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While significant strides have been made over the last two decades in restructuring Afghanistan’s health system, with the Ministry of Public Health (MoPH) introducing two key health packages (Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS) to form the backbone of the health system, Afghanistan remains off course in meeting it’s global health targets (Sustainable Development Goals (SDGs).

The withdrawal of US and NATO forces, in August 2021 and the return of power to the Taliban resulted in the collapse of Afghanistan’s economy and the interruption of essential services including primary health care.  Consequences include a devastating impact on the quality of care and availability of services: closure of health clinics, shortage of medicine and supplies and unpaid staff. In addition, high food prices and prolonged drought have resulted in an increase in food insecurity and malnutrition and outbreaks of life-threatening diseases (polio, measles, malaria, dengue, cholera and COVID-19) continue, severely weakening an already fragile health system.

In 2013, AfD set up the Shaheed Abdul Razaq Comprehensive Health Centre (CHC) in Khawja Bughra District in the north of Kabul.  The area was characterised by poor health indicators, lacked access to a nearby health service (nearest 2 hours by foot), and was in close proximity to the main road leading north of the country, enabling access to populations outside of Kabul province as well.  CHCs are a critical element of the health architecture as they not only refer patients effectively to tertiary care (hospitals) when necessary but also reduce the load on a very strained tertiary health system by triaging less complex and critical cases.

Shaheed Abdul Razaq CHC is the first port of call for 60,000 people and is used by around 2,000 patients every month.  Currently, the CHC employs 12 staff members including female medical personnel.  It provides essential services for maternal and child health, including family planning, ante/post-natal care, nutrition screening, micronutrient supplementation, and vaccination.  The centre also provides an OPD service with an on-site laboratory, an ultrasound facility and pharmacy.  Patients are charged 50 Afghani (Afs) per service received (60 Afs for an ultrasound), family planning and vaccinations are provided free, and medicines are charged at cost.  Any income raised is used to support the running costs of the centre; currently, 99% of the running costs are recovered.   AfD’s CHC-paid services are approximately 10-20% of the cost of for-profit private clinics charges.  It is noteworthy that since the Taliban regime and consequent withdrawal of international funding, AfD has for the most part been able to maintain its services, unlike many public health facilities.

During the first half of 2022 (Jan-Jun.) our OPD service treated nearly 7,500 patients (>75% female),  women received sexual and reproductive health care, 1533 children were screened for malnutrition, just over 12,000 vaccines were administered, and 3,027 laboratory tests were carried out.  In addition, AADA (Agency for Assistance and Development of Afghanistan) started providing treatment on-site for children with severe acute malnutrition (SAM).  AfD also conducted a comprehensive assessment of the Shaheed Abdul Razaq CHC to identify what works and what doesn’t and to provide useful data to inform future decision-making.