Community Health:

Basic Package of Health Services (BPHS):

In March 2002, the Afghan Ministry of Health began a process to determine its major priorities for rebuilding the national health system, and which health services were so important for addressing the greatest health problems that they should be available to all Afghans, even those living in remote and underserved areas. It was decided to call these crucial services a Basic Package of Health Services (BPHS). The key elements to include in the BPHS were (1) those services which would have the greatest impact on the major health problems, (2) services that were cost-effective in addressing the problems faced by many people and (3) services which could be delivered to give equal access to both rural and urban populations. Basic Packages of Health Services is being funded by Rural Expansion of Afghanistan’s Community Based Healthcare Program (REACH), a program launched by USAID with partnership of Management of Sciences for Health
SDO is one of the implementing partners of BPHS in Ghazni province in 5 districts: Deh Yak, Zana Khan, Jaghatu, Jaghuri, and Malistan. SDO started its activities in Deh Yak and Zana Khan in November 2003. However, in Jaghuri, and Malistan the activities were started in November 2004 after the facilities were handed over from RCA to SDO.

A total of 15 health facilities, 9 Comprehensive Health Centers (CHC) and 6 Basic Health Centers (BHC), have been established in the aforementioned districts. Discussions and negotiations are made with the community before setting up each health facility since the cooperation and contribution of the community is a must in running the facilities.
After setting up the clinics, Community Health Workers are identified and selected in the catchment area of each clinic. These CHWs then undergo three phases of training. At the end of the first phase of the training, the CHW is called an Active CHW who has a basic set of Kit with the help of which he/she serves the people in its coverage area. So far 187 CHWs have become active from a total of 350 CHWs. The rest are being identified or are under training.
In addition to basic and comprehensive health services in our clinics, Health Education is also provided to women who come to the clinics for treatment of their children or themselves. Every day regular sessions of health education is conducted in which an average of 25 women receive information about different health issues such as hygiene, malnutrition, child spacing, usage of medicine, iodine deficiency disorder, ARI, and other subjects. In year 2004, a total of almost 30,000 women received Health Education in our health facilities 2 CHC and 2 BHC in Deh Yak and Zana Khan district.

Mobile Health Clinics:

With the financial assistance from Development Cooperation Ireland (DCI) through Trocaire, SDO successfully implemented two years and 4 months of the Mobile Health Clinic project from March 2002 to July 2004.
The overall aim of this project was to help improve the child and maternal health conditions in the target areas through the provision of primary health services and development of a health education program

Three clinics were established with the assistance of the community in Qarabagh, Shakardara and Farzah districts of Kabul province. The clinic space was the contribution from the community. Each clinic consisted of one medical doctor, one nurse, one pharmacist, one lab technician, one lab assistant, one registrar and one female health educator.
After the set up of the clinics, each village shura leader was told to prepare a list of the children of the village. Once the children in the list were provided with a general checkup, the team moved to another village. This process continued until all the villages of each district were covered by the project. Each clinic provided treatment for 60 children.
In addition, the mothers of the children received the health education classes on different health issues. Topics such as Breast Feeding, Communicable diseases, Family planning, chronic diarrhea, Pregnancy, Water and Sanitation, Malnutrition, ARI (Acute Respirator Infection), TB and Measles, Mine awareness, Child development were taught to the mothers. Each clinic provided health education for 40 mothers each day.

SDO implemented Nutrition project in 7 phases from June 2002 to December 2004 with the financial assistance from Norwegian Church Aid (NCA).
Through this project, SDO has covered Beni Hisar, Kamari, Tara Khail, Deh Araban, Arghandi Ulia, Chahar Asyab, Sheena, Mir Bachakot, Bot Khak and other districts of Kabul province. These districts were selected after a thorough survey which indicated that many cases of malnutrition exists in these areas. Thus, SDO decided to implement the project in the aforementioned areas after the agreement of the government. Discussions were made with the community and health sectors in the area for establishment of Supplementary Feeding Centers (SFC). These centers were established in the areas where no prior health facility was available.
One day per week, the target areas were surveyed using a standard form for identification of vulnerable children. Then these children were issued registration cards. By these cards they were referred to the SFCs where they were given BP-5 biscuits according to their weights.
In the registration card, the weight of the child was recorded. The time of his next visit to the center was mentioned there too. On the next visit the child was weighed again and it was compared with the pervious weight. Afterwards, proper amounts of BP-5 biscuits and important instructions on how to feed the child were given again accordingly.
According to records of SFC, most of the children have gained weight and their health condition improved after the first visit to the centers. The maximum number of times that a child would visit the center was 8 weeks. About 90% of the children gained weight and became healthy after their 4th to 6th weeks of visit. The other 10% were referred to hospitals.

During the phase 7th which started in August and ended in December 2004, a total of 1,458 malnourished children, 129 lactated mothers and 179 pregnant women became healthy after taking the BP-5 biscuit for 6 or 8 weeks, however some of them gained weight after 4 to 6 weeks.
Health Education was provided to the mothers of the malnourished children. In each session 10 women were given information about different basic health care. This was considered to be one of the important parts of the Nutrition project. Only in 7th phase a total number of 14,030 women received health education. Following table shows the number of admitted and discharged pregnant (P) and lactating women (L) during phase 7th: