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Improving Maternal and Child Health in Afghanistan: A Study
– Reported, 18 January 2013
The evidence base on organising, delivering, and paying for effective and equitable health services in any resource-constrained setting is very weak. To make health service delivery work in difficult environments, such as Badakhshan province in Afghanistan, the Northern Areas of Pakistan, and Gorno-Badakhshan province in Tajikistan, substantial challenges must be addressed because each has to overcome one or more traps of bad governance, emerging from civil war, and/or being landlocked. To improve maternal and child health (MCH), emphasis must be given to strengthening health systems, increasing access to information and care, and addressing the related community and development issues.
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Health indicators, including levels of maternal and infant mortality, are very different in adjacent geographical border areas of Afghanistan, Pakistan, and Tajikistan.
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These differences reflect the combined and complex interplay of elements within the different health systems, as well as political, economic, social, and cultural factors.
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Reducing maternal and child mortality requires focus and balance in all of these dimensions and can best be achieved through service interventions underpinned by general development.
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A policy promoting cross-border health programmes could immediately make available existing resources that could contribute to reducing maternal and child mortality in all three geographical locations.
The Afghan government, with support from international donor agencies, contracted the Aga Khan Development Network (AKDN; http://www.akdn.org/) to implement a health programme in the province. The programme, which started in 2003, follows the Ministry of Public Health policy that makes a single nongovernmental organisation responsible for planning, implementing, and monitoring the health services in a district or province. This approach attempts to avoid duplication of effort, ensures efficient control of resources, and promotes effective programme management. Care is provided through a three-tiered system, consisting of:
1. Community health workers (CHWs);
2.Two to four basic health centers with outreach (outpatient services and normal deliveries); and
3.One comprehensive referral health center covering a minimum population of 25,000 (limited inpatient capacity, but in border areas of Badakhshan includes complete essential obstetric services as well as blood transfusion services) or district hospital per cluster.
In addition to health services, other interventions are being implemented. Interventions in education (with a major emphasis on female education), natural resource management, agriculture and marketing, water and sanitation infrastructure, road construction, telecommunication, electricity, micro finance small business development, and civil society promotion are combined with economic development and cultural restoration activities to constitute an area development programme. The impact of this approach to reducing maternal and child mortality remains to be determined, along with an investigation to identify the components with the most significant impact. Still, there are promising early signs of increases in the availability and utilisation of health services.
CREDITS:
Gijs Walraven,* Semira Manaseki-Holland, Abid Hussain, and John B Tomaro
http://www.ncbi.nlm.nih.gov/
