The Islamic Transitional Government of
Afghanistan
Ministry of Public Health
Health and Nutrition Sector Coordination Report
Reporting Period: 23-29 November 2002
Email to submit information for next week's newsletter: registry@afg.emro.who.int (mention in subject line:
“for weekly update on health sector”. Reports can also be requested through this address.)
Contents
Coordination
Sub-sectors
Regional overview
Missions to Afghanistan, international meetings/ training & workshops
Surveys and assessments
Calendar of forthcoming activities
Coordination
Program secretariat
Meetings this week were cancelled due to the TAPA Board Review presentations being held all week in
AACA
Health coordination meeting:
Reviewed progress of
 Private sector taskforce that is presently working on rules and regulations for private pharmacy
and drug prescriptions.
 Health information system task force: which is now compiling all reporting system existing in order
to analyze what works and what does not. It was requested that the taskforce looked at
communications possibility to establish a unique network of communications for HIS.
 Human resources task force, which is preparing a national workshop for beginning of January on
policy planning, health service category of workers, main service providers and training.
 The Ethic committee lacks support and will be suspended for the time being.
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Sub-sectors
Primary Health Care
During the last two weeks a visit was conducted to both Herat and Jalalabad provinces successively with
the objectives of assisting in organization of work, consolidating on going BDN projects and expanding to
new villages.
In Herat the following activities were carried out: BDN team was completed with a women and was established within the WHO office
MoH provincial director was assigned as BDN provincial focal point.
TSTs in the three districts of Karokh, Guzzarah and Enjil are being placed. Members of each TST include
district governor as team leader, health, education, agriculture and women representatives
Village level sub committees for health, women, education, agriculture, youth, sanitation and water are
being set in each of the 5 villages, and guidelines and procedures were given for effective financial
management. Agreement for partnership with DACAAR and HRS organization was reached to provide
drinking water, paving roads, improving sanitation and delivering basic health services to all BDN villages.
New social and income-generating projects are being prepared to the five villages according to the
regional guidelines and tools and according to the village priorities and needs as this matter was
discussed and agreed with them. 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.
2 New villages for expansion of BDN were identified in the districts of Guzzarah and Enjil, preparatory
activities were initiated.
In Jalalabad the following activities were achieved: The BDN team was completed to be 5 members after the addition of a female member.
The provincial director of MoPH was also assigned as the BDN provincial focal point.
The TSTs of the three districts of Batikot, Behsood and Chaparhar are being placed.
Sub committees at the old and new villages are being formed. New social and income-generating projects
are being prepared by the team for the old villages according to the villages’ priorities and needs and in
accordance with the regional BDN tools and guidelines.
Three public meetings were held with three villages of Trilly, Abdian and Kariz Kabir for introducing the
BDN concepts, strategies and procedures as these villages were chosen for expanding the BDN on the
same old districts.
EPI & Polio Eradication
Preparation for December NIDs (National Immunization days) is going on. Training of NIDs staff has
already started in Kabul and other regions. ToT (training of Trainers), Training courses for NIDs District
coordinators, Cluster supervisors and Volunteers completed in Kabul city. The training is still going on in
other regions. In the course of preparation for NIDs, coordination meetings also conduct at different
regions.
Mother and Child Health
A visit was made to Kandahar Mirwais hospital, Maternity ward. The aim was to improve and to strengthen
Essential Obstetric care services in the mentioned hospital. Currently only normal Obstetric cases are
managed in the hospital and all complicated cases are referred to ICRC hospital.
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Nutrition
A Breast Feeding Counseling Training Workshop was held from 25-28 Nov 2002 in Kandahar province. 17
health staff from MOPH and NGOs has received the mentioned training. The main purpose of the
workshop was to enable the health staff to:
-Provide health education to the mothers and community on importance of breast milk, breast condition,
breast-feeding LBW and sick babies, etc.
-Build confidence and give support to mothers with regards to breast-feeding
-Mange or refer breast conditions
-Advice on women’s nutrition, health and fertility
Tuberculosis
The Stop TB-Afghanistan team and Dr Haidari, deputy Director of the National TB Programme in
Afghanistan, have visited Ghazni from Nov. 24 to 27 in order to assess the situation of TB control activities
in the four provinces of South Eastern Region. The team has met with Ghazni Province Director of Health,
Dr Zia Gul and has been accompanied in his trip within the region by the regional TB Coordinator, Dr
Abdullahi Qahir and by the NHC of Ghazni, Dr Shukur.
Three TB clinics have been visited during the mission, namely Espandeh clinic run by Islamic Aid, Andar
clinic run by Norwegian Committee for Afghanistan and Ghazni TB Centre run by MSF. Due to shortage of
time and uncertain security conditions, the team did not succeed to visit MoH facilities running TB
programme. However, anti-TB treatment and reagents for the estimated 400 new cases occurring each
quarter has been delivered to WHO sub-office in Ghazni for further despatch to the units offering DOTS in
the region.
One major problem highlighted during the field visit was the hardship faced by the patients to report for
treatment every day to the clinic. This leads many patients to seek care from the private sector, always
well represented by private practitioners and private pharmacies throughout the region. Unfortunately,
treatment in the private sector is only affordable by the most affluent group of patients and, in any case,
does not provide careful follow-up of the cure, a vitally important component of TB control both for the
individual patients and for the community at large. The Stop TB team has taken this opportunity to
recommend that the principles of DOTS are abided to in all health institutions and that locally suitable
solutions are identified and implemented to ensure larger access to DOTS and successful compliance
with treatment. Admission of patients coming from distant areas is one of the possible solutions, already
practised by Islamic Aid and MSF. Another is probably Community Based DOTS, using for instance the
village’s mullah as local promoter, treatment supporter and defaulter tracer in his own community.
During the meeting with MSF-France team in Ghazni, the need for all parties involved in TB control to
collaborate among themselves under the leadership of MoH was reiterated and accepted by the French
NGO. Its representatives received copy of the National guidelines on TB control and agreed on reporting
regularly to the regional TB coordinators according to MoH standards, thus making programme monitoring
more representative of the entire region.
Health Promotion
Second meeting of IEC working group was held at the Health Education, Promotion and Publication
Department of MoH on November 28,2002 which was chaired by Dr. Sherzai and attended by all the
members. The meeting was opened by Dr. Sherzai who welcomed all the participants and requested the
participants to develop a strategy for the future plan of action of this working group. As a first step, it was
decided to compile all partners’ activities in the sector, in order to define future strategy based on existing
situation.
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Laboratory
While microbiology service may seem quite a luxury, which only will increase the health budget, most
media and reagents for the microbiology laboratory can be made locally and the saving on expensive
antibiotics can be substantial. The main aim is to stop the spread of resistant bacteria, and if this is
achieved, the savings can be enormous. As an extra reward, such service will also result in a more
effective treatment, decrease the patients' sufferings, and improve the prospect of complete cure.
In the last many years, no microbiology laboratory was functional in Afghanistan, and for this reason the
specimens and samples were sent for e.g. to Islamabad.
WHO started a training course in microbiology at the Central Laboratory, Kabul, teaching 15 laboratory
technicians in basic microbiology techniques, stool and blood culture, with all theoretical and practical
needed support. This course will continue till December 14th, and other courses will be opened in 2003.
Blood bank / Blood transfusion service
The overall goal of WHO is to assist Afghanistan in its efforts to achieve the provision of safe blood and
blood components, based on voluntary regular non-remunerated blood donation, without pressure or
inducement. Ensuring blood safety is among the highest priorities of the health care. Many infective
agents are potentially transmissible through the transfusion of blood and blood products. Although the
relative importance of different agents may vary even within different areas of Afghanistan, microbiology
transfusion practice is a topic of global importance. The provision of blood and blood products free from
contamination by any infectious agent is the global aim.
For this reason, WHO had prepared and presented a complete program proposal regarding the
rehabilitation of the Blood Transfusion Service, in Afghanistan. For implementing any project in this field,
WHO would like to receive a better collaboration from the Central Blood Bank, that is actually in charge
with the coordination of the BTS, in Afghanistan.
Emergency preparedness and response
Steps are taken toward multi-sectorial management of emergencies were the MoH will take an important
place due to the impact of disasters in Heath. Meeting with ministry of interior and with the new UNAMA
EPR coordinator are leading in this direction.
Overview of Geographic Areas
Central Area
EPI/Polio
Training of all categories of manpower is finalized in Kabul city while in other provinces the training of the
coordinators is over.
All trainings would be finalized by the second week of December .
Northern Area, Mazar
The 3rd Fall NIDs trainings for NIDs coordinators and supervisors are going on in all of the provinces and
district level
Report of 5 cases of pertussis in Sar-i-Pul Province by SC UK. According to the investigation report of the
regional EHA coordinator and MoPH Sar-i-Pul, an outbreak could not be confirmed; a total number of 3
cases in 6 villages were identified; samples have been taken and will be dispatched to a reference
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laboratory. It is to be noted that there is no routine EPI activity in the area (villages at 3 hours driving
distance from Sar-I-Pul center)
Report by MoH Jawzan of 5 cases of Diphteria in Khamyab District, a WHO/MoH team went in the area to
assess the situation.
Western Area, Herat
PHC training for 27 medical doctors started in the regional hospital of heart.
24 TBAs completed their training in Enjil district and received their TBA kit to initiate their activities directly.
Identification of 3 new suspected case of AFP, under laboratory investigation.
Initiation of new BDN activities in Herat, see PHC sector.
Meetings & workshops
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AFP surveillance weekly meeting was held on 25th and 27th of November at WHO office. Beside
WHO concerned staff, MoH National EPI officer and UNICEF senior advisor for MoH EPI section
also attended the meeting. The meeting reviewed 60 reported AFP cases.
TAG (Technical Advisory Group) debriefing meeting was held on 28th of November. WHO and
UNICEF EPI staff attended the meeting. Dr. Naveed Sadozai from WHO and Dr. Kamrul Isalm
from UNICEF make presentations. The meeting discussed the progress of Polio eradication and
decided to establish working group to take action for further improvement of PEI in Afghanistan
based on TAG recommendations.
WHO EPI team met with the director of planning at the planning department of MoH on 28 of
November. MoH national EPI manager was also present. Dr. Naveed Sadozi WHO EPI team
leader briefed them on PEI progress and focused on main issue of for coming NIDs and AFP
surveillance. It was decided to use infra structure of NIDs especially at the community level for
other health purposes. They also decided to increase role of MoH in different aspect of PEI
especially AFP data management.
Calendar of forthcoming activities
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November 24-26 southern area: Nomads OPV campaign
November 27: Weekly meeting on Epidemic Investigation and Response in MOH, Library.
November 29 - December 30, 2002: NIDS Review workshop in Jalalabad
December 3: AFP Surveillance Weekly Meeting
December 4: Health strategies meeting for southern central highlands area, UNAMA compound A.
December 11-13, 2002: National Workshop on Operational Planning for DOTS Expansion at
Regional and Provincial level in Kabul
December 15-17, 2002: Third NIDs
December 12: Meeting of Expert Review Committee in Kabul
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For more information:
WHO Afghanistan Office
House No. 249, Street No. 10
Wazir Akbar Khan Mina
Kabul, Afghanistan
Tel: (0093) 70279010/1-2
Digital lines : 2300181/2
E-mail : registry@afg.emro.who.int
Fax No : 0047 233 08112 2207
WHO Afghanistan Support Office
P. O. Box No. 1936
House 218, Margalla Road, F-10/3
Islamabad, Pakistan
Tel: (92 51) 221 1224, 2104770.4
Fax: (92 51) 228 0830
E-mail: supply@whoafg.org
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