The Islamic Transitional Government of
Afghanistan
Ministry of Public Health
Health and Nutrition Sector Coordination Report
Reporting Period: 31 August - 06 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
A working group is preparing the final version of the National Development Budget for the Health
and Nutrition Sector for further discussion in the Program Secretariat. The Ministry of Finance
requested sectors to come up with a budget for the present and the next fiscal year, sorted out by
sub-sectors and their respective budgets.
The Global Fund is a trust fund, administered by the World Bank, to tackle priorities within the
control of Malaria, TB and HIV/AIDs. Project proposals should be submitted until end of
September. As for the time being there is no national governmental coordination body which is
indispensable for the implementation of work plans funded by the global fund, a proposal will be
submitted addressing the strong need for capacity building in this sector.
The Task Force for Community Health Workers developed criteria for selection of CHWs, their
Terms of Reference and contents of training. The drafted documents have been discussed in the
Health Coordination Task Force Meeting that took place on September 5. They will be further
discussed in the Program Secretariat and proposed to the MoPH for final approval.
Likewise a Memorandum of Understanding was drafted by NGOs to standardize salaries. This
draft will be discussed in the next Health Coordination Task Force Meeting (September 19).
For all coordination bodies (Program Secretariat, Health Coordination Task Force, National
Technical Coordination Committee) new Terms of Reference have been prepared for discussion
and final approval.
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Sub-sectors
EPI & Polio Eradication
Mr. Hamid Karzai, President of the Transitional Government of Afghanistan inaugurated the
National Immunization Days on 02 September by giving polio drops to a child in the National
Stadium in Kabul. The ceremony was preceded by a football match between two teams from
Kabul city, which was watched by a large number of people.
Moreover, all the regional and the provincial Governors inaugurated the campaign in their
respective regions and provinces.
Nation-wide immunization days were implemented from 03-05 September. Preliminary reports
suggest a high coverage throughout. The high focus remained on the southern region, provinces
of Farah and Kunduz and all the big cities of he country. Special teams were established at the
borders between Afghanistan and Pakistan, which provided OPV drops to all incoming and
outgoing children of eligible age for 7 days.
Thorough monitoring plans were implemented, which included monitoring of the NIDs during
implementation and post-NIDs monitoring. In all the clusters with less than 95% coverage in the
South, Farah, Kunduz and Kabul teams returned to their catchment area for finding missed
children. The NIDs in Afghanistan were fully synchronized with those in the neighboring countries.
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Reports received from the field, show an overall satisfactory 1st round of fall NIDs.
26 UNICEF staff members monitored NIDs activities in various locations.
Some difficulties were however encountered in the immunization of children in areas
where most of the people are returnees. NIDs supervisors monitoring around Kabul City
discovered that some houses had been left out.
Only reports from the Central regions have been received from zonal offices.
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A total number of 208 AFP cases have been detected (polio and non-polio) out of which 5
are confirmed.
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Field offices will be asked to send their report as son as possible. Recently a decision
has been made to carry out a new round of NIDs from 15-17th December 2002.
Maternal and Child Health
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EmOC trainers in Malalai Hospital started the implementation of the interventions learned
– active management of 3rd stage of labour, partograph use and infection prevention.
New rehabilitation has been completed in the hospital– i.e. the kitchen, as well as new
drug supply and materials from UNICEF’s support.
The laboratory and blood transfusion facility have been assessed by a
MoPH/UNICEF/WHO team.
Mental Health
A three weeks training course for primary health care physicians doctors was conducted in the
mental health department from 10-31 August 2002.
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15 doctors (only one female doctor) from Paktya ,Maidan / Wardak, Ghazni, Herat, Rabai Balkhi
Hospital, Dehi Sabz, Aliabad Hospital and the Mental Health Hospital Kabul attended the course.
The sessions included lectures and practical activities. Lectures covered common mental health
problems in PHC settings.
Nutrition
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UNICEF continued to support programs on supplementary feeding intervention in 174 feeding
centers run by NGOs throughout Afghanistan.
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An agreement with NGO partners to provide blanket feeding in Kandahar for children,
pregnant and lactating women is now finalized.
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UNICEF, concerned ministries and NGO partners held a meeting to initiate operational
research on child care practices.
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Preparatory work on the Baby Friendly Hospital Initiative training for the second batch of
trainees was carried out at Malalai Hospital.
Tuberculosis
Anti TB drugs have been distributed to Mazar-e-Sharif and Ghazni. Likewise 5 sets of
microscopes for the new TB centers in the Northern area ( Mazar-e-Sharif, Sheberghan, Kunduz
and Takhar provinces) have been distributed.
Emergency and Humanitarian Action
Cholera campaign:
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Distribution of emergency supplies for increased cases of Acute Watery Diarrhea (AWD)
continued throughout this week. ORT corners received supplies in Ringer’s lactate solution
while 6 hospitals in Kabul and 4 provincial hospitals were supplied with antibiotics.
Expansion of activities included the chlorination of wells and the provision of hygiene
education in Kabul City.
Water supply and sanitation
Within the control of diarrheal diseases, emergency chlorination of water sources in the
city of Kabul has been carried out. A hygiene education meeting was held at MOPH. For
the rehabilitation of urban water supply projects a series of meetings were held in the
Ministry of Town Planning and Housing. A data collection format with regard to urban
water supply systems in Afghanistan was developed by WHO’s section for water and
sanitation. For providing opportunity for the workshop on water quality surveillance in
Mazar in October 2002, the education material prepared is translated into Dari.
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Health Promotion
On September 4, a training workshop for women journalists of Radio Afghanistan on Basic
Journalism Skills started with the inauguration ceremony at the Aina media center in Kabul. This
15- day training workshop is one of the component of the women’s Health Radio Project aiming to
contribute to the reduction of mortality and morbidity amongst Afghan women and children
through relevant health information via radio on topics salient to their survival and improvement of
their health status. This training workshop has been designed to assist in enhancing the capacity
of Radio Afghanistan staff to develop, produce and broadcast women’s health programs to the
Afghan population both in the Dari and Pushto.
The Department of Health Education, Promotion and Publication of MoPH, in collaboration with
the Public Information Unit of WHO has initiated efforts to compile and publish a medical manual
and guidelines for health professionals and health workers. In this regard all NGOs within the
health sector have been contacted; two meetings have already taken place.
WHO Afghanistan is intending to initiate a WHO-monthly newsletter on ongoing and planned
activities. The first edition of this monthly newsletter is planned for October 1.
Overview of Geographic Areas
Central Area
Within the control of diarrheal diseases and the program for EPR, a mission, composed by the
regional coordinator for Emergency Humanitarian Action (EHA) and a member of the MoPH
department for Communicable Diseases visited the provincial hospital of Maidan and the Ibrahim
Khil Clinic. 7 boxes of medical supplies (Ringer Lactat and Glucose) were distributed to the
hospital. One suspected case of Cholera had been referred from Jalrez District, Wardak
Province.
Maidan Hospital has the capacity of 30 beds (Surgery, Pediatrics, Internal Medical and Nutrition);
80 to 120 patients are daily treated in the OPD. The Outdoor Patients Department (OPD) is
supported by the NGO IMC. The number of staff is not sufficient; electricity is not available;
bathrooms are not functioning.
According to villagers, the Maidan Hospaital does not provide appropriate facilities; patients are
brought by their family to Kabul.
2 stool specimen suspected for Cholera and dispatched to the National Institute of Health in
Islamabad were positive. The origin of the patients is close to the district center. The patients
have recovered. According to the MoPH director of Maidan Province the number of cases of
acute watery diarrhea had increased but not the number of sever dehydration.
Meeting with Dr Attaullah Responsible for Ibrahim Khil Clinic (30 min. drive from the provincial
hospital), supported by IMC:
Between 50 to 70 patients are treated daily in OPD. The number of acute watery diarrheal cases
is reported regularly to their sub office. There is increase in the number of AWD cases. Cases of
severe dehydration, after application of Ringer, are transferred to Maidan Provincial Hospital, as
the clinic does not receive sufficient amount of fluids for an appropriate treatment. Only 5 litres
Ringer Lactate /month is provided.
EPI / PEI activities:
Round table discussion on TV where the Deputy minister of Haj and Awqaf, director of foreign
department MOPH, deputy manager of REMT, UNICEF and WHO discussed the importance of
the next two rounds of NIDs in the context of interruption of the wild virus transmission in
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Afghanistan by the end of this year. It was clear that the commitment and mobilization of the
community is a multisectoral responsibility.
The Fall Rounds of NID’s for the year 2002 in Afghanistan have been inaugurated at the Kabul
stadium. The ceremony has been really successful and honored by the presence of His
Excellency Mr. Hamid Karzai, President of the Transitional Islamic Government of Afghanistan. A
high profile delegation has also assisted to the ceremony. Professor Nematullah Shahrani, Vice
President, Mr. Yunus Qanooni, Minister of Education, Dr. Sohaila Seddiq, Minister of Public
Health, Dr. Mihraban Depute Minister of Public Health, All heads of departments of MoPH, Kabul
Mayor, Ambassadors, Dr. Riyad M. F. Musa Ahmad, Officer-in-charge of WHO, UNICEF
Representative and heads of the NGO community in Kabul.
The ceremony has started by recitation of verses from the Holly Qura’an followed by the National
Anthem. A concert for 25 minutes has followed, where school children performed a song for the
NIDs. The Minister of Public Health, WHO and UNICEF Representatives delivered their
speeches. A soccer game took place afterwards as a symbol of a healthy life style.
H. E. the President has dropped OPV doses to two of the Afghan children as sign for his personal
interest and commitment for a brighter future for Afghanistan.
On the two sides of the executive lounge, women and children were invited to attend the opening
ceremony. Local radio/TV and representatives of the international media covered the event from
the start. As part of the celebrations, Kabul had a parade, which started from the REMT in the
morning. It has gone all around the city. NIDs messages were disseminated through
megaphones.
Monitoring of NIDs:
There were 15 monitors in Kabul city as follows;
WHO:
3 person
UNICEF:
3 persons
IMC:
1 person
Ibn Sina:
1 person
Relief International: 2 persons
UNFPA:
1 person
IFRC:
1 person
ARCs:
1 person
MSH:
1 person
SCA:
1 person
The campaign started successfully on 3rd Sep and monitored through WHO, UNICEF, NGOs
MOPH and independent monitors during three days. There were two review meetings every day
in WHO office for monitoring findings and afterwards at REMT/MOPH for the daily update. There
were three missions for monitoring of Kabul districts and three missions from WHO side to
monitor NIDs and post NIDs in Parwan, Kapisa and Wardak provinces. Their findings will be
submitted after analysis. Detailed finding of Monitors during and after the implementation of the
NIDs will be submitted as soon as they have been compiled and analysed.
Post NIDs coordination meeting: the coordination meeting has taken place at WHO, office to
insure a high quality campaign particularly in Kabul city due to the high numbers of returnees
(according to UNHCR reports). It was agreed that 95% is the least acceptable coverage in Kabul
city, it was also obvious that this 95% should be cluster wise and not total coverage. The post
NIDs monitoring activities should be the final judgment on the coverage. A team of monitors from
WHO/ REMT are now in the field to evaluate the situation.
The final coverage reports are not yet received from the REMT. It has been emphasized the
importance of the timeliness and completeness of the data collection and compilation.
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Social mobilization: Messages and spots have been broadcasted through the Radio/TV and
mobile groups for mobilization of the community to reach each and every child for OPV.
AFP Surveillance: three AFP cases have been detected this week from Part-8 of Kabul city,
Jaghato district of Wardak and Kohistan district of Kapisa province. The three samples were
adequate and in good condition when sent to the referral laboratory.
Northern Area, Mazar
The NIDs were inaugurated in the MoPH on September 2. All governmental departments were
present. 2 AFP cases were detected and stool specimen sent to the reference laboratory in
Islamabad.
The Malaria Task Force recommended sending 4 physicians and one laboratory technician to
Zarie District, Balkh Province, for further investigation and treatment of reported outbreaks of
Malaria.
The outbreak of Malaria in Jawzjan Province is under control. WHO provided necessary medical
supplies as the Provincial MoPH had faced shortages.
North-Eastern Area, Faizabad
A death related to severe dehydration and diarrhea was reported from Sari Tal, a remote area in
Teshkan District, as there is no access to health services.
NIDs were going on. Monitoring results indicate a very good coverage and respect of the door-todoor strategy even in very remote areas.
Western Area, Herat
In the pediatric ward of the Regional Hospital a 7 years old girl died due to diarrhea and severe
dehydration. A stool specimen could not be taken. From another severely sick child the specimen
could be taken and sent to the reference laboratory in Islamabad.
There are no reports on outbreaks in both IDP camps, Maslakh and Shaidayee. Village Health
Volunteer Training for 20 teachers and Imams was carried out in Badghis Province by WHO,
especially in the prevention of Malaria. 1000 slides taken in by the MoPH of Badghis have been
sent to WHO Kabul for cross checking.
An AFP case was detected from Shindand cluster.
Southeastern Area, Ghazni
On August 31st the monthly health coordination meeting was held. Topics of discussion were the
control of acute watery diarrhea, monitoring activities of the NIDs, strengthening of AFP
surveillance, training of VHVs and TBAs by MoPH and, with support of WHO, the establishment
of an EPI fixed center in a newly re-opened clinic in Ghazni.
WHO Ghazni, together with the village development committee of Rabat, organized a 3-daysanitation campaign for the disposal of garbage. More than 50 people participated in this activity.
WHO provided anti-diarrheal, anti-malaria, essential drugs, MCH supply and HIS material to 6
BHCs, run by the MoPH in districts of Paktika Province.
An AFP case has been detected in Khost Province.
The NIDs were launched with a ceremony in Ghazni’s hospital with participation of governmental
authorities, UN agencies and NGOs. NGOs have supported the campaign in terms of logistic and
monitors. Around 5000 volunteers, supervisors, coordinators and monitors have been engaged in
the area.
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Eastern Area, Jalalabad
A Health Coordination Meeting was held on August 28th, covering the following issues: report on
the control of diarrheal diseases, report on NIDs and Measles Mortality Reduction Campaign,
celebration of Breast Feeding and new activities of agencies.
20 TBAs in Hesarak District, Nangahar Province, received refresher training through WHO.
Southern Area, Kandahar
Within the preparation and implementation of the NIDs, MoPH, WHO, UNICEF and NGOs carried
out the following activities: advocacy meeting with governmental departments; parade on
September 2nd in Kandahar, Qalat and Bust; advocacy meeting for 350 women in Bust city and
for 400 women in Naharisarj Distrit; radio announcement and round table interview with Kandahar
TV and radio; football match in Kandahar stadium for dissemination of NID messages.
2 cases of Polio have been confirmed from Helmand Province.
Missions completed / ongoing / planned
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Dr. Stephanie Simmonds, consultant on health policy and strategic planning will work with the
MoPH until September 12th. The third session of the first capacity building seminar for MoPH
staff on health policy and planning will be held on her last day of stay.
Calendar of forthcoming activities:
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September 12, MoPH Library, 10:00: National Technical Coordination Committee (NTTC)
meeting
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September 15, MoPH Library, 9:00: EPI Interagency Coordination Committee
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September 17, Kabul Hotel, 8:00: Coordination Meeting on Reproductive Health, followed
by a three-day Workshop on Safe Motherhood
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A Reproductive health co-ordination meeting will be held on 17 September and will be
followed by the Safe motherhood strategic visioning and planning workshop II that will
take place, 17 – 19th September.
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September 23-25, Khyber Restaurant, Workshop on National Community-Based Health
Care, MoPH, WHO, UNICEF and MSH
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September 23-25, Insaf Restaurant, Workshop on Eye Care Strategic, MoPH, CBM, WHO
and IAM
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October 23 to 28, Mazar, MoPH: workshop on water quality surveillance
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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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