[Compa ny name] Assessment Report- Health and Integrated Protection Needs in Ghazni Province Abdul Qadir Baqakhil Dr. Waseel Rahimi Akbar Ahmadi Vijay Raghavan Final Report Acknowledgements The study team thank representatives of the following institutions who have met us in both Kabul and Ghazni during the assessment. WHO – Kabul, UNICEF – Ghazni, Emergency – Ghazni, DACAAR – Kabul, Provincial Health Directorate, Ghazni; Provincial Hospital, Ghazni; Afghanistan Red Crescent Society (ARCS), Ghazni; DoRR, Ghazni; ICRC – Kabul and Ghazni, Swedish Committee for Afghanistan, Ghazni; AADA BPHS and EPHS team in Ghazni Thanks of INSO for conducting the assessment of the field locations and also for field movements Special thanks to the communities and their representatives who have travelled all the way from their villages in distant districts and participated in the consultation workshop we had in Ghazni. Our sincere thanks to the District wise focal points, health facility staff and all support staff of AADA, Ghazni who tirelessly supported in the field assessment and arrangement of necessary logistics for the assessment team. Our special thanks to Dr. Samim Nifkhar, Provincial Manager, BPHS and EPHS, AADA in Ghazni for his kind support and providing all the needed information and coordinating the field mission and stakeholders’ consultations in the province. Without his support the mission wouldn’t be possible. We thank the founder/Director of AADA, Dr Jamaluddin Jawid who proposed for this joint programme planning between Johanniter and AADA beyond our existing programme of Community Midwifery Education in Takhar province and expand the partnership to Ghazni, the neediest province for health and that too for trauma care. Thanks to Health and Protection Clusters for their constant inputs and support. Thanks to OCHA-HFU team for their feedback on our previous programme and that helped in refining our assessment focus and added the components of additional issues like operations, logistics and quality of supplies which were discussed elaborately with the field team of AADA. Thanks to Access and Security team in OCHA for their feedback on access and security sections. Special thanks to ECHO team in Kabul for their feedback to our previous assessment report of Ghazni which is valuable while we did the needs assessment in Ghazni. Page 2 of 104 Final Report Abbreviations IEA Islamic Emirates of Afghanistan MoPH Ministry of Public Health ANSF Afghanistan National Security Forces AADA Agency for Assistance and Development of Afghanistan AHF Afghanistan Humanitarian Fund (OCHA funded, formerly CHF – Common Humanitarian Fund) ORCD Organization for Research & Community Development UNOCHA United Nations Office for the Coordination of Humanitarian Affairs WHO World Health Organization UNICEF United Nations Children’s Fund UNHCR United Nations High Commissioner for Refugees WSTA SCA Swedish Committee for Afghanistan ALP Afghan Local Police AOG Armed Opposition Groups AGE Anti Government Element ACG Armed Criminal Group INSO International NGO Safety Organization HAG Humanitarian Access Group ACBAR Agency coordinating Body for Afghan Relief and Development DAC District Administrative Centre HFU Humanitarian Funding Unit IMF International Military Forces BBC British Broadcasting Centre UNAMA United Nations Assistance Mission in Afghanistan MSF Medicine Sans Frontiers HI Humanitarian & Inclusion/ Handicap International SIGAR Special Inspector General for Afghanistan Reconstruction BPHS Basic Package of Health Service EPHS Essential Package of Hospital Service CHC Comprehensive Health Center BHC Basic Health Center Page 3 of 104 Final Report DH District Hospital PHC Primary Health Centre PH Provincial Hospital RH Regional Hospital PPHD Provincial Public Health Directorate TP Trauma Post FATP First Aid Trauma Post (Is also mentioned as FAP- First Aid Post) CSO Community Social Organizer CBPF Country-Based Pooled Funds RAF Rapid Assessment Format HMIS Health Management Information System IED Improvised Explosive Device GOA Government of Afghanistan PHCC Provincial Health Coordination Centre EPI Expansion Program on immunization ARCS Afghanistan Red Crescent Society DACAAR Danish Committee for Aid to Afghan Refugees Page 4 of 104 Final Report Glossary Shura Community Development Council Malik Head of Community Development Council IEA/Taliban Islamic Emirate of Afghanistan/Taliban Zakat payment made annually under Islamic law on certain kinds of property and used for charitable and religious purposes, one of the Five Pillars of Islam. Oashar Kind of Tax under Islamic Law in different kinds of cultivation product Lahya Rules or Statement that establishes a principle or standard, and serves as a norm for guiding or mandating action or conduct. Masuliyat Responsibility Arbaki Afghan Local Police Breshna Electricity provider company in Afghanistan Page 5 of 104 Final Report Contents Acknowledgements ......................................................................................................................... 2 Abbreviations .................................................................................................................................. 3 Glossary ........................................................................................................................................... 5 Section 1 : Background ................................................................................................................... 8 Background of Ghazni Province ...................................................................................................... 8 Background for the Assessment ................................................................................................... 10 Assessment Methodology ............................................................................................................. 11 Section 2 : Summary of the findings .......................................................................................... 14 Section 3: Introduction ............................................................................................................... 17 Security ......................................................................................................................................... 17 Conflict situation ........................................................................................................................... 20 Section 4 : Health Assessment .................................................................................................... 22 Health Facilities in Ghazni ............................................................................................................. 26 Damages to Health Facilities ......................................................................................................... 27 Trauma Cases details in Ghazni Province ...................................................................................... 33 Supporting Referral Sites with capacity to respond mass casualty .............................................. 42 Coordination with relevant health actors at Ghazni and Kabul .................................................... 43 Recommendations from the stakeholders on the recruitment of qualified staff ........................ 45 Training of Health Facility Staff on Triage, First Aid and First Responder’s training and Mass Casualty Management .................................................................................................................. 45 Advocacy related to health and trauma care ............................................................................... 46 Section 5: Access Assessment ..................................................................................................... 48 Impact on Health Services in Ghazni ............................................................................................. 63 Violations of Health Facilities noticed in the assessment by the actors involved in conflict. ...... 66 High Violations by Taliban/AOGs .................................................................................................. 67 Recommendations ........................................................................................................................ 72 Key Activities considered for the proposed project ..................................................................... 74 Section 6 : Protection Assessment ............................................................................................... 75 Barrier Analysis ............................................................................................................................. 78 Protection Risk Analysis ................................................................................................................ 82 Recommendations and suggestions ............................................................................................. 87 Prostatic and Orthotics Care ......................................................................................................... 87 Mental Health in counselling Post Trauma Disorder Syndromes (PTDS) and referrals ................ 88 Coordinate with UNFPA in their implementation phases with establishing FPC in Ghazni district’s and provincial hospital ................................................................................................... 89 Page 6 of 104 Final Report Coordination ................................................................................................................................