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Home: Where
MSH Works: Asia
and the Near East: Afghanistan Afghanistan 
Afghanistan is a country whose past weighs heavily on its present condition. Despite major achievements in reconstruction since 2001, the damage of the Soviet occupation (1979-1989) and the Taliban regime (1994-2001) are still major hurdles for development efforts to overcome. MSH's experience in Afghanistan spans over thirty years of work to strengthen the health system and improve access to and the quality of primary health care services. Most recently, MSH has assisted the Afghan government to rebuild the national health system and focus on services that will have the greatest impact on the major health problems to both rural and urban populations. |
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THE EXPANDING CONTRACEPTIVE USE (ECU) PROJECT
The previous Accelerating Contraceptive Use (ACU) project increased contraceptive prevalence rates (CPR) in three areas from 9 to 34; 20 to 44; and 24 to 51 from October 2005 to June 2006. The project demonstrated that innovative family planning approaches can be highly effective in Afghanistan.
With continued generous support from the William and Flora Hewlett Foundation, the ECU project builds on and replicates the model created during the successful ACU project in order to increase access and successful use of contraceptive methods while bringing innovations to meet the needs of women and men in three Afghan communities. The ECU continues working with the same local NGO partners which collaborated with the ACU project (AADA, BDN, and STEP). Also, the project is implemented in close coordination and cooperation with the Ministry of Public Health, the USAID-funded COMPRI-A, HSSP, and Tech Serve projects, local communities, non-governmental organizations, and international organizations.
Communication for Behavior Change: Expanding Access to Private Sector Health Products and Services in Afghanistan (COMPRI-A) Project
The COMPRI-A Project is working to increase Afghans' access to health information and products by strengthening private-sector capacity through a comprehensive and integrated social marketing program. MSH, as subcontractor to The Futures Group LLC, leads the training and policy components of the project. Specifically, MSH provides the senior team member in Training and Communications for Community Mobilization. This team member will reach many cadres in Afghanistan (mullahs, community shuras, and the general public) with relevant health messages; provide refresher training to community health workers and pharmacists; and equip retailers with interpersonal communication skills about the correct use of socially marketed products. MSH also provides the senior team member in Policy Development and Implementation/Research who will focus on pharmaceutical regulation and policy; Ministry of Public Health policies, standards, and guidelines related to quality of care; building public/private partnerships; and coordinating policy activities among the implementing partners.
RURAL EXPANSION OF AFGHANISTAN'S COMMUNITY-BASED HEALTHCARE (REACH)
In May of 2003, USAID awarded MSH a three-year contract to improve access to basic health services for Afghans and to strengthen the national health system. The goal of the REACH Program is to improve the health of women of reproductive age and children under five. REACH is ensuring that an estimated 7.5 million people in underserved areas of Afghanistan have access to a basic package of health services. REACH is strengthening the existing national health system by assisting with the development of policies and standards, building systems for human resources and health information, training nearly 7,000 health service providers including more than 6,000 community health workers and empowering women and communities to protect their health through training and education.
THE ACCELERATING CONTRACEPTIVE USE PROJECT
Funding from the William and Flora Hewlett Foundation focused on identifying best practices for improving the quality and impact of family planning services in Afghanistan. The intervention began as a small project focused on providing misoprostal tablets to Afghan women in order to prevent postpartum hemorrhaging and therefore decrease maternal mortality. The project team however quickly discovered that, contrary to earlier research and beliefs, there was also a sizable demand for family planning services. By refocusing the funding on understanding the demand for family planning in Afghanistan, MSH realized that there was a larger opportunity to improve women's health and prevent maternal deaths. The MSH project team refocused the grants funding to provide evidence of family planning demands throughout the country to increase its use in the Ministry of Public Health's Basic Package of Health Services.
AFGHANISTAN HEALTH SERVICES ENHANCEMENT (AHSEP) PROJECT
In 2002, the Ministry of Public Health asked MSH to assist in the reconstruction of the Afghanistan health system by heading the first nationwide assessment of health resources in more than ten years. MSH trained teams of Afghan nationals to inventory health facilities nationwide — reaching more than 1,000 facilities, almost 1,500 pharmacies, and interviewing close to 3,000 workers. The survey revealed districts that had only one health facility for every 5,000 people, and some facilities that tried to serve more than 100,000 people. The survey also showed that only half of more than 750 primary care facilities had safe water and only a quarter had electricity, while one-third functioned without toilets. In addition, 40 percent of facilities had no female workers, and strong social barriers often prevented women from receiving health services from men. MSH concluded that 70 percent of primary care clinics were unable to provide complete maternal and child health services. The outcome of this assessment led to the development of the Basic Package of Health Services (BPHS) through a collaborative process involving a variety of stakeholders. The Ministry of Public Health and the donor community are currently using these estimates to provide services through grants to Afghan and international NGOs. The BPHS is now the official policy of the Islamic Republic of Afghanistan, and those delivering government-supported health services must provide the basic package first before adding other services.
AFGHANISTAN NATIONAL HEALTH PROGRAM
Launching a health sector project in Afghanistan in 1973, MSH's founding staff members concentrated on developing a rural health system. MSH founder Dr. Ron O'Connor believed, "given host-country commitment, progress can be made — even in the most difficult environment — in the practical delivery of rural health services in a developing country." After conducting a needs assessment, MSH worked closely with the Central Ministry, both to establish community-based health services for rural populations and to improve the overall delivery of health care in the Afghanistan.
