21 January 2002

U.N. Agency Outlines Afghan Health Needs

Reducing "unacceptably high levels" of death, disease and disability must be the immediate priorities for improving health in Afghanistan, according to a January 21 analysis released by the World Health Organization (WHO).

"Improved health of the Afghans can serve as a bridge to sustainable security, peace and development," according to the WHO press release. International aid agencies must coordinate their efforts to achieve rapid improvements in public health in Afghanistan, WHO says, at the same time they work to support the Afghan Ministry of Health.

The WHO identifies the most important activities as:

• control and prevention of communicable disease; -- reducing the high levels of death among mothers and newborns; -- reducing malnutrition; -- providing mental health services; -- improving emergency health care services.

Following is the text of the WHO press release:

Populations enjoying good health also have the capacity to reduce poverty levels and achieve sustainable economic and social development. Improved health of the Afghans can serve as a bridge to sustainable security, peace and development.

The imperative in Afghanistan is to reduce the unacceptably high levels of mortality, morbidity and disability in the shortest possible period of time. Given the limited human resources and financial constraints, it is crucial to focus the concerted efforts of all health partners on the most effective interventions able to save and improve lives. At the same time, efforts should be made to improve the knowledge base to allow for policy development for longer-term goals. Before a strategy for health sector recovery can be implemented, however, management systems must be put in place, including a reliable salary system for health workers.

The aim of the international community must and will be to support Afghan Ministry of Public Health (MoPH) to assume ownership of the recovery and reconstruction phase. In addition, assistance will be provided to the MoPH to improve its management and coordination of international aid, develop and sustain sector-specific indigenous capacity and implement national and regional health plans.

The major activities for immediate recovery include:

• control and prevention of communicable diseases. Priorities for prevention and control of major communicable diseases include diarrhea, acute respiratory infections, vaccine-preventable diseases in children, tuberculosis, malaria and leishmaniasis. Expanded Program on Immunization would remain a major strategy for reduction of infant and child morbidity and mortality. Polio eradication and measles campaigns would be a priority in the immediate recovery period.

• reducing the high levels of maternal and neonatal mortality. Priority interventions to prevent excess neonatal and maternal mortality and reproductive health morbidity consist of providing simple clean delivery kits for use by mothers or birth attendants to promote clean home deliveries; making available delivery kits for midwives to facilitate clean and safe deliveries at the health facility; and activating a referral system to manage essential emergency obstetric care.

• alleviating high levels of malnutrition. Selective interventions such as supplementary and therapeutic feeding programs, integrated with primary health care, will be required in the immediate phase. Measures to prevent and control micronutrient deficiencies (mainly iodine, vitamin A and iron) are also required.

• addressing the need for mental health services. A cultural approach, specific to Afghanistan, is required to identify the prevalent mental health problems, to assess the magnitude of needs, to develop adequate psychosocial programs and to train personnel accordingly. While policies will need to be formulated for long-term mental health programs, the use by primary health care workers of available simple tools and protocols to deal with psychosocial problems should be encouraged.

• treatment and rehabilitation of trauma victims. Establishing and strengthening emergency health services and expanding them geographically is a priority. Rehabilitation of emergency referral systems should address areas of transportation and communication, diagnostic facilities for referral, laboratory needs, and rehabilitative and surgical capacity to meet the growing need for such health services.

Immediate steps for recovery also include enhancing the health information system. Health surveillance and response activities should be integrated and streamlined. Common reporting channels and standardization of data collection tools are needed to maximize existing resources for surveillance and disease control.

The MoPH requires urgent institutional support. A group of professionals (e.g. health economists, financial system specialists, health planners, policy and system development specialists, etc.) should be hired in an advisory role to support the MoPH. Similar technical assistance should be deployed at the regional level.

Limited rehabilitation works should be carried out. Basic equipment for health facilities must be procured, as well as transport and communication. Vehicles and communication equipment are needed to improve referral of urgent cases to the nearest health facility, where emergency obstetric and surgical services are available. The immediate aim is to make most health facilities operational, while major upgrading and reconstruction work will be carried out subsequently.

The supply of drugs, vaccines and essential medical equipment must be ensured. A procurement and distribution system and increased supply of essential drugs are needed for an expansion of health activities as well as regulation of import of medicines whether donated or through the private sector.

In the initial phase of reconstruction, training will be mainly of short courses, workshops and hands-on supervision. Formal training in those areas most in need, such as midwives and nurses, should start immediately. Training institutions will be refurbished and properly equipped.

The Medium to Long Term: Reconstruction

It is expected that at the end of the first period characterized by relief cum recovery activities, the most urgent humanitarian needs will have been addressed with an important impact on mortality and morbidity and that the health system capacity will have been expanded and prepared to face the challenges of reconstruction.

During the reconstruction phase the demand for all types of health services will increase and the expansion of the network will have to be accompanied by the deployment of newly trained staff, who will improve both the quality and efficiency of health care. Health programs will be expanded to include the control and management of prevalent, non life-threatening diseases. Information and financial flows, and support systems are also expected to improve, stabilizing the sector.

The reconstruction phase will focus on: planning and implementation of health policies and programs, development of human resources and physical infrastructure and addressing various forms of community financing.