Doctor and patients in Afghanistan

The System Enhancement for Health Action in Transition (SEHAT) Program implemented by the Ministry of Public Health aims to expand the scope, quality, and coverage of health services to the population, particularly the poor, across Afghanistan. The program, estimated at a total value of $407 million, is jointly supported by the Government of Afghanistan with $30 million, IDA Grant $100 million, Health Results Innovation Trust Fund $7 million, and ARTF $270 million. The SEHAT Program, which supports the provision of basic health services and essential hospital services in 21 provinces as well as the Kabul urban area, was approved on June 17, 2013, for a period of five years of funding. The closing date for the project is June 30, 2018. 

Challenge

THE AFGHAN HEALTH SYSTEM has made considerable progress over the period of 2002–2012 due to Ministry of Public Health (MoPH) leadership, sound public health policies, innovative service delivery, careful program monitoring and evaluation, and development assistance. The number of functioning health facilities increased from 496 in 2002 to more than 2,000 in 2012. Data from household surveys (between 2003 and 2011) show significant improvement in the coverage of reproductive and child health services as well as a drop in maternal and child mortality.

However, despite the aforementioned progress, the country faces significant challenges in the sector. Afghanistan’s infant and under-five mortality rates are still higher than the average for other low-income countries. Afghanistan also has one of the highest levels of child malnutrition in the world. About 40.9 percent of children under-five suffer from chronic malnutrition, and women and children suffer from high levels of vitamin and mineral deficiencies.

Approach

THE HEALTH SECTOR has experienced a significant turnover since the establishment of a new administration in 2002. The government has given the utmost importance to addressing the high maternal and child mortality, especially in rural areas. The MoPH undertook a series of critical and strategic steps: it defined a Basic Package of Health Services (BPHS) and later an Essential Package of Hospital Services (EPHS); and it established a system for contracting on a large scale with international and national nongovernmental organizations (NGOs) for delivery of these services.

The SEHAT Program aims to expand the scope, quality, and coverage of health services provided to the population, particularly the poor, across the country, and to enhance MoPH stewardship functions. The program supports the provision of BPHS and EPHS in both rural and urban areas. It is strengthening the national health system and MoPH’s capacity at central and provincial levels, so it can effectively perform its stewardship functions.


From the time the hospital came under SEHAT support, everything has changed for the better. It has been a blessing for the hospital. We are now able to help keep patients healthier — helping to create a healthier Afghanistan.
 
- head physician, Nangarhar Regional Hospital

Results

  • Maternal and child health services: Health Management Information System (HMIS) data show an increase in the utilization of key maternal and child health services during the first six months of 2014 as compared to the same period in 2013. 
  • Health facilities: Since the start of SEHAT in June 2013, 35 new health facilities have been established, 14 health facilities have been upgraded, and around 1,000 health facilities have been equipped to provide health services in the target areas.
  • Children: More children have benefited from project outcomes since SEHAT began. According to HMIS data, the proportion of children under-five with severe acute malnutrition who have been treated has reached almost one third (32 percent).
  • Service delivery: In the large majority of provinces, BPHS and EPHS are delivered by NGOs under a contracting mechanism. As key components of the project, 27 NGOs have been contracted and properly managed to deliver health services in the target areas.

Upgraded Regional Hospital Boosts Health Care Services

Doctors rush to a seven-year-old child as he lies on a bed in the emergency room of the Nangarhar Regional Hospital in Jalalabad city. Located at the junction of the Kabul and Kunar Rivers, Jalalabad is the capital of Nangarhar province and the second largest city in the country. Nangarhar Regional Hospital is one of the city’s largest hospitals, serving its population as well as those from other provinces.

An hour earlier, the child, who was returning from school, was injured in a traffic accident and survived with a fracture in his right leg. Dr. Nazeer (name changed) was the first doctor to attend to the child. “He suffered severe shock,” he says as the child is taken to the operating room. “Initially he was unconscious, but he gained consciousness after we treated him and now his condition is stable. He will have to undergo surgery for the severe fracture in his leg.”

The condition of the hospital is drastically different from what it was a year ago. In January 2014, the SEHAT Program began its support of Nangarhar Regional Hospital. "From the time the hospital came under SEHAT support, everything has changed for the better,” says  the head physician at Nangarhar Regional Hospital. According to him, after a year of assistance, the hospital has increased its capacity to serve up to 1,000 patients including those from neighboring Kunar, Nooristan, and Laghman provinces.

“We have seen a lot of positive changes here at the hospital since last year,” the hospital head says. “We have increased the capacity of the emergency room from 35 to 100 patients, and total number of beds from 420 to 535. Previously, the hospital suffered from a lack of sophisticated equipment such as X-ray, CT-Scan, and laboratory equipment. The SEHAT Program has supplied the hospital with the required equipment.”

The Nangarhar Regional Hospital now has the capacity to carry out 65 operations and assist at 80 birth deliveries per day. “The SEHAT Program has been a blessing for the hospital,” he says. “We are now able to help keep patients healthier—helping to create a healthier Afghanistan.”