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    Home / Central Data Catalog / DHS / AFG_2018_SPA_V01_M
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Service Provision Assessment Survey 2018-2019

Afghanistan, 2018 - 2019
MEASURE DHS: Demographic and Health Surveys
Ministry of Public Health
Created on March 17, 2020 Last modified March 17, 2020 Page views 3169 Documentation in PDF Study website Interactive tools Metadata DDI/XML JSON
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Documentation

Download the questionnaires, technical documents and reports that describe the survey process and the key results for this study.
Questionnaires
Afghanistan Service Provision Assessment Survey 2018
Download
Country Afghanistan
language English
Download https://www.dhsprogram.com/pubs/pdf/SPA31/SPA31.pdf
Reports
Afghanistan Service Provision Assessment 2018-19, Final Report
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authors Ministry of Public Health, Wazir Akbar Khan, Kabul, Afghanistan The DHS Program, ICF, Rockville, Maryland, USA
Date 2019-10
Country Afghanistan
language English
Table of contents TABLES AND FIGURES .......................................................................................................................... vii
FOREWORD ............................................................................................................................................... xi
ACKNOWLEDGMENTS ........................................................................................................................ xiii
READING AND UNDERSTANDING TABLES FROM THE 2018-19 AFGHANISTAN SPA ......... xv
ACRONYMS AND ABBREVIATIONS ............................................................................................... xxiii
MAP OF AFGHANISTAN ..................................................................................................................... xxvi

1 OVERVIEW OF HEALTH SECTOR IN AFGHANISTAN ...................................................... 1
1.1 Health Financing ................................................................................................................. 1
1.2 Enabling Policies and Strategies to Improve Health Status ................................................. 2
1.2.1 Afghanistan vision ................................................................................................. 2
1.2.2 MDGs, SDGs, and other global initiatives ............................................................ 2
1.2.3 National health policy ............................................................................................ 2
1.2.4 National health strategy ......................................................................................... 3
1.3 The Health Care System ...................................................................................................... 3
1.3.1 Introduction ............................................................................................................ 3
1.3.2 National and specialty hospitals ............................................................................. 4
1.3.3 Private health sector ............................................................................................... 4
1.3.4 Governance structure at the national level ............................................................. 4

2 METHODOLOGY .......................................................................................................................... 7
2.1 Overview ............................................................................................................................. 7
2.2 Institutional Framework and Objectives of the Survey ....................................................... 7
2.2.1 Institutional framework .......................................................................................... 7
2.2.2 Objectives of the Afghanistan Service Provision Assessment survey (AfSPA) .... 8
2.3 Data Collection Methods ..................................................................................................... 8
2.4 Implementation .................................................................................................................... 9
2.4.1 Survey oversight .................................................................................................... 9
2.4.2 Questionnaire adaptation ..................................................................................... 10
2.4.3 Pretest................................................................................................................... 10
2.4.4 Main training ........................................................................................................ 10
2.4.5 Data collection ..................................................................................................... 11
2.4.6 Data management and report writing ................................................................... 12
2.5 Sampling ............................................................................................................................ 13
2.5.1 Sampling methodology ........................................................................................ 13
2.5.2 Sample of health service providers ...................................................................... 14
2.5.3 Sample for observations and exit interviews ....................................................... 14

3 FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, AND SUPPORT SYSTEMS ................... 21
3.1 Background ........................................................................................................................ 21
3.2 Availability of Services ..................................................................................................... 22
3.2.1 Availability of specific services ........................................................................... 22
3.2.2 Availability of basic client services ..................................................................... 22
3.3 Service Readiness: Basic Facility Infrastructure to Support Quality Service Provision and Client Utilization ................... 22
3.3.1 Basic amenities for client services ....................................................................... 22
3.3.2 Availability of basic equipment ........................................................................... 23
3.3.3 Standard precautions for infection control ........................................................... 24
3.3.4 Capacity for processing of equipment for reuse .................................................. 24
3.3.5 Laboratory diagnostic capacity ............................................................................ 25
3.3.6 Availability of essential medicine ........................................................................ 25
3.4 Management Systems to Support and Maintain Quality Services and Appropriate
Client Utilization ............................................................................................................... 25
3.4.1 Management, quality assurance system ............................................................... 25
3.4.2 Supportive management practices at the facility level ......................................... 26
3.5 Availability of Human Resources for Health .................................................................... 26

4 CHILD HEALTH SERVICES ..................................................................................................... 37
4.1 Background ........................................................................................................................ 37
4.1.1 Health situation of children in Afghanistan ......................................................... 38
4.2 Availability of Child Health Services ................................................................................ 39
4.2.1 Outpatient curative care, child growth monitoring, and child vaccination .......... 39
4.2.2 Vitamin A supplementation ................................................................................. 39
4.2.3 Frequency of available service ............................................................................. 39
4.3 Service Readiness .............................................................................................................. 39
4.3.1 Guidelines, trained staff, and equipment for sick child care ................................ 39
4.3.2 Infection control in sick child services ................................................................ 41
4.3.3 Laboratory diagnostic capacity ............................................................................ 41
4.3.4 Medicines and commodities for sick child care ................................................... 41
4.3.5 Guidelines, trained staff, and equipment for vaccination services ....................... 42
4.3.6 Availability of vaccines ....................................................................................... 42
4.3.7 Infection prevention in vaccination services ........................................................ 43
4.4 Sick Child Care Practices .................................................................................................. 43
4.4.1 Full assessment .................................................................................................... 43
4.4.2 Diagnosis-specific assessments and treatment ..................................................... 44
4.5 Client Opinions .................................................................................................................. 44
4.6 Basic Management and Administrative Systems ............................................................... 45
4.6.1 Supervision .......................................................................................................... 45
4.6.2 Training ................................................................................................................ 45

5 FAMILY PLANNING SERVICES ............................................................................................. 55
5.1 Background ........................................................................................................................ 55
5.2 Family Planning Services in Afghanistan .......................................................................... 56
5.3 Availability of Family Planning Services .......................................................................... 57
5.3.1 Contraceptive method mix and method availability ............................................ 57
5.3.2 Frequency of availability of family planning services ......................................... 58
5.3.3 Specific methods offered ..................................................................................... 58
5.3.4 Availability of family planning methods on the day of the assessment ............... 58
5.4 Service Readiness .............................................................................................................. 58
5.4.1 Service guidelines, trained staff, and equipment ................................................. 58
5.4.2 Infection control ................................................................................................... 59
5.5 Adherence to Standards for Quality Service Provision ..................................................... 59
5.5.1 Counseling and client assessment at first family planning visits ......................... 60
5.5.2 Counseling at all family planning visits ............................................................... 61
5.6 Client Opinion and Knowledge ......................................................................................... 61
5.6.1 Major problems .................................................................................................... 61
5.6.2 Clients’ knowledge about methods ...................................................................... 61
5.7 Basic Management and Administrative Systems ............................................................... 62
5.7.1 Supervision .......................................................................................................... 62
5.7.2 Training ................................................................................................................ 62

6 ANTENATAL CARE SERVICES .............................................................................................. 73
6.1 Background ........................................................................................................................ 73
6.2 Availability of ANC Services ............................................................................................ 74
6.3 Service Readiness: Guidelines, Trained Staff, and Basic Equipment for ANC ................ 74
6.3.1 Items for infection control during provision of ANC .......................................... 75
6.3.2 Diagnostic capacity .............................................................................................. 75
6.3.3 Availability of medicine for routine ANC ........................................................... 75
6.4 Adherence To Standards .................................................................................................... 75
6.5 Availability of Services for Prevention of Mother-to-Child Transmission of HIV in Facilities Offering Antenatal Care Services ............. 78
6.6 Malaria Services in Facilities Offering Antenatal Care Services ...................................... 78

7 DELIVERY AND NEWBORN CARE ........................................................................................ 93
7.1 Background ........................................................................................................................ 94
7.1.1 Maternal and newborn health status and health care utilization .......................... 94
7.2 Availability of Delivery and Other Maternal Health Services ........................................... 95
7.3 Service Readiness .............................................................................................................. 95
7.3.1 Service guidelines, trained staff, and equipment for delivery services ................ 95
7.3.2 Medicines and commodities for delivery and newborn care ................................ 96
7.3.3 Infection control ................................................................................................... 97
7.4 Signal Functions for Emergency Obstetric and Newborn Care (EmONC) ....................... 97
7.5 Newborn Care Practices .................................................................................................... 98
7.6 Basic Management and Administrative Systems ............................................................... 98
7.6.1 Supervision .......................................................................................................... 99
7.6.2 Training ................................................................................................................ 99

8 HIV/AIDS AND SEXUALLY TRANSMITtED INFECTIONS ............................................. 107
8.1 Background ...................................................................................................................... 107
8.1.1 HIV/AIDS situation in Afghanistan ................................................................... 107
8.1.2 Definitions of HIV/AIDS services ..................................................................... 108
8.1.3 HIV testing and counseling ................................................................................ 108
8.2 Service Availability ......................................................................................................... 108
8.2.1 Infection control ................................................................................................. 109
8.2.2 Basic management and administrative systems for HIV testing and counseling ............... 109
8.3 HIV Care and Support Services ....................................................................................... 109
8.4 Antiretroviral Therapy ..................................................................................................... 110
8.4.1 Service availability ............................................................................................. 110
8.4.2 Service readiness ................................................................................................ 110
8.5 Services for Sexually Transmitted Infections .................................................................. 110
8.5.1 AfSPA approach to collection of information on sexually transmitted infections ........................ 111
8.5.2 Service availability ............................................................................................. 111
8.5.3 Service readiness ................................................................................................ 111

9 NON-COMMUNICABLE DISEASES ...................................................................................... 117
9.1 Background ...................................................................................................................... 117
9.2 Major Non-communicable Diseases in Afghanistan ....................................................... 118
9.2.2 Cardiovascular diseases ..................................................................................... 118
9.2.3 Chronic respiratory diseases .............................................................................. 119
9.3 Diabetes: Service Availability and Readiness ................................................................. 119
9.3.1 Availability of services for diabetes ................................................................... 119
9.3.2 Service readiness for diabetes ............................................................................ 119
9.4 Cardiovascular Diseases: Service Availability and Readiness ........................................ 120
9.4.1 Availability of services for cardiovascular diseases .......................................... 120
9.4.2 Service readiness for cardiovascular diseases .................................................... 121
9.5 Chronic Respiratory Diseases: Service Availability and Readiness ................................ 121
9.5.1 Availability of services for chronic respiratory diseases ................................... 122
9.5.2 Service readiness for chronic respiratory diseases ............................................. 122

10 TUBERCULOSIS ....................................................................................................................... 127
10.1 Background ...................................................................................................................... 127
10.2 Availability of TB Services ............................................................................................. 128
10.3 Service Readiness ............................................................................................................ 128
10.3.1 Guidelines and trained staff ............................................................................... 128
10.3.2 Diagnostic capacity ............................................................................................ 129
10.3.3 Treatment and availability of medicines ............................................................ 129

11 MALARIA SERVICES .............................................................................................................. 133
11.1 Background ...................................................................................................................... 133
11.2 Availability of Malaria Services ...................................................................................... 134
11.3 Facility Readiness for Malaria Diagnostic and Therapeutic Services ............................. 134

12 HOSPITAL INPATIENT CARE SERVICES .......................................................................... 139
12.1 Emergency Services ........................................................................................................ 139
12.1.1 Availability of guidelines and basic equipment ................................................. 140
12.1.2 Availability of items for infection control ......................................................... 140
12.2 General Adult Inpatient Ward Services ........................................................................... 140
12.2.1 Availability of guidelines and basic equipment ................................................. 141
12.2.2 Availability of items for infection control ......................................................... 141
12.3 Delivery Ward Services ................................................................................................... 141
12.3.1 Availability of guidelines and basic equipment ................................................. 141
12.3.2 Availability of items for infection control ......................................................... 141
12.4 Pediatric Ward Services ................................................................................................... 142
12.4.1 Availability of guidelines and basic equipment ................................................. 142
12.4.2 Availability of items for infection control ......................................................... 142
12.5 Intensive Care Services ................................................................................................... 142
12.5.1 Availability of guidelines and basic equipment ................................................. 142
12.5.2 Availability of items for infection control ......................................................... 143

REFERENCES.......................................................................................................................................... 153
APPENDIX A PERSONS INVOLVED IN THE 2018-19 AFSPA ..................................................... 155
APPENDIX B QUESTIONNAIRES ..................................................................................................... 157
Download https://www.dhsprogram.com/pubs/pdf/SR263/SR263.pdf
Afghanistan Service Provision Assessment (AfSPA) 2018-19, Key Findings
Download
authors The DHS Program
Date 2019-10
Country Afghanistan
language English
Download https://www.dhsprogram.com/pubs/pdf/PPT70/PPT70.zip
Survey Presentations
Download
authors The DHS Program
Date 2019-10
Country Afghanistan
language English
Download https://www.dhsprogram.com/pubs/pdf/PPT70/PPT70.zip
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