Afghanistan

This supplement to the Journal of Global Public Health is devoted to the re-development of the health system in Afghanistan beginning in 2002. It discusses the processes that were adopted by the Ministry of Public Health and its partners, and the activities of the non-governmental organisations that, for the most part, were responsible for overseeing the delivery of health services to the population. It also presents an overview of the results that were obtained during the ensuing 10 years.

Abstract In Afghanistan, malnutrition in children less than 60 months of age remains high despite nutritional services being offered in health facilities since 2003.

Abstract The Paris Declaration defined five components of aid effectiveness: ownership, alignment, harmonisation, managing for results and mutual accountability. Afghanistan, which has received a high level of donor aid for health since 2002, has seen significant improvements in health indicators, expanded access to health services and an increased range of services.

Abstract In 2001, Afghanistan's Ministry of Public Health inherited a devastated health system and some of the worst health statistics in the world. The health system was rebuilt based on the Basic Package of Health Services (BPHS). This paper examines why the BPHS was needed, how it was developed, its content and the changes resulting from the rebuilding.

The shortage of skilled birth attendants has been a key factor in the high maternal and newborn mortality in Afghanistan. Efforts to strengthen pre-service midwifery education in Afghanistan have increased the number of midwives from 467 in 2002 to 2954 in 2010. We analyzed the costs and graduate performance outcomes of the two types of pre-service midwifery education programs in Afghanistan that were either established or strengthened between 2002 and 2010 to guide future program implementation and share lessons learned. CME graduates achieved an overall mean competency score of 63.2% on the clinical competency assessment, compared to 57.3% for IHS graduates. Reproductive health activities accounted for 76% of midwives' time over an average of three months. Approximately 1% of childbirths required referral or resulted in maternal death. On the basis of known costs for the programs, the estimated cost of graduating a class with 25 students averaged US$298,939, or US$10,784 per graduate.

Drawing on their experience in a range of developing countries, including 20 years of long-term experience in Afghanistan, Cambodia, Indonesia, and the Philippines, Steve and Cathy Solter identify 10 important lessons about assisting ministries of health Pursuing true country ownership for effective programs requires a long-term approach involving persistence, patience, keen understanding of counterparts’ perspective, deference, building of trust, focus on priorities, technical competence, and sustained optimism.

This study, conducted in five rural districts in Afghanistan, used qualitative methods to explore traditional practices of women, families and communities related to maternal and newborn care, and sociocultural and health system issues that create access barriers. The traditional practices discussed include delayed bathing of mothers and delayed breastfeeding of infants, seclusion of women after childbirth, restricted maternal diet, and use of traditional home remedies and self-medication instead of care in health facilities to treat maternal and newborn conditions. This study also looked at community support structures, transportation and care-seeking behaviour for maternal and newborn problems which create access barriers. Sociocultural barriers to better maternal-newborn health include shame about utilisation of maternal and neonatal services, women's inability to seek care without being accompanied by a male relative, and care-seeking from mullahs for serious health concerns. This study also found a high level of post-partum depression. Targeted and more effective behaviour-change communication programmes are needed. This study presents a set of behaviour-change messages to reduce maternal and newborn mortality associated with births occurring at home in rural communities. This study recommends using religious leaders, trained health workers, family health action groups and radio to disseminate these messages.

As part of the special feature on leadership and human resources, Management Sciences for Health profiles three leaders who have made a significance difference in the HR situation in their countries.

Background: Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential.

Following over 30 years of conflict in Afghanistan, the Ministry of Public Health and its partners are rebuilding the pharmaceutical system to provide safe, affordable, and equitable access to medicines. Pharmaceutical system structures and processes are being strengthened; however, developing the pharmacy workforce is critical to ensuring the sustainability of these efforts.

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