MSH's REACH Program is Building Strong Systems to Improve Health and Save Lives in Afghanistan

Provincial Planning Coordinating Committees meet monthly to monitor health conditions and review performance throughout the province. {Photo by Steve Sapirie 2004.}Photo by Steve Sapirie 2004.

War and conflict over the past 25 years have had dire consequences for the health of the Afghan people, particularly women and children. The health system was decimated, hospitals and health clinics were destroyed, and many trained health personnel fled the country, all contributing to some of highest infant and maternal mortality rates in the world. Today, through the USAID-funded REACH Program (Rural Expansion of Afghanistan's Community-Based Healthcare)-a three-year, $128 Million contract-Management Sciences for Health is working in partnership with the Ministry of Public Health and many nongovernmental organizations (NGOs) to rebuild the health system and provide Afghan households with a basic package of health services.

While attention is often focused on how to support national health policy development at the Ministry of Public Health (MOPH) to improve local health delivery, work done at the provincial level plays a critical role. Provincial Public Health Offices serve as a vital link between Ministry planners at the central level and health care providers working locally throughout the country to ensure that vaccines are available, fewer women die during childbirth, and there is reduced mortality from diarrheal disease. The successful decentralization of health services management in Afghanistan requires strong provincial health administration. Systems must be in place to monitor health conditions and collect data to plan for staff and medicines, review service performance throughout the province, identify and plan for training health workers, and plan and manage service-improvement initiatives. Without these vital systems that MSH's REACH Program is working on, women and children will continue to die from preventable causes.

Provincial Public Health Offices: Playing a Critical Role

In partnership with the MOPH, MSH's REACH Program has established Provincial Health Coordinating Committees (PHCC) in 16 of Afghanistan's 34 provinces. These committees provide a strong foundation for the decentralization of health services management. Provincial health officials now have a concrete set of steps and tools for analyzing health data; setting targets and objectives for improving care in priority areas; and establishing a framework for monitoring service performance and health outcomes. The planning process produces a three-year rolling development program and a one-year operational plan that the PHCC uses to manage and monitor its efforts. These plans are submitted to the MOPH to provide updated information on facility and staff development, recent service performance, and evolving provincial priorities.

PHCC committees coordinate the efforts of different groups providing health services in their provinces. Together, they develop a comprehensive work plan to address priority health issues, such as maternal mortality, TB, and childhood immunization. They are putting systems in place to track medicines; detect disease outbreaks; monitor service operations and finances, and human resources; and coordinate NGO activities throughout the province. PHCC committees meet monthly to review progress and modify plans.

The data gathered by these newly instituted systems will provide the MOPH with information crucial to steering national health policy and making timely decisions to save lives.