Improving Health Care Provision for the Afghan People

Even though life expectancy in Afghanistan has increased, maternal mortality is still high. According to World Bank figures, there are 396 deaths per 100,000 live births. Infant and child mortality rates are also among the highest in the world.

Context

Every 14th child out of 1,000 live births, will not survive beyond their fifth birthday. According to UNICEF around 600,000 children under the age of five are dangerously malnourished. In the areas outside Kabul especially, health care provision is inadequate. Many health care facilities are outdated and poorly equipped.

Objective

People living in northern Afghanistan receive better health care. In particular, progress is made in the care for pregnant women, mothers and children. The capacities of the participating hospitals are developed. The equipment and management of the clinics as well as the qualification of the staff have been improved. Telemedicine is used to bring medical expertise to remote regions. Developing and expanding primary health care provision improves living conditions for the people of northern Afghanistan. This is a key prerequisite for stability in the country. Improvements that are felt quickly, if possible, are pursued.

Measures and Results

Since 2006, the KfW Development Bank has been supporting the reconstruction, renovation and building of health care facilities in northern Afghanistan on behalf of the German Federal Foreign Office. Medical care in the region is being further improved by rehabilitating hospitals and expanding their capacities, but also by introducing telemedicine services.

A regional hospital for Balkh and the neighbouring northern provinces

After a fire destroyed the old building, a regional hospital in Mazar-e Sharif was rebuilt with German assistance and opened in 2013. Balkh Regional Hospital has a key role in providing health care services in the region: it is the main local hospital for about 430,000 inhabitants of Mazar-e Sharif and serves as a referral hospital for up to six million people living in the surrounding area. Moreover, it is a teaching hospital with its own school of nursing and midwifery, and plays a key role in training new health care professionals and nursing staff.

Expansion of the Mother and Child Health Centre in Mazar-e Sharif

Recently, development efforts have focused on establishing appropriate obstetric care and paediatric services in Balkh Regional Hospital. The Mother and Child Health Centre used to be hopelessly overcrowded, with only 90 beds available for the 15,000 births per year. Four patients would often have to share just one bed. Since May 2019, a new Mother and Child Health Centre on the grounds of Balkh Regional Hospital has been available to the people of Mazar-e Sharif. The centre has 360 beds, 180 of which are assigned to gynaecology and obstetrics and 180 to paediatric care. In addition to the new building, the procurement of medical and non-medical equipment is an important part of the measures.

Restoration of the provincial hospital in Feyzabad

Feyzabad Provincial Hospital is the only referral hospital in Badakhshan Province, in the remote north-east of the country. Almost one million people use it as their regional health care centre. The KfW Development Bank is supporting the much needed extension of the hospital building and its technical facilities. A new Mother and Child Health Centre has been built and a telemedicine centre established. The measures were implemented in cooperation with the Aga Khan Development Network (AKDN), which has been running the hospital since 2009 on behalf of the Afghan government. The restoration of the hospital is of significant socio-political importance for the region and is a flagship project for Germany’s engagement in Badakhshan.

Doubling patient capacity

The hospital received a new diagnostic and treatment centre, a new in-patient building with 76 additional beds and the necessary medical and non-medical equipment. This has increased the capacity of the hospital to a total of around 140 beds.

High patient satisfaction

Data surveys on medical services and monthly patient surveys are part of the measures to improve health care. The results are positive: at the end of the first six months of 2018, around 95 per cent of all patients said they were satisfied with the services provided by the hospital.

The services provided by the provincial hospital have continued to improve over the project period. In 2018, they reached the annual targets set by the Afghan Ministry of Public Health in almost all categories.

Telemedicine closes gaps in service provision

Over recent years on behalf of the German Federal Foreign Office, a total of ten hospitals and health centres have been built and fitted out in the northern Afghan provinces of Badakhshan, Balkh, Kunduz and Takhar. Despite the significant improvement in health care services overall, access to medical services remains difficult for people living outside urban centres. Three quarters of the population of the region – particularly women – hardly have access to health care.

Telemedicine is meant to change this. The telemedicine network in northern Afghanistan is being developed with support from Germany. It will help to improve health care provision in the provinces of Badakhshan, Balkh, Kunduz and Takhar. One of its main priority areas is providing health care services for mothers and children.

To support the telemedicine network, around 40 health centres and four provincial hospitals are being established or expanded as regional centres. The necessary technical equipment and modern diagnostic devices will be provided and medical staff will receive relevant training. A new Mother and Child Health Centre with a telemedicine centre for Badakhshan Province is being established at the hospital in Feyzabad.

At a glance

Programme:
Mother and Child Health Centre in Mazar-e Sharif; Upgrading of the Provincial Hospital in Feyzabad; Telemedicine in Northern Afghanistan
Commissioned by:
German Federal Foreign Office
Partner:
Afghan Ministry of Public Health (MoPH)
Implementing organisations:
KfW Development Bank
Provinces:
Badakhshan, Balkh, Kunduz, Takhar
Programme objective:
To improve the health care provision for the population – in particular for pregnant women, mothers and children – in Afghanistan’s northern provinces
Overall term:
Mazar-e Sharif: January 2015 – November 2019; Feyzabad: November 2009 – June 2018; Telemedicine: April 2020 – March 2023