Continuation of non-COVID19 essential health services

1. Sustaining non-COVID-19 essential health services,
Afghanistan
Najibullah Safi, MD, MSc. HPM
Program Manger Health System, WHO – Afghanistan

2. Background
• The foundations of the current health system of Afghanistan was laid
down in 2002
• The MoPH opted to expand primary health care
• With strong support from key development partners, MoPH developed the
Basic Package of Health Services in 2003 and the Essential Package of Hospital
Services in 2005
• Considering the low capacity of public sector, an innovative approach of
contracting-out to NGOs as service provider is used to rapidly expand the
coverage of health services to remote and underserved areas
Friday, August 28, 2020 2The 11th AAAH Webinar Series

3. Introduction
• There are indications that the utilization of healthcare services have
gone down (Sehatmandi MTR)
• Several healthcare providers have been affected by COVID and
therefore not available
• There is a surge in demand for emergency and critical services
• Restoring people’s faith in the health system and health facilities is
challenging
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4. Status of COVID-
19 as of 24
August 2020
101208
38054
8305
28360
1389
3610
0
20000
40000
60000
80000
100000
120000
Sample tested Total cases Active cases Recovered cases Deaths Number of HCW
infected
Status of COVID-19 as of 24 August 2020
- Survey data indicates that 31.5% of the population is infected
(around 10 million people)
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5. Comparison of
key P4P
indicators
quarter 1 2019
vs 2020
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
1000000
Cesarean
Section
CYP ANCs PNCs Institutional
Deliveries
Major
Surgary
PENTA3 TB treated
Cases
TT2+
Comparision of P4P indicators
Q1 2019 Q1 2020
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6. Comparison of
key indicators
quarter 1 and 2
2019 vs quarter
1 and 2 2020
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0
500
1000
1500
2000
2500
Jan Feb March April May June
Hospital Deaths
2019 2020
75000
80000
85000
90000
95000
100000
Jan Feb March April May June
Institutional Delivery
2019 2020
0
1000000
2000000
3000000
Jan Feb March April May June
ARI
2019 2020
16925264 16400286 15920004 13197288
407026 392886 405232 307278
0
5000000
10000000
15000000
20000000
Q1 Q2 Q1 Q2
2019 2020
OPD/IPD Q1 & Q2 2019/2020
OPD IPD

7. Comparison of
key indicators
quarter 1 2019
vs quarter 1
2020
0
20000
40000
60000
80000
100000
120000
140000
160000
Comparision of key indicators
Q1 2019 Q1 2020
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8. Strategy for sustaining non-COVID-19 essential health services
• WHO suggested 10 strategic actions to maintain essential health services
during COVID pandemic
1. Adjust governance and coordination mechanisms
2. Prioritize essential health services and adapt to changes contexts and needs
3. Optimize service delivery settings and platforms
4. Establish safe and effective patient flow at all levels
5. Rapidly optimize health workforce capacity
6. Maintain availability of essential medication, equipment and supplies
7. Fund public health and remove financial barriers to access
8. Strengthen communication strategies to support the appropriate use of essential
services
9. Strengthen monitoring of essential health services
10. Use digital platform to support essential health service delivery
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9. Strategies for sustaining essential health services conti.
• Adjust governance and coordination mechanisms
• To ensure coordination different committees were established
• Used the existing CCC/EOC for coordinating COVID-19 response, PMO and GCMU
(responsible for BPHS/EPHS) are part of coordination platforms
• Prioritize essential health services and adapt to changes contexts and
needs
• Continue providing BPHS and EPHS
• Optimize service delivery settings and platforms
• Fever corner established in health facilities
• Additional or specific health facilities were assigned for the management of COVID-19
(were re-purposed health facilities)
• Establish safe and effective patient flow at all levels
• Expanded IPC, training and enhanced public awareness on safe care-seeking
behavior
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10. Strategies for sustaining essential health services cont.
• Rapidly optimize health workforce capacity
• Identified and registered more than 10,000 additional medical doctors
(deployed only few hundreds)
• Comprehensive training programs for existing and potential staff
• Maintain availability of essential medication, equipment and supplies
• BPHS and EPHS received their medicines and supplies through the contracted
NGOs
• Government allocated additional budget for COVID-19
• Partners (WB, WHO, UNICEF, ADB, EU) provided extensive support
• Fund public health and remove financial barriers to access
• All services are provided free of cost
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11. Strategies for sustaining essential health services conti.
• Strengthen communication strategies to support the appropriate use of
essential services
• Extensive awareness campaign using different communication channels
• Strengthen monitoring of essential health services
• M&E directorate, PMO, GCMU,PPHDs, and Polio network increased monitoring of
routine and COVID-19 services
• Disaggregated data on age and sex is available
• Use digital platform to support essential health service delivery
• Expanded the use of DHIS 2
• Established public dashboard for COVID-19
• Provision of health education messages through all mobile companies
• Provision of online training courses for the first time in Afghanistan
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12. Conclusion
• Impact of COVID-19 on essential health services
• Reduced utilization of services (not linked with payment)
• Slightly increased utilization of services (linked to payment of NGOs) – this
raised questions and concerns and need further evaluation
• A good opportunity for strengthening ICU care, IPC, capacity building
of staff, and expansion of lab services
• Better coordination and capacity in responding to emergencies
(different platforms were merged and brough under one EOC)
• More attention to health services, increased budget allocation by
government and partners
• Better preparation for potential second wave of diseases in coming
winter
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13. Thanks
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