Basic Support for Institutionalizing Child Survival), with support from MSH, is working with the Afghan Ministry of Public Health (MoPH) and UNICEF to demonstrate in nine districts how an expanded program on immunization (EPI) micro-planning can successfully increase the number of immunized children.

 

[Dr. Karima, General Directorate of Pharmaceutical Affairs, Ministry of Public Health, speaks at the opening ceremony of the Drug and Therapeutics Committee training course for provincial hospitals]Dr. Karima, General Directorate of Pharmaceutical Affairs, Ministry of Public Health, speaks at the opening ceremony of the Drug and Therapeutics Committee training course for provincial hospitals

 

 

Afghanistan’s mountain ranges are beautiful to the eye. Rugged peaks and ridges are separated by valleys, carved out over the centuries by streams and rivers supporting the green web of vegetation along their banks.

But many of the small villages that cling to the walls of these valleys are often cut off for months by heavy snow or the floods that follow the spring melt. The cold wet climate, together with smoke from household stoves, increases the risk of pneumonia, particularly among babies and children. One in five deaths of young Afghan children is caused by pneumonia, an infection easily treated with antibiotics if diagnosed early enough.

Health Workers in Southern Sudan

A few weeks ago, I had the opportunity to visit Southern Sudan. For over five decades, Southern Sudan endured civil war, unrest, and several waves of forced displacement and refugees. The infrastructure of nearly every sector was mostly destroyed throughout the region. It is a classic fragile state situation.

Since the Comprehensive Peace Agreement was signed five years ago, the Government of Southern Sudan, donors, international organizations, nongovernmental organizations, private organizations, and, most importantly, health workers are coming together to rebuild a shattered health system.

Now the global community focuses attention on Southern Sudan as they prepare for a Referendum vote to decide if they will officially break away from Northern Sudan to become an independent state. The vote is scheduled to begin January 9, 2011.

Kitchen Garden Produce & Afghan Boy

The carefully irrigated and shaded kitchen garden provided welcome splashes of different shades of green against the surrounding dry brown soil and rocks. We congratulated Shukria, a community health worker (CHW), on the lush vegetables and ripening fruits as we entered her home.

Shukria explained that the gardens that she and other women were growing started with the community-based growth monitoring program through the Family Health Action Groups. The growth monitoring is successfully identifying children under two who were not gaining enough weight or were undernourished. She and other mothers spent time counseling the mothers of the identified underweight children.

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