| authors |
Ministry of Public Health, Wazir Akbar Khan, Kabul, Afghanistan The DHS Program, ICF, Rockville, Maryland, USA |
| 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 |
