New Hope for Rural Health Care

Mohammed Ibrahim stood outside the hospital in Mazar-e-Sharif, fighting back tears. With one arm he helped steady his wife as she leaned against a wall, cradling the lifeless body of their infant son under her burqa. Weeping, she looked to the sky as she cursed the doctors and the government.

When their child was born in their rural village three days earlier, Mohammed Ibrahim said they knew immediately he needed medical care.

“After birth, my child was not normal,” he said. “I brought him to the clinic at the centre of the district several times but they couldn’t do anything for him.”

So the Ibrahims brought their infant 50 kilometres to the biggest hospital in the city of Mazar. “But it was too late,” he said.

Rural Afghans routinely face a two-to-six-hour walk to obtain the most basic health care. In some areas, a single doctor covers the population of an entire district and is barely able to see the 80 to 120 patients who daily arrive at the clinics. The United Nations estimates that the infant mortality rate in Afghanistan is 165 deaths per 1,000 life births and that the rate of women who die during childbirth is 1.7 per 1,000 births. Both are the highest rates in the region.

But this situation may soon improve because of programmes that are expected to offer a standardised health-care system in Afghanistan’s rural provinces. The health-care system, promised last year by President Hamed Karzai, is getting underway with the help of foreign aid.

Earlier last month, officials of the World Bank and the Afghan Ministry of Health signed an agreement with the Bangladesh Rural Advancement Committee, BRAC, a Bangladesh non-governmental organisation working in Balkh Province in northern Afghanistan. BRAC will take the lead role in improving heath care in the region, of which Mazar is the capital.

“The Afghan people are victims of easily preventable diseases, such as infant and maternal mortality, acute respiratory infections in the winter and diarrhea in the summer,” said Enam Ul Haq, BRAC’s director in Balkh.

By the end of last month, construction was to have begun on four new hospitals in the province. New community health-care centres and training for medical staff, health workers and midwives will follow, he said.

The government’s standardised health-care programme is designed to make medical care available to wide areas of Afghanistan where war and neglect have made health care unavailable.

The plan is to designate a single agency in each rural Afghan province as the lead health-care provider to better coordinate the availability and delivery of doctors and nursing care, said Dr. Ghaus Udin Anwari, deputy head of the health department in Balkh.

In Balkh province, for instance, some 20 different organisations have been struggling to meet the needs of the population, he said. Those groups were invited to apply to become the regional provider, and BRAC won the contract, he said.

Enam Ul Haq said he does not yet know how much money the World Bank will provide for his programmes.

Similar efforts are under way in the neighbouring Jowzjan province, funded by the US government and operated by Save the Children. That programme, called Rural Expansion of Afghanistan Community Health, REACH, was also finalised last month in an agreement with Development & Humanitarian Services for Afghanistan, DHSA, an Afghan NGO based in Sheberghan.

At the end of a 25-month aid programme, the Jowzjan health-care system will be turned over to DHSA to run.

“We are implementing the basic health care package that is designed by the Ministry of Health,” said Ramish C. Puri, head of Save the Children UK in northern Afghanistan.

He said the Jowzjan programme will try to involve young people in evaluating the problems and needs of their area by forming advisory youth counsels. Like the programme in neighboring Balkh, REACH will develop new community-based health clinics while expanding some existing clinics into hospitals.

The money in Jowzjan will also help raise the salary of caregivers. Nurses in the province who have been earning 60 US dollars a month should see their pay raised possibly to as much as 200 dollars a month, Puri said.

The US government has pledged 2.6 million dollars from the Aid to International Development programme, AID, to pay for programmes in about half of the province for the next 25 months.

Officials in both Balkh and Jowzjan said similar programmes are being developed for all of Afghanistan’s rural provinces.

Qais Faqiri is an independent journalist with IWPR in Mazar-e-Sharif