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The Islamic Transitional Government of Afghanistan

Ministry of Public Health

Health and Nutrition Sector Coordination Report

Reporting Period: 28 June – 5 July 2002

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Contents

Program Secretariat / Coordination

Sub-sectors

Regional overview

Missions to Afghanistan, international meetings/ training & workshops

Surveys and assessments

Calendar of forthcoming activities

Coordination

Meeting on Program Secretariat – Health and Nutrition

On Wednesday July 3d, the new Health and Nutrition Program Secretariat working group met to define the future coordination structure for the health and nutrition sector. The Program Secretariat working group is composed of MOPH, WHO, UNICEF, UNFPA and 4 NGOs: AMI, Medair, CHA, IAM. The NGO, GMS, was also present at the meeting.

As per the letter of understanding of the Program Secretariat (PS), coordination of the sector shall be implemented by the Program Secretariat and through the Ministry of Public Health (MOPH). In order to facilitate the process of coordination, the sector of health and nutrition shall be divided into task forces representing sub-sectors. Each task force can be divided further into working groups if deemed necessary. Each task force shall adopt a participatory approach. A team leader for the task force shall be elected in the first meeting and terms of references will be developed.

Eleven task forces have been identified, according to the MOPH organogram. Some may be merged after few months, with a decrease of the workload and identification of close links.

A general panel meeting will be convened bi-weekly that may still maintain the name of NTCC. Its goal is to present to all stakeholders the work of the different task forces and share any other information. The Technical Advisory Committee (TAC) will also be maintained as the policy and planning cell of the PS.

At the regional level, WHO sub-offices will also support the regional health directorate; the regional health coordination committee will present information about the work of the task forces. The task forces shall be determined by each region’s capacity, even though some including nutrition, EPI, MCH are to be developed in all regions. Proper link-up shall be maintained with the PS at the national level.

Task Force for Aid Coordination (MoPH, WHO, UNICEF, UNFPA, ICRC, EC, USAID and SCA)

An ad hoc meeting of the Task Force was held on 4 July 2002 on Capacity building for health information, surveillance and data management inside the MoPH, with the participation of MoPH, WHO, UNICEF, ICRC, MSH, and SCA. It has been agreed that the MoPH should be the place where data on health would need to be available and analysed, be it coming from surveys or surveillance systems. For this purpose, capacity that is now concentrated at the multi-sectoral level (such as in AIMS) is to be seconded to the health sector.

Currently MoPH at the central level is at the very beginning of building capacity for data management and health information. However, in some regions (e.g. Herat) the capacity in the MoPH is more advanced. Participants agreed to the idea of a joint unit inside the MoPH, which would gradually incorporate data management activities that are currently not managed by MoPH. This unit would be supported by the secondment of staff of the agencies currently working in this field. Some discussion among participants concerned the time period that is needed before capacity can be increased by supporting agencies, ranging between immediately to up to 18 months. A meeting will be held to talk about a draft discussion document on the topic.

Capacity Building Exercise

A fifth exercise of a joint mission, composed of UNAMA and AACA, visited Faizabad, Kunduz and Takhar in northeastern Afghanistan:. The overall purpose of the mission was to engage in constructive dialogue with local authorities and the assistance community, to assess the needs in the area and to jointly establish opportunities for capacity building in the future.

Sub-sectors

Primary Health Care

A training course on primary health care for health personnel of Kabul province Basic Health centers and staff from the MOPH has been conducted from June 23 to July 04 2002 in the MOPH library. Trainers from WHO and MOPH facilitated the course. It was attended by 23 health professionals.

EPI & Polio Eradication

• Micro plans for Sub-National Immunization Days (SNIDs) have been finalized. Training of volunteers will start from 2nd week of July.

• Three AFP cases have been reported, two from Kandahar and one from Faizabad, Badakhshan.

• AFP surveillance activities have been intensified in all regions to achieve the target of interrupting the transmission of the wild polio virus in Afghanistan by the end of 2002.

Maternal and Child Health

• The SMI (Safe Motherhood Initiative) Task Force meeting was held on July 2d at UNICEF. Representatives of MOPH, UNFPA, UNICEF, WHO, international and national NGOs participated in the meeting. There was an update of the support to the Malalai hospital which has been chosen as a future center of excellence for SMI. Task force discussed the need for training of TBAs, particularly in remote areas, where there is no MCH center available. It is important to discuss the role of TBAs to provide awareness to the community with regards to women’s health. This issue will be presented by WHO and Ibnsina in next SMI Task Force Meeting, end of July.

• A MCH Task force meeting will be conducted in late July 2002, which will be chaired by Director of MCH Department of MoPH and sponsored by WHO.

• WHO plans to launch a safe motherhood needs assessment in 12 provinces of Afghanistan. WHO will carry out the survey in places not covered by the UNICEF survey.

Mental Health

The training course on Mental Health Nursing ended on June 30th. Eighteen nurses, 14 from Mental Health Hospital and 4 from Neuropsychiatry service of Aliabad hospital attended the course. Only 3 of them were female nurses. Dr Temorshah Mosamim, Deputy Director Mental Health, and Mr Khair Mohammad Nekyaar, Head clinical psychologist from mental health department, facilitated the training.

The training included theory and practical sessions. All topics began with group work presenting their presentations followed by lectures for comparison. Copies of materials in Dari were distributed to the participants.

A team of nursing staff headed by Mr.Masood Totakhail, Head of Nursing Unit, Mental Health Department, was established to implement newly acquired skills in mental health nursing in hospitals. The priority is to observe the right of patients suffering from psychological disorders by providing humane treatments. The team will have weekly meetings to discuss difficulties encountered and monitor the process. Patients’ relatives will also be trained on the topic.

Communicable Diseases

Several rumors of cholera outbreaks have come from different regions of the country, but none has been confirmed. (Ed’s note: Since the publication of this report, three cases of cholera have been confirmed in Kabul. See Central Area report.)

Guidelines for the Control of Diarrheal Diseases in Dari and Pashto have been reprinted and will now be sent to the areas to be used during training sessions for basic health care workers. Reporting and surveillance data forms have been distributed during the last weeks and are available at WHO and MOPH offices of communicable diseases.

2000 vials of anti rabies vaccine have arrived in Islamabad. The vaccine will be made available in Kabul and other WHO sub-offices next week.

Emergency Preparedness and Response

International Relief is preparing a 2 days workshop on EMS on July 18 with MOPH, Office of Disaster Preparedness (ODP), WHO and the Norwegian Red Cross. The goal is to build networks, capacities and to plan for emergency response at central level with all partners involved.

Last week, WHO received verbal information about an increased number of cases of viral Hepatitis B in Logar province. A WHO/EHA officer went to investigate the situation.

Water supply and sanitation

A mission was conducted by CWS staff to highlight the IDPs water and sanitation activities in Kunduz. CWS staff participated in a meeting organized by MoPH to discuss the existing environmental health situation in Kabul and the ways to improve it.

The list of required pumps, pipes and other materials for Chare-Kar (Parwan) was finalized and sent for procurement from the international market. Additionally, a training program is planned for water supply engineers working in Herat to acquaint them with the available on-site water quality-testing techniques.

Health Promotion

The Afghan Ministry of Public Health, supported by WHO, is launching a nationwide radio campaign focusing on control of diarrheal disease. The radio campaign is accompanied by a door-to-door house education campaign in the old town of Kabul for the next two weeks. This MoPH activity is being carried out with the technical support of Save the Children-US.

A health promotion coordination workshop will start on Monday, June 15th at the Kabul Hotel. Participants will work to design a common and coordinated approach to health information dissemination in the next six months, focusing on prioritized health issues and filling in gaps nationwide in delivery of health education.

Overview by Geographic Areas

Central Area

Seven suspected cases of cholera have been reported in 6 different hospitals of Kabul. Stool samples have been collected and sent to the National Institute of Health (NIH), Islamabad, to confirm the diagnosis, but results are pending. The Department of Communicable Diseases of MoPH conducted investigation and sensitization in the affected households. The CDD Task Force is meeting weekly to monitor the situation and has begun activities to improve access to safe and make emergency stocks of medical supplies available.

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North-Eastern Area, Faizabad

A training course was conducted on AFP surveillance for district health coordinators, at the Faizabad hospital. Added training on cholera preparedness and response, on HIS and on malaria control was included in the curriculum, to respond to actual needs.

On June 25Th started a distribution of 5000 bed nets for most vulnerable people in the region jointly with health education and sensitisation about their use and their importance.

Northern Area, Mazar

Training of Trainers on Control of Diarrhoal Diseases began this week for 22 members of NGOs and MOPH. These trainees will then train the medical staff in their respective provinces. In total, 180 doctors and nurses will be trained during the coming weeks.

Also, two teams of 5 people have been trained on the spot to initiate surveillance and quick response in case of emergencies, cholera guidelines were distributed and specific health education was conducted in schools, mosques and health structures.

An assessment was conducted in Saripol province, to answer to rumors of malaria outbreak. In Sayad

District, 2% of slides were positive for malaria (all P. Vivax), in Soozma Qala district, 25% of slides were positive for malaria, of which 95% were identified as P. Vivax and 5% P.Falciparum. In Sheram, all slides were negative for Malaria.

In Balkh province, SC UK is rebuilding the Dehdadi clinic and Samaritan Purse the Khulm district hospital

Ibn-Sina will take over the programs of IMC in Bodana Qala. In Faryab provinces, ICRC will run Kohuistan clinic and CHA will repair Sherin Tagab clinic.

Southern Area

Assessment mission in Zabul Province, one of the most drought-affected provinces of the southern Afghan area: Six of the nine districts do not have health facility and the entire region suffer from a huge shortage of health workers, especially female. The Qalat Hospital provides OPD-IPD; Lab and X-Ray, and EPI activities. 180-200 consultations per day are registered at the OPD service, laboratory offers routine blood, malaria, glycemia, uremia and LFT analysis as well as urine and stools examinations; even though there is no shortage of vaccines, epi coverage is very low. The NGO Doctor World Wide supports staff incentive, food for patients, and reagents for the hospital.

Joint assessment mission in the villages hit by bombing in the Dehrawood district of Urozgan province this week was led by local authorities. The number of damaged houses was documented, proper number of casualties is still unclear. There is no more need for added emergency relief after WHO support with new emergency health kits and burn kits at the main hospital and Unicef support with Non Food Items.

Mirwais regional hospital has expanded the number of beds of the infectious diseases ward from 22 to 44 beds, with the support of MSF, in addition the ward has a specific cholera treatment center with a capacity of 100 beds.

Missions completed

Community Based Initiatives and Healthy Lifestyle Promotion

A team from WHO EMRO Regional Office, Dr. Sussan Bassiri and Dr. Mubashar Sheik, visited Afghanistan from July 2-7 to prepare the plan of action for the expansion of Basics Development Needs programs in Afghanistan during the next 12-18 months. The Regional Office has allocated funds to develop this project based on the realization that, to have real impact on the quality of life of the people and to gain substantial and sustainable health gains, it is necessary to address all determinants of health and to support the individuals, families and communities to attain self sufficiency and self reliance through integrated and comprehensive development. This is why EMRO is actively promoting, among member countries, community based initiatives like Basic Development Needs (BDN), Healthy Cities Program (HCP), Healthy Villages Program (HVP) and Women in Health and Development (WHD). These approaches require communities to assume greater responsibilities in defining their needs, identifying priorities, mobilizing local resources and developing necessary local organizations. The goal is to create supportive political, physical and economic policies and plans producing a positive impact on the overall environment and quality of life.

Considering the gravity of the situation in Afghanistan and problems faced at the grass roots level, it is very appropriate to strengthen BDN. Program activities have demonstrated the positive impact on health and well being of the concerned communities, but the coverage of the program has remained limited so far. The reconstruction phase offers an excellent opportunity to spread the benefits of integrated development to a wider segment of the society.

After meeting with various donors and other UN agencies as well as a meeting with Her Excellency Minister of Public Health, the team visited a BDN site in Ghazni in Rabat village. Then they conducted a two-day workshop with five WHO National Health Coordinators and their MOPH counterparts in order to finalize a plan of action and a timetable for action.

Ongoing Missions

Dr Nabila Metwali, WHO Regional Advisor for Laboratory, Blood Safety and Medical Technology, is on mission in Afghanistan from 6 to 16 July to support and assist the development of laboratory services in the country.

Dr. Nadia Teleb, WHO Regional Advisor for Communicable Disease Surveillance and Response; Dr. Gooya, Communicable Disease Officer, MOH, Iran; Dr. Nassehi, TB Control Officer, MOH, Iran, Dr. Faizullah Kakar, Epidemiologist / Medical Officer, WHO Pakistan; Dr. Phillipe Calain, CSR, WHO HQ; Dr. Salah Ottmani, TB Control Program Officer, WHO HQ are on mission in Afghanistan from 11 to 18 July to advise MOPH on Communicable Disease Control and provide a global perspective on CD Control during the Workshop in Kabul.

Meetings & workshops

❑ July 10, MCH Task force meeting

❑ July 13: Malaria and Leishmaniasis Coordination Meeting, Kabul (Sitara Restaurant)

❑ July 14 - 16: National Workshop Communicable Disease Control, Kabul (Sitara Restaurant)

❑ July 17: Health information and surveillance meeting, Kabul (MoPH)

❑ July 17: National Interagency Coordination Committee for TB control, Kabul (Sitara Restaurant)

❑ July 14-15, UNJLC Winterization Planning Workshop, UNJLC office, Kabul

❑ July 15-18, Health Promotion Coordination Workshop, Kabul Hotel

❑ July 18-19, Emergency Medical Services Workshop, sponsored by International Relief.

❑ July 21st, Nutrition Coordination meeting (10:30am): MoPH

❑ July 22 – 24, Khost Province: Redevelopment Conference to address the goals, requirements and issues for the redevelopment of Khost through workshops that bring together government departments and redevelopment partners

Calendar of forthcoming activities

❑ 15-17 July, Merlin course in teaching and training methods.

❑ 13-27 July, Joint donor mission’s visit to Kabul and other areas of Afghanistan

❑ 21-26 July 2002, second regional training workshop on management of data for the global youth tobacco survey, in WHO regional office for the Eastern Mediterraneen, in Cairo.

❑ 1-31 August 2002, Agha Khan University, Karachi: Course on epidemiology, biostatistics and surveillance.

❑ 5-6 October 2002, 3rd DOTS/TB expansion working group meeting, Montreal, Canada

❑ 21-23 October 2002, International conference on wastewater management and its effect on the environment in hot and arid countries, Muscat, Oman.

Other news

❑ Dr. Isabel Hemming will work as Health System Development officer in WHO Afghanistan.

❑ Mr. Charles Peetree will take the position of Director at the UNAMA policy, planning and assessing branch.

For more information:

|WHO Afghanistan Office |WHO Afghanistan Support Office |

|House No. 249, Street No. 10 |P. O. Box No. 1936 |

|Wazir Akbar Khan Mina |House 218, Margalla Road, F-10/3 |

|Kabul, Afghanistan |Islamabad, Pakistan |

|Tel: (93) 702-79010..12 |Tel: (92 51) 221 1224, 2104770..4 |

|Fax : (47) 233-08112, ext 2207 |Fax: (92 51) 228 0830 |

|E-mail: WRO@ |E-mail: supply@ |

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