20 January 2010 - As a major technical partner for health development in Afghanistan, the World Health Organization will continue to work with Afghan ministries and groups to improve health care in the country this year.

WHO is working in close collaboration with the Ministry of Public Health, other UN agencies, bilateral agencies and Civil Society Organizations (CSO), rendering its technical, financial and material assistance through its main office in Kabul and seven sub-offices in Jalalabad, Gardez, Faizabad, Kunduz, Mazar-i- Sharif, Kandahar and Herat.

The key strategic priorities of WHO for 2010 include:

Primary Health Care and Health System Strengthening (PHC/HSS)
WHO will provide guidance on health system development based on the values and principles of Primary Health Care (PHC), particularly in the areas of governance and leadership; human resource development; service delivery (including Basic Package of Health Services and Essential Package of Hospital Services, and outreach activities through community health workers); health information system; health care financing; and health technology support.

Our policy advice will address means of improving the access to, quality, equity and efficiency of health services.

The programmatic focus will be on human rights and gender mainstreaming in health; decentralization of health services whilst enhancing the referral system; promoting a culture of quality assurance and improvement (standard setting, accreditation and (re)-licensing) including patient safety; and promoting community based initiatives in support of PHC.

The Basic Development Needs (BDN) programme, which addresses the social determinants of health (SDH), and establishes effective mechanisms for community participation and inter-sectoral coordination and which is ongoing in Kabul, Jalalabad, Kundiz, Kandahar, Faizabad, Bamyan, Ghazni and Herat, will be consolidated and expanded to other sites.

Our assistance to the Ministry of Public health (MoPH) in the areas of essential medicine, mental health & substance abuse, prevention &control of blindness, and disability and rehabilitation will continue.

Being the MoPH’s lead technical partner on HSS, WHO will continue to contribute to the development and implementation of the HSS work streams funded by the GAVI alliance and the Global Fund.

This includes mapping of the CSOs working in the health sector of Afghanistan, and establishment of Community Midwifery Schools in four more provinces (Kunar, Ghazni, Nimroz and Zabul).

A pilot project regarding partnership with the private providers for the service delivery in remote and insecure areas is being launched in Farah and Uruzgan provinces.

Reproductive Health (RH)/Maternal and Child Health and Nutrition
WHO will continue its support in the adaptation, training and implementation of evidence based Making Pregnancy Safer (MPS), Family Planning (FP) and nutrition guidelines as well as training of health care providers especially in essential obstetric care, essential newborn care and family planning, including the training of community midwives.

As lead technical agency, WHO will assist the MoPH in conducting a Maternal Mortality study along with MACRO International, JHU, UNICEF and UNFPA.

A community based behaviour change communication programme on family planning will be piloted in three provinces.

Communicable Disease Surveillance and Response (CSR)
The Disease Early Warning System (DEWS), a communicable disease surveillance system with laboratory support, will be expanded by adding 25 sentinel sites to the existing 177 in all 34 provinces.

This will help in early detection of disease outbreaks and facilitate a timely response with control and preventive measures.

WHO will conduct training for 500 surveillance focal points and the capacity of the Central Public Health Laboratory at the Afghan Public Health Institute (APHI) will be further enhanced.

Influenza H1N1 monitoring, testing and response will remain a priority in 2010, as will the building of the core national capacity to identify and respond to Public Health Emergency of International Concern (PHEIC) diseases and events.

WHO will support research leading to publication in the field of vaccine preventable diseases, neglected diseases and more.

Expanded Programme for Immunization (EPI)
WHO will continue its assistance to improve immunization coverage against six vaccine preventable diseases in all districts.

The targets is to achieve 90 per cent DPT3 (Pentavalent) coverage among age one years nationally; over 80 per cent coverage with all routine immunizations; 80 per cent coverage of tw doses of tetanus toxoid in child-bearing age women; eliminating Neonatal Tetanus (conducting Supplementary Immunization in 160 high risk districts), and sustaining 90 per cent reduction in measles cases.

WHO will conduct courses on district micro-planning for 200 EPI managers, supervisors and trainers, and will also conduct refresher courses for 400 vaccinators including 60 nurses from health sub-centres and mobile health teams.

For achieving “no stock-out” for vaccine and immunization supplies, new WHO tools will be introduced, and cold chain and logistics officers will be trained.

The campaign for 100 per cent safe injections will continue.

WHO will assist NEPI/MOPH in developing a comprehensive multi-year plan (CMYP) for 2011-2015.

Polio Eradication Initiative (PEI)
Polio eradication will remain a top priority for 2010, particularly in the Southern part of the country.

2010 should see interruption of polio virus transmission in the South, continuing good immunity among the children of other regions and maintaining a sensitive surveillance system in all parts of the country.

District/Cluster specific plans for thirteen high risk districts are being developed and refined with MoPH and UNICEF.

SIAs strategy includes four National Immunization Days (NID) targeting 7.3 million children under five and four additional Sub NIDs in high risk zones (South, Southeast, East and Farah province) using a new tool, Bivalent Oral Polio Virus (OPV), the first round is scheduled from 14-16 February 2010.

Malaria and Leishmaniasis Control Programme
WHO will continue to work towards the elimination of Plasmodium falciparum malaria from Afghanistan through preventive measures and vector control including distribution of long lasting insecticide treated nets (LLITNs) in 14 malaria high risk provinces.

National staff will be trained on basic malaria microscopy; malaria epidemic/outbreak response; supervision and quality assurance of newly established laboratories.

Amongst others Community health workers and community health supervisors will be trained on conducting rapid diagnostic tests.

Laboratory services will be established in the border provinces adjacent to Turkmenistan.

WHO will also continue to support the national Leishmaniasis programme through provision of drugs, training in case management, epidemiological surveillance, vector control and support to research projects.

TB and Leprosy Control Programme
WHO will continue to assist the MoPH in expanding TB control services to remote areas through the establishment of Community Based DOTS (CBD).

Urban DOTS is being launched in Kabul city to strengthen coordination and referral between health facilities and tertiary hospitals. Involving private health sectors and establishing private-public mixed DOTS is another component of this initiative.

Practical Approach to Lung Health (PAL) will be piloted in Kabul city to increase TB case detection.

The Stop TB partnership, established last year, will be expanded to the sub-national levels.

WHO will assist the Afghan TB and Lung Society to conduct quarterly scientific conferences and to publish quarterly medical journals.

A TB Patients Association will be established.

WHO will assist the National TB Programme address drug resistance through TB Drug Resistance Survey (DRS) in six provinces; strengthening of the National Reference Laboratory (NRL); equipping two Regional Reference Laboratories, and through the development of guidelines for managing MDR-TB.

Enhancing general awareness regarding TB through TV and radio spots, other promotional materials, publications, events and training for community leaders will remain a priority in 2010.

WHO will continue its assistance for training of health workers and dermatologists in leprosy endemic provinces; for strengthening the referral system; and for enhancing general awareness towards leprosy elimination n the country.

HIV/AIDS prevention and control programme
WHO will continue to assist the MoPH in developing the HIV /AIDS policy, strategy, guidelines and tools, and in building capacity at the central and provincial levels, with special attention to the Voluntary Counselling and Treatment centres (VCT).

WHO will continue its support for Anti-Retroviral Treatment (ART) centres.

The collaboration mechanism between TB and HIV programmes will be further strengthened in order to decrease the burden of TB in people living with HIV through case finding and prevention therapy, and for decreasing the burden of HIV in TB patients through counselling, testing, care and support.

Emergency Humanitarian Action and Health Cluster
WHO is the Health Cluster lead agency.

The response capacity of the health sector will be strengthened through improved coordination, technical support, procurement and distribution of medical supplies and kits as well as advocacy and resource mobilization for all partners to ensure that urgent needs of vulnerable groups are met.

WHO will also continue to respond directly to natural and manmade disasters and crises (floods, droughts, earthquakes, displacements, outbreaks etc).

WHO will continue to promote humanitarian principles including the neutrality and impartiality of health facilities and workers through evidence-based advocacy and outreach to all parties and local communities.

WHO will continue and expand its regular support to hospital sector with a focus on Emergency Essential Surgical Care/Anesthesia and ICU by providing specialized medical equipment (ICU unit), training of doctors and technicians, and technical contribution for the revision of MoPH technical guidelines (EPHS, hospital licensing and accreditation, and HMIS).

Website: WHO Afghanistan