Improving Health Care Provision for the Afghan People

In order to safeguard public health in areas outside the capital Kabul, the German Government is supporting the reconstruction of, and the provision of adequate medical equipment for, health centres across Afghanistan. Measures to eradicate wild poliovirus in Afghanistan – one of the three countries where it is still endemic (the others being Nigeria and Pakistan) – are also funded by the German Government.

Situation

In Afghanistan, average life expectancy has risen substantially in recent years and is now almost 63 years. However, the maternal mortality rate is still high. Afghanistan also has one of the world’s highest child mortality rates: for every 1,000 new-borns, 7% die before the age of five. Many children are malnourished. Medical care is inadequate, particularly in areas outside Kabul. Many of the country’s health facilities are dilapidated and poorly equipped.

Objective

In order to achieve sustainable improvements in health care provision for Afghans living in the northern provinces, the projects – which form part of the civilian reconstruction programme – aim to expand the health system and bring it up to an adequate standard, with a modern hospital infrastructure, management systems and qualified staff.

Measures & Results

The construction of a modern health infrastructure, with additional training for medical staff, is improving health care provision in the provinces. In addition to improved diagnostic methods, innovative technologies such as telemedicine are being deployed. The new hospitals are designed to comply with modern standards of hygiene and energy efficiency and thus provide an improved health environment for patients and staff.

After a fire destroyed the main building at Balkh regional hospital in the centre of Mazar-e Sharif, a new main building was built, with a total of 360 patient beds, including numerous Intensive Care Unit (ICE) beds as well as operating theatres, an imaging unit, laboratory, an accident and emergency unit and telemedicine facilities. It is the main hospital for 500,000 local residents of Mazar-e Sharif and is also a referral hospital, serving a population of up to two million from outlying areas of the province Balkh. As a teaching hospital with its own nursing and midwifery school, the hospital plays a key role in training the next generation of doctors and nursing staff. To date, in-service training, including practical on-the-job instruction and advice, has been provided for more than 400 staff. A capacity-building programme for hospital administrators in Mazar-e Sharif, introduced in 2009, focuses primarily on maternal and child health and on management. Workflows have been streamlined, the flow of patients has been reorganised, allocation of space has been optimised, patient records have been digitised, and warehousing, waste disposal and maintenance have all been enhanced. Performance has improved across all departments. A professional team of 14 well-qualified technicians ensures that installations and equipment work efficiently. The hospital can now carry out all necessary repairs and maintenance itself.

The hospital is currently being extended to include a modern Mother and Child Health Centre with an additional 300 or so beds, medical facilities and equipment. Due to open in mid-2018, the Centre will provide quality obstetric and paediatric care.

In addition, hospitals and health centres have been built or upgraded in various other towns and cities across Afghanistan. One example is the provincial hospital in Feyzabad which, following building works and the establishment of a new organisational structure, will in future serve as a referral hospital for Badakhshan Province (population: around one million). Other examples are the two district hospitals in Baharak and Keshim and the health centre in Wordouj. In Kunduz Province, the Kunduz regional hospital has been extended, and a new district hospital has been built in Khan Abad. In Takhar, a basic health centre has been constructed at Gala Batur. Construction of the new 170-bed provincial hospital in Tāloqān was completed in 2017. All these hospitals and health centres have the necessary clinical facilities, including operating theatres, imaging units and laboratories. Comprehensive training in paediatrics, nutrition, laboratory analysis, technical maintenance and administration has been provided. This includes eHealth training run by the Aga Khan Foundation (AKF) in Feyzabad. In addition, smaller health centres have been built and funded through district development programmes in the northern provinces of Takhar, Badakhshan, Baghlan and Kunduz. In all, 65 hospitals and health centres have been built or refurbished since 2009.

These infrastructure measures make a major contribution to improving health care provision for the estimated four million people, most of whom are living in poverty, in Badakhshan, Kunduz and Takhar Provinces in Northern Afghanistan.

The German Government also supports efforts to combat polio within the framework of the Global Polio Eradication Initiative (GPEI), which is led by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in Afghanistan. Germany provides co-funding, mainly for the procurement of polio vaccines and cool-chain technology, polio surveillance, technical support and security.

Polio eradication measures mainly focus on the southern and eastern regions of Afghanistan where poliovirus is still endemic or has entered the country across the border with Pakistan. Afghanistan’s 5.7 million children under five years of age, who make up around 18% of the population, are the target group. From the start of January to the end of October 2017, only seven polio cases were reported in Afghanistan. This means that there is now a realistic prospect of eradicating the last wild poliovirus in existence. This would not only benefit Afghanistan: it would be a major global success story.

At a glance

Activities in the provinces Badakhshan, Balkh, Kunduz, Takhar.
Programme:
Rebuilding the Balkh regional hospital in Mazar-e Sharif, with construction of a new Mother and Child Health (MCH) Centre, capacity development at the regional hospital in Mazar-e Sharif, upgrading of the provincial hospital in Faizabad (Badakhshan), upgrading of hospitals and health centres at seven locations in Badakhshan, Kunduz and Takhar Provinces (including the Kunduz regional hospital and Tāloqān provincial hospital), support for polio eradication
Commissioned by:
German Federal Foreign Office (AA), German Federal Ministry for Economic Cooperation and Development (BMZ), Japanese International Cooperation Agency (JICA), Swedish International Development Cooperation Agency (SIDA), Norwegian Government
Partner:
Afghan Ministry of Public Health
Implementing organisations:
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, KfW Development Bank
Provinces:
Badakhshan, Balkh, Kunduz, Takhar
Programme objective:
To develop a well-functioning health system with a modern hospital infrastructure and qualified staff as a contribution to the country’s civilian reconstruction
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