The Islamic Transitional Government of Afghanistan

The Islamic Transitional Government of Afghanistan Ministry of Public Health

Health and Nutrition Sector Coordination Report Reporting Period: 21-27 September 2002

Email to submit information for next week's newsletter:[email protected] (mention in subject line: “for weekly update on health sector”. Reports can also be requested through this address.)

Contents

Coordination Sub-sectors Regional overview Missions to Afghanistan, international meetings/ training & workshops Surveys and assessments Calendar of forthcoming activities

Coordination

Program secretariat:

The 25 September program secretariat meeting was cancelled due to the organization of the Community- Based Health Care workshop, conducted from 23-25 September.

National development budget:

Senior staff of the MoPH and the Program Secretariat presented the penultimate version of the health NDB submission, in an inter-ministerial conference at AACA on 24 September. Some additional amendments will be made to the health NDB submission before the final document is submitted to UNAMA on 1 October. UNAMA will consolidate all sectoral submissions, and the cabinet will then consider the NDB.

Global Fund to Fight AIDS TB and Malaria (GFATM)

The Global Fund Commission of Afghanistan (with members of MoPH, WHO, Medair, HNI, and ARC representing the coordinating bodies for tuberculosis, malaria and HIV/AIDS control) has submitted in time

1 to the Global Fund Secretariat in Geneva a proposal of around 3 million USD to build capacity to address AIDS, tuberculosis and malaria in Afghanistan. The plan’s main aim is to lay the groundwork for reconstructing HIV, tuberculosis, and malaria control activities - while strengthening the capacity of the Ministry of Public Health to provide oversight, monitoring and evaluation functions. The final results of the GFATM-review process are expected in January 2003.

Provided that funding will be granted for the current 18 months period of the current plan, it is expected that the MoPH will not only be the driving force to implement these communicable disease control activities, but will also have the management capacity to administer any further donor funding. After partnerships and strategic plans have been developed, and the capacity of health services relating to AIDS, tuberculosis, and malaria control have been strengthened through this proposal, the Global Fund Commission will apply to the GFATM for further funding to implement disease control activities. More information on the proposal and the Global Fund Commission is available with MOPH (Dr Abdullah Fahim, Dr Hanif Khoshal, Dr Khaled Siddiq, Dr Abdul Wasi Asha), WHO (Giampaolo Mezzabotta, Nadine Ezard, Yon Fleerackers), Medair (Marylin Johnson), and HNI (Esmee deJong).

Sub-sectors

Primary Health Care

The MoPH, MSH, UNICEF and WHO organised a three-day workshop on Community Based Health Care from 23-25 September. MSH played the major role in planning and conducting this very successful workshop. A detailed accounting of the proceedings will be provided in the next co-ordination report.

EPI & Polio Eradication

A detailed analysis of the measles immunization coverage by districts has led to the elaboration of a redo plan for measles campaigns where coverage was below 80%. This plan will be implemented before the winter begins. To date, approximately 8.2 million children between 6 months and 12 years of age received measles vaccines throughout Afghanistan. A national coverage survey will be carried out in November to assess the actual coverage of the ongoing campaign. As per the report received Approximately 5.6 million children under the age of five years were covered during the first round of the Fall National Immunization Days (NIDs) in September. The next round of Fall NIDs will be held from 22-24 th of October. All logistics including vaccines are in place. UNICEF-Kabul is planning a Total Office Mobilization (TOM) for NID monitoring. Four new Acute Flaccid Paralysis cases (AFP) were reported in the following provinces: Faryab, Herat, Wardak and Nangarhar.Genetic sequencing results in Kunduz, Kabul and Zabul cases are still awaited to determine the linkage with other isolates. Dr. Daniel Tarantola, Director, Department of Vaccines and Biologicals, WHO/HQ is visiting Kabul from October 20 – 23rd 2002.

Maternal and Child Health

MCH working group meeting was held on 24 September 2002 in UNFPA- Kabul. The group discussed about the design of a Job description for Pharmacists working in an MCH clinic. The group emphasized the development of a standard job description for Pharmacists which describes his / her responsibilities in the MCH clinic, after a lengthy discussion a draft job description was developed. The Next MCH working group will be held on 1st October 2002 at the CHA office. The Afghanistan team (one obstetrician, 2 midwives and 1 anesthesiologist – all from Malalai Maternity Hospital and a UNICEF staff member) will travel to Dhaka to attend the second phase of the training of trainers on Emergency Obstetric Care. This workshop is organized by UNICEF Regional Office for South Asia and the Averting Maternal Death and Disability program of Columbia University with technical support of the JHPIEGO. This is a three week follow up training on EmOC – skills and knowledge update -, which

2 was attended by the same team last August. The team had practiced the newly acquired skills and will be taught new training methodologies. This team is a core team for training on EmOC in Afghanistan. As part of the effort to create Centers of Excellence for Emergency Obstetric Care, UNICEF consultant on health facilities renovation (Mr. Davis Potter) visited the Jalalabad University hospital, the Metharlam hospital and the Ghani Khail hospital between 22-26 September. to assess renovation needs on these buildings and consult the staff working in these hospitals. The consultant will than make plans for renovation and alternative layout to restore the hospitals physical structure. He will also travel to Herat in October.

Preparation is underway for the workshop on curriculum development for the auxiliary midwives training in Ghanikhail that will be held in Jalalabad during the first week of October. Two experts: an Obstetricin/Gynecologist and a midwife from JHPIEGO will be the main facilitators of the workshop.

As a follow up to the National Safe Motherhood Strategic Planning and Visioning workshop held in Kabul from 17-19 September, preparation is underway to conduct the same planning workshops at the regional levels. Central,southeastern, western, eastern, northeastern and southern regions will conduct the Safe Motherhood planning workshop in October.

Eye Care

A Planning workshop leading to a National plan on Comprehensive Eye Care was held from 23-25 September 2002 at Popo Lano Italian Restaurant in Kabul. This workshop was sponsored by CBM (Christoffel Blind mission) and WHO. Many governmental and non-governmental organizations, CBM, WHO and MOPH was attended in this workshop. Main purpose of the workshop was to develop a National Plan on Comprehensive Eye Care in Afghanistan on behalf of the Ministry of Public Health.

Nutrition

Continued to support the partner NGOs in the targeted supplementary feeding projects and therapeutic feeding projects through out the country. Staff of Malalai hospital were trained on the 18-hour BFHI training. The training was attended by the participants from outside Kabul. The Micronutrient team of UNICEF visited the Western and North East regions to assess the salt situation and feasibility of salt iodization in these areas. The team also consulted the potential partners for Vitamin C distribution in these regions.

Emergency preparedness and response

A workshop organized by UNOCHA on civil military coordination in preparation of winter emergencies, sponsored by the Swiss Agency for Development and Cooperation was held in Dubai, . The workshop welcomed members of the ISAF and the Joint coalition as well as UN agencies and NGOs working in Afghanistan. The objectives were to set up coordination mechanisms for all stakeholders and the government in preparedness to emergencies like earthquakes, floods, avalanches, which have a high probability to occur during the coming winter. Unfortunately, low participation of operational actors from Afghanistan didn’t allow for the preparation of a plan of actions. A draft on procedures for civil military coordination in time of emergency was elaborated and should be reviewed in Kabul during a two-day workshop that will be organized by UNAMA in October, 2002.

3 Communicable Diseases

As preparedness for next winter we together with MoPH and NGOs decided to conduct TOT of ARI from 7th to 9th of October 2002, in Indira Gandhi Hospital. During a meeting held with MOPH, WHO (CSR section), SC-US, and IMC, the training schedule and training material has been discussed, and planning of the workshop has been finalized. Training material will be selected from the Supervisory skills of ARI management, and some of the material of a community child health care package inspired on IMCI (targeted at village health volunteers to identify and treat 4 conditions in children under 5: danger signs, pneumonia, dehydration, malaria).

The number cases of acute watery diarrhea admitted in 12 sentinel sites (both total, as well as those with severe dehydration) are decreasing, and have dropped now below 200. This is a sign that the epidemic is under control.

Malaria, Leishmaniasis

Increased malaria incidence is reported in northern and northeastern regions (particularly in the provinces of Kunduz, Khanabad, Balkh, Faryab) of Afghanistan consistent with seasonal peak of falciparum malaria transmission. In the absence of reliable data, implementing agencies and MOPH to strengthen diagnosis and treatment, with WHO supporting MOPH to conduct mobile clinics to more remote areas. Contact [email protected]

Tuberculosis

The Afghan delegation that took part in the Regional Meeting of the National Managers of TB Control in EMRO, held in Damascus (Syria) from Sep 15 to 18, 2002 is now back home. The situation of TB in Afghanistan is followed with much interest by the Regional Office in that the burden of TB in our country alone accounts for a large proportion of the regional cases. Afghanistan, along with the other high burden country in the region, Pakistan, will therefore continue to be given high priority by EMRO. It was recommended by Strategic Technical Advisory Group (STAG/EMRO) that Afghanistan completes the planning process for DOTS expansion by end October 2002 and starts implementing the plan by November 2002.Other important issues that need to be explored and eventually developed are the involvement of the private sector in TB control, operational research and drug-resistance surveillance.

In addition to this brief report on the Damascus meeting, it is worth mentioning that TB is one of the components of the proposal presented for funding to the Global Fund to fight AIDS, TB and malaria on Sep. 27, 2002. The results of the application will be known in January 2003.

Water supply and sanitation

The Emergency chlorination project initiated in July is continuing. This is the 3 rd round of this project. As in previous rounds WHO is providing technical assistance as well as hygiene education materials. CWS site engineer currently is in Kunduz to start implementations of the project. The project will be launched as soon as possible provided there are no objections from WFP. CWS staff participated in the hygiene education meetings held in this period. The same staff of this unit also participated in the Water and Sanitation Sector Group (WSG) meeting held on Sep. 26.02. Furthermore, CWS unit is arranging an environmental health workshop for Mazar. EURO/WHO has agreed to cover the cost of traveling of an environmental health specialist for this workshop.

4 Overview of Geographic Areas

Central Area

A joint mission MoPH PHC department and WHO EHA section was held on 23.9.02 –25 9.02 for winterization preparedness. The main purpose is to identify and supply the isolated areas, before blockage of the road and to establish mobile clinics to the needy and isolated areas. During the mission, we identified AZRO and KHARWAR districts as target areas. The AZRO District has 4 clinics that are supposed to be supported by ISRA if they receive the necessary funds. There are presently no clinics in Kharwar District, however AMI is intending to initiate a program if funds are made available. WHO may temporarily support these areas during winter to ensure access to health care services for these populations.

The second round of the NIDs campaign against polio is under preparedness. The district’s micro plan has been reviewed. Meanwhile training is taking place in the Hazarajat area where the NIDs will start on October 10th. Specific plans to reach missed children of Nomads traveling to the Eastern region are being prepared (The total number of Nomad children vaccinated during F1 is 9,850 under five). Two AFP cases have been detected this week from Bagram district of Parwan and Tagab district of Kapisa provinces. The two samples were adequate and were sent in a good condition to the referral laboratory. RPOs visited AFP focal points to encourage their timely detection of the AFP case

Northern Area, Mazar

Dr K. Schemionek, arrived in Mazar where she will work as regional public health advisor for the Northern areas. The MOPH focal point for HIS returned from a one-month course in epidemiology in Islamabad at Agha- Khan-Hospital supported by WHO. The post-NIDs survey showed 96% coverage for the first round of NIDs in September 2002. A one-day training on EPI for secondary school teachers was conducted in Mazar. A suspected case of AFP was revised in Samangan. The number of diarrheal diseases cases in Jawzjan district is decreasing, the two camps set up to welcome a high number of patients should be closed by the end of the month. A high number of ringworm cases (130 students) occur in a school in Samangan province, treatment guidelines were provided to MOPH and NGOs. MSF reported 3 cases of confirmed diphtheria in Faryab provinces. As well, increased number of confirmed cases of Plasmodium Falciparum malaria is detected in Faryab and Jawzjan Provinces.

Kunduz,

With the visit of Dr Nadine Ezard, WHO consultant for Roll back malaria, a meeting was organized to review the action taken against the increase of malaria cases in the area. Merlin, MRC and WHO are involved in the case management of malaria patients. New protocols were disseminated and the future project of operational research on chloroquine efficacy was elaborated. The mission visited Khanabad district and Imam Sahib where a prevalence of 8% Plasmodium falciparum, 3% plasmodium vivax was found. Two trainings on tuberculosis, one for the doctor and the nurses, the other for the lab technicians started this week and for 10 days. The staff of the 6 new TB clinics of Kunduz are attending the course.

5 Southern Area, Kandahar

WHO is supporting 2 nursing schools in Kandahar and in Helmand provinces as part of the capacity building program. In both provinces 50% of the students who will graduate this year are female. Of the 7 polio cases found in Afghanistan this year, 3 cases are reported from Kandahar ( Sarban Qala, Musa Qala, districts of Helmand and Zabul). Therefore, special emphasis is given to the preparation of the second round of the NIDs on 21-22 of October 2002

Eastern Area, Jalalabad

The WHO Representative in Afghanistan visited the eastern area on September 24 2002: Basic development needs programs were reviewed in Chardehi village of Batikot district. Funds generated from the projects were redistributed to an added 34 vulnerable families for the implementation of their income generating projects. WHO distributed 10 000 tabs of chloroquine to the Malaria referral center and 150 vials of anti-rabbies vaccines to the Regional health director. Three suspected cases of AFP were investigated and specific EPI coverage was conducted for the Returnees.

Western Area, Herat

One suspected case of cholera has been reported from the pediatric ward of the regional hospital, from a 6 year old girl. Stool samples have been collected and sent for confirmation of causative germs. Memorandum of understanding has been signed between the MOPH, WHO and Malteser-Hilfsdienst for the support of the DOTS/TB activities in Herat. WHO is preparing with he MOPH the training on PHC management and leadership TOT course at the regional level. The new basic health center in Karokh district has been inaugurated this week, the health center has been constructed by IAM and will be supported by Ibn Sina, under the supervision of the MOPH.

Missions completed / ongoing / planned

 Dr Abdul Hannan Choudhuri, a medical officer for the control and prevention of blindness, from WHO Bangladesh is in Afghanistan to attend the eye care workshop in Kabul.

Meetings:

 September 23, IMPD: Leishmania task force

 September 30- - October 3, Cairo, Egypt, 49th Session of the Regional Committee for the Eastern, Health Minister meeting

 October 8: US Secretary of Health and Humanitarian Services visit to Kabul

 October 8: 10 am IMPD: Malaria Task force

6  October 6-8: Central Area SMI Strategic Planning Workshop

 October 12-14: Jalalabad, Herat, Kandahar, Kunduz: SMI Strategic Planning Workshop

 October 13, 10:00 am. MoPH: NTCC meeting

 October 2 and 9, 14:00, MoPH Library: Cholera & ARI Task Force

 October 20, 10:30: Nutrition Task Force

Calendar of forthcoming activities

 23–25 September 2002, Community health workers workshop, Kabul

 21-23 September 2002, Eye care workshop, Kabul

 5-6 October 2002, 3rd DOTS/TB expansion working group meeting, Montreal, Canada

 October 7 to 9, Indira Gandhi Hospital: Training of trainers workshop on ARI, with participants of NGOs and MOPH from 6 areas

 21-23 October 2002, International conference on wastewater management and its effect on the environment in hot and arid countries, Muscat, Oman.

For more information:

WHO Afghanistan Office WHO Afghanistan Support Office House No. 249, Street No. 10 P. O. Box No. 1936 Wazir Akbar Khan Mina House 218, Margalla Road, F-10/3 Kabul, Afghanistan Islamabad, Pakistan Tel: (0093) 70279010/1-2 Tel: (92 51) 221 1224, 2104770.4 Digital lines : 2300181/2 Fax: (92 51) 228 0830 E-mail : [email protected] E-mail: [email protected] Fax No : 0047 233 08112 2207