Access to Primary Healthcare in Kabul, Afghanistan

Introduction

The Shahid Abdul Razaq Comprehensive Health Center (CHC) in Qusaba, Kabul, continues to address critical health needs, guided by the Ministry of Public Health (MOH) standards. The CHC provides essential health services such as Outpatient Department (OPD) consultations, maternal and newborn care, vaccinations, laboratory tests, pharmacy services, and training for community health workers. In addition, a new maternity ward was recently inaugurated, providing 24/7 child delivery services to a population of nearly 100,000 people.

Despite Afghanistan's economic and social challenges, the CHC has upheld its commitment to sustainable, community-centered healthcare. This report highlights its performance and challenges in the 3rd quarter of 2024.

Health Services Delivery (July-September 2024)

During the recent quarter, the CHC provided health services to over 9,500 patients, reflecting a five percent increase from the previous quarter due to enhanced community outreach and awareness campaigns. Of these 9,500 patients served, the services provided can be broken down into the following.

• Within the Outpatient Department, 2,145 consultations were provided, of which 37% were for acute respiratory infections, 10% for gastrointestinal illnesses, and 8% for urinary tract infections.
• The Maternal and Newborn Care and ultrasonography departments conducted nearly 700 antenatal and postnatal visits. With strengthened referral systems, antenatal care services increased by 12% in the last quarter. Additionally, the health facility saw an increase in child deliveries, safely delivering the babies of eight mothers.
• The CHC administered 4,200 doses of vaccines, including BCG, OPV, and measles, as part of the national immunization program. In addition, 350 women received tetanus vaccinations.
• The nutrition department, which had been closed for the previous six months due to a lack of financial support, was finally reopened. With its reopening, the department screened 150 children under five years old for malnutrition. Ten percent of these were determined to be suffering from moderate acute malnutrition (MAM), and six percent had severe acute malnutrition (SAM). In collaboration with partner organizations, treatment was successfully administered to these children.
• The Pharmacy and Lab received an in-kind medicine donation from a local trader. The donated medicine included Pantoacid, which treats stomach acid and heartburn. In addition, 2,400 boxes and 250 bottles of Fourts Bz plus syrup, which contains active vitamins, minerals, and amino acids beneficial for the health of pregnant and lactating women, were also donated. The full donation was estimated to be at least $4,500 USD.

To treat the thousands of patients who seek out the Health Center's services, the CHC has maintained a team of 12 dedicated staff members who continue to provide essential services. With the recent addition of new services through the launch of the maternity ward, the number of permanent staff members has risen to 16, with three volunteers now contributing CHC's essential care.

In August, a seminar was conducted to enhance the staff's capacity to detect and cure common acute diseases. Training sessions were conducted on maternal health, infection prevention, and community mobilization to build the staff's capacity. Additionally, during the month of August, a group of 16 women received formal training to become Community Health Workers. Having finalized their training at the end of the quarter, these women are now actively conducting health and education sessions in underserved areas.

Challenges

While serving patients, the CHC continues to face barriers. Most significantly, the CHC faces resource limitations as persistent shortages of essential medications, including Vitamin A and iron supplements, and medical equipment hinder the number and quality of services the CHC can provide. Furthermore, high levels of food insecurity and malnutrition continue to overwhelm health systems. Finally, the restrictions on women's employment in many sectors have reduced overall access to skilled female healthcare providers.

Despite these challenges and Afghanistan's challenging socio-economic environment, the CHC continues to demonstrate resilience in delivering quality healthcare services. Its role is pivotal in improving the health and well-being of vulnerable populations in Qusaba. With sustained investment and strategic partnerships, the CHC can overcome current limitations and expand its impact.

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Qasaba ditrict in North Kabul is a place where many poor families live. Lack of maternal health services in this area has been causing the births to take place at home, without a trained health personnel. Upon request of the community, AfD established a maternity ward at the health facility which will provide maternal and new born services to mothers.

Two new midwives were recruited recently and the construciton of the ward, separation of rooms, installment of proper delivery room was accomplished by end of June. The two midwives actively engaged in receiving PNC and ANC patients along with the gynocologist at the health facility in July. The meeting and visits for women in their third trimester of pregnancy has been promising. The ward includes prenatal, childbirth, and postnatal care. The activation marks a significant step towards improving maternal and child health outcomes in the north area of Kabul, giving possibilities for patients from Parwan province also benefit from the services.

To ensure continuous and high-quality care, AfD has recruited two qualified midwives through a transparent recruitment process (selection of CVs, written test, interview, check of background). Out of 5 identified candidates, two were selected who will provide services 24/7. These midwives are responsible for:

• Conducting prenatal check-ups
• Assisting with labor and delivery
• Providing postnatal care and support
• Educating mothers on newborn care and breastfeeding

Achieving the goal of providing life-saving health services particlurly to mothers during this time, as women face many backsets is considered critical. Restrictions on women's movement, employment and education has pledged the population into a severe vulnerability condition where many of them not only dont have money to buy food but also cannot afford very basic health related expenses. 

It has been repeatedly reported that many pregnant women ask for half proportion of medicine and essential vitamins that they need to take during the 1st trimester (particlulaly folic acid, various vitamins, and medicine to treat anemia) as they cannot afford to pay for them. In the absence of health insurance systems many families fall bellow poverty line when someone from the familiy faces a health problem requireing an immense treatment or recovery scheme. 

AfD remains commited to the provision of health care services to those people in need and with the generaous donations of our donors who are willing to cover proportion of the medical expenses of these families,  we ensure that those medical services remain at reasonable and affordable cost to the poorest populations.