Healthcare Reforms Bring Results in Afghanistan's Bamyan Province

Tupchi Village, Bamyan City – Women and children from far and near can be seen approaching Topchi Sub Health Center in the outskirts of Bamyan City, as it opens for another busy day. One of the first patients to arrive is Ziagul Muradi, 20, a homemaker from Tupchi village. She has brought her 11-month-old son, Mahdi, to be vaccinated against measles.

As a first-time mother, she appreciates the services of the village clinic and visits often. “I need to get a doctor’s opinion about my child’s health,” Ziagul says, confident in the care she will receive because “the doctors here are very professional and have access to good medicine.”  

Located 12 km from Bamyan city center, the Tupchi Sub Health Center serves between 1,400 and 1,800 patients a month, mainly children under five and women.

The clinic first opened in 2002. Ministry of Public Health (MoPH) reforms begun in 2013 under the System Enhancement for Health Action in Transition (SEHAT) program improved overall quality of care by improving access to medicine, training health care for clinic staff, ensuring cleaner and safer facilities, and making health information more accessible to patients.

For residents like Bibi Sangi, 40, a cattle farmer, Tupchi Sub Health Center is a lifeline to quality health care. Her grandson, Mowlody, 6, has suffered from chest and breathing ailments since birth. Without the Tupchi Sub Health Center, “we would have nowhere else to go and would rely on faith in God alone to solve our health problems,” she says.

SEHAT, closed in June 2018, worked to expand the scope, quality, and coverage of health services provided to the population, particularly vulnerable groups. SEHAT was supported by the International Development Association (IDA), the World Bank's fund for the poorest countries, and the Afghanistan Reconstruction Trust Fund (ARTF), administered by the World Bank on behalf of 34 donors.

The Sehatmandi project, which came into effect in July 2018, is building on SEHAT’s work. Specifically, The project is supported by IDA, the ARTF, and the Global Financing Facility (GFF), a multi-stakeholder partnership for reproductive, maternal, newborn, child and adolescent health and nutrition.

Raising Health Awareness

As a core responsibility under Sehatmandi, the service provider contracted to MOPH to manage the Sub Health Center carries out health campaigns to educate local communities on health issues. “Previously, people had no idea what a vaccine was and what its purpose was because access to vaccines was limited and health education was rudimentary at best,” says Bahuddin Ahmadi, a vaccinator at Tupchi Sub Health Center. His work is especially important to him because two children in his family had died from measles.

Outreach staff go out to Tupchi and its neighboring villages and provide health education to residents, generating interest in health care, which has resulted in higher rates of vaccination in the area.

At the same time, action is being taken to combat the circulation of false information and promote correct facts on health care. Adela Sharifi, 37, midwife at the Tupchi Health Center, says that unattended home births have decreased as a result of recommendations on prenatal care, information on dangerous symptoms, family planning, and benefits of delivering at a clinic or a hospital. “Residents have themselves decided to deliver at a health care facility,” she says.

Easy and timely access to health services such as vaccines for children and women in Tupchi clinic of Bamyan province has resulted in low rate of child and mother mortality. The clinic is operating under ARTF supported Sehatmani project. Photo credit: Rumi Consultancy / World Bank

Unhealthy, traditional postnatal practices have stopped since mothers were educated on breastfeeding and proper nutrition. “Previously, after birth, before feeding the babies with their mother’s milk, families would feed them animal fat or soil for three days owing to some religious beliefs,” Adela says. “Other infants were fed sugared water."

“People in this province are very poor, but they have increased their knowledge about health-related issues and changed their habits accordingly,” she says. According to Adela, reported cases of severe anemia, malnutrition, and night blindness, which once affected 80 percent of women in the area, have largely fallen.