|Author(s):||S. Vriesendorp*1, M. Mubarak2, S. Solter2, S. Hedyatullah2|
|Affiliation(s):||1Leadership, Management and Sustainability Program, Management Sciences for Health, Cambridge, United States, 2Leadership, Management and Sustainability Program, Management Sciences for Health, Kabul, Afghanistan|
|Keywords:||Afghanistan, Provincial Public Health Offices, community health workers, leadership development|
Despite the enormous obstacles to building a health system in Afghanistan, past projects and current work demonstrate the spirit of the Afghan people to unite around the issue of access to health care. The Technical Support to the Central and Provincial Ministry of Public Health (Tech-Serve) Project, led by Management Sciences for Health (MSH), works to strengthen the leadership and management of the Ministry of Public Health (MOPH) at the central and provincial levels by making managers more aware of their role as stewards of the health system and introducing accountability for results in 13 provinces that are supported by USAID. The project works under the assumption that through strengthening leadership and management skills of the health manager within the structure of the WHO’s health systems strengthening building blocks, the MOPH will be better able to perform its primary function as stewards for better health.
Tech-Serve supports the move towards decentralization of health services management by building the capacity of Provincial Public Health Offices (PPHO) to successfully perform the core public health functions and tasks as defined by well-performing PPHOs. Decentralization of health services management is successful only when the central level trusts that the provincial level knows its responsibilities and its standards of performance and if, consequently, district and community levels are fulfilling their respective roles as implementers. The project works directly with provincial health directors and their teams to effectively articulate their health priorities to develop and implement strategies. A member of Tech-Serve project staff is embedded within each province, working closely with the Provincial Public Health Director and his/her team. Using the Leadership Development Program (LDP) approach developed by MSH with financial support from USAID/Washington, Tech-Serve has trained more than 1,800 health professionals (including senior-level MOPH and NGO managers) and scaled up the LDP to include 66 health facilities throughout the 13 focus provinces. In each of these places management and leadership has been demystified and translated into a number of behavior practices that help people produce intended results. At the community level, the project supports capacity building of Community Health Workers (CHWs). TechServe provided technical and financial assistance to the MOPH to celebrate the first National CHW Day to recognize the leadership role of CHWs in delivering health services in Afghanistan. With project funds, the MOPH produced a documentary film on the CHW’s role in the health system and their community activities.
A review of the work completed to date indicates that building provincial leadership and management capacity demonstrates improvement in health service results. With provincial public health teams more responsive to the needs of the population, a first step is taken to rebuild the trust of the population in at least some government services. Both access to healthcare in a time of conflict and the number of people accessing services, have increased. The number of health facilities where health managers are consciously and systematically leading and managing has increased from 40 in 2007 to 66 in 2008. These managers are showing improved results in vaccination coverage, access to family planning services, and in the areas of maternal and child health and combating communicable diseases. The most significant improvement in the targeted health facilities is visible in an increase of almost 70% in institutional deliveries, a 34% increase in DPT3 vaccination coverage and 28% increase in family planning consultations. Independent field observations and the national Health Management Information System data confirm the positive impact of the leadership and management strengthening interventions on the behavior and practices of health workers.