The Islamic Transitional Government of Afghanistan
Ministry of Public Health
Health and Nutrition Sector Coordination Report
Reporting Period: 21 December -27 December 2002
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Missions to Afghanistan, international meetings/ training & workshops
Surveys and assessments
Calendar of forthcoming activities
Primary Health Care
Progress was made within WHO’s BDN (Basic Development Need) program. Missing BDN structures were created at all levels and existing ones were reorganized. Roles and responsibilities were clarified. A formal BDN management-training course will be conducted in Jalalabad. Structures created were TSTs, sub-committees for health, water and sanitation, agriculture, education and for the first time women committees. Provincial BDN focal points from the government side were established; only Bamyan and Ghazni are uncovered so far. Those structures underwent certain reorganization including VDCs, CRs. For the first time female CRs have been identified. At the national level negotiations are ongoing with the MoH to identify an appropriate National BDN coordinator. A national BDN orientation workshop is planned to serve as advocacy for other related sectors and as a means for strengthening the partnership building towards BDN.
For BDN teams that lack female members women were identified. Female staff was also assigned to TSTs in most of the districts depending on the availability of literate female government staff.
The team of Jalalabad prepares the translation of the newly revised BDN tools adapted for training of the TSTs. The material will be utilized for training TSTs of other districts in the rest of the provinces.
WHO had organized a course on BDN management in Islamabad for BDN focal points from all areas in Afghanistan. Appropriate BDN offices in all areas were assigned to them, furnished and equipped. Each BDN team elaborated a quarterly plan of action for BDN activities.
Chara-Asyab and Baghman have been identified for the launching of a sustainable, community supported district health care system. Quick assessment on district health resources was conducted and data are being analyzed. The organization and formation of health management teams and district health Shuras are underway. This District Health System (DHS) will be implemented in the same district where BDN activities are carried out. Both approaches contribute and complement each other in strengthening the health component in BDN areas and at the district level as a whole.
Consolidation of the old BDN areas is going on by introducing many corrective measures e.g. improving the financial management of the loans, establishment of the community development fund (CDF). New social and income-generating projects for the village level are being prepared according to the village priorities and needs. Special focus will be given to health and other social projects while maintaining the income-generating activities for the very poor members of the communities, creating linkages and coordinating with other PHC programs in order to ensure the implementation of the Basic Health Service Package in each and every BDN area.
The new areas for expansion were identified all over the provinces. In some provinces preparatory steps were already taken like introduction of the BDN concept to the district officials and the villages Shuras and Maliks and the formulation of all structures at different levels. The training of those structures and the conduction of the need assessment survey will follow soon.
In Herat an agreement for partnership was reached with DACAAR and HRS organization to provide drinking water, to pave roads, to improve sanitation and to deliver the basic health services to all BDN villages. The same agreements were reached with other organizations working in Jalalabad andFaizabad.
Regular reporting formats were distributed and explained to all BDN teams visited. A supervisory checklist was prepared and distributed. Numerous meetings were held with line Ministries, related sectors and NGOs at all visited provinces for BDN orientation, promotion and advocacy to improve the intersect oral collaboration and strengthen the program’s partnership.
With the beginning of the New Year all BDN teams together with the newly formed TSTs will start developing the village annual development plans.
EPI & Polio Eradication
The preparation for supplementary immunization activities (SIA) for Maternal and Neonatal Tetanus Elimination (MNTE) is going on. A joint meeting with WHO, UNICEF and the MoH was held on December 21, followed by a meeting conducted on December 22. The latter involved representatives of some NGOs/agencies (IFRC, MSH, SC-USA, SC-UK, IMC and MRRD). The main objective of the meeting was to introduce the action plan to all partners involved in EPI. Another meeting was held with representatives of radio and television. MNTE strategies, action plans and operational guidelines were introduced. The meeting also clarified main aspects of partners’ contribution to the MNTE and particularly to the SIA. A MNTE training package for different categories of the SIA staff has been completed, including handouts, course schedule, session plan and lesson plan.
At the time being three rounds of TT vaccination for women in childbearing age has been planned for 4 big cities of Afghanistan (Kabul, Mazar, Kandahar and Jalalabad).
District micro plans have been prepared, volunteers have been selected, a training package for ToT, coordinators, supervisors and volunteers has been prepared and will be translated. The first round of the MNTE campaign will be conducted on February 2nd, the second round in March, the third round in September 2003.
Mother and Child Health
A ToT training course for TBA trainers started from 24-29 Dec.02 in Herat province. 12 participants from surrounding districts of Herat and Badghis province are attending this training. The main objectives of this training are:
-To train the TBA trainers on overall objectives, plans & polices regarding training of TBAs.
-To teach monitoring, supervision, support and follow up of TBAs
-To train the TBAs in conducting a safe and clean delivery at community level
-To train the TBAs in recognizing dangerous sings during pregnancy, delivery and postpartum
The leishmania task force, chaired by the president of the malaria/leishmania institute (IMPD), adopted a proposal from WHO that the taskforce be mandated the responsibility of managing all anti leishmania supplies. Though WHO is so far the sole source of anti leishmania drugs to the public health facilities in Afghanistan, the taskforce is encouraging other partners who might have received drugs from other sources to provide it with information on types and quantities of these drugs. Last week the taskforce replenished supplies to all health facilities that are registered with the taskforce as leishmania treatment centers in Kabul City.
In a bid to standardize registration, reporting and supervision of anti leishmania activities, a two days training workshop for MOPH staff is scheduled on January 27th, 2003 in collaboration between IMPD, WHO and HNI.
A meeting took place between the Health Sector Advisor and TB coordinator of JICA, and WHO TB team on December 21st. Due to a traffic accident, the director of the National TB Institute was not present. JICA is reconstructing a new TB Institute in Darm. Possibilities were discussed how to involve JICA in supporting the national TB control program.
Water and Sanitation
The rehabilitation of the water supply project in Kunduz through WHO is ongoing. So far, excavation of the foundation for the pump and generator houses has been completed; excavation for the boundary wall is partly completed. The provisions of stones for the foundation of these structures as well as stone masonry works have started.
The construction of VIP latrines in Kandahar is ongoing. This project is to be completed in the coming weeks.
An assessment of available water resources for the city of Herat and a training course for health and water / sanitation personnel is planned to happen in the month of January.
Emergency preparedness and response
MoPH together with WHO established 3 mobile clinics in 3 remote and inaccessible areas of the central area: in Dornama District, Kapisa Province; Kohi Safi District, Parwan Province; Kharwar District, Logar Province. Staff for all mentioned teams has been assigned by MoH. Medical supplies and incentives for 3 months are provided by WHO.
Overview of Geographic Areas
New Emergency health Kits have been distributed to the targeted areas, Dornama/Kapisa,
Kharwar /Logar and Koh-e-Safi /Parwan province in presence of the Provincial Health Director and District Governor under the Winterization Preparedness Project of EHA.
The mentioned kit is enough for 10000 populations for 3 months.
The main aim for this winter is to reduce the mortality and morbidity rate, particularly among the Mothers and Children.
EPI / PEI activities:
Provincial Coverage report of FR-3 NIDs shows that the total 1170780 children have been vaccinated against poliovirus.
Meanwhile Intra and Post NIDs monitoring got done through MoH, NGOs and Independent monitors. 100% clusters in Kabul city and more than 50% in other districts monitored. The monitoring finding for percentage of coverage in Kabul city 96%, Kabul districts 96%, Logar province 98%, Wardak province 98%, Kapisa province 99% and Parwan province 98%.
Three rounds of TT vaccination program for CBA (15-45yrs) ladies are under plan for 4 big cities of Afghanistan (Kabul city, Mazar City, Kandahar and Jalalabad city).
The first round of MNTE campaign will be conducted on 2nd Feb, 2003, second round will be conducted in March and third round will be conducted in September 2003.
Two AFP cases have been detected this week from Bagram district of Parwan province and Nijrab district of Kapisa province. The two samples have been sent in good condition to the referral laboratory. Meanwhile the AFP focal points have been visited for encouraging of Active AFP surveillance for year 2003.
The work on 106 patients included in Chloroquine Efficacy Study was completed successfully and 106 more patients have been taken under study to evaluate the efficacy of Fansidar.
MMRC (Measles Mortality Reduction Campaign) Training for vaccinators, health workers, district coordinator and supervisors was conducted.
The 10-day implementation of MMRC started from 24.December 2002.
It was agreed with CFA that Social Mobilization Training Polio/AFP/EPI for the children centers of CFA would be conducted in January 2003.
Western Area, Herat
An 18-day Mental Health Training course for 20 medical doctors of western region has been started on 21.December 2002.
A 6-day TBA training course for 10 TBA trainers has been started on 23.December 2002.
A 2-day ARI Training course for 40 medical doctors has been started.
Post NIDs monitoring training and implementation was conducted.
Southeastern Area, Ghazni
A three-month carpet weaving training course for 20 men and women and skill gaining training for 10 females for three months have been completed successfully in BDN model area Jermatu of Rashidan district, supported by WHO.
Eastern Area, Jalalabad
On 24th December three medical teams consisting of MoH and WHO were sent to the Northeast and East Nooristan for establishment of temporary static clinics in Korder, Kamdesh and Peshawarak villages of East Nooristan.The clinical activities will start by 1st week of January 2003.
WHO sent a team to the East Nooristan with emergency medical equipment, stationary, HIS Materials, health education materials and basic office furniture to establish the temporary static clinics.
9 staff (3 doctors and 6 nurses) will be working in the temporary static clinics for this winter project, supported by WHO and IMC for three months in the east Nooristan.
Two-5-day TBA Training programmes for 20 trainees were conducted by MCH Unit of MoH/Nangarhar in Nooristan province technically and financially supported by WHO.
ARI Training was conducted in Regional Level by WHO.
Calendar of forthcoming activities
For more information:
WHO Afghanistan Office
House No. 249, Street No. 10
Wazir Akbar Khan Mina
Tel: (0093) 70279010/1-2
Digital lines : 2300181/2
Fax No : 0047 233 08112 2207
WHO Afghanistan Support Office
P. O. Box No. 1936
House 218, Margalla Road, F-10/3
Tel: (92 51) 221 1224, 2104770.4
Fax: (92 51) 228 0830