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APHA Scientific Session and Event Listing

Recorded presentation

A. Frederick Hartman, MD MPH, Paul Ickx, MD MSc, Laurence Laumonier-Ickx, MD, and William Newbrander, MHA PhD. REACH/Afghanistan, Mangement Sciences for Health, 784 Memorial Dr., Cambridge, MA 02139, 617-250-9500, fhartman@msh.org

Afghanistan was one of the early pioneers of community-based health care prior to the Soviet invasion of 1979. But twenty-three years of war and political instability that followed destroyed the health system. The fall of the Taliban in 2001 initiated a new era of health system development. Since 2002, the MOPH has made several important policy decisions to improve the crippled health system: 1. The MOPH would be the steward of the health system, with service provision contracted out to NGO's. 2. Donors divided up the country in contracting areas to fund services. USAID accepted responsibility for 13 provinces through the Rural Expansion of Community-based Healthcare (REACH) project. 3. All health services would follow the Basic Package of Health Services (BPHS) which defines services by levels and interventions, focusing on women and children. 4. Equity principles were stressed in all policies; rural health services stressed over urban, 50% of CHW's would be female, hospitals would never consume more than 40% of the health budget. REACH has focused on improving quality of the BPHS through 3 simple tools: a routine HMIS for the BPHS and two standards-based quality improvement tools, the Fully Functional Service Delivery Point (FFSDP) for ambulatory services and the Performance Quality Improvement (PQI) for hospital services. In 2.5 years, national coverage of the BPHS expanded from 5% of the population to 77%. REACH covers 37% of the population (8.1 million people) through 327 facilities and 6000 CHW's, providing 500,000 services/month. Results to date show that performance can improve significantly in a short period of time by increasing coverage and by improved quality standards scores from baseline to follow-up. When designing health systems interventions in a fragile state, it is important to focus on: 1. responding to the immediate needs of the population; 2. capacity-building efforts for both the public and private sectors; 3. developing quality improvement tools to measure progress and promote sustainability

Learning Objectives: At the conclusion of this session, participants will be able to

• Recognize that it is possible to expand coverage of health services rapidly and also improve the quality of services at the same time in fragile states.
• Describe two standards based methods effective for improving the quality of both basic primary health care services and referral level hospital services.
• Identify key policies that make a difference in health services quickly.

Keywords: Community-Based Health Care, Quality Improvement

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation