The Islamic Transitional Government of
Afghanistan
Ministry of Public Health
Health and Nutrition Sector Coordination Report
Reporting Period: 21-27 September 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:
The 25 September program secretariat meeting was cancelled due to the organization of the CommunityBased Health Care workshop, conducted from 23-25 September.
National development budget:
Senior staff of the MoPH and the Program Secretariat presented the penultimate version of the health
NDB submission, in an inter-ministerial conference at AACA on 24 September. Some additional
amendments will be made to the health NDB submission before the final document is submitted to
UNAMA on 1 October. UNAMA will consolidate all sectoral submissions, and the cabinet will then
consider the NDB.
Global Fund to Fight AIDS TB and Malaria (GFATM)
The Global Fund Commission of Afghanistan (with members of MoPH, WHO, Medair, HNI, and ARC
representing the coordinating bodies for tuberculosis, malaria and HIV/AIDS control) has submitted in time
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to the Global Fund Secretariat in Geneva a proposal of around 3 million USD to build capacity to address
AIDS, tuberculosis and malaria in Afghanistan. The plan’s main aim is to lay the groundwork for
reconstructing HIV, tuberculosis, and malaria control activities - while strengthening the capacity of the
Ministry of Public Health to provide oversight, monitoring and evaluation functions. The final results of the
GFATM-review process are expected in January 2003.
Provided that funding will be granted for the current 18 months period of the current plan, it is expected
that the MoPH will not only be the driving force to implement these communicable disease control
activities, but will also have the management capacity to administer any further donor funding. After
partnerships and strategic plans have been developed, and the capacity of health services relating to
AIDS, tuberculosis, and malaria control have been strengthened through this proposal, the Global Fund
Commission will apply to the GFATM for further funding to implement disease control activities.
More information on the proposal and the Global Fund Commission is available with MOPH (Dr Abdullah
Fahim, Dr Hanif Khoshal, Dr Khaled Siddiq, Dr Abdul Wasi Asha), WHO (Giampaolo Mezzabotta, Nadine
Ezard, Yon Fleerackers), Medair (Marylin Johnson), and HNI (Esmee deJong).
Sub-sectors
Primary Health Care
The MoPH, MSH, UNICEF and WHO organised a three-day workshop on Community Based Health Care
from 23-25 September. MSH played the major role in planning and conducting this very successful
workshop. A detailed accounting of the proceedings will be provided in the next co-ordination report.
EPI & Polio Eradication
A detailed analysis of the measles immunization coverage by districts has led to the elaboration of a redo
plan for measles campaigns where coverage was below 80%. This plan will be implemented before the
winter begins. To date, approximately 8.2 million children between 6 months and 12 years of age
received measles vaccines throughout Afghanistan. A national coverage survey will be carried out in
November to assess the actual coverage of the ongoing campaign.
As per the report received Approximately 5.6 million children under the age of five years were covered
during the first round of the Fall National Immunization Days (NIDs) in September. The next round of Fall
NIDs will be held from 22-24 th of October. All logistics including vaccines are in place. UNICEF-Kabul is
planning a Total Office Mobilization (TOM) for NID monitoring.
Four new Acute Flaccid Paralysis cases (AFP) were reported in the following provinces: Faryab, Herat,
Wardak and Nangarhar.Genetic sequencing results in Kunduz, Kabul and Zabul cases are still awaited to
determine the linkage with other isolates. Dr. Daniel Tarantola, Director, Department of Vaccines and
Biologicals, WHO/HQ is visiting Kabul from October 20 – 23rd 2002.
Maternal and Child Health
MCH working group meeting was held on 24 September 2002 in UNFPA- Kabul. The group discussed
about the design of a Job description for Pharmacists working in an MCH clinic. The group emphasized the
development of a standard job description for Pharmacists which describes his / her responsibilities in the
MCH clinic, after a lengthy discussion a draft job description was developed. The Next MCH working group
will be held on 1st October 2002 at the CHA office.
The Afghanistan team (one obstetrician, 2 midwives and 1 anesthesiologist – all from Malalai Maternity
Hospital and a UNICEF staff member) will travel to Dhaka to attend the second phase of the training of
trainers on Emergency Obstetric Care. This workshop is organized by UNICEF Regional Office for South
Asia and the Averting Maternal Death and Disability program of Columbia University with technical support
of the JHPIEGO. This is a three week follow up training on EmOC – skills and knowledge update -, which
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was attended by the same team last August. The team had practiced the newly acquired skills and will be
taught new training methodologies. This team is a core team for training on EmOC in Afghanistan.
As part of the effort to create Centers of Excellence for Emergency Obstetric Care, UNICEF consultant on
health facilities renovation (Mr. Davis Potter) visited the Jalalabad University hospital, the Metharlam
hospital and the Ghani Khail hospital between 22-26 September. to assess renovation needs on these
buildings and consult the staff working in these hospitals. The consultant will than make plans for
renovation and alternative layout to restore the hospitals physical structure. He will also travel to Herat in
October.
Preparation is underway for the workshop on curriculum development for the auxiliary midwives training in
Ghanikhail that will be held in Jalalabad during the first week of October. Two experts: an
Obstetricin/Gynecologist and a midwife from JHPIEGO will be the main facilitators of the workshop.
As a follow up to the National Safe Motherhood Strategic Planning and Visioning workshop held in Kabul
from 17-19 September, preparation is underway to conduct the same planning workshops at the regional
levels. Central,southeastern, western, eastern, northeastern and southern regions will conduct the Safe
Motherhood planning workshop in October.
Eye Care
A Planning workshop leading to a National plan on Comprehensive Eye Care was held from 23-25
September 2002 at Popo Lano Italian Restaurant in Kabul. This workshop was sponsored by CBM
(Christoffel Blind mission) and WHO. Many governmental and non-governmental organizations, CBM,
WHO and MOPH was attended in this workshop. Main purpose of the workshop was to develop a
National Plan on Comprehensive Eye Care in Afghanistan on behalf of the Ministry of Public Health.
Nutrition
Continued to support the partner NGOs in the targeted supplementary feeding projects and therapeutic
feeding projects through out the country.
Staff of Malalai hospital were trained on the 18-hour BFHI training. The training was attended by the
participants from outside Kabul.
The Micronutrient team of UNICEF visited the Western and North East regions to assess the salt situation
and feasibility of salt iodization in these areas. The team also consulted the potential partners for Vitamin
C distribution in these regions.
Emergency preparedness and response
A workshop organized by UNOCHA on civil military coordination in preparation of winter emergencies,
sponsored by the Swiss Agency for Development and Cooperation was held in Dubai, . The workshop
welcomed members of the ISAF and the Joint coalition as well as UN agencies and NGOs working in
Afghanistan. The objectives were to set up coordination mechanisms for all stakeholders and the
government in preparedness to emergencies like earthquakes, floods, avalanches, which have a high
probability to occur during the coming winter.
Unfortunately, low participation of operational actors from Afghanistan didn’t allow for the preparation of a
plan of actions. A draft on procedures for civil military coordination in time of emergency was elaborated
and should be reviewed in Kabul during a two-day workshop that will be organized by UNAMA in October,
2002.
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Communicable Diseases
As preparedness for next winter we together with MoPH and NGOs decided to conduct TOT of ARI from
7th to 9th of October 2002, in Indira Gandhi Hospital. During a meeting held with MOPH, WHO (CSR
section), SC-US, and IMC, the training schedule and training material has been discussed, and planning
of the workshop has been finalized. Training material will be selected from the Supervisory skills of ARI
management, and some of the material of a community child health care package inspired on IMCI
(targeted at village health volunteers to identify and treat 4 conditions in children under 5: danger signs,
pneumonia, dehydration, malaria).
The number cases of acute watery diarrhea admitted in 12 sentinel sites (both total, as well as those with
severe dehydration) are decreasing, and have dropped now below 200. This is a sign that the epidemic is
under control.
Malaria, Leishmaniasis
Increased malaria incidence is reported in northern and northeastern regions (particularly in the provinces
of Kunduz, Khanabad, Balkh, Faryab) of Afghanistan consistent with seasonal peak of falciparum malaria
transmission. In the absence of reliable data, implementing agencies and MOPH to strengthen diagnosis
and treatment, with WHO supporting MOPH to conduct mobile clinics to more remote areas. Contact
ezardn@afg.emro.who.int
Tuberculosis
The Afghan delegation that took part in the Regional Meeting of the National Managers of TB Control in
EMRO, held in Damascus (Syria) from Sep 15 to 18, 2002 is now back home. The situation of TB in
Afghanistan is followed with much interest by the Regional Office in that the burden of TB in our country
alone accounts for a large proportion of the regional cases. Afghanistan, along with the other high burden
country in the region, Pakistan, will therefore continue to be given high priority by EMRO.
It was recommended by Strategic Technical Advisory Group (STAG/EMRO) that Afghanistan completes
the planning process for DOTS expansion by end October 2002 and starts implementing the plan by
November 2002.Other important issues that need to be explored and eventually developed are the
involvement of the private sector in TB control, operational research and drug-resistance surveillance.
In addition to this brief report on the Damascus meeting, it is worth mentioning that TB is one of the
components of the proposal presented for funding to the Global Fund to fight AIDS, TB and malaria on
Sep. 27, 2002. The results of the application will be known in January 2003.
Water supply and sanitation
The Emergency chlorination project initiated in July is continuing. This is the 3 rd round of this project. As in
previous rounds WHO is providing technical assistance as well as hygiene education materials.
CWS site engineer currently is in Kunduz to start implementations of the project. The project will be
launched as soon as possible provided there are no objections from WFP.
CWS staff participated in the hygiene education meetings held in this period. The same staff of this unit
also participated in the Water and Sanitation Sector Group (WSG) meeting held on Sep. 26.02.
Furthermore, CWS unit is arranging an environmental health workshop for Mazar. EURO/WHO has
agreed to cover the cost of traveling of an environmental health specialist for this workshop.
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Overview of Geographic Areas
Central Area
A joint mission MoPH PHC department and WHO EHA section was held on 23.9.02 –25 9.02 for
winterization preparedness. The main purpose is to identify and supply the isolated areas, before
blockage of the road and to establish mobile clinics to the needy and isolated areas. During the mission,
we identified AZRO and KHARWAR districts as target areas. The AZRO District has 4 clinics that are
supposed to be supported by ISRA if they receive the necessary funds. There are presently no clinics in
Kharwar District, however AMI is intending to initiate a program if funds are made available. WHO may
temporarily support these areas during winter to ensure access to health care services for these
populations.
The second round of the NIDs campaign against polio is under preparedness. The district’s micro plan
has been reviewed. Meanwhile training is taking place in the Hazarajat area where the NIDs will start on
October 10th. Specific plans to reach missed children of Nomads traveling to the Eastern region are being
prepared (The total number of Nomad children vaccinated during F1 is 9,850 under five). Two AFP cases
have been detected this week from Bagram district of Parwan and Tagab district of Kapisa provinces. The
two samples were adequate and were sent in a good condition to the referral laboratory. RPOs visited
AFP focal points to encourage their timely detection of the AFP case
Northern Area, Mazar
Dr K. Schemionek, arrived in Mazar where she will work as regional public health advisor for the Northern
areas.
The MOPH focal point for HIS returned from a one-month course in epidemiology in Islamabad at AghaKhan-Hospital supported by WHO.
The post-NIDs survey showed 96% coverage for the first round of NIDs in September 2002. A one-day
training on EPI for secondary school teachers was conducted in Mazar. A suspected case of AFP was
revised in Samangan.
The number of diarrheal diseases cases in Jawzjan district is decreasing, the two camps set up to
welcome a high number of patients should be closed by the end of the month. A high number of ringworm
cases (130 students) occur in a school in Samangan province, treatment guidelines were provided to
MOPH and NGOs. MSF reported 3 cases of confirmed diphtheria in Faryab provinces.
As well, increased number of confirmed cases of Plasmodium Falciparum malaria is detected in Faryab
and Jawzjan Provinces.
Kunduz,
With the visit of Dr Nadine Ezard, WHO consultant for Roll back malaria, a meeting was organized to
review the action taken against the increase of malaria cases in the area. Merlin, MRC and WHO are
involved in the case management of malaria patients. New protocols were disseminated and the future
project of operational research on chloroquine efficacy was elaborated. The mission visited Khanabad
district and Imam Sahib where a prevalence of 8% Plasmodium falciparum, 3% plasmodium vivax was
found.
Two trainings on tuberculosis, one for the doctor and the nurses, the other for the lab technicians started
this week and for 10 days. The staff of the 6 new TB clinics of Kunduz are attending the course.
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Southern Area, Kandahar
WHO is supporting 2 nursing schools in Kandahar and in Helmand provinces as part of the capacity
building program. In both provinces 50% of the students who will graduate this year are female.
Of the 7 polio cases found in Afghanistan this year, 3 cases are reported from Kandahar ( Sarban Qala,
Musa Qala, districts of Helmand and Zabul). Therefore, special emphasis is given to the preparation of the
second round of the NIDs on 21-22 of October 2002
Eastern Area, Jalalabad
The WHO Representative in Afghanistan visited the eastern area on September 24 2002: Basic
development needs programs were reviewed in Chardehi village of Batikot district. Funds generated from
the projects were redistributed to an added 34 vulnerable families for the implementation of their income
generating projects.
WHO distributed 10 000 tabs of chloroquine to the Malaria referral center and 150 vials of anti-rabbies
vaccines to the Regional health director.
Three suspected cases of AFP were investigated and specific EPI coverage was conducted for the
Returnees.
Western Area, Herat
One suspected case of cholera has been reported from the pediatric ward of the regional hospital, from a
6 year old girl. Stool samples have been collected and sent for confirmation of causative germs.
Memorandum of understanding has been signed between the MOPH, WHO and Malteser-Hilfsdienst for
the support of the DOTS/TB activities in Herat.
WHO is preparing with he MOPH the training on PHC management and leadership TOT course at the
regional level.
The new basic health center in Karokh district has been inaugurated this week, the health center has been
constructed by IAM and will be supported by Ibn Sina, under the supervision of the MOPH .
Missions completed / ongoing / planned

Dr Abdul Hannan Choudhuri, a medical officer for the control and prevention of blindness, from
WHO Bangladesh is in Afghanistan to attend the eye care workshop in Kabul.
Meetings:

September 23, IMPD: Leishmania task force

September 30- - October 3, Cairo, Egypt, 49th Session of the Regional Committee for the
Eastern, Health Minister meeting

October 8: US Secretary of Health and Humanitarian Services visit to Kabul

October 8: 10 am IMPD: Malaria Task force
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
October 6-8: Central Area SMI Strategic Planning Workshop

October 12-14: Jalalabad, Herat, Kandahar, Kunduz: SMI Strategic Planning Workshop

October 13, 10:00 am. MoPH: NTCC meeting

October 2 and 9, 14:00, MoPH Library: Cholera & ARI Task Force

October 20, 10:30: Nutrition Task Force
Calendar of forthcoming activities

23–25 September 2002, Community health workers workshop, Kabul

21-23 September 2002, Eye care workshop, Kabul

5-6 October 2002, 3rd DOTS/TB expansion working group meeting, Montreal, Canada

October 7 to 9, Indira Gandhi Hospital: Training of trainers workshop on ARI, with participants of
NGOs and MOPH from 6 areas

21-23 October 2002, International conference on wastewater management and its effect on the
environment in hot and arid countries, Muscat, Oman.
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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