The Islamic Transitional Government of
Afghanistan
Ministry of Public Health
Health and Nutrition Sector Coordination Report
Reporting Period: 14-20 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
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
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.
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.
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Sub-sectors
EPI & Polio Eradication
During September 14th to 20th, 18 cases of Acute Flaccid Paralysis were reported from all over the
country. One case each from Western region, Southern region, Badakhshan and Northern region, four
cases from Eastern and Northeastern regions each and 6 cases from Central region.
The first Tele-conference call on polio eradication in Afghanistan was held on September 18 th 2002 with
WHO Geneva, CDC, UNICEF HQs, and WHO Pakistan. Objectives of the call were to brief all partners on
the current situation of Afghanistan in more detail, to allow to form a preliminary pre-TAG consensus on
the main issues affecting the programme, and to have intermediate guidance for the country team.
There are seven known wild virus-confirmed cases in 2002 to date, 4 P1 (Farah - May 25, Helmand - May
3 and July 20, Kunduz - June 28) and 3 P3 (Nangahar - Feb 21, Zabul - July 6, Kabul - July 28). Thus,
the geographical extent of virus transmission in 2002 is already wider compared to 2001, with virus was
found in 4 Regions and 6 provinces in 2002, compared to 2 Regions and 3 provinces in 2001.
During the meeting following points were discussed:
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Recent epidemiological evidence suggests that virus transmission continued in several high-risk
areas of Afghanistan known to be infected or high-risk in 2001 (Southern region, probably Kunduz
area)
Two key factors contributing to the increase in the number of reported cases are:
o Improvements in surveillance (especially in the south), and
o Major, rapid population movements, especially the influx of returning refugees from
Pakistan and Iran, which increases the levels of susceptibility to infection and ease virus
transmission in-country, as well as increase the risk of importation of wild poliovirus from
endemic areas in Pakistan.
While SIAs rounds in 2002 have been excellent in many areas of Afghanistan, improved SIA
monitoring has detected gaps in SIA quality in areas consistent with epidemiological findings.
To maintain and improve population immunity, especially in view of the major current population
movements, a large SNIDs round, targeting up to 300 of Afghanistan’s 330 districts, will be
conducted in mid-December.
The participants were informed that Her Excellency Minister of Public Health has approved the
dates for December NIDs round which will be conducted from 15 to 17th December, 2002.
The next Afghanistan Technical Advisory Group for Polio meeting will be held on 4 and 5 of
November in Kabul.
Maternal and Child Health
RH Coordination meeting was held on 17 Sep 2002 in Kabul Hotel, co-chaired by MOPH and UNFPA.
Governmental and non Governmental Organizations, WHO, Unicef and JICA attended in the meeting. As a
part of agenda UNFPA, UNICEF, WHO and MCH Director - MOPH presented their recent activities, plans
and developments on SM as well as presentation on the preliminary result of the health survey, which was
conducted by MSH. The RH Coordination Meeting followed by National Safe Mother hood Strategic
Planning and Visioning workshop which took place for duration of three days (17-19 September, 2002).
Main objective for this workshop was as follows:
1. To share the content of the National strategy for the reduction of maternal mortality
2. To review the progress since the first workshop and share experience related to Safe motherhood
in Afghanistan
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3. To assess the needs for the implementation of the strategy at each service level (hospital, health
center, community)
4. TO identify roles and responsibilities of partner organizations/group contributing to the strategy
(MOPH, WHO, UNICEF, UNFPA, NGOs, Afghan society of Obstetricians and gynecologist,
external partners, Donors and community groups)
5. To develop national and sub national work plans to identify expected outcomes by December
2003 and draft detail plans for October 2002-March 2003 and for the next one month period.
National Safe Motherhood Strategic Visioning and Planning Workshop were conducted in Kabul on 17-19
Sept. This was following of the Safe Motherhood workshop conducted this year in May in Kabul.
Participants of the workshop were MoPH, Staff of Centers of Excellence (Kabul, Jalalabad, Mazar and
Kandahar), UNICEF including UNICEF Regional Office for south Asia, UNFPA, WHO, Columbia
University (Averting Maternal Death and Disability Programme) and some donors. The outcome of the
workshop is:
Understand the content of the national Safe Motherhood strategy.
Identify the needs for the implementation of the strategy at each service level: hospital, health center and
community.
Know the roles and responsibilities of the partner organizations that will contribute to the implementation
of the strategy.
Draft national and sub-national workplans to identify expected outcomes by December 2003; draft action
plans for October 2002 - March 2003 that contribute to the strategy; and draft action plans for the coming
4 week period.
Nutrition
Continued support a total of 174 supplementary feeding centers implemented by NGO partners and
MOPH in various parts of the country.
A three-day BFHI training conducted in Malalai Hospital in Kabul. A total of 25 staffs, including three from
the Mazar MOPH Hospital, attended the training. The three staffs from Mazar who are trained in Kabul as
“Master trainers” will conduct the 18 hour BFHI training in Mazar.
A technical group that consists of the members from CCMaC (national NGO), Ministry of Public Health,
ACF and UNICEF worked on the training modules designed for Therapeutic Feeding programme.
UNICEF team involved in the operational research on the Infant Feeding Practices Project visited
Panjsheer Valley to initiate the research work, a pilot project in the country.
UNICEF staff visited Super Flour Factory (SFF) located in Kabul. The factory has been producing the
complementary food, based on locally available ingredients. As this product is suitable in the
supplementary feeding centers, MCH clinics as well as at household level, UNICEF is exploring the
modality of collaboration with the factory.
UNICEF Micronutrients team visited Herat to explore salt production and salt iodization. The team
discussed issues related to salt production and iodization with the Ministry of Mines and the Ministry of
Pubic Health. The team also visited salt mines to explore the feasibility of expanding existing capacity.
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Communicable Diseases
The number of diarrheal disease patients is decreasing in Kabul city as well as in other area affected by
outbreak but surveillance will continue as well as health promotion and education and well chlorination
activities. In the national task force, Dr Koshal, requested health partners to begin preparation for increase
of ARI cases during the winter. A refresher training is planned, agencies are requested to present their
plan in prepartion of ARI increase of cases to MOPH by next week.
This week no reports of outbreaks have been received from other regions.
Tuberculosis
Meeting of the National managers of the TB Programmes in Syria Damasens, the Eastern Mediterranean
Region EMRO, 15-17 September 2002 and Inter-country workshop on national strategic plan
development for countries with high burden of TB in EMRO, 18 September 2002.
Deputy director of Planning Dept of MoPH, national TB manager, Dr. Gampaolo Mezzabotta and Dr. A.
Zarabi from WHO and TB responsible from Medair participated in the meeting.
A workshop on Dots Expansion Programme is going to be held in the northern region of Afghanistan and
a lab technician course will start on 20, 9, 2002 in Kunduz and a 10 day workshop for doctors and nurses
starting from 23,9, 2002
Health Promotion
As part of Women’s Health Radio Project the first part of training workshop, which was on Basic
Journalism skills for women journalists of Radio Afghanistan to train them elements of good journalism
including Science/Health journalism and sensitization of health issues , has been completed. The second
part of training workshop for Health Education will be Held on October 8-22,2002.The Health Education
training workshop aims to
 Improve journalists understanding of women’s health issues in Afghanistan
 Improve the quality, currency and visibility of reporting on women’s health issues
 Give journalists background on health behavior and behavior change models
 Teach journalists how to communicate health
 Develop journalists ability to turn identified issues into messages for radio broadcast
 Develop journalists critical thinking
 Produce a reference guide for health communicators
 Promote coverage of health issues among media professionals
Overview by Geographic Areas
Central Area
Coordination
The provincial coordinating body meeting of Wardak province has participated, WHO announced to
support Wardak public health directorate with emergency supply and with establishing temporary clinics in
vulnerable areas during the winter.
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A- Fall NIDs 2002:
Compilation of FR-1 NIDs:
Coverage report of FR-1 NIDs collected from all districts of central and Hazarajat regions and completed.
For a better view of the area coverage, the final numbers were compiled at cluster level, which would be
the backbone for having the coverage reports at village level. This would be the cornerstone for a very fine
tuned micro-plan for the whole region.
The coverage was verified carefully at the field level and it is really impressive. All implementers have
done a great effort for the Polio eradication and specifically during the campaign.
Specific coverage reports for the Nomadic population have been compiled to evaluate the exact number
and immunization status. Their directions and the season of movement is also closely monitored.
Nomadic movements have started already; their final destination is the eastern region (Nangarhar and
Laghman). In that regard 19 mobile teams have been mobilized for that endeavor. Basically, the teams
are at the outlets of the cities and move towards the next nearest city. The teams are on motorcycles
moving to and forth Kabul, Logar, Wardak and Kapisa provinces in different radius. This activity started on
the 17th of September for one week. Findings will be discussed with the counterparts.
B-Social mobilization:
A meting was held in WHO office with UNICEF, Heath education Department of the MoPH and REMT
colleagues for the final agreement on the social mobilization materials for FR-2 NIDs02.
C-AFP Surveillance:
Two AFP cases have been detected this week from Bagram district of Kabul and Nawur district of Ghazni
provinces. Samples sent to the referral laboratory.
Active surveillance is on its track, all resources are available to maintain it especially the trained technical
manpower.
A joint mission of UNICEF and WHO has visited part 8 (Beni Hissar) to follow up the immunological state
of the returnees since the latest epidemiological review has emphasized how critical it was.
A field visit to Puli-Charkhi catchments camp where UNICEF and WHO senior staff looked at the activity
there. All returnees under 5 years of age receive 2 drops of OPV and afterwards all children between 6
months till 12 years of age receive measles vaccine. The camp is run by UNHCR and the vaccination
center is run by REMT i.e. MoPH staff.
D-Measles mortality reduction campaign (MMRC):
In a meeting at WHO office, all stakeholders (MoPH, WHO and UNICEF) it was agreed by all counterparts
that the MMRC campaign will be completed in certain provinces of the central region as part of the
prevention against that killer disease especially in Winter, according to the yearly reports.
All MMRC activities will take place between now and the 5th of October 2002. Kabul Province will be
covered, Kapisa also three districts, Khoshi district of Logar and Maidan district of Wardak. Trainings
have started for all the categories of the campaign and the coverage would be reported at the end of the
campaign.
Northern Area, Mazar
Four survey teams conducted a coverage survey after the National Immunization Days in 21 clusters of
Mazar city, where they identified few missed children, who were referred to an EPI fixed center for the
administration of oral polio vaccine.
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Communicable Diseases
Cholera outbreak in Jawzjan district seems to become under control, where the number of cases admitted
in health facilities is decreasing day by day.
In the regional hospital of Mazar, a 12 days training on tuberculosis control will be conducted from 28
September onwards, for 22 medical doctors. Tuberculosis drugs have been distributed to clinics where
TB care is being delivered, as well as 30 cartons of BP5 and BP100 biscuits. The deputy TB coordinator
and the national health coordinator of WHO assessed in Aaqcha and Khulm districts where to establish
tuberculosis care. The district hospital of Aaqcha disctrict, Jawzjan province, has provided 3 rooms for
tuberculosis care. MOPH will train one nurse in the regional laboratory in Mazar during one month, and
WHO will provide microscope, reagents and other laboratory equipments, train 2 doctors and 2 nurses in
tuberculosis control, and ensure regular supply of drugs.
Northern Area, Kunduz
Coordination
During the monthly Health and Nutrition Coordination Meeting, with participation of 10 different agencies
and NGOs, the latest news on malaria in Imam Sahib district, on tuberculosis expansion in the region, and
on supplementary feeding centers was shared.
Malaria
In Imam Sahib district, Kunduz province, using a rapid diagnostic test, 25 (17%) out of 144 samples tested
among a convenience sample of persons living in 3 villages (Kalbat, Gharraw, Gurgori) were found
positive for malaria, including 5 Plasmodium vivax and 20 Plasmodium falciparum. Only in Gurgori village
the proportion of tested persons found positive for Plasmodium falciparum reached 10%. Here one
technician and one health worker was assigned to strengthen malaria control, with the recommendation to
start presumptive malaria treatment regardless of the result of blood exam. The same presumptive
treatment should be given to all persons living in villages where more than 15% of persons tested with a
rapid diagnostic test are found to be positive for Plasmodium falciparum. The director of MOPH of Imam
Sahib district had also requested all private pharmacies to provide 1000 tablets of chloroquine, and 20
000 tablets were provided as well by the local clinic supported by Swedish Committee for Afghanistan.
Tuberculosis
Qala-I-Zal and Imam Sahib districts, of Kunduz district, were visited by a joint WHO - MOPH team, to
select personnel in health centers which will implement new tuberculosis control activities. District
authorities expressed their support to the tuberculosis programme. Another clinic in Kunduz district has
been supervised.
Northeastern Area, Faizabad
A Health Coordination meeting has been held, where the results of the NIDS have been discussed.
According to preliminary reports from the field, the first round of fall 2002 NIDs have been implemented
successfully in all districts of Badakhshan, including Darwaz and Pamir districts
Eastern Area, Jalalabad
The Health Technical Working Group met on 28 August in Jalalabad, and will meet again on 25
September.
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EPI/ Polio Eradication
The first round of fall 2002 NIDS gave coverage results of 100% (331507 children) in Nangarhar, 109%
(119295) in Kunar, and 96% (111521) in Lahgman provinces, which covers 41 districts in total. All NGOs
have been requested by the representative of the Regional EPI Management Team, to participate in
looking for missed children during monitoring after the NIDS.
The most recent update on the Measles Mortality Reduction Campaign in 5 districts of Kunar and
Laghman provinces which had not yet been covered, gave coverage results ranging from 82% to 122% (in
total 52553 children between 6 months and 12 years old).
Communicable Diseases & Malaria
Following the report of an increase of people suffering from diarrhoeal disease in Joudara village, Dehbala
district, an investigation team found only 63 cases with some dehydration, and the laboratory of National
Institute of Health of Islamabad, Pakistan, found that the result of the examination of a stool sample
collected in the village was negative for cholera. However, new samples have been collected and sent to
Islamabad.
In the 4 weeks of August 2002, 7 health facilities in Jalalabad have reported 5 deaths and 2124 alive
cases (including 174 with sever dehydration) of acute watery diarrhoea. The epidemic seems to be under
control.
Aide Medicale Internationale reported that they had found 40 out of 100 people in Laghman province
positive for Hepatitis B (Hbs antibody).
Also, because in 2001, 50% chloroquine resistance had been found in the region, and because of the
increase of cases of Plasmodium falciparum malaria reported, the monthly Health Technical Working
Group which met on 28 August, decided to refer the question of adding Fansidar with chloroquine as a
standard treatment in all health facilities, to the national policy level in Kabul.
Reproductive Health
The NGO NAC will start training 70 midwives in the Nangarhar Intermediate Medical School, in close
collaboration with the Regional MCH department. During the Breast-feeding week (an international
initiative started by WHO and UNICEF in 1978), 37 female staff have been trained, and 2200 women had
received a health promotion message supporting and protecting breast feeding. Banners and posters
have been distributed in the region.
Two refresher training course for TBAs were conducted in Ab-e-Zangani and Ghwagiza villages of
Hesarak District.
WHO organized a meeting for the delivery of health services for the 300 IDP families in Hesar Shahi
Camp. It was agreed that the ISRA clinic will take care of the health of the IDPs and refer sever cases to
MOPH hospital.
Missions completed / ongoing / planned
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Mr Eugene Dewey, Assistant secretary of Population, refugee and Migration Programme from the
Us State department will visit Afghanistan for 4 weeks, from the beginning of next week.
Meetings :
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September 23, IMPD: Leishmania task force
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October 8: 10 am IMPD : Malaria Task force
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October 13, 10:00 am.MOPH: NTCC meeting
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October 20, 10:30 : nutrition task force
Calendar of forthcoming activities
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23–25 September 2002, Community health workers workshop, Kabul
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5-6 October 2002, 3rd DOTS/TB expansion working group meeting, Montreal, Canada
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16-20 September 2002, Second Global Team Meeting on Making Pregnancy Safer (MPS),
Geneva, Switzerland.
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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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