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ACKNOWLEDGEMENTS

Direct costs of these missions were paid by the World Health Organization,

This project developed, implemented and supported by The Coordination of Medical Committees,was the result of the cooperation of CMC members: Medecins sans Frontieres (B/H), SwedishCommittee for Afghanistan, Norwegian Afghanistan Committee, Management Sciences for Health,Mercy Corps International, Medical Training for Afghans, International Medical Corps, and theGerman Afghanistan Foundation.

Special acknowledgement is also due to the staff of CMC: Jeff Paulsen, Director, Shirley Eaton,Assaduallah, Ahmad Wali, and Sayed Mahood Fazel who assisted in the monitoring preparationand the development and editing of this final report. In addition, Mella Alto Leiter, SwedishCommittee for Afghanistan for her active participation in the overall project.

CONTENTS

IntroductionPage 1

Report on NorthPage 12

- Province of BAGHLANPage' 13

- Province of SAMANGANPr4ge 21

-- Province of BALKHPage 24

Report on Center missionPage 30

- Province of BAMYANPage 31

- Province of URUZGANPage 33

- Province of GHORPage 43

Report on South missionPage 49

- Province of ZABULFaEr2. 50

- Province of QANDAHARPage 52

- Province of HELMANDPg;' 60

Questionnaire on the attitude of HWsconcerning the training of women Pe 67Tables of results

- Province of BAGHLANPage 69

- Provinces of SAMAÑGAN and BALKH Page 75

- Province of BAMYANPage 60

- Provinces of URUZGAN and GHOR Page 86

- Provinces of ZABUL and QANDAHAR Page 91

- Province of HELMANDPage 98

Price of some medicines in the surveyed shops Page 102

WHO CMC Health Workers Skills Check List

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INTRODUCTION TO THE REPORT-ONCMC MOi3ITORING AND EVALUATIOiI MISSION

MAY to NOVEMBER, 1021

1. OBJECTIVES.

Evaluate the possibilities of establishing fieldmonitoring techniques of Health Workers (HWs) byteams of Afghan monitors.

1.1.1. Train 6 Afghan Physicians as monitors.

1.2. Evaluation of HWs in the Health facilities insideAfghanistan.

1.3. Monitor other facilities, without evaluating the HWs.

1.4. Visit Medicine stores anad collect informationconcerning: - availability of medicines.

- price.- qualification of private HWs.

1.5. Collect information about the HWs attitudes towardsthe training and the work of women in MCH and healtheducation.

2. DESCRIPTION OF ACTIVITIES.

2.1. Preparation May - June 1991.

2.1.1. Recruitment nf "Medical Monitors ".

Six Afghan doctors were selected by written exam andinterview. Selection criteria were:

* Medical knowledge.Clinical Skills.

* Knowledge of English.* Work experience in rural areas in Afghanistan

and in particular experience of supervision ofclinics and training of health workers in thefield.

2.1.2. Training of Monitors.

- Training sessions were conducted by the MonitoringCoordinator and the CMC Director.

- People involved in the training of HWs alsoparticipated in the training of the monitors.

- Training lasted 3 weeks (May 13 -30). Thefollowing topics were covered.Organisations involved in health management inAfghanistan, UN Agencies (WHO, UNICEF), NGOs,ACBAR.The different systems of data collection onhealth facilities in Afghanistan (ACBAR and WHODatabases).

* Health priorities in Afghanistan.* What a Health worker is. With the participation

of MSH; the monitor spent 2 days at the MSHtraining centre.Correct use of different monitoring andevaluation forms. 2 days were spent on practicalmonitoring exercises at MTA and IMC whereHWs are trained.

2.1.3. Recruitment of "Non- Technical Monitors"

6 Afghans were recruited to act as guides for themonitors in the field and to carry out the non-technical surveys.

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2.1.4. Preparation of Evaluation and Monito-rin0 Forms.

- For each health facility visited one copy of theWHO Health facility questionnaire form was to becompleted; non -technical monitors completed onlypages 1 and 2 and the last 2 pages of thequestionnaire .

- The WHO -CMC Health Worker Skills Check List was a10 page form prepared for the evaluation of eachhealth worker. It had to be completed in 3 to 6days by awarding a score between 0 and 2 for eachskill (300 listed) observed while the healthworker was at work. 80 skills were considered aspriority skills and the monitors had to awardmarks for these by interviewing the HWs if it wasnot possible to mark them through observation.

- Other forms prepared:* "Consultation Checklist" which served as an aid

for the monitors helping them to evaluate thefollowing activities: examination of thepatients, diagnosis and treatment of thediseases.

* "Pharmacy Report Form" giving location, list andprices of medicines.

* "Private HWs Report Form" giving name, training,location and list of the medicines used.

2.2. Implementation of "Pilot Missions ".

- 3 teams were formed, each composed of 2 doctors and 2non -technical monitor /guides.

- The "Pilot Missions" lasted 2 weeks each team workingin a border province: PAKTIA, PAKTIKA, KUNAR.

- In each province, 3 sites were chosen for evaluation.The task was to complete evaluation of HWs in 2 ofthese clinics.

- 14 sites of medical facilities datadase were visited:4 in KUNAR6 in PAKTIA4 in PAKTIKA

7 HWs were evaluated.4 private pharmacies and 6 "Pri-. ate Doctors" werevisited.

,{c Some clinics targeted proved not to exist or wereclosed at the time of the visit; m an y of theHealth workers were absent

. In the case of PAKTIKAthe clinics targeted were all closed or proved not to

The1 he mon itors therefore conducted anevaluation of the Hers in a fourth clinic.

2.3. Monitoring July - September 1991.

- The objective was to evaluate HWs in 24 clinics:8 in Central Afghanistan (BAMYAN, GHOR, URUZGAN)8 in South Afghanistan (QANDAHAR, HELMAND, ZABUL)8 in Northern afghanistan (BALKH, BAGHLAN, AANGAN)

- 16 Facilities were selected from the WHO Database ineach region.

- In 3 Months, the monitoring teams visited 73 HealthFacilities and located and identified 164 HWs; in 42Health Facilities an evaluation work was carried out,and 98 HWs were evaluated.

H.F.Visit

H.F.Eval.

WHs HWseval.

PrivateHWs

NORTH

SAMANGAN 5 2 5 3 5

BALKH 5 4 16 13 15

BAGHLAN 15 8 32 21 11

SOUTH

ZABUL 2 0 0 0 0

QANDAHAR 18 9 45 17 3

HELMAND 7 5 22 13 6

CENTRE

BANYAN 12 8 27 18 11

GHOR 4 2 6 3 11

URUZGAN 5 5 11 10 6

TOTAL 73 43 164 98 68

- 47 HWs answered to the questionnaire on their attitudetowards the training and the work of the women in MCHand health education.

- 68 Private health providers have been visited 66 ofwhom were selling medicines.

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r- 2.4. Preparation of Report October -November 1991.

The teams came back to Peshawar at the end ofSeptember and preparation of their reports started inOctober.

Each team wrote a narrative report concerning theiractivities including:* Initial objectives.

Chronological list of facilities visited.* Brief assessment about the facilities.

Information concerning "private practitioners ".* Photographs.-k Comments on the information gathered.

- Summary tables were prepared for each provincethe information gathered for each clinic.

showing

- Summary tables were prepared listing the condensedscores for the HWs skills.

3. PRELIMINARY INDICATION BASED ON THE MONITORS' REPORTS.

3.1. Health Facilities.

19 of 73 Health Facilities visited were not registeredin the WHO database. In two cases there was no clinicexisting in the area indicated in the WHO database.This could be because they had been re- locatedelsewhere.

3.2. Health Workers.

Out of 164 identified Health Workers 35 were notregistered in the WHO database. Nearly half of the HWsregistered in the WHO database were not present duringthe monitors visits. In general there is a lot ofconfusion in the field; some HWs have changed HealthFacilities but a certain number of other Hws havedisappeared completely.

3.3. Health Worker Skills

It has been difficult to draw relevant conclusionsconcerning the skills of the 9$ Health Workers. In thesummary tables we have condensed the results bycalculating for each HW evaluated an average score from0 to 10 based on the all the skills under each chapterheading in the skills check list. Some chapters havebeen merged together and only the most important skillsunder the chapter headings are shown.We have obtained a summary of -3 pages which can be usedto answer some questions concerning the activities ofthe HWs evaluated.In some cases it have been impossible for the monitorsto attribute a score.

Curative activities: in most of the facilities thereis at least one HW capable of correctly diagnosing andtreating the essential pathologies. Tthere is,however a tendency to prescribe too much medication,eg. vitamins, analgesics, or antibiotics in the caseof diahorrea when it is not neccessary.

- Clinical examination: a great weakness amongst the HWsseems to be lack of clinical examination of thepatient. It is true, however, that most of the timethey are faced with a rush of patients.

Nursing. Procedures: there seems to be seriousnegligence by the HWs regarding cleanliness andsterilisation. The instruments and materials used fordressings and wound care are very seldom sterilisedalthough in practically all of the clinicssterilisation materials or Formaline tablets areavailable.

- Community Health: are the HWs playing an active roleto give "Health Information "? Except in a few rarecases, no!Although they know very well what should be taught tothe local population and they have a goodunderstanding of how the enviroment can causediseases, the HWs are not capable of identifying thebest way to communicate health messages acrosstraditional barriers. In the best cases informationis spread in the waitng room. Educational material isused to decorate the room or as tablecloths. It istrue that in Afghanistan health education is not aneasy subject and that in general the local authoritiesand the communities are not very motivated. In thesame way that the HWs make little effort to influencethe local community, NGOs make little effort toinspire the HWs.

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- Data Collection: most of the Health Facilities have a"green book ". This is often completed in anundisciplined manner at the end of the day or the endof the week, if not before returning to Peshawar orQuetta. The principal source of information whenmaking late entries into the "green book" is the HWsmemory!

- Condition of the Health Facilities: half of the healthfacilities evaluated were dirty; one in four weredisgusting. Often a Health Facility can be found in avillage thanks to the mount of empty packets, useddressings and old syringes thrown in front of thedoor.

3 4. Attitude of HWs Concerning the Training and Work ofWomen in MCH and Health Education.

- 85% of HWs think that women would be more accepted thanthemselves to meet the health care needs of the womenand children.

- 96% of the HWs declare that they will accept the helpof a woman for health education and gynecological care.But only 15% of them would train a woman to giveGYN /OBS care and 28% to teach nutrition. 55% wouldprefer a mobile team to come and train the women.However 54% will not allow their wives to work and 46%do not think their wives of capable of learning MCHskills; 51% of HWs wives are illiterate.

- It is interesting to note that 87% of the HWs thinkthat they already meet the healthcare needs of thewomen and children. This is bizarre because especiallyin the south of Afghanistan women are often not allowedto enter the clinic.

3.5. Private HWs

- Their qu lifications: of 68 private HWs 49 had nomedical qualifications and the others consisted of: 1

was a BHW; 11 were MHWs; 3 were FAs; 3 were nurses; andi pharmacist.

- Available medicines: it is relatively easy to procureantibiotics and analgesics. One particular medicinestore had very little variety of medicines despite alarge choice of tonics, vitamins and syrups. Manyampoules and vials are available generally. Oftendangerous drugs like anti -TB, anti -hypertension oranti- epileptic medicines are for sale. (One privateHW, a mullah, thought that the INH medicine that he wasselling was for treatment of coughs!)

Art iiy .Lt ie s_ to make business. Most private : -IW's

declared that they only sold ímedicin=s to patient= withprescriptions from a official H',J, but numerous factsprove the contrary. After a simple interrogation, theysell to the "patients" a large variety of medicines,vlrio'_._ syrups, lit am ins and -moo ..._1 =d -tonics-. n __.:the medicines sold are destined for a member of thefamily of the "patient" Some of them give injectionsafter having washed a much-used disposable syringe withhot water.

- FenFcr.;icIc:; : some of these private HWs are formercollaborators of NCOs who find working in the privatesector assures them of a supply of drugs which pleasethe public better and provide them with higher incomes.

4. DIFFICULTIES.

4.1. Travel Constraints. Travel between clinics is expensive,it is therefore preferable to select closely groupedtargets.

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2. Tran ,Lnc rt. tirçt_leÌT!

. Due to the shortage of transport andfluctuating prices - between 10,000 and 30,000 Af 's fora day ride in a truck or a pick -up. In only 4 cases didthe local authorities give us free assistance inreaching the next target.Therefore we often selected and visited facilities closetogether.

4.2. Political and milit..i.ry situation. Despite politicaltensions in the area it was always possible to move fromone zone to another. In only one case we had to cutshort a visit because fighting was due to start in thearea. In some other cases the visit of a facility couldnot be carried out because of temporary securitydifficulties. In Samanagan the team was captured for 3hours by pro -government militia and released becausethey worked in a programme funded by WHO.

4.3. General_ security_ We did not have a car which onoccasion made travel difficult. However, this proved tobe a positive factor where security was concerned, weavoided the potential danger of hijacking.It is advisable to move around in Afghanistan asmodestly as possible; to avoid having too much baggage,and to avoid showing to many gadgets such as video`;,cassette players or money. A simple camera issufficient for a monitoring travel.

5. RECOMMENDATIONS FOR FUTURE MONITORING.

5.1. The technical monitoring should be continued.

- 6 Afghan doctors are trained as monitors and caricollect information and make reports.

- The existence of an independent monitoring will pushthe NGOs working in health to update their files andforward information concerning the location of theirhealth facilities and their staff more regularly toWHO database.

- Technical monitoring is the only method of knowing inwhat conditions the HWs really work.

5.2. Technical Monitoring can be Improved.

- In using a more simple skill check list;

- In recruiting more qualified personnel for the non-technical survey who will be capable of collectingmore detailed information in the health facilitiessurveyed.

5.3. The Technical Monitoring can Prove Effective.

- If monitoring missions are made next year it should bepossible to visit twice as many facilities andevaluate twice as many HWs because the monitoringcould be started very early in the year and last for 6months.

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Summary table ofScores of 98 HWs

Score< 3

Score3 -7

Score> 7

Activity inHealth promotion

92 5 1

Technique ofExamination

16 27 51

FacilityCleanliness

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29 29 39

Record of data 35 10 43

Measles 12 39 47

Impetigo 8 31 59

Conjunctivitis 12 24 62

Tonsilitis 8 37 53

Otitis 14 40 44

Bronchoitis 8 41 49

Diarrhea 8 37 53

Malaria 8 19 71

BHW in Khoja. Molk, a tidy clinic in the bazaarNo place to examine the patients

Foster are used for decorative purpose onlyBetween the HW and the community there is just

Another tablet in the Wall

Summary table of ((Score!Scores of 98 H'Ws < 3

Score3 -7

Score> 7


92 5 1


16 27 51

FacilityCleanliness

29 29 39


Measles 12 39 47

Impetigo 8 31 59


Tonsilitis 8 37 531

Otitis 14 40 44

Bronchoitis 8 41 49

Diarrhea 8 37 53

Malaria 8 19 71

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Best scorein ` 3 clinics

Score< 3

Score3 -7

Score7


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2 1


3 10 29

FacilityCleanliness

i 11 13 19


Measles 1 15 27

Impetro 2 9 32


Tonsilitis 2 10 31

Otitis 5 11 27

Bronchoitis 1 15 27

Diarrea 2 14 27

Malaria 3 7 33

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North Mission(13 Thly - 15 October, 1991)

Provinces of: SAMANGANBALKHBAGHALAN

Monitoring team: Dr MOHAMAD NADERDr ZUHURULLAMr SAFEL MALLUK

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BAGH LAN PROVINCEI. OBJECTIVES

1. Nahreen Health FacilityWHO Facility No: 21Supported by: IMCDist rict:

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Staff listed: 4 NILs

4 Vacci nat obi

*1 X-ray Technician* 1 Lab Technician

Qala-i-Qazi Health Facility. WHO Facility No: 1038

Supported by: I MC

District: Baghlan JackedStall listed: * 2 MLs

* 1 Lab Technician

3. Bagh-i-Zerat Health FacilityWHO Facility No: 1266Supported by: SCADistrict: Baghlan SanteeStaff listed * 4MLs

4. Shaliabudin Health FacilityWHO Facility No: 1151Supported by: MSHDistrict : Pul-i- KlininryStaff listed: * 3 MLs

ALTERNATIVES5. Flo]. Health Facility

'WHO Facility No:1151Supported: MSHDistrict: NahreenStaff listed MD

* 2 BHWs

6. Barka Health FacilityWHO Facility No: 1711Supported by: MSHDistrict: NahreenStaff listed: '4' 2 MLs

7. Dahana Ghory Health FacilityV11-10 Facility No: 1971

Supported by: MSHDistrict: Pul-i- K hum ry

Staff listed: * 1 MD

3 MLs

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II. REPORT OF TJ-iE, TRIP

The team left Peshawar on July 13, 1991, and arrived in Chitral that eventing. We hadplanned on leaving on July 14 but our trip was delayed due to heavy fighting in Zebak andIshkashim. We departed on July 23 and arrived at the Flol Health Facility in Baghlan Province.

i,ust 1.

A. The team reached Flot Health Facility (Objective Nó: 5) on August 1, 1991. Thefacility had been relocated to Borka Sub -District Center. Only one HW was on duty. We left onAugust 3, 1991.

B . The team reached Borka Health Facility (Objective No: 6) August 3, 1991. Only aguard was present . The clinic was closed because one ML was ill and the others were gone. Weleft the next day.

C. The team reached Nahreen Health Facility (Objective No: 1) August 4, 1991 in theevening. Five staff members were present. We worked there for five days and left on August 9,1991.

D. The team reached Buz Dara Health Facility on August 9, 1991 and worked for threedays, departing August 12. Due to security in the area it was impossible to go Andarah HealthFacility tObjective No:8).

E . Since Shiekh Jalal Health Facility was on the way to our next objective and we hadthe time we did an evaluation there from August 13 to 15. We departed for our next objectiveAugust 16.

F . The team reached Imam Qutaiba Health Facility (Objective No: 2) in Qala -i -Qazivillage in Baghlan Jacleed on August 16. Two NILs were present. We departed on August 20.

G. The team reached Khalazai Health Facility on August 20, 1991. Although it wasnot an objective, but was on our way to the next facility we decided to do an evaluation of thisfacility. One physician and two MLs were on duty. We worked for four days and left August 24,1991.

H . The team reached Baghi- Zerrat Health Facility, Baghlan Sanaty, August 24. FourNILs were present. We worked four days and departed August 27.

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We ''parted for Shahabudclin'Health (Objective No: 4) on August 27. Due tosecurity we travelled at night on the Kabul Puuli Khum ry Highway. We reached our objective latethat night. The local conunaiider told us the clinic was closed because there was no staff. eve

rested that night and on August 28 we started toward Saillangan Province. We travelled tlx.: KabulHairatan Highway. Enroute we stopped at the Gawbargan Health Facility in Pull Khunlry Districtand evalLuied the facility. One ML and 2 were On duty }, wordad for i,: i.

departing September 4, 1991.

J. We visited Dahani Ghory Health Facility (Objective No: 7), Changaghli village,September 3. Only the physician was present, the other staff was in Peshawar for re-supplying.We left September 4.

III. PRESENTATION OF RESULTS.

A. FLOL HEALTH FACILITY.

1 . General appreciation of the. clinic.:4: One out of three BHWs were on duty. The physician was working in

another facility (Nahrin Health Facility.).

The facility is made of mud and consists of one room with no latrine.`` Well water is used.

Evaluation of the staff.

:" Diagnosis and treatment: The BHW medical skills were extremely poor. Hewas unable to examine patients properly, and he had no idea how to treatthe problems. Even something as simple as diarrhea.

;1. Clinic management: Extremely poor. The physician was gone and hadturned the management of the clinic over to the BHW.

"' Nursing procedures: No aseptic techniques were being used and the BHWdid not understand the techniques.

' Health promotion: None

Non -technical monitoring.Drug Stores: We evaluated three.

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t3 . NAHREEN HEALTH F ACILI i Y.

1 . General appreciation of the clinic.:r: All staff was present.

The C''iiillc is 3t11cie of znuJ and Le.in:eI >t consisting of six rooms. an Cif.

OPD. laboratcr.'. x -ray drug store and a staff room with a latrine. -Fais istemporary site, a new buildiil'_ is i_eing constructed.

": The clinic had one generator (,Kw) and a broken x-ray unit.Stream water is used for everything.

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Evaluation of the staff.Diagnosis and treatment: The medical knowledge of the staff seemed good.Their diagnosis and treatment was prof :erly° clone.

Clinic management: A physician was designated to be the manager,however, he was gone and the malaria technician was attempting themanagement. His relationship with the staff was poor, registration ofpatients was not being done.Aseptic procedures were being used. Autoclaving was being done.However, disposal of waste products was extremely poor, it was beingdeposited outside in the open.Health promotion: None.

3. Laboratory.:4: Ten to fifteen specimens per day were being satisfactory done. We brought

slides for the lab coordination in Peshawar to check.

4. Non- technical monitoring.

:4: Drug Stores: Four drug stores were evaluated they were well stocked.

C . B UZ VARA HEALTH FACILITY.

1 . General appreciation of the clinic.:4: One HW listed in the WHO database was present, other listed HWs were

absent. However, two unlisted HWs were there.z The clinic was made of mud and consisted of one room with no latrine.4: Stream water was being used.

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Evaluation of the staff.::: Diagnosis and treatment: The NIL medical knowledge was poor, the two

BHWs were much better.Clinic management: The ML manager needs a lot of management training.Nursing procedures: No aseptic methods were being used.

3. 'Non -technical monitoring..'- Facilities: One health post supported by MSH with one BHW located in

Bag le Mazar village.

D. SHIEKH JALAL HEALTH FACILITY.

1. General appreciation of the clinic.

.,: Two MLs were on duty. These MLs, Mahmood WHO I.D. No. 1265 wassuppose to be in Kuhna Qala Health Facility and the other WHO I.U. No.1664 was supposed to be at Khala Zai Health facility.

:4: The clinic is made of mud, has four rooms and a latrine.+- Spring water is used.

Evaluation of the staff.Diagnosis and treatment: Medical knowledge seemed good. The staff wasunhappy because they claimed they had not been supplied by SCA for sixmonths.

:': Clinic management: The ML is the manager and seems to being doing anadequate job.Nursing procedures: A pressure cooker was being used to sterilize. Aseptic

techniques seemed good.:'= Health promotion: None.

Non -technical monitoring.We were unable to find any drug stores, private health providers or privatehealth facilities.

E. alAM QUTAIBA HEALTH FACILIIY.

1 . General appreciation of the clinic.:: Two Mls were listed in the WHO database and were on duty. The lab

technician was away buying instruments for the lab.

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The building, is made of mud and consists of four rooms with a latrine.Stream and well water is used.

We considered this a model clinic and the best of all we monitored.Evaluation of the staff.Diamnosis and treatment: The NiLs ir_edical l:uowl cL:e extremely_c cci.

They could diagnosis and treat prop rly. They eyein dice extraction of teeth.

There were no drugs, tl' y were waiting, to be re-supplied. The clinic wasvery busy tecause the patients liked and believed in the vILs.Clinic management:: Both NiLs were managing the clinic and doing an

excellent job. Their registration system was very good, war injuries, OPDdentistry and chronic disease were all listed separately. The disposalsystem of waste was excellent.Nursing procedures: Sterilization and all aseptic techniques were beingclone properly.Health promotion:The NILs had assigned a person to teach patients by using

charts. They were in hopes LVIC would supply them a flip chart.

3 . Non-technical monitoring.Health facility: One health facility supported by SCA was monitored.There were two NILs on duty. This facility is located in Kuihna Qala.

F . KAHALA ZAI HEALTH FACILITY.

1 . General appreciation of the clinic.Out of a staff of seven, one physician and one ML was present.

": The facility is made of mud with four rooms and no latrine. 25% of thestructure was damaged during the var.The clinic had one generator (5Hp /2000 RPM). They do have a power line

from Puli Khunnry.One Russian portable x -ray unit was there but not in use.

: Well water was used.

:4:

Evaluation of the staff.One of the NILs, a graduate from Kabul Sciences Faculty did accuratediagnosis and treatment. The other NILs skills were poor.Clinic managenhent: A physician is the manager and seems to be doing agood job.Aseptic techniques were good but sterilization needed improvement.

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Health promotion: None.

3 . Non -technical monitoring.:F: Health facilities:

One facility located in Baba Zangi village, supported by DISH had twoBHWs working there.An additional facility located at Saraki S. supported by ;DISH had two

BHWs working there.

G. BAGHI ZERAAT HEALTH FACILITY.

1 . General appreciation of the clinic.

Two HWs listed in the WHO database was on duty. In addition, twounlisted staff members were present. One of these was a mid -wife.The facility is made of cement and stone, consists of five rooms, with nolatrine or lab. and is in need of repair.

:" Stream and well water is used.

:«:

:F.

Evaluation of the staff.Diagnosis and treatment:Only one HW was knowledgeable. The otherswere extremely poor at diagnosis. They were unable to differentiatebetween the four kinds of diarrhea, nor could they calculate a correct dosagefor treatment. Due to religious beliefs we were unable to evaluate the mid-wife.Clinic management: The clinic management seems to be acceptable.Nursing procedures: Aseptic techniques were being used and a pressurecooker was being used for a sterilizer.Health promotion: The mid -wife was working with the women.

3. Non -technical monitoring.

No drug stores, private health facilities or private health providers were inthe area to be monitored.

H . GAWHARGAN HEALTH FACILITY.

1 . General appreciation of the clinic.: «: The entire staff, one ML, one BHW, one first aider were on duty. The first

aider was listed as working at. Shahabuddin Health facility (Objective No:4).

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The clinic consisted of four rooms, a dressillP, roonl. staff room. Ciïa.-', store

and a depot. The O 7 t'1 > ::5 in a tent.

Well water is being used.

,riïi.:a o>,I o:t` the staff. -,- 1

Diagnosis and treatlIleilt: The ML health i7lotvtt:í:ioé. seemed ,00Q, the

others very poor. Because ti:'.; ML was so rushed by clients his

examinations were poorly done.Clinic management: The ML 11i:nla2,ers work seems satisfactory.r ` `

": Nursing procedures: Due to patient load and being, hurried, procedures

were not accurate.Health promotion: None.

. Non -technical monitoring.There were no drug stores, private health facilities or private healthproviders to be -.:valuated.

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SAMANGAN PROVINCE

I. OBJECTIVES

PRIOR HEALTH FACILITIES

1. Sarbagh Health Facility

WHO Facility No: 1892Supported by: IMCDistrict: AibakStaff listed: * 3 MLs

* 3 Vaccinators

2. Khwaja Sanboor Health FacilityWHO Facility No: 1671Supported by: MSHDistrict: AibakStaff listed: * 3 MLs

* 1 Medical student* 2 Nurses* 1 First Aider

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HISTORY OF THE TRIP

A. the team left Changaglilie Health Facility of Baghlan Province August 4. reachedAaq Chashmna of Sainai gan Province that evening. The next day in Darai Gunjeshkak we werecaptured by Saeedi Kayhan troops supported by the Kabul govern ent. \Vbev they were sure thatwe were working, for WHO they released us. ''Are went to Sa:rawiai1 and spelt 1Le Ill; !t. ieVe

reached Sarbagh Health Facility (Objective i o:1) on August 6, 1991. We worked for four days

and left on August 11, 1991.

B . Due to security in the area we were unable to evaluate Khwaja Sanboor HealthFacility (Objective No:1). Sind (Objective No: 3 -) was closed and the Roye Doab Health Facilitywas on our way to Balkh Province we decided to evaluate it. We reached this facility August 12.This clinic was supported by SCA. WHO database No: 1766. One out of three HWs werepresent. We worked there for three days and left on August for Balkh Province.

III. PRESENTATION OF RESULT

A. S ARB AGH HEALTH FACILITY.

WHO had listed six staff members, four out of the six were there, 1 HW. 3vaccinators. In addition there was one unlisted HW.

1 . General appreciation of the clinic

:+ Two HWs, one listed, the other not listed, out of six were present.-1_ The building is made of stone and mud and is in fair condition. It consists

of five rooms. A new building is under construction and is 80% complete.

.+- Spring water is used.

Evaluation of the staff.* Diagnosis and treatment: Both HWs medical knowledge was good. They

were extremely busy and missed some pathognomonic points.Clinic management: Both HWs managed the clinic. Their work was

satisfactory.:: Nursing procedures: Sterilization was done by autoclaving. Aseptic

techniques were very good."'Health promotion: None. However, they hoped to get flip charts

other materials and health information from MCH.

22


* Drug Stores: One was checked. Prices are in the annex.Facilities: One facility listed in Deh Kalam village supported by SCA, wasmonitored.

B. ROYE DOAB HEALTH FACILI"I'Y.

Since GAC had stopped its activities in Roye Doab District the clinic locatedatQashaga village had been moved to this district.

1. General appreciation of the clinic.* One out of three MLs was on duty.

* The clinic is located in the ex- district hospital. The building is made of

stone and cement. It consists of seven rooms with a latrine. However, theclinic is limited to one room.

* Stream water is used.

2. Evaluation of the staff.

* Diagnosis and treatment: The MLs medical knowledge was very good. Hispatient examinations and diagnosis were accurate. He was able to performminor surgery such as amputations.

* Clinic management: The manager was the ML. He has had somemanagement training, but needs more.

* Nursing procedures: A pressure cooker was used for sterilization. Aseptictechniques were good.

* Health promotion: None.


* Facilities: One health facility located in Khuram village, supported by SCA,with one HW was evaluated.

23

BALKH PFBVI_?CE

I. OBJECTIVES.

PRIOR HEALTH FACILITIES.

1. Woloswali Sokhta (Baba Ewan) Health Facility.WHO Facility No: 1877 +

Supported by: 1MC.District: SholgaraStaff listed: * 3 MLs.

* 1 Dentist.* 3 Vaccinators.

2. Ibni Sina (n.adeem) Health Facility.WHO Facility No: 1935Supported by: MSH.District: Sholgara.Staff listed: * 3 MD.

* 1 ML.* 3 Nurse.-k 1 Dental -technician.

2 Lab- technician.* 1 X-ray technician.

3. Keshendeh Health FacilityWHO Facility No: 1959Supported by: MSH.District: Keshendeh.Staff listed: * 2 MLs.

1 Dent- technician.* i B H W .

1 First aider.

24

_ Tl . HISTORY nF THE TRIP.

Iwo

A. Objective No. 1 Bab:y. Ewa. Health F,a.ui li ty was reachedon jeptr_mbi-. 20, 1091. It was or'='n. = stayed for fourday and departed September 24.

B. Objective No: 2 Ibni Sina Health Facility was reachedon September 25. The clinic was busy with patients. Weworked for four days and departed September 28.C. The team reached Zabehulla Shaheed Health Facility onSeptember 29. This facility was not in our objectiveshowever we decided to evaluate it since it was on ourway. The team stayed for five days and departed onOctober 2,

D. Al Burt Health Facility nonlisted in objectives wasreached on October 3. The clinic was open. We stayedone day and departed October 5.

III. PRESENTATION OF RESULT.

A. BABA EWAZ HEALTH FACILITY.

1.,K

2.

General appreciation of the clinic.The WHO database

listed seven HWs. Two listed and twounlisted were present.The building was made of mud and consisted of one roomdivided to two parts. There was no latrine.Well water is used.

Evaluation of the staff.Diagnosis and treatment: The medical knowledge of theHWs was very good. One HW was able to perform somesurgeries.Clinic managment: The ML, Abdul Majeed is the clinicmanager. His work is well organized.Nursing procedures: Aseptic technques were perfect.Isolation and disposal of waste products wassatisfactory.Health promotion: None.

0. Non- technical monitoring.Drug Stores: Six drug stores were monitord.

B. TDNI SINA HEALTH FACTLT

1. General appreciation of the clinic..< Four out of eleven HWs were present.'f The building was made of mud and consisted of fifteen

rooms including OT, OPD, (.11:c:1 :motor' staff o _ .. twolatrines and one laboratory.Water is supplied to the clinic from a well.L- >a.luat ion of the staff . -

Diagnosis and treatment: The medical knowledg- of theHWs was not satisfactory, the physicians would notallow them to work in OPD with them.Clinic management: The physician manager was absentand the ML was incharge. The clinic was well managed.

k Nursing procedures: All the nursing procedures weredone perfectly. Hand washing was observed.


. ZABEHULLAH SHAHEED HEALTH FACILITY.

1. General appreciation of the clinic.:f Four out of fifteen HWs were present.* The temporary building is made of mud. A new building

is under construction which will have twelwe rooms..< Water is supplied from a stream.

2. Evaluation of the staff.* Diagnosis and treatment: The medical knowledge of one

HW was good, the others was fair. They did not payattention to history taking and physical examinations.

* Clinic management: The ML, Noor Mohammad was incharge. His management was not satisfactory.Nursing procedures: Sterile techniques were not usedbut clean was observed.Health promotion: None.

3. Non -technical monitoring.* Facilities: One SCA Clinic Khair Abad village was

checked. There was one unlisted physician working.

D. AL BUR?, HEALTH FACILITY.

1. General appreciation of the clinic.* Two HWs were present. The WHO database listed three

HWs. The third one was working in the Ibne SinaHealth Facility by commander request in Qadeemvillage.

* The temporary building was made of mud and consistedof two rooms.

* Water is supplied from a pond.

26

2. Evaluation of the medical staff.Dia.`;nosis and treatment: H'Ts at Al Bur: HealthFacility were fair. ML, M. Yusuf was working at IbneSina. Health Facility. His knowledge was excellent. Heperformed very difficult surgeries suocessful>>

.

Clinic management: Clinic ...an:aen.because the ML in charge was working at Ibne SinaHealth Facility, and had no time to ma.na._;e thisclinic. Nursing procedures: Is non existent. Handwashing was not observed. The clinic was a model offilth.Health promotion: None.

3. Non- technical monitoring.k Drug' Stores: Nine drug stores were monitored in thearea. See the annex.

27

CONCLUSIONS O F THE NORTH :41 S û T Q i'1

Our team visited twenty three health facilities in NorthernAfghanistan. Evaluation was done in fourteen healthfacilities for thirty se-Ten HWs.

* S health facilities in Baghlan Province.-'F 2 Health facilities in Sa.mangan Province.* 4 Health facilities in Balkh Ptovince.

G-oI or. l Con,sidcration on. The Clinic.- Most of the clinics were clean and neat, four clinics werenot clean. The majority of clinics had green booksfor registration, and half of the clinics registration hadincorrect descriptions of cases and treatment. Only inQala Qazi clinic the activity of the OPD, dental cases andwar injuries were registered.- Most of the HWs used clean methods, sterile methods werenot good , except for three clinics.- Many clinics did not have good equipment. Stethescope, BPcuff and thermometers were always present.Khala Zai clinic had a portable x -ray machine but they werenot able to use it. Also one x-ray machne was in Nahreenbut it was broken.

- Staff organization was not good in most clinics. Forexample out of fifteen HWs only five were present in BalkhProvince. In many cases there was no accurate jobdescription for staff members. Qala Qazi clinic was a goodexample of a well organized clinic.

Medical Aetivities:

Thirty seven HWS had satisfactory techniques for patientexamination. Fifteen of them had the ability to make a gooddiagnosis from the signs they found from the patientexamination. In one clinic there was no one who could doa correct diagnosis. Some time when the HWs realized that wewere evaluating them, they became stressed and missedpathognomonic points.

- Most HWs had the knowledge to promote health education andknew of the community needs, but none planned on doing itIn only one case the staff was teachnig prevention ofdiarrhea and use of ORS in the waiting room. It was beingdemonstrated and explained. We feel that the non activityof the HWs regarding health information is mainly due to:h, lack of motivation of the HWs.HWs do not know what strategy to use to motivate thecommunity. They consider the clinic a center for thedistribution of medicine.Because of the lack of cooperation by localauthorities due to war conditions and the largenumber of injured patients, the HWs think that healthpromotion is not important.

28

:;..'ia1. ssr2[,1,r 1iof a (-)t ìryar'r. F";Vc;tFa

We can say that the present health care system is notefficient in both quantative and qualitative. For examplethen_ -gee two health faoilities in Borka wt:i Di, :s.r1__ inBa h1 .ì: P:-y _nce. The first was nactiv_-' and the other wasclosed, even .though the people of the area were poor andneedy. This problem was the some for Al Buy': Health Facilityin Balkh Province. There was a village in SSaiiiangan provincewhose population was approximately 16,000 and there was nohealth facility. The private health care systen is notsatisfactory beacuse of lack of knowledge by providers andhigh prices of drugs.

Cs enAr:{l F`ror1Ì p.m s ;

It is difficult to go to Northern Afghanistan because youhave to walk long distances or ride a donkey or horse.

The prevalance of TB is wide spread and there is no programmeto control or take preventive measures.

Malaria is common and because of inappropriate use ofchloroquine it is becoming resistant to treatment.

All parties and groups including the government Malitia arebeginning to respect the WHO programmes in this area.

Security Problems.

We were unable to evaluate two clinics, due to security.

However, this is not a permanent problem.

Eolitica.l 5t.attls .

In most cases the local authorities help the HWs but sometimethey interact in the clinic affairs, for example at NahreenHealth Facility in Baghlan Province the HWs were ordered bythe commander to carry the generator and the x -ray machine tohis home and take a radigraphy. Because of this the radiationtube was broken.

29

F'y r y'1rSI hr

,13.4

I±'

7 1 i ly'1

-.,. ::.:. ,-;}

:.. ' ' s _ t _*-,;,.4, ii

et+- .;` . r':.v, ':++i...

s1ti.i I' _

ti`+l tivcï.y.# -

FlolMSH ClinicA one room clinic used for apharmacy (three days a week).

Activity is limited due tolimited supplies.

Nahreen

Danger to the environment.Contaminated items on theground.

Nahreen

MLHW - Lab Technicianworking in the lab. Duringour trip we saw three labsbut only one Lab Technicianwas present.

r

Buzdara

MSH ClinicNahreen

One unclean room, poorlyarranged.

Shikh -Jalal

SCA Clinic

Dressing a patients wounds.

Qala -Qazi

IMC Clinic

Most of the dental work isextraction of teeth becausethe clinic does not have afully equipped operatory.

r

r

r

r

r

.....evlie

!t!;

''__..KhalazayGAC Clinic

(Soon to be closed)

Barh -e- Zenicet

SCA Clinic

A well arranged pharmacy and

a well managed clinic.

Patient examination being done bya highly skilled MEW.

e

GowarcanGAC Clinic

Consultation in a tent. The onlybuilding is used for dressing woundsand storage of supplies.

ti '

Roy-e-DoaabSCA Clinic

771111 .14

Sar BaghIMC Clinic

Dressing a patients woundsoutside in the light. Theprocedure was clean butnot sterile. Sterile proceduresmay not be possible inAfghanistan at this time.

HW working with a patientafter amputation of a foot. Adifficult job due to the politicalsituation and lack of supplies.The facility was dirty.

r

.......

Babu EwarzIMC Hospital

HW examining a child. Mostunusual since the other threeHWs do not examine patients.

rr

ff

rr

r

ShulganMSH ClinicJamiat Civilian Hospital

A rare example of a sterilesurgery being performed bytwo HWs. Three physiciansare on staff none werepresent at the clinic.

Besh DeraAl Burz MSH Clinic

Drug Store located in theclinic. Example of storageconditions. This wasthe situation found in threeout of fourteen cases.

Shul GaraSCA Clinic

Hospitalization.Most patients are Mujahideen.

CENTER MISSION(v July - a October, 1991 )

PROVINCES OF: BANYANURUZGANGHOR

Monitoring Team: Dr Mohammad Yusuf:Dr Shakil Ahmad Khalil:Mr Mohammad Aziz Rastagar:Mr Amir Mohammad Wafa:

30

Medical MonitorMedical MonitorMonitorMonitor

BANYAN PROVINCEI: OBJECTIVES

PRIOR HEALTH FACILITIESl.Shaheed Fahimee Health Facility.

WHO Facility No: 1482Supported by: SCA.District: Bayan Center.Staff listed: * 2 MLs.

2.Seva (ad Health Facility.WHO Facility No: 1751Supported by: SCADistrict: Bamyan Center.Staff listed: * 1 ML.

3.Fa.tmasty Health Faciity.WHO Facility No: 0

Supported by: MSHDistrict: Barcyan Center.Staff listed: * 2 BHWs.

4.Foladi Health Facility.WHO Facility No: 1195Supported by: IMC.District: Ba.myan Center.Staff listed: * 3 MLs.

1 Lab-Technician.

ALTERNATIVES.5.Abul Fa al Health Facility.

WHO Facility No: -

Supported by:District:Staff listed:

MSH.Kah Mard .

=+- 4 M L s .

F. âha.hf:ed Ya.Eda.n Panah Health Facility.WHO Facility N o: 1714Supported by: MSH.District: Baniya.ii Center.Staff listed: -+; 3 MLs .

* I Lab Technician.

7.Wc.rc." Health Facility.WHO Facility No: -

Supported by: ?y,C.

District: W'-'=i`'.

Staff listed: * 2 ML s..:L

8.7ak..t Health Facility.WHO Facility No: -

Supported by-

S CA .

District: ,-.I'Jr2:_ .

Staff . i,çted - 2 1-i_.ti" .

31

HISTORY OF THE TRIP

The team lett Pc'sllx,i'ár en July 3, 1591. The begL'u1111g of our trip was difficult c',Lìi, to bombings

occurring along the way to Paklklra, Zurmat District of Palaia Provlllce.

t/' :LLL..L -{). + t1.L .]1_:..L..-Lll C:láL:...L 1tL,:1L:11 c:..111. Y.Y.13 c:IJuly 13, 1951. 11...

clinic was open and staffed with olle 1:1W. Our monitoring activities lasted three days. The patient

load was light due to a shortage of drugs and patients were using other clinics in the area.

B. Objective No: 3, Fatamastee Health Facility was reached on July 15, 1991. Both BHWswere on duty. Our monitoring evaluation lasted five clays. 'We departed on July 20.

II.

C. Objective No: 2, the Sheva Qad Health Facility was reached July 21, 1991. Both BHWswere present. We did monitoring evaluation in this facility for three days, and departed on July23, 1991.

D Objective No: 6, Shaheed Yazdan Panh Health Facility was reached on July 24, 1991.Upon our arrival two BHWs were on duty, four were absent. However, when they heard of ourarrival they reported for duty. We departed this facility on July 30, 1991.

E. Objective No: 4, Foladi Health Facility was reached on July 31, 1991. Two MM/1Ls were onduty, the lab technician was on leave. Our monitoring evaluation lasted five days with us departingon August 3, 1991.

F . Objective No: 5, Fazal I- Iealth Facility was reached August. after a full day of travel.Three MLs were on duty. We evaluated the facility for six days, departing August 12, 1991.

G. Objective No: 7, Waras Health Facility was reached on August 15, 1991. Both MLs wereon duty. Our work lasted five days and we departed on August 20,~1991.

H. Objective No: 8, Takaht Health Facility was reached on August 20, 1991. One ML was onduty, the second ML reported for duty the following day. We worked for five cthys at this facilitydeparting August 24, 1991 for Uruzgan.

32

III. PRESENTATION OF THE RESULTS

A. SiI .AII; ..EU 1~. iiF.\ lEE HEALTH FACILITY.

1. General appreciation of the clinic.One out of two HW s were present.The facility is located in a concrete building with five rooms. However, due to

constraints by the local authorities the clinic is limited to one room. There is no

latrine.Spring and stream water is used.

Evaluation of the medical staff.Diagnosis and treatment: The medical knowledge of the HW is very poor, he ,vas

unable to differentiate between the four kinds of diarrhea and treat them properly.

The HWs physical examination of patients were not properly done.

'*: Clinic management: The HW lacks management skills, needs training and supplies

to do the job properly.Nursing procedures: Aseptic techniques were not used and any knowledge of this

seems to be forgotten.


3 . Non-technical monitoring.*Drug Stores: One drug store was monitored. In addition to selling drugs, the store

sold a wide variety of other items.

B . FATMASTY HEALTH FACILITY.

1. General appreciation of the clinic.*Both HWs were on duty and busy in the clinic."'The facility was one room with no latrine.* Spring and stream water is used.

Evaluation of the staff.Diagnosis and treatment: The medical knowledge of the two HWs was notsatisfactory. They did not even know how to use a stethoscope and had no

knowledge of normal lung sounds.:4: Clinic management: The two HWs are managing the facility and appear to have had

no management training.

33

r

r

r-

t.;roO--edtses: With a t:.y. Úxc-gptious Loth l-iWs seemed. cosn?t.:tcnt.

techniques ere

Noti-technical znoliitorinDrug. ití_7re,a 111_ `.'.La only Ori. to LSalllat: . Prices Llre

,-i% , A ) HEALTH1 i l i i.' I'i_, l Y

1. Genet:. l appreciation of the clinic... 'f lic HW was present and ruimhng the clinic.

: The clinic was no model, it looked like and empty shop.The PIW lacked drugs. What he had he carried from the clinic to his hoer.. and backon a daily basis.The total water supply is stream water.

Evaluation of the staff.:.: Diagnosis and treatment: The HWs knowledge is not baci but the examination of

patients leaves something, to be desired.:4: Clinic management. The HW needs management training. In addition he only

staffs the clinic, six months at a titre, tlr rest of the time he is hi Peshawar beingre- supplied.

: *: Nursing procedures: Aseptic techniques were not used. No isolation method is

used and disposal techniques are incorrect.:': Health promotion: None.

3 . Non -technical monitoring: One drug store was monitored. Prices are in the annex.

D. SHA-TEED YAZDAN PANAH HEALTH FACILITY.

1 . General appreciation of the clinic.According to the WI -IO database there should be four NIL} -T \'Vs and two BHWs

working at this facility. In reality there are five BHWs, three of them should beworking in small health posts in the area.

:,: The local authorities have divided the work of this facility. Some of the work isbeing done inTopchi village aid some in 'layman Center Bazaar.

`: The building at Topchi village was in fair condition. It consisted of five rooms,all of these needing sonic: repair.

34

Evaluation of the stafT.

Diagnosis and treatlrent. Ili:,ctic<tl iq1owi:'.ci'.-'_e ,:vas extremely poor. Tue #Ws

were not able to ChügIlosi, a simple disease such as a t'C1IülIC:;1 cold Cî :rt_nillii5.

I1ley do not do enough investigation and physical e:úüIllnation are poorly done.

Soine times treatment is even clurgerous to patients. due to wrong or over

medication of patients.,r-,

°: Clinic management: The chilll inana'.er is a i-tis !'.'ork- is illaCclirate he

desperately needs management training. Unfortunately ?;_'<11i 1'_ T ., 15 not O;'.

duty at the time of the evaluation.:'z Nursing procedures: No isolation, nor aseptic techniques were being used.

Incorrect dosage of dn:s were being administered.Health promotion: None.

3. Non- technical monitoring.": Drug Stores: Two drug stores were monitored. Prices are in the annex.

Private health providers.Dr. Saaeed As sad Tawfeeq, M.D., graduate of the Medical Faculty of Kabul

University is a private health provider. He receives Afs 300 for a consultation.

Mr. Ethan' a graduate nurse from Kabul Nursing Institute is also in private practice.

Consultation fees are Afs 300.

: Health facilities: Shat red Eng Saeed .Matlaoob Qasim Health Facility located close

to the old city of Zuhak, has fourteen rooms and five beds. The structure is made

of cement and mud. It has a lab complete with instruments, no supplies or lab

technician. The clinic has a small operating theater, one delivery room, OPD and a

latrine. It has one generator (?.Kws), one ambulance, one x -ray machine, and a

refrigerator. The staff consists of two female M.D.s, two female BHWs and one

male ML.

E. FOLADI HEAL l f1 F ACILITY.

1 . General appreciation of the clinic.:i: Tivo MLs were on duty (one listed, one unlisted.), the lab technician (not listed) was

on leave.:': The building is made of mud, has three rooms, OPD, store, kitchen and a latrine.

:': It is a very active clinic with a heavy patient load.

Evaluation of the staff.: Diagnosis and treatment: Both I -IVs were very knowledgeable. - Their examines of

35

;:t i4 Is ,.vere very Il:or011';IL and their treailnì%ní. 'l:r:ìie. Free staff '."vas eager

t o learn tlìl,i. _,o .,,., `..er_. bus,: !raining 31 t«I' tI__ .,.._. d'.' : t'i .,I' .

Clinic management: Mr. .C.CAIll:tiL clinic manager is ver`:" cc_tm!'i:teint.

Nursing procedures: NllrsiIl`1, procedures are well performed. Aseptic 'illiCt isolation

techniques v,iere ver." good.

Health promotion:

Laboratory.:" They have the esseiltial instruments for the lab, but the newly trained, inexperienced

lab :ec'liniciali was on leave.

4. Non- technical monitoring.. Drug Stores: On dug store was monitored. prices are in the annex.

:': Private health providers:fir.''Ioliiunxnacl Naa.zir and ex- agriculture student is the Public Health

Commissioner of Hezb-i -VVi slat Islíunia Afghanistan in the B arrlyall Center. In

addition he is working as a private health provider. His knowledge is very limit. 1

and his advice is very poor. i.e. he advises the i .opte that vaccinating children i

bad for their health.

F . WARM HEALTH FACILITY.

1 . General appreciation of the clinic.

:,: Both H iVs were presellt and busy seeing patients.:.: The clinic consists of one room located in a restaurant. The clinic is very busy.

thus the restaurant is doing well.:`: Water is supplied to the clinic from a spring.

Evaluation of the staff.:': Diagnosis and treatment: H \Vs knowledge was good, however, patient

examinations were inaccurately done.Clinic Management: Both H \Vs are managing the clink affairs inadequately.

Contaminated materials are deposited on the ground outside the clinic.

Nursing procedures: 'There was no aseptic techniques, isolation is forgotten.Health promotion: No program exists even though they have the knowledge to

promote in their area.

3 . Non-technical monitoring.Drug Stores: One drug, store was evaluated.

:4: Health facilities: Three other facilities were monitored in the area.

36

5

- Mr. Mohammad' Nabi BHW/MSH, Ghurzak-i-Ulva vil1ae has a one room truld

clinic. hi addition to Mr. Nabi there are two H1A7s working at ¡hi', clinic. one y.as

on leave at the time of the visit.- Mr. Giuliani Nabi Wafaee BSH/MSH, Qaumy Yari village is numing a one roomculli made or :mid.

- Mr. Giuliani Sakhi Paramedic/SCA, Sarap villa:-Ze is running a one room clinic

made of mud.

G. TAKET HEALTH FACILITY.

. General appreciation of the clink.Both of the Iii/Vs were present.

The clinic is made of mud and consists of three rooms.The one generator (2Kws ) donated to the clinic by SCA has disappeared.One horse was donated to the clinic for transportation, unfortunately it died.

Evaluation of the staff."'Diagnosis and treatment: Both HWTs have little medical lalowleci_e. Their

examination of patients are poor, and their diagnostic skills are bad.Clinic management: The clinic manager needs a lot of management training.Nursing procedures: Sterile techniques do not exist.

": Health promotion: None.

. Non-technical monitoring.There were no drug stores, health facilities or private health providers.

37

URUZGAN PROVINCE

I. OBJECTIVES.


1. Khedmant Health Facility.NHO Facility No: 1777Supported by: SCA.District.: Shahrestan.Staff listed: * 4 MLs.

2. Madrasa Health Facility.WHO Facility No: -

Supported by: MSH.District: Kejran.Staff listed: * 4 MLs.

3. Khedeer health Facility.WHO Facility No: -

Supported by: IMC.District: Dai Kundi.Staff listed: * 3 MLs.

4. Bandar Health Facility.WHO Facility No: 0

Supported by: SCA.District: Dai Kundi.Staff listed: * 1 ML.

ALTERNATIVES.

5. Imam Khumainy Health Facility.WHO Facility No: 1653Supported by: SCA.District: ShahrestanStaff listed: * 1 MD.

* 4 MLs.

38

:a J 1.'. _.11 i.1CllitV

e i__G:a ï:f L_ . > ü113.1.

1. l,'n ..!!"'a.! 1:91

-11 . Titis facility .i Id ì :a1»:,::7an . .,.jl S .li. vasíl 011 . ..l.;llSI 31. 1991.1.,

'We travelled 10 Imam Fill1n,+.ir.y Health Facility (V,)','.c 31. (.)11ly cinc

1 .. 1 :,... : .a._, ;!_ 1` . , i[:.!: ...':C.i!;i[ lSlaiill íJ .<i''1111115CaII. l.v _s.L ,.7., ere 1111i'c;SP.ti.\.r"ai foi' íe 5111;L)hl:l,.` bY'r. rilie:.

days at this fachin.c. íi[:T32iitIIi:' on .,:;L'tcïllCei

C. 'file ¡cam reached Shaheecl Sadini Health Facility on September 5. It was not in ourobjectives. However. it was located on OUT way and '.il'. decided to evaluate it too. We were therefor live ci<i.ys, departing ou September 10.

D. On September 1 i we travelled to,.vard Kejran o11 our way to Ghor Province, when wereached Ieiin ei we ran into fighting,. Silice the Security situation was îlot safe. Ive c.ancelled thispart of the trip, and went to Miedeer, then to La1- w- Sarjangle District of Ghor Province. Finallyreaching Khedeer Health Facility (Objective No:3) on September 13. Ali staff was present. We- worked for six days and departed September 18.

E. On September 19 we beìnu1 work in radar Health Facility (Objective No:4) and workedthere for three days. We departed on September 22 for Glior Provence.

III. PRESENTATION OF RESU I'S.

A. KHFDMAT HEALTH FACILITY.

1. General appreciation of the clinic.All the staff was present and busy with patients.The clinic consisted of two rooms, one for OPD, tile other for dressing.

. +. A manmade spring provided water for everything at the clinic.


:: Diagnosis and treatment: Mr. Rasool, clinic manager is \yell trained in health careand his work is satisfactory. 'Ile other three members of the staff are not welltrained and performed poorly ami are accepted as MHW.

." Clúùc in ulageinent: Mr. Rasool, clinic ilrulager is in need of inauzageincnt. training.Nursing procedures: Nursing procedures are limited. No isolation techniques areused. hi addition the staff ik'cars overcoats during practice.

:`: Health promotion: Patients with chronic illnesses are issued cards with all their

39

health information, so they can be properly treated if they go to another healthfacility.

3. Nontechnical monitoring.": Private health providers:

- Mr. Ibrahim Shkfflt"y', graduate of Mashhad Health Center in Ir:3I1 ls'-v('rkl;lg as ;1First Aider in Chaprasak Bazaar. He receives Afs 100 consultation fee.

- Mr. Ghularn Abas Rezvvany, graduate of :vlasllhad Health Center in Iran is workingas a First Aider in Dlklprasak Bazaar. He receives Afs 100 consultation fee.

B . I vIANI KIIUMANIN HEALTH FACILITY.

1 . General appreciation of clinic.

One HW our of five was present.11 facility is located in the ex- district hospital. It has n1~uly rooms and a largeyard.

The building is made of concrete and is need of repair.": Water is supplied by a stream and sometimes a spring.

Evaluation of the staff.": Diagnosis and treatment: The knowledge of the HW on duty was very poor even

though he could do patient examinations well."= Nursing procedures: There are no nursing procedures.'Health promotion: None.

Non -technical monitoring.

*Drug Stores: One drug store was monitored. It is located in the health facility andbelongs to one of the HWs. Prices are high. See annex.

C. SHAHEED SADIQI HEALTH FACILITY.

Due to security we were unable to go to Kejran District, instead we evaluated this facility.

1. General appreciation of the clinic.": All the staff was present.

": The facility is made of mud with two rooms (shops) and is located in the bazaar.Water is supplied by well and a spring.

40

Evaluation of the staff.::: Diagnosis and treatuiciit: The HWs were knowlecheable, doing, a very good job and

v orking hard.

:: Clinic management: Ail three of the H \Vs managed the clinic.": Nursing procedures: There is no isolation or aseptic techniques.


. Non -technical monitoring.:: Private health providers:

- Mr. Ali Husain and Mr. Qlrban Ali Sultani, graduate First Alders (six monthcourse) of - Mashhad Health Center in Iran is providing some health care. Hereceives Afs 300 for a consultation.

- Mr. Mohammad Rezai, graduate First Aider (two month course) of Mashhad HealthCenter in Iran is also providing health care. He receives Afs 200 for a consultation.

D. ILIIEDEEh HEATLH FACILITY.

1. General appreciation of the clinic.Two out of three HWs were present.

The clinic is located in the ex- district hospital. Due to damage to the building it islimited to one room.

"- The main water source is a stream. In addition a small spring is available duringthe suminer season.

Evaluation of the staff.Diagnosis and treatment: Medical knowledge is good. However, patientexaminationination is poor.

:: Clinic management: Mr. Mohairunad Yaser, clinic manager needs managementtraining. Patient information is rarely entered in the green books and then it is notalways accurate.

:4 Nursing procedure: Very poor, no isolation techniques..K Health promotion: None.


Drug Stores: One drug store was monitored. Prices are in the annex.

Private health providers: Mr. Safdar Zaree, gradate First Aider (six month course),Mashhad Health Center in Iran. Consultation fees are Afs 300.

41

E. BANDAR HEALTH FACILITY.

1 . General appreciation of the clinic.": Only one HW was present.

The facility has one room. ruade of mud.,_ Water is-supplied frein a spring.

Evaluation of t,e staff.Diagnosis and treatment: Tl HWs knowledge is lin ited. Examination andtreatment is very poor.

": Clinic management: Clinic management is very poor.

Nursing procedures: Aseptic and isolation techniques have been forgotten.Health promotion: None and none anticipated.

3 . Non -technical monitoring.

Drug Stores: One drug store was monitored. Prices are in the annex.ti; Private health providers. Mr. Ahinady, graduate (nine month course), Mashhad

Health Center in Iran is practicing. Consultation fees are Afs 200.

42

GHOR PROVINCE

I. OBJECTIVES.


1. Doghar Health Facliity.WHO Facility No: 1027Supported by: IMC.District.: Pasaband.Staff listed: * 2 MLs.

2. Sia Chashma health Facility.WHO Facility No: 0Supported by: SCA.District: Lal- w- Sarjangle.Staff listed: * 1 ML.

3. Jar Afghanan Health Facility.WHO Facility No: 0

Supported by: SCA.District: Lal- w- Sarjangle.Staff listred: * 1 ML.

4. Saghar Center Health Facility.WHO Facility No: 0

Supported by: MSH.District: Saghar.Staff listed: * 2 MLs.

* 2 BHWs.

ALTERNATIVES:5. Leppco Health Facility.

WHO Facility No: 0Supported by: CAC.District: Lal- w- Sarjangle.Staff listed: * 1 Lep -tecnician

*, 1 BHWs.* 4 First aiders.

43

HISTORY OF TIIE TRIP.

The team left i.-nuzgau September 22, 1991, and reached Lal-w-S;!rga.ngle on September

24.

We arrived :tt l!;;t C11,ls1nIIm:i Sept-wimt 'r _'J,l'.'`Jf. Oil_'. i :;is i?n duty. ,`,'e

worked for three days. d':.U,:n'ting September 27.

B. We went to Srajangle to check the Jar AfharanHealth Facility. There was no staff

at this facility so we returned to Lal and checked the Leppco Health Facility. We worked there for

three clays, departing on October.

C. We reached Lal District of Ghor Province and continued on to Kar Qul in Bamv.nm

Province. We then proceeded to Shah, Pakistan arriving October 7, and finally to Peshawar on

October 8, 1991.

III. PRESENTA1ION OF RESULTS.

A. SIA CHASHNIA HEALTH FACILITY.

1. General appreciation of the clinic.

:'' The clinic was closed upon arrival. However, the HW was located and

came to the clinic. Although it is a designated clinic, the practice of health is

not done there. The HW has established the clinic in one room located in

Lal Bazaar. Drugs are in scarce supply and stored in the corner of the

room.

Il.

Evaluation of the staff.Diagnosis and treatment: The HWs knowledge is so poor he cannot even treat

simple diseases, i.e. treating gastritis with antibiotics, and giving tetracycline to

children.Clinic management: Tne clinic is poorly managed because tl HW is in politics

which takes the bulk of his time.

'4' Nursing procedure: All the instrzuuents have disappeared, patients say the HW has

taken them home.

" Health promotion: Although thy. HW is the Health Commissioner he has no idea

how to promote health.

44

3 . Non -technical monitoring -in the area.Drug Stores: the team monitored three drug stores in the area.Private health providers: Mr. Yagoob is illiterate with no health education is

practicing. He sells drugs and includes his fee in the prick.

LEPt":'i)1 HEALTH t i F. iCii.T.i Y.

i . General appreciation of the clinic." The facility is in good condition. It is made of mud and consists of twelve rooms

with sections set aside for TB and Leprosy patients.

Evaluation of staff.Diagnosis and treatment: The HWs Imowledge is good. Examination and treatment

done poorly.Clinic management: iL'1r. Qurban Ali is the clinic manager and needs a great deal of

training.Nursing procedures: Aseptic techniques do not exist. There is one dressing room,all patients including Leprosy patients are treated there. The sane pancement set is

used for all patients.Health promotion: The female HW is teaching the women about birth and hygiene.

3 . Non- technical monitoring in the area.' Drug Stores: One drug store was monitored." Health facilities:

- Mr. Rajab Ali, BHW /MSH is worldng in Qatlesh village of Sarjangle. The clinicconsists of one room and is run with the cooperation of Hezb- i- Wandat Islami ofAfghanistan. Drugs and green books were taken by Commander Basir in Behsoocl,District of Wardak Provino. All the local authorities have been informed by himthat he has established a new clinic to help the needy and poor.

- Vaccination distribution center of Lal Center: Mr. Mohammad Sarwar Garrnabi is

responsible for the center. Mr. Gamiabi's work is outstanding. He is extremelyknowledgeable, well organized, a great health promoter, and is a real role model for

his district. This center was able to vaccinate more than 23,000 persons since,October 1989. Four HWs work there as vaccinators.

X Private health providers: Wandat clinic is made up of three people. Mohammad

ILazezly, an ex- teacher, Saeed Nadir Naweed and Qurban a First Aider. Theyreceive Afs 500 to 1,000 per consultation.

45

C'Cì''+Ci,USIOiVS OF THE CENTER MISSION

Summary Of Information Collected:

Fifteen sites oT:witr. facilities were evalu<ted n {':Ltral itgh1nL`t:n.

S un Bani a n Province

in Uruzgan Provincein Ghor Province

Six sites of health facilities were monitored.

4 >sn Bamyan Province

in Ghor Province.

Thirty HWs were evaluated.

1 b in Banyan Province10 in Uruzgan Province3 in Ghor Provinces,

Thirty drug stores and private health providers were monitored.

General Consideration Of The Clinics:

Most of the clinics were clean and neat except Sia Chashma Health Facility in Ghor Province. Weobserved green books in all evaluated clinics but their written information is not perfect. HWswork on green books a long time after their work has been completed. In some cases they go forresupplying to Peshawar before doing green book entries.

Most clinics do no have sufficient equipment. Most have stethoscopes, BP apparatus andthermometers. However, some clinics have equipment that the HWs do not know how to use.For example the suction apparatus at Khedeer Health Facility. In some clinics H \Vs use equipmentwithout training such as a stethoscope in Sh Yazdan Pana Health Facility in Barnyan Center.

Staff organization is not observed in most facilities. There is no correlation among the activities ofHWs, one is naming the clinic and the others are on leave. In Sh Yazdan Pana Health Facility oneHW out of six was working every day. In rare cases staff organization is well arranged, a goodexample is Foladi Health Facility in Bcunyan Center.

46

is C:1Lit '.tti'.1t:r S.

611 t h., ìP.a¡C7rit:: of C:,.d,111natic';11 is not being done. found that about 30'-fl"- of the

[2.` were 1.1 OOtil tllst;`r'." f:it,:iillg and physical e_l"aIr'lilatlo2ìs. hi most cases the physical

L lI' I t^ ; i sounds,. i2 ' ? i 1 Ì P.R. zz lte'-_ I T':ItiO 1 is lll?ll ..d O t:,l SO 1:_ .:. _,4' CF'_cC.ü1_ and rarely s Other .[.rt; 1 .ï: LifS.

. ;Irsl?Ig procedures were not satisfactory. .:lost of tlä, i"11'i's we.re -careless. For example li,L i pco Health Facility they were using tl'.e salIle dressing set which was used for leprosy patients.

^ Sterile tc:ciiiL'Ques were not observed in many cases.

>.íost of the HZVs ,'re poor in inamagiiig some diseases such as TB, diarrhea. and respiratoryproblems. .\lost of the HINs are not able to treat simple cases of diarrhea and they give no adviseto patients. 'vlost HWs could not differentiate bronchitis from pneumonia.

Health promotion : in most clinics there is no program to promote health. Many HWs are not ableto motivate the local authorities and community because of their lack of knowledge. On the otherhand they explained they have some knowledge of curative measures. Most of the H \Ys simply donot know how to go about doing health promotion. Some clinics such as Folacii HealthFacility /LbIC in Paunyan Center and Khedmat Health Facility / vITA in Uruzgan Province weredoing a good job of collecting information.

General Appreciation Of The Health Care System In The Area:

(1.110/.

Tuberculosis is wide spread in Hazarajat. H \Vs do not organize prevention by motivating localauthorities or providing: information to the population. The curative system is not well organized,no field laboratories for diagnosis. H\Vs have not had enough training in TB case management.

Leprosy is also common in Hazarajat. However, there is one leprosy center is in Ghor Province,but it is not effective, the staff is properly educated or trained. Leprosy patients are not isolatedfrom others, patients clothes are washed in the river and that water goes right into the villages.

Malnutrition is a big problem, the people are needy and poor, and the availability of good food israre.

Other problems are gouter and diarrhea. Malaria is not present in the area except traveller cases.Some I-ItiVs propose that supporters send small amounts of anti malarial drugs.

47

Gtmeral Problems:

Local authorities are usually action people in clinic affairs for their personal gains. Sh YazdanPana Health Facility was separated in to two parts by the cominaunclers, and they were competingagainst each other. The Public Health Commissioner of Bainyan Center was against thevaccination program and explained to the people that vaccination was dangerous to your health.

h is difficult to travel to Central Afghanistan due to the lack of transportation.

There always seems to be differences between the WHO data base and HWs working in theclinics. The committees must send fresh information to WHO.

Resupply of drugs are not timely, except the clinics supported by IMC. Most clinics are closedwhile the HWs come to Peshawar for their supplies.

All BHWs are working as physicians even though they lack the skills, training or education. Thisis dangerous in many cases. For example some emergency cases are treated at home and onlyreferred whey they become very complicated.

4 8

r;

t

Sh. FahimySCA Clinic

Incomplete examination.

FatmastySCA Clinic

Dressing patient wound.

- '

Sheva QadSCA Clinic

In most clinics HWsdo not use the isolationtechnique.

Sh Yazdan PanaMSH Clinic

A good building, butmuch to large.

r

FoladiIBC Clinic

Consultation. A model HW.

.. 0/7-,/*0/7-,/*/

41 J/ ,r-T;;,j.; 4MY

.

;' eel

\

4)+1,-.-;; ti

`J _ r,; ,I

Waras

IMC Clinic

Patient examination.

A knowledgeable ML workingin difficult conditions.

r

r

r

r

r

m

Abul FazalMSH Clinic

Consultation in aone room clinicwith no windows.

Takht

SCA Clinic

Consultation, limited to BPand lung sounds.

KhedmatSCA Clinic

A model of good nursingprocedures for a burnedchild.

r

r

r

r

Imam KhumanySCA Clinic

Isolation iscompletly ignore

Sh. SadigiMSH Clinic

The poster on the wall is fordecorative purposes not educational.

r

Khedeer

IMC Clinic

Consultation. A rare HAWwho can diagnose afterexamination.

Sia ChashmaSCA Clinic

A few empty cartons andtins of drugs donated byUNICEF Kabul. We locateddrugs in Lal Bazaar that hadbeen sold by the HW.

Bandar

SCA Clinic

A one room clinic.

Leppco Clinic

A large Leprosy andTB control hospitalwith an OPD.

SOUTH MItiSION(10 July - 16 September, 1991)

PROVINCES: ZABUL.QANDAHAR.HELMAND.

MONITORING TEAM:Dr Mohammad Na.zir Rasoly: Medical Monitor.Dr ghulam Mujtaba: Medical Monitor.Dr Phillip:' Bonhoure: Monitoring Coordinator.Mr Sultan Mohammad: Monitor.Mr Gul Agha: Monitor.Mr Mohammad Azim: monitor.

49

r

ZABUL PROVINCE.

I. OBJECTIVES.

:T,IOR HEALTH FAÎLITIES:

1. Shah Joy Health Facility.WHO Facility No: 1148Supported by: MSH.District: Shah Joy.Staff listed: * i ML.

2. Shah Joy Health Facility.WHO Facility No:Supported by: SCA.District: Shah Joy.Staff listed: * 1 ML.

ALTERNATIVES.3. Shahr -i -Safa Health Facility.

WHO Faclity No: 5064Supported by:- MCI.District: Shahr -i -Safa.Staff listed: Not Mentioned.

4. Malakhyan Health Facility.WHO Facility No: 1795Suppored by: MCI.District: Arghandab.Staff listed: NOt Mentioned.

50

II. HISTORY OF THE TRIP.

The team left Peshawar for Quetta on July 9, 1991 andstayed five days making contact with politicalorganizations and MCI office. We reached AfghanistanJuly 15, 1991.

A. We reached Shahr -i -Safa health facility July 15,1991. It was closed and the medical staff had gone toQuetta for resupply of drugs. The guard was asked toopen the clinic. We stayed for one day to monitorthis facility. The team left July 16, 1991.

B. The team reached Malakhyan Health Facility on July16, 1991. It was closed and under construction. TheHWs had gone to Quetta for resuppling of drugs. Westayed one day and left on July 17.Due to security problems we cancelled the visit of 2other health facilities in Shah Joy District. We leftZabul Province for Qandahar Province July 20.

51

KANDAHAR PROVINCE.

I. OBJECTIVES.

1. Hadira Health Facility.- WHO Facility No: 1636

Supported by: MSH.District: Arghandab.Staff listed: * 3 MLs.

* 2 BHWs.

2. Chargholba. Health Facility.WHO Facility No: 1183Supported by: IMC.District: Arghandab.Staff Listed: * 1 MD.

* 5 MLs.

3. Suzni Health Facility.WHO Facility No: 1794Supported by: MCI.District: Shah Wali KotStaff listed: * 3 MLs.

* 1 FA.

4. Zail Abad Health Facility.WHO Facility No: 1674Supported by: MCI.District: Khakrez.Staff listed: * 1 MD.

* 4 MLs.

ALTERNATIVES.

5. Shoheen Health Facility.WHO Facility No: 1394Supported by: SCA.District: Arghandab.Staff listed: * 1 ML.

* 3 Not recognized.

6. Zala Khan Health Facility.WHO facility No: 1180Supported by: MSH.District: Panjwai.Staff listed: * 2 ML.

7. Arugh Health Facility.WHO Facility No: 1634Supported by: MCI.District: Khakrez.Staff listed: * 1 ML.

* 2 FAs.

52

8. Bagh Mehrab Health Facility.WHO Facility No: 1797Supported by: MCI.District: Ghorak.Staff listed: * 1 ML.

* i FA.

9. Bagh Pul health Facility.WHO Facililty No: 13

Supported by: MCI.District: Dand.Staff listed: * 1 MD.

* 2 MLs.* 1 OT- technician* 2 Lab- technician.* 1 X -ray Technician.* 1 Dent- technician.* 2 HWN.

II. HISTORY OF THE TRIP.

The team reached Kandahar on July 20,1991 and startedwork.

A. The team reached Khoja Molk on July 20, 1991. Therewe discovered the MCI clinic of Suzni (Objective No3) it was open and staffed with one ML, and one FirstAider. We stayed four days and left on July 24.

B . We visited Khakrez Health Facility in Zail Abadvillage, ( Objective No:4), locally called ShahMagsoodi Clinic, arriving on July 24. Four HWs wereon duty with the clinic open. We stayed for fivédays and left July 28.

C. We visited Arugh Health Facility (Objective No:7) onJuly 28. The clinic was open but with only a FirstAider present. We stayed two days and left July 30.

D . We reached Al Shefa Health Facility in Baghi Mehrab,district of Ghorak (Objective No:8) on July 30. Itwas open with one HW on duty. We stayed three daysand left August 2 for Helmand Province. After threeweeks in Helmand we proceeded to Kandahar Province.

E . The team visited the Baghi Pul Health Facility(Objective No:9) August 24. The hospital was openwith four HWs present. One HW was in Quetta forresupplying. We only stayed four days due to unstableconditions.

53

Chargholba Health Facility (Objective No:2) wasreached August 28. The facility. was staffed with aphysician, two HWs were absent,and the ML was inPeshawar for supplies. Due to security we worked fourdays and left.

G. We visited the Hadira Health Facility (ObjectiveNo:1) September 1. The clinic was open with one HW,the others were in the area working. We worked fourdays and left on September 5.

H. Since Panjwai Health Facility was enroute we decidedto evaluate it. It was not listed in the WHODatabase. Three HWs were present, a physician, MLand a First Aider. One ML was gone for resupplying.We stayed there for four days and left onSeptember 6.

I. Zala Khan Health Facility (Objective No :5) waslocated in Zang Abad that we reached on September 6.One ML was present, the other was gone forresupplying. We worked there two days and departedSeptember 8, for Helmand Province.

III. PRESENTATION OF THE RESULT.

A. KHOJA MOLK HEALTH FACILITY.

1. General appreciation of the clinic.* One ML and one First Aider out of a staff of four was

present.* Originally this clinic was located in Shah Wali Kot.

Due to the small population the commander requestedthe clinic be moved temporarily to Khoja Molk. Thefacility is made of mud and has three rooms, one is alab. The lab -technician was not present.

* River water is used.

2. Evaluation of the staff.* Diagnosis and treatment: The medical knowledge of theML was good. He did not advise patients, concerningrelated diseases. The First Aider /BHW had a poorunderstanding of health care.

* Clinic_ management: the manager is doing a good job.* Nursing Procedures: Aseptic and isolation techniques

are not used. Hand washing is forgotten.* Health promotion: None.

3. Laboratory.Because the lab- technician was absent for resupplyingin Quetta there was no activity.

54

4. Non- technical Monitoring.}.. Facilities:- Tabin Clinic /MSH. Three BHWs were present.- Khoja. Molk Clinic/MSH, One BHW present.- Puli Sarband Clinic /MSH, One BHW present.- Joy Sher Clinic'SCA, One ML present.- Khoja. Molk Clinic /MCI, One ML present.- Khoja Molk Clinic /MCI, Three HWs present.- Shaheen Clinic \MSH, One BHW present:* Tree pharmacies in the bazaar

B. SHAH MAQSOODI HALTH FACILITY

1. General appreciation of the clinic.* All staff was present.* The structure is made of mud and brick, and is still

under construction.* There is no latrine.* Water is supplied from a karez.

2. Evaluation of the staff.* Diagnosis and treatment: The medical knowledge of the

staff was very goad, and treatment of patients wasappropriate.

* Clinic management: It is well organized under thecontrol of one physician, each member of the staff hasdefinite tasks to do, for example dressing andconsultations. Green books were present and used forr egister at ion.

* Nursing Procedures: Sterilization and clean techniqueswere being done. Isolation technics were considered.Hand washing was forgotten.

* Health promotion: Individual health education wasprovided. They plan to train a FHW.

3. Laboratory.One laboratory, with a busy lab- technician.

C. ARUGH HEALTH FACILITY.

1. General appreciation of the clinic.* The listed HW in the WHO data base was absent.A nonlisted BHW was working.

* The roof of one of the two rooms had been destroyed byheavy rains last winter. The dressing room and drugstock were in another house belonging to the field -

commander. The commander is consructing thisbuilding.

* There is no latrine.* Water is supplied from a Karez.

55

i Evaluation of the staff.Diagnosis and treatment: The medical knowledge of theBHW was extremely poor. The patients were not properlyexamined. Administration of drugs were not properlydone, e.g. Chloramphenicol 6 mg /kg for typhoid.Clinic management: Thé Ml manager was absent and theBHTÍ did not have the skills to manage. No Green bookwere being used.Nursing Procedures: No aseptic or isolation techniqueswere being used. Hand washing was forgotten.Health promotion: None.

D. AL SHEFA HEALTH FACILITY.

1 General appreciation of the clinic.* Two listed HWs in the WHO database were absent.

In addition a nonlisted ML was present.* The clinic is temporarily in a mud building consisting

of six rooms without latrine.* River water is used.

2. Evaluation of the staff.* Diagnosis and treatment: The ML was excellent, and had

a good medical knowledge. In fact he was a model inall Kandahar Province. Drugs were used in anappropriate way for treatment of diseases.

* Clinic management: The clinic was well organized.Green books were presents and completed. The HW wasperforming many tasks, dressing, OPD, and drugsdistribution.Nursing Procedures: Sterile, clean and isolationtechniques existed. Hand washing was being done.

* Health promotion: Health promotion was doneindividually.

E. BAGHI PUL HEALTH FACIILITY.

1. General appreciation of the clinic.* Three out of nine HWs were present.* The building is made of cement, consists of two rooms.Another building with two rooms is being used forstaff accommodations. One partially finished building( without windows, doors and roof) was destroyed by aheavy raining last year.

* There was an X -ray machine not in use because therewas no place to put it.

* No latrine existed, and stream water was used.

56

2. Evaluation of the :st. T3.f f .

* Diagnosis and treatment: All staff was fair indiagnosing, OPD and prescribing drugs.

* Clinic management: The lab -tech manager wasvery well organized.

4. Nursing Procedures: Hand washing was being done.However, sterile and clean technique were rarely done.

* Health promotion is done by the vaccinationteams.

3. Laboratory. One operating laboratory.

4. Non -technical monitoring.* Facilities: One hospital belonging to NHA was visited

in Selo of Mir Triais Mina. It had a OPD, laboratory, x-ray, dispensary, OT and beds for the patients.

F. CHARGHOLBA HEALTH FACILITY.

1. General appreciation of the clinic.* Four of six HWs were present.* The facility is located in an IMC constructed building

consisting of 12 rooms, including flash systemlatrine.

* Stream water is used.* A generator is used for electricity.

2. Evaluation off the staff.* Diagnosis and treatment: Their medical knowledge was

not bad , but the patients examination were improperlydone.

* Clinic management: The physician manager was absentduring the evaluation. Clinic management wasunsatisfactory. Green books were not present. Weobserved that some patients came inside the dispensarywithout being examined.

* Nursing Procedures: No aseptic or isolation techniqueswere being used. Hand washing is forgotten.

* Health promotion: They were cooperating with theAVICEN vaccination team working in the area.

3. Laboratory.There was a laboratory but the lab- technician wasabsent.

r G. HADIR.A HEALTH FACILITY.

1. General appreciation of the clinic.* One HW out of five was present.* The building was made of mud and consisted of two

rooms without latrine.* Stream water is used.

57

2. Evaluation of the staff.Diagnosis and treatment: The medical knowledge of theHW was good. He paid attention to the history ofpatients, examination and treatment was perfect.Clinic management: Run by the ML but not well.One room is used for all medical purpose and therewere no green books.Nursing Procedures: Sterile, clean and isolationtechnics were not accurately done.


H. PANJWAI CENTER HEALTH FACILITY.

1. General appreciation of the clinic.* Three out of four HWs and one physician was present.The physician was not listed in the WHO database.

* The building is made of cement consisting of eightrooms, had two latrines within 7 meters distanceof the well.

* Water is supplied from a well.

2 Evaluation of the staff.* Diagnosis and treatment: The medical knowledge of the

ML was very good. His treatment and advice to patientswas satisfactory.

* Clinic management: The clinic is managed by aphysician. His management skills are sufficient.

- Nursing Procedures: Isolation, sterilization and cleantechniques were being done. Hand washing was sometimesforgotten.

* Health promotion: They promoted health individually.

3. Laboratory.The lab was busy. However, the lab technicians skillswere extemely poor, an HW could have done a betterjob

4. Non -technical monitoring.* Facilities: One facility in Pashmal, supported by

IAHC. Total staff ten people.

I. ZANG ABAD HEALTH FACILITY.

This clinic was listed in the WHO data base as being inZala Khan but we found it have been moved to Zang Abadvillage.

1. General appreciation of the clinic.* One out of two HWs were present, a newly appointedphysician was there.

* The building is made of mud, consists of six rooms.* Water is supplied from a stream.

58

2. Evaluation of the staff.* Diagnosis and treatment: The medical knowledge of theML was satisfactory. Although he did not takecomplete and comperhensive histories of patients.

'k Clinic management: The newly arrived physician wasthe clinic manager. Evidently there had been nomanagement in the past.

* Nursing procedures: Sterilization and isolationtechniques were forgotten and hand washing did notexist.

* Health promotion: Nothing special.

59

HELMAND PROVINCEOBJECTIVES.

1.Garai Health Facility.WHO Facility No: 1628Supported by: MCI.District: Baghran.Staff listed: * 1 ML.

* 1 First aider.

2.Dara Baghran Health Facility.WHO Facility No: 33Supported by: MCI.District: Baghran.Staff listed: * 1 MD. * 1 Lab -technician.

* 1 MLs. * 1 OT- technician.* i Dent. * 1 X -ray technicain.* 1 Nurse. * 2 First Aiders.* 7 BHWs.

3.Shahrag village Health Facility.WHO Facility No: 5021Supported by: MCI.District: Mosa Qala.Staff listed: * 2 MLs.

4.Tangi Kajaky Health Facility.WHO Facility No: 16Supported by: MCI.District: Kajaky.Staff listed: * 3 First aiders.

* 1 Unknown.

5.Katozai Health Facility.WHO Facility No: 5027Supported by: MSH.District: Sarban Qala.Staff listed: * 1 ML.

* 2 Nurses.

ALTERNATIVES.

6.Nad Ali Health Facility.WHO Facility No: Not listed.Supported by: IMC.District: Nad Ali.Staff listed: * 1 MD.

* 1 ML.

7.Nawah Health Facility.WHO Facility No: Taken from IMC data baseSupported by: IMC.District: Nawah.Staff listed: * 2 MLs.

60

- II. HISTORY OF THE TRIP.

Kajaky District of Helmand Province was reached August 2,1991.

A. ni j jctive No :4 We arrived Tangi Ka.j3_ky Health FacilityAugust 2. Two HWs were present . We departed on August_6 1991.

B. Objective No:1 Garai health facility was reached onAugust 3. One WHo listed HW and Two nonsisted werepresent. We worked one day and had to evacoate thearea ASAP due to severe conflicts in the area.

C. Objective No:2 Dara Baghran Health Facility wasreached on August 10. The clinic was active. We stayedfor six days and departed on August 15.

D. Objective No:3 Shahrag Health Facility was reachedAugust. 17. One ML was present. We evaluated thefacility for three days and departed August 19.

E. Objective No :5 Katozai Health Facility was reachedAugust 20. The clinic was active. The team stayed fourdays and departed August 23 for Kandahar Province tocontinue our work.

III. PRESENTATION OF RESULT.

A. TANGI KAJAKY HEALTH FACILITY.

1. General appreciation of the clinic.* Two out of four HWs were present.* The building is made of stone and cement located in

the ex- district office of Kajaky dam. It consisted offour rooms with a nonfunctionning flash systemlatrine.

* River water is ised and is satisfactory piped to theclinic.

2. Evaluation of the staff.* Diagnosis and treatment: Both HWs were knowledgeable

in diagnosis but not in treatment, for examplethey treated peptic ulcer patients with Aspirin andgastritis with Vermox.

* Clinic management: The clinic manager was anonmedical person. He was illiterate in management.The clinic was filty with contaminated materials.

* Nursing procedures: Nursing procedures werenonexistant and the staff did not care to learn.Health promotion: None.

61

3. Non-technical monitoring."K F a i'_ l it ïe s . Ori _ active hospital was :Ti ü Yi 1 J re{ i

supported by IAHC. It was staffed with nine people.

B. GARAI HEALTH FACILITY.

.

K

?k

General appreciation of the clinic.Three H'!s nonlisted in WHO data base were present.The building is made of mud consists of four roomswithout latrine.Water is supplied from a stream.

Evaluation of the staff.Diagnosis and treatment: The medical knowledge of theHWs was rather good.Clinic management: The ML clinic manager was doing asatisfactory job. The green books were being used.Nursing procedures: Hand washing was observed in halfthe cases, sterilization , cleaning and isolationmethods were being properly done.Health promotion: There was a preventive andscreening programs for Malaria and T.B. control.

3. Laboratory.A non listed laboratory existed in the clinic.

C. DARA BAGHRAN HEALTH FAíCILITY.

1. General appreciation of the clinic.* Five out of sixteen WHO listed HWs and one nonlisted

were present.-+ The building is made of mud and consists twenty eight

rooms. There was inpatient beds, OT, X -ray, T.B.Control Center and two functioning latrines.

* Water is supplied from the river.

7. Evaluation of the staff.* Diagnosis and treatment: The medical knowledge of the

HWs was satisfactory, however, their drug prescribingwas inadequate, for instance 10 mg /Kg chloramphenicolfor typhoid.

* Clinic management: The Physician manager was absentThe ML was managing and doing an exellent job.

* Nursing procedures: Isolation, sterilization andcleaning rules were strictly enforced. Hand washing wasnot being done, instead they used gloves frequently.

* Health promotion: Good preventive measures concerningT.B. and Malaria control was being done by an outreach team consisting of six people. The commander ofthe area had put the HWs incharge of all the medicineshops.

62

3. Laboratory.It was an active laboratory with a knowledgeable lab-technician. In addition one ML was responsible for T.B.follow up and rogistera.tion.

4. Non-technical monitoring.Facilities: The MCI Clinic in Pai Sang with a staff oftwo MLs was monitored.Private health providers: Mullah Obaidullah has nomedical background. He examines patients, he does notrecieve a fee, but sells drugs beyond his medicalknowledge. He prescribes high level drugs such asdexamethasone, gentamicin, hormones like progestrone.In addition he uses veterinary oxytocine for humanbeing

D. SHAHRAG HEALTH FACILITY.

1. General appreciation of the clinic.* One out of two HWs was present.* The buildigng was made of mud. It was very old and

consisted of three rooms, two without doors.* Unclean spring water is used.

2. Evaluation of the staff.* Diagnosis and treatment: The medical knowledge of theHWs was good both in diagnosis and history taking.

* Clinic management: The ML clinic manager wasinefficient. A new building was being constructedwithout his supervision.

* Nursing procedures: Aseptic and isolation technics werenonexistant, i.e. using unsterile cotton in infectedareas.


3. Non -technical monitoring.* Private health providers:- A first aider in Shegalai village was providing some

health care. He charged no fee for consultations, butsold drugs. Antibiotics like cloxacilline andchloramphenicol were present.

- Abdul Khaliq, graduate from Union Aid one month FirstAid Course was practicing. He did not charge forconsultation but did prescribe and sell drugs.

63

E. FATn7AT HEALTH FACILITY.

1. general appreciation of the clinic.* Two out of three HWs were present.The building was made of mud and consisted of fiverooms 74ith a newly built latrine.sell water was used.

2. Evaluation of the staff.* Diagnosis and treatment: Diagnosis , treatment and

history taking was satisfactory.* Clinic management: The ML clinic manager was very

organized.* Nursing procedures: Aseptic technics were being used,

but hand washinf was not being done.-K Health promotion: No over all health promotion wasbeing done, on occasion the ML would advice somepatients individually.

64

CONCLUSIONS OF THE SOUTH MISSION

We visited twenty seven health facilities in Southern Afghanistan. Evaluation was carried out infourteen clinics which included the evaluation of thirty HWs. Twenty six of them were MLs andthe other were First Alders.

Kandahar 9 health facilities

Helmand 5 health facilities

General Conditions Of The Clinics:

Most of the clinics were clean, four were not. In general the health facilities had green books andreferral forms. three had no green books.

In all clinics the medical instruments were not stored in sterile or even in clean conditions.

Usually all the staff was not present. There was no division of duties. In Shahrag HealthFacility, Helmand Province only one HW as present and he could not run the clinic alone.

Medical Activities:

Generally the HWs took the history of patient's and examined them. In Helmand Province thefemale patient's were never examined because they are not allowed to go in the clinic. They wereinterrogated outside. Some HWs never examined patient's because their skills were to poor andthey were unable to diagnose. In one clinic the HW was helped by a physician.

HWs nursing skills were poor. For example they never wash their hands before examiningpatient's. This was the situation in Bahran Health Facility, Helmand Province and Ghorak HealthFacility in Kandahar Province.

Specific Diseases And Health Problems:

Malaria, malnutrition and diarrhea diseases are the major important health problems. All HWswere giving antibiotics for patient's with diarrheal diseases and they were unable to differentiatediarrhea from malnutrition.

Health Promotion:

The HWs were evaluated had a good perception of the need of health promotion but they rarely had

65

r

plans to do so. They usually prefer to distribute medicine, since this seems to meet the demands ofthe patient's. No one is concerned with the needs of the connnunity. Due to patient load HWs saythey have no time to give advice and health information to patient's. Mir Wali Health Facility inBaehran, Helmand Province have a TB and Malaria control program but due to non cooperation ofthe local authorities the impact of these programs are very low. HWs have difficulties in referringpatient's, there is no diffusion of information in the area. In dealing with TB and Malaria control.very few patients are referred to large empty hospitals. For example three patient's in a twentyfour bed hospital.

Health care delivery in the area that we saw seemed suitable:

A. However, there was an absence of supervision by physicians.B . Private health facilities were available but the staffs skills and knowledge was poor.

General Problems:

Political information in the health care system: All the health facilities we visited were supportedby the commanders and other authorities in the area. In Kandahar, Arghandab, Khoja Molk. allthe facilities had been by the commanders for security as well as political reasons. More than tenfacilities were disbursed around the bazaar of Khoja Molk.

66

Bagh -e -Pul

MCI Hospital(A two room hosptial)

Dental technician at work.

Panjwai Center Clinic

An HW Lab Technician.

His knowledge is very limited inmicroscopic examinations.

rI.+

XX . 1"44 r- i'--'' - ": ,_,.

Some clinics are more fortunateand have a ML for a Lab Technician.

SHAH MAQ3?IDI CLINICZel Abab -KhkrezThis is a good example ofa well organized clinic.

In some health facilitiesphysical examinations areignored.

`r lDressing room. Dressing

KajakiMCI Clinic

equipment on floor.

sr"

1

A model disorganized clinic.

Arughr MCI Clinic

HW dressing wounds. Hand washing,aseptic and isolation techniques aretotally ignored. This situation occurs

rin many clinics.

f

OP-

SharagIMC Clinic

Drug Store and dispensary.

HW distributing drugs.

,,.{-°

e1L

r.. ;: /

SharagIMC Clinic

An HW distributing drugs.

HWs must perform manytasks and work alone. _

Another disorganized clinic.

r

SharagIMC Clinic

A disorganized dressing room.

rr

HadiraMSH Clinic

HW performing an incorrectphysical examination. In someclinics examinations are completely

ignored.

ChargholbaIMC Clinic

Example of an unorganizeddressing room.

r Panjwai Center Clinic

A good example of a well organized1 clinic. Physical examinations are well done.

pr

1A

ChargholbaIMC Clinic

All instruments are used fordisplay purposes only, notfor patient care. Patientsare not examined for healthproblems only interrogated.

Baoluan

MCI T.B. Center

Explanation of the register.

r

r

r

r

Lilit1o1`l\\`\t ,

CharghelbaIMC Clinic

Unused material anddrugs improperly stored.

r

Improperly stored dressing material.

T r TO THE ^ T * 9 T r ON THE ATTITUDEAì16 iEH._ Tt_ .íE i3EaI0.1 I:-1P,. G , TEOF HEALTH WORKERS CONCERNING THE TçAIidINî_ OF WOMEN

- 47 filled the cquesticnnaire.

Married: Yes 35: : 7 4 íé- No 12:

1. Do you feel that you are able to meet the health care-needs of the women and children in your village?

Ye. 41: 87 c;No 6: 13%

2. Would a woman be more acceptable to teach propernutrition to women in your village?

Yes 40: 85%No 7: 15%

3 Would a woman be more acceptable to provid health careto women in your village?

Yes 40: 85%No 7: 15%

4. Is there now a woman in your village to go to forobstetrics and gynecological care?

Yes 19: 40%No 28: 60%

Question 5 to 8 for married only.

5. Would your honor allow you to permit your wife to work?Yes 16: 46%No 19: 54%

6. Can your wife read and write?Yes 14: 40%No 18: 51%

No answer 3: 9%

7. Would your wife be able to learn about teaching propernutrition?

Yes 16: 46%No 16: 46%

No answer 3: 9%

8. Would your wife be willing to learn the basic ofobstetrics and gynecology?

Yes 19: 54%No 12: 34%

No answer 4: 11%

67

9. Would a widow in your village be allowed to work?Yes 27: 57%No 14: 30%

No answer 6: 13%

10. Bald you be willing to accept the help of a woman inyour village in teaching nutrition?

yep; 45: 96%No 1: 2;n °

No answer 1: 2%

11. Would you be willing to accept the help of a woman inyour village in providing obstetrics and gynecologiccalcare?

Yes 45: 96%No 1: 2%

No answer 1: 2%

12. In what way would you feel most comfortable trainingwomen in community health?

55% Have a mobile team going inside Afghanistan totrain women.

28% Would be willing to train a woman in theirvillage to teach nutrition.

15% Would train a woman in their village to giveOB/GYN care.

68

CMC MONITORING &.

EVALUATION MISSION;

PROVINCE of E3AUHLAN

FACILITIES VISITED

.15,

8 Evaluated and 7

Monitored

EXPECTED 1NUM13EH, OF HW :

NUiIBi:Ei. PRESENT

HWs EVALUATED

45 17 Plus 15 Non

1i stesl in WHO llnt,3hase

21

NAME OF THE FACILITY

AND LOCATION

'

(District - Village)

SUPPORTED

BY

WHO ID

NUM.HE'li.

I

NUMBER

I

NUMBER

OF S'T'AFh'IOV STAFF

IN

Wl-IC)

I

PRESENTI

DATABASE;

}

r( * )

DATE OF

VISTE

,

( M/Y )

`

- --

-

1,-1N

1.N WHO

DATABASE

- LAB

PRESENTI '

h'LOL HEALH CEN'l'Es'H,

Nahrin -

r'lol

MSH

1151

}

-i

j1

1P, 01/08

I

02/023

NN

A13

U'/,

AE

Z U

HA

i'Ali,

lCLINIC

Burka - Center

`1SH

1 'Î

11

2Closed

jM t)3%()Ñ

, 1

04/08

NN

NA

1t1N

I1S

AL

TH

CENTER

Nahrin Bazar

1MC

2111(**i

6l

05/08

,

09j08

l1'

E3UGllAEtA HEAL'T'H CENTER

Nahrin - Buzciara

MSl-1

1109

31

3I E 09/08

(4--*)

i

12/08

NN

SH11{ JALAL HEAL'T'H CENTER

Baghlar) Jacleed-ShirJalal

SCA

Non

Listed

1

2I E

13/08

I15/08

NN

IMAM-QU'l'A1GBA HEAL'T'H CEN

Baghlan Jadeed-Qala

Qazi

1.MG

1038

32

E 16/08

19/08

Nl'

I 1

KHALAGA1 HEALTH CENTEH.

Baghian Sanati-Khalazai

t.iA(,

1664

1

(**)

I3

1 E20/08

(*****)

I

23/08

fff

1

;.

L

iI i

M: Monitoring, E:


Including 4 Vaccinators,

ahsewnt the dad of the

visit-. for working reasons.

2 BHW present were. not.

Ii sd t.eçi

in WHO

I)riI aLase

One of them is working

in SHLKLI JAtAt, LI in e.

One of them is not

listed in WHO Hatahasse.

0

11

1i

11

11

11

11

CMC MONITORING &

EVALUATION MISSION; PROVINCEof BAGMAN

FACILITIES VISITED

:15,

8 Evaluated and 7 Monitored

EXPECTED NUMBER OF H1+1:

45

NUMBER PRESENT

17 Plus 15 Non Listed in

1VI-IO Database

HWs EVALUATED

21T

NUMBER

NUMBER

( * )


SUPPORTED 1NlIC)

l-I) OF STAFF OF STAFF llA7'h',

OE

1,',11

LAB

AND LOCATION

BY

NUMBER

IN WHO

PRESENT

VISTE

IiJ

b.11O

PRESENT

(District - Village)

DATABASE

( M%h; )

DATABASE

hA(.7H-1-GEIZA'l' HEALTH Ci;N'l'E

SCA

1161

Ii;

21/08,

L;aghian Sanati-(,)eshlq

Akhtar

(;;(:

)'27/08i

SHAHA13UD1N CLINIC

SCA

1266

3No(M) M 28%08

NI)

1'uli Khumri - Shahabudi.n

Clinic

E

1

GA1'HAItGAN CLINIC

GAC

Non

329j(18

Ì

Pti

Pv

Yi.il i

Khiumri - Qara Iihani

Li sted

02/09

CHANG AGHLl CLINIC

MSH

19'ï 1

=1

1M (Li /09

N

Puli Khumr.i - Dana

t)4%09

1QUNA

QALA HEALTH CENTER

SCA

1265

tì

L1li/08

v

13aghlan Jadeed-Qona gala

( **** )

I

SAki

H l

DA SHAtl.11) CLl I.0

NSH

Non

`'

M Z1/08

Y.ghian Sanati-3abaGano

iListed

--- '

MULLAH SHAMS HEALTH CENT

MSH

Non

°G

M 22%08

NN

13aghlan Sanati-Road 5

1Listed

,

M: Monitoring,

i,:

hvaluation of the staff.

*x:

One Midwife and One.

M1-i4d

rire pre.tient but not

listed in WHO Dat.nhn

.

***: One i'irst Aider is working

in (r,.1WAl;(,AN

('I.,INI('

.

1,m: One of the Mid Level

Health Workers is in

`;H l li}t

C;L I N I(' .

CMC MONITORING & EVALUATION MISSION;

PROVINCE of HACHEAN

FACILITIES VISITED

.

EXPECTED NUMBER OF 1-1W:

NUMBER PRESENT

HWs EVALUATED

1 5

,8 }':valuated and 7 Monitored

45 17 Plus 1.5 Non listed in WHO Database

21

NAME OF THE H'AC1L1`1'Y

AND LOCATION

`

SUPPORTED

BY

WHO .11)

NUMBER

NUMBER

OF S7'A1'1+'

IN WHO

DATABASE

NUMBER

OF STAFF

PRESENT

(4: )

1)A'l'I; OF

VISTE

(M/E1

\l'

l..

;d1Ù

I.)A'l'AHs^,Sh.

1

UA}?

;

PRESENT

Y,AGH-li-ïvlAlAN. HEALTH POST

NAHR.LN

HUGI)A}tA

MSH

Not

Listed

1.

-t

M 10/0I3

NN

1

I ,

,____

:M: Monitoring,

li:

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73

'

PROVINCE

mmmx

.

-_I

/

-II-

-11

clinic Identification

uxLu'uz

KHALAZAI

mxsoLau.AmnAc

mum/.^^L

r101

v^xv,m

v

(Committee)

'o'r)

(CAC)

(SCA)

's,u)

'/"')

|

Staff

NM 11w2

oxm amo mm/

m112

mmz mm/

nxxz

BHW 1nHwl

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10.0

10.0

10.0

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7.9

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7.5

10.0

5.4

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1.0.0

10.0

10.0

10.0

5.0

10.0

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10.0

10.0

5.0

110.0

10.0

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10.0

10.0

10.0

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10.0

10.0

10.0

10.0

5.0

10.0

5.0

10.0

5.0

5.0

110.0

5.0

10.0

5.0

10.0

5.0

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10.0

10.0

10.0

10.0

10.0

0.0

10.0

5.0

5.0

0.0

110.0

0.0

10.0

5.0

10.0

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10.0

10.0

10.0

10.0

0.0

10.0

6.7

6.7

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1.7

1

8.3

1.7

10.0

10.0

10.0

1.7

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10.0

10.0

10.0

10.0

10.0

10.0

6.3

5.0

5.0

5.0 110.0

10.0

7.5

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10.0

5.0

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10.0

10.0

110.0

10.0

10.0

10.0

5,0

5.0

5.0

5.0

110.0

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10.0

10.0

10.0

5.0

1,Castro Intestinal

9.7

0.8

9.7

9.7 (m.o

5.3

5.7

8.3

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5.5 110.0

7.5

10.0

7.8

5.9

4.4

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10.0

10.0

10.0

10.0 110.0

7.5

8.6

7.5

5.0

3.8

110.0

0.3

10.0

10.0

10.0

2.5

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10.0

10.0

110.0

10.0 110.0

10.0

10.0

10.0

10.0

10.0 110.0

10.0

10.0

10.0

s.o

10.0

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10.0

m." 110.0

10.0

110.0

10.0

10.0

10.0

10.0

10.0 110.0

10.0

10,0

10.0

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m.^

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10.0

3.3 |m.o

10.0

110.0

7.5

6.0

10.0

7.5

5.0

1

7.0

5.0

7.9

5.0

7.5

3.3

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10.0

10.0

10.0

10.0 110.0

10.0

10.0

10.0

5.0

5.0

110.0

5.0

10.0

5.0

10.0

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10.0

x.S

9.0

9.0

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8.1

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4.0

7.5

4.0

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5.3

9.3

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10.0

10.0

10.0

10.0 'w.n

10.0

10.0

10.0

10.0 |m.o

1

7.5

10.0

10.0

10.0

10.0

10.0

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|10.0

0.0

5.0

5.0

0.0

10.0

5.0

0.0

5.0

0.0 110.0

0.0

10.0

5.0

10.0

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10.0

10.0

10.0

10.0

1

5.0

10.0

0.0

0.0

5.0

|5.0 110,0

5.0

10.0

10.0

10.0

5.0

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10.0

10.0

10.0

10.0

5.0

10.0

5.0

5.0

0.0

0.0 110.0

5.0

10.0

5.0

10.0

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10.0

5.0

10.0

10.0

0.0

5.0

0.0

1

5.0

5.0

5.0 110.0

0.0

10.0

5.0

5.0

0.0

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10.0

9.3 1110.0

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110.0

10.0

6.3 1110.0

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10.0

10.0

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6.4

10.0

4.0

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10.0

10.0

110.0

10.0 110.0

10.0

10.0 110.0

10.0

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10.0

10.0

10.0

10.0

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10.0

10.0 1110.0

10.0

0.0

10.0

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CMC MONITORING & EVALUATION MISSION; PROVINCE

of tiAM,',(;A :'

FACILITIES VISITED

.5,

:;Monitored &

2 Evaluated

EXPECTED NUMBER OF HW:

16

NUMBER PRESENT

1-IWs EVALUATED

'l

+INon Listed in WHO Database

NUMBER

NUMBER

(1'

)


SUPPORTED WHO 1U OF STAFF Oh S'l'.A.h'h'

I)V'l'I':

Oh'

LAD

LAD

AND LOCATION

BY

NUMBER

IN

(`'H(.)

PRESENT

VISTE

1;N

will)

l'l;E

SE(N

'l'UA7ÀIiASI?

( M/h: )

DATABASE

r_

`-

.

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SAIIAGH HEALTH CENTER

INC

1i92

i(

U'i /U3

r1

A11iAK

SARI3AGH

( k* )

(i:-t::

)11 /()`.)

1

llOAA13 SHAH l'1±:SANll CLINIC

SCA

1766

E 1:.1/09

NPd

HOYE llOAAH

CENTER

1/09

HOYE UOAAY, CLINIC

GAG

1.666

tì

Clinic

N 11,/0

iv

N

HOYE DOAAB CENTER

Closed

SAIi, BAGH CLINIC

SCA

O1

1MOH/Oh

NN

ll1s1-1 KALAM

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SCA

Oi

fN

IZ/U'1

Nd

i;

Ai 13AK

KHURAM

I

_,Ì

I

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I ' I

j

:M: Monitoring, E: Evaluation of the statt.

:Including 3

VaCClrlal-.oI"'-. who were absent for ldclrli

1'i2S2r)11;;.

**'*

:(.)ne or the 2

MlilJs present was not listed

in WHO Database.

rn

Ii

II

II

II

CMC MONITORING

& EVALUATION MISSION;

PROVINCE of t;ALKtl.

FACILITIES VISITED

:5,

1 Monitored

4 Evaluated

EXPECTED NUMBER

OF HIV:

36

NUMBER PRESENT

:11+ 5 Non Listed

in WHO Wit.has-..

HIVs; EVALUATED

:14

NAME OF THE

li'AC1L1'1'Y

AND LOCATION

'SUPPORTED

BY

WHO Ill

NUMBER

NUMBER,

UV STAFF

IN WHO

DATABASE

1

NUMBER

OF STAFF

PRESENT

( * I

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VI(-i'1'1''

( M/E 1

1..\B

IN WHO

1)A'l'Al;_,.Sh;

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PRESENT!

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CEN'l'h:tt.

IMC

1877

71

i,'20/09

NN

SH()LUAILA

BABA EIVAG

(** )

(*** )

24/09

1-L'NE SINA BALLiHI

H.CEN'l'.

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1935

11

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i:25%09

1íJ

SHC)LUARA

QAL)EEM

28/09

SHA11.11) ZABIHULLAH

CLINI('

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1749

15

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E29/09

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SHULUA1tA

CEN'1'EH,

02/10

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MSH

1158

3:i

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SHULUA1tA

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( ****

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1PI01/10

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Listed

I

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Evaluation of the

staff.

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listed in WHO database.

All of them were not

listed

i n WH(.

rlat.abse .

PROVINCE

xxxAx:Aw

xac:x

(oxx)

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/

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9.7

5.7

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0.0

0.0

0.0

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2.9

2.1

1.4

2.1

0.7

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0.0

0.0

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10.0

10.0

10.0

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10,0

8,3

10.0

6.7

5.0

10.0

2.5

10.0

10.0

10.0

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- NUTRITION

7.5

3.3

7.5

8.8

4.2

|5.7

10.0

7,0

0.8

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1.3

7.0

6.7

6.7

1.7

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i- PATIENT EXAMINATION

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10.0

10.0

110.0

8.0

10.0

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10.0

10.0

10.0

110.0

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5.0

5.0

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9.4

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9.0

5.5

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6.4

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10.0

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10.0

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10.0

9.3

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7.9

8.6

8.6

9.3

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2.9

5.7

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1.4

10.0

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8.1

8.8

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5.6

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6.9

6.9

9.2

8.1

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7.9

0.0

0.0

0.0

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2.5

2.5

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7.5

10.0

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7.5

7.5

7.5

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0.0

0.0

0.0

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10.0

10.0

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7.5

10.0

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7.5

10.0

7.5

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0.0

0.0

0.0

0.0

0.0

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10.0

10.0

I

7.5

10.0

10.0

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110.0

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0.0

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10.0

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110.0

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1

CM(' MON l'l'011, 1 NG & EVALUATION MISSION;

Yh'C)V

N('':

of KAMAN

FACILITIES VLSI'l'EU

:12,

4 Monitored & 8 EvaLuated

EXPECTED NUMBER OF H1V :

_.'/

NUMBER PRESENT

:14

+ 13

IIWs EVALUATED

:18

Non Listed in WHO I)a1 ,';Base

NAME OF THE h'ACI-LL'l'l'

ANI) LOCATION

SUPPORTED

Y,)'

WHO ID

NUMBER

4

NUMBER

OF STAFF

IN WHO

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F-.I!M13Eu

OF s'l'Arv

PRESENT

(>-

I

1):1'I'E OF

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Sl-IAI-IIZN(.11v'

SCA

1482

21

I,;73/Hi

15/Hi

FA'J'MAS'l'l'

HEALTH CENTER

BANYAN CENTER FA`1'MAS''Y

SCA

O.7

,E E

ih/01

20/01

21/011

'2Z/07

SIIL:IV'A QAI)

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11

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h5

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li

21 JO'7

30/07

FOLADI HEALTH CENTER

L',AÎYAN CENTER FOLAllIllAR.A

lMC',

1190

1a

( *XX )

Et

31/01

01%08

ENG. S.

MA'I'LU13 OASEM

IYAMYAN CENTER

SHASHI'UI-,

MSH

2h

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5M

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l~:

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1-, h e start.

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i n WHO Database.

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11

ni^/xu. r^//*:

.ûn

'om`

...".

)


(Committee)

staff

mm

(WW1

xxnz

xxx

mnnz

MIN

uxw/

m/n2

oovx

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5.6

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_iii

U.:2 --

- HEALTH PROMOTION

* unvw/eue

* Activity


- NUTRITION

- PATIENT EXAMINATION

" zen^xni«oe

'



" Wound Care

* First Aid

* Administration of Drugs

" Nursing Procedures


* Datas and Records

" Facility Cleanliness


I

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1

PROVINCE

HAIIYAN


(Committee)

S1l.FA

(SCA)

FATIIATSTY

(SCA)

FOLADI

(IMC)

SIIE

VA

IABDUL FAZAL

(IISII)

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1

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Of

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0.

- SPECIFIC DISEASES

AND HEALTH PROBLEMS

* Pediatrics

.Measles

.Pertusis

.*W.C.H.

.Abmormal Delivery

.Abnormal Post -Partum

Dermatology

.Impetigo

.Allergic skin diseases

* Dental.

* Eye

.Viral conjunctivitis

.Bacterial

* E.N.T.

.Common Cold

.Otitis Media

.Tonsilitis

1.7

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PROVINCE

BANYAN

/`/


1o^mmu,ee)

sx.rx

(ocx)

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,ur»1

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m:/

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* Cardiovascular

.xvvert,"uvn

* Castro Intestinal

.Diarrhea

.Worms

.Gastritis

* Genito Urinary

' /

.Cystitis

* Infectious Diseases

.Malaria

'

.xeniounio

.Typhoid

.um/era

.Hepatitis

p mcvl^sx"leto/

.Back pain

,

* meoronovrxxu,ry

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(; h

EVA1.,UA'l' I ON

PAUL_

TI ES V 1 S 1'l'1:1)

:,

O

EXPECTED NUMBER Oh'

Il1d:

6

NUMBER PRESENT

:

HtVs

h:1'ALUA'l'1:1)

:10

NiSS_I ON ;

1'I,Ov 10iF

Monitored

Non

1,l =tte'rl

WHO

I)ril:-il

I

NAME OP'

' l ' I 1 E

1'A(' 1 Ll'l'Y

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WHO

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rd)Irllil':11

OF

1` : 1 Fr

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NAME OF THE FACILI1A

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EXPECTED NUMBER OF HW: bb

NUMBER PRESENT

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NAME OF THE FACILIn

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EXPECTED NUMBER OF HW :

54

NUMBER PRESENT

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1


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T Equipment and Supplies

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9.7

2.9

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10.0

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10.0

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97

i)

11

11

11

11

I1

II

II

lI

11

CMC MONITORING & EVALUATION MISSION; PROVINCE

nf HHLrtA:"Ji1

FACILITIES VISITED

.'!,

2 Monitored

(V5 Evaluated

EXPECTED NUMBEIt. OF HW: 28

NUMBER PRESENT

:22

HWs EVALUATED

:13

NAMh, OF THE h'ACILl'l'Y

AND LOCATION

SU1?l'OH.'l'1sll

BY

WHO 11)

NUMBER

NUMBER

ON STAFF

IN WHO

DATABASE

NUMBER

OF STAFF

PRESENT

(1

DATE OF

V I S'I`L:

IM/E/

I:.Ì

IN

til

l)A'I' AI;

13ANll-L:-KAJAKI. CLINIC

KAJAK

`1'ANG.L

MCI

16

IL:

0:2/()8

N

13AG111tAN

GHAR

MCI

1628

3L;

I)8/08

10/08

N

MIR WALl SI1AHlll HOSPITAL

liAGH1tAN

I)AIl,A

MC1.

33

16

!=i

(**

)

111/025

15/08

1'

MOSSA QALA

S11AltAG

1MC

5021

?1

L 17/08

N

SAti13AN QALA

liA'l'OGAi

MSH

5027

32

F_'O/OK

'2,3'()8

N N

BAGHRAN

YAYSANG

M('1

1801

i,_'

Ml 1/Oli

IKAJAK.L

'l'ANGl KAJAKI

1AHC

Not

Li steci

6

( m )

.M: Monitoring, E: Evaluation of the starr.

**

:1

of them is not listed in WHO 0at.taheis<-.

**.3 of them are not listed

in Mnsso (,)ai a 111\c Hospital.

r

LAB

1'll L.K Eí,'l'

I(

1/40

PROVINCE

-----------

HELMAND


(Committee)

..h

tIIR WALT SHAHID HOSPITAL

(MCM)

Staff

M11141

(111412

H1113

MHW4

MilW5

1111W6

- HEALTH PROMOTION

* hnowlege

94

8.8

6.9

8.1

7.2

7.5

* Activity

3.6

3.6

3.6

1.4

3.6

3.6


10.0

10.0

5.0

10.0

10.0

10.0

- NUTRITION

0.2

7.3

1.7

3.3

1.7

3.3


I.

Tecnhnique

9.3

7.9

10.0

8.0

3.5

-,.¡:',


10.0

10.0

0.0

5.0

0.0

10.0


8.9

8.3

8.7

7.6

7.2

6.5

* Wound Care

7.1

7.1

5.0

1.4

0.0

2,9

* First. Aid

10.0

10.0

10.0

8.5

6.3

10.0


7.0

7.1

7.1

8.6

7.9

8.0

* Nursing Procedures

7.9

7.9

8.6

5.7

2.9

5.6

-FACILITY MANAGEMENT

8.8

8.8

5.8

8.8

8.8

8,8

* Datas and Records

10.0

10.0

10.0

10.0

10.0

10.0


5.0

5.0

5.0

5.0

5.0

5.0


10.0

10.0

10.0

10.0

10.0

10.0

*Staff

10.0

10.0

10.0

10.0

10.0

10,0

LIL

.I

s0t

1114

'11

511A

h 1

t3

l

Liri0

'

I(1

160.

3333

33;1

1111

2;1

115

11.6

1i

.106

:

9,7

10

.!-

;.

).4

1.4

6.0

0.0

¡0,0

10.0

5,0

16,0

In.0

10,0

1.9

10.0

10,0

4,)

10 .1

1.

1.

10.0

10.0

0.0

10

It

4o

9,0

9.0

1.6

S.1

t.

t...I

lt

1.4

2.3

I17.1;

10.0

5.0

li.:1

9.0

It

t.

10,0

).1

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0.0

tit

10,0

II

1. 6

)1

1l

Y1

1Y

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})

)>

|>

>1

Y

PROVINCE

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mlt^ ,^'/`

`

,'`1;

Faz


tc"m"uroe)

MIR nyo Sum//o HOSPITAL

(n,/)

cAx^/

.m/)

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':n,\

/mv_1

:ô/zx/

(-x)

//mn

Staf

fmou

/mos

/m14o

mo/

/m62

n(

- SPECIFIC DISEASES

AND HEALTH PROBLEMS

/

* Pediatrics

8.3

10.0

5.0

5.0

6.7

n./

0.0

5.0

6.7

(:.7

»'"

s.'

.neay\eu

10.0

10.6

5.0

5.0

5.0

10.0

10.0

5.0

5.0

/v.»

o."

>o

/:.o

.x~rmai^

10.0

/»'«

5.0

5.0

5.0

5.0

10.0

5.0

10 u

5.0

0',

o

* W.C.H.

10.0

10.0

2.5

5.0

5.0

7.s

7.5

7.s

s:o

5,0

^^7

"

10.0

.um^,mxl Delivery

10.0

10.0

0.0

5.0

0.0

5.0

5.0

5.0

5.0

..`

1) ''

/:`'`

10 .1

1

10.0

10.0

5.0

5.0

/»'«

10.0

10,0

10.0

s.o

5.0

o.'

/^,.`

o o, Dermatology

7.0

8.3

5.0

2.5

5.0

7.5

10.0

5.0

u,/

S.5.

"i

.Impetigo

10.0

5.0

5.0

5.0

10.0

10.0

/«'»

5.0

10.0

s.o

10,0

.o5.

11

.Allergic skin diseases

diseases

10.0

10.0

5,0

0.0

0.0

5.0

10.0

5.0

6.7

,x5../

~ Dental

m.o

Eye

8.3

10.0

5.0

10.0

7.5

10.0 110.0

10.0

10.0

7.5

5.0

w.o

w.^

.Viral conjunctivitis

10.0

10.0

5.0

10.0

5.0

10.0 110.0

10.0

10.0

5.0

so

m."

/u.o

'Bacterial

10.0

10.0

5.0

10.0WA

m.n

m.o

10.0

10.0

10.0

5.0

m,',

10.1

1

}

E.N.T.

|10.0

10.0

6.7

x.3

10.0

8.3 |m.o

10.0

8.2

y.}

5.0

o.`

5.0

.Common Cold

'

10.0

m.o

10.0

10.0MA

MA

/m.o

m.o im.o |/o.o

5.0

mo

5.0

.Otitis Media

'o.o

10.0

5.0

5,0WA

s.0MA

MA

,

10.0

5."

S.o

5^0

5.0

.ro"siluis

10.0

10.0

5.0WA

MA

HA

WA

/«.o

10.0 110.0

s.»

m."

5.0

o

PROVINCE

xncoxwn


n/x oxu xxuon xHOSPITAL

r--

xan^/

-I

'committee)

Iwoz)

1

111Cr1

Staff

/om/

1.10*2

mox mow

/11045

mmn 11111W1

m/:z

`R

espi

rato

ry9.4

10.0

6.7

5.8

5,6

a.»

9.2

9.2

.or"^c*,iuu

10.0

10.0

5.0

10.0

5,0

10.0 110.0

10.0

.Pneumonia

10.0

10.0

5.0

5.0

5.0

10.0

10.0

10.0

.Asthma

10.0

10.0

5.0

5.0

5.0

10.0 im.o

10.0

.TB suspected

6.7

10.0

10.0

5.0

x.o

0.7

5.0

10.0

~ Cardiovascular

10.0

os

us

os

ui

/m o

mo

10.0

mo

..

..

..

.

./yne,t~"tiô

10.0

10.0

5.0

5.0

5.0

m.o |mo

s.v

,, Castro Intestinal

8.0

8.2

8.8

6.3

6.3

8.1

9.2

u.s

.Diarrhea

7.5

8.8

10.0

7.5

10.0

10.0

10.0

10.0

.Worms

110.0

10.0

10.0

0,0

0.0

5.0

10.0

10.0

.Gastritis

10.0

10.0

10.0

10.0

0.0

10.0

5.0

10.0

||

|

4. Genito Urinary

6.7

7.5

5.0

5.0

7.5

10.0

10,0

?.s

.Cystitis

10.0

10.0

5.0

5.0

5.0

10.0

10.0

10,0

.

* Infectious Diseases

o.0

10.0

5.0

7,0

6.0

6.0

10.0

8,0

.Malaria

10.0

10.0

10.0

10.0

10.0

10.0

10.0

10.0

.Meningitis

5.0

10.0

5.0

m,o

5.0

5.0

10.0

10.0

.Typhoid

10.0

10.0

0.0

5.0

5.0

5.0

10.0

5.0

/

.Cholera

10.0

10.0

0.0

5.0

5.0

5,0

10.0

5.0

.Hepatitis

10.0

10.0

10.0

5.0

5.0

5.0

10.0

10.0

/

(

* xoycuzvax^le'u/

10.0

10.0

10.0

10.0

10.0

10.0

10.0

10.0

.Back pain

10,0

10.0

10.0

10.0

10.0

10.0

10.0

10.0

* wev,^»y,c^/xtry

5.0

7.5

0.0

5.0

0.0

5.0

10.0

10.0

I

.xnx/,ev

!

5.0

5.0

0.0

5.0

0.0

5.0 |m.o

10.0

L,

L.

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uuxA m"/

'.nx`

u/'//

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r^/c

7.'{

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15.

vv

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5.0

5.0

/".o

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5.0

5.0

0.0

|5.0

5."

n /u.o

^.3

,.5

5.0

5.s

6.4

5.0

5.0

5.0

s.o

5.0

10.0

5.0

5.0

5.0

5.0

5.o

m.o

10.0

m.o

^x

10.0

10.0

7.5

5.0

^'»

5.0

5.0

S.0

5.0

110.0

(

S.o

5.0

S.o

5.0

5 3.0

5.0

»,»

5,0

0.0

5.0

10.0

S.o

5.0

5.0

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5',

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/^.o

10.0

w.o

/./.o x

3 .o

.

. ^..

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s^

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1, ,0

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/o.v

S.»

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7.5

110.0

o.o

sv'

|

|

o',

'...

0.0

.(

.

11

1

Tablet available, *1: number of !-Thop..ri io which h. ittC aa preent, ,2 ,11;),ke -orjr,?

1

PROVINCES li BAMYAN

I NO OF SHOPS 1-7 'H-1

I

VISITED Ill 1

,

I

R :,!!

I GRUZGAN q %1OR q5AMANGAN 1 BALKH

11---1

i

I

BAGHLAN 1 HELMAND !IQANDAHAR i

ill 1 6 I

%

I 5 , IliI

it

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F- - - i

' 3

i11 i t,

1 r.IEDTCINES PI I .,2 l',1

1t

i

.. , .,, ,.,'.2 :,1_ -,.

i,2 1'1 '2 .,1 :,2 7r1 '2

I .IAAPICILLINE 11 1

4

30 i 2

t

30 1 1 , 32 Ii

!

15 1 9

4

ae.fi 1 2i

25.5 3

I

39I

I

1 4

ICOTRIMOXAZOLI s 8

1

iI

It

it

1

,li

li

ii

1 20 1bt

5 1 25

TETRACYCLINE1

1 1 251

1 2 21 II 1

,

25 1

1

1 3 23.3 1 15

,CHLORAAPHENICOL

1

I 1

i

25 1 3 17.3 1 1 28 i 3 1 15

IRIFAMPICINE1

3 43 1

i

1

:

35 7 43.5 1 1 501

I.N.H1

3 8 3 27.3 i 3

ETHAMBUTHOL 3 45

METRONIDAZOL 1 25 1 15 40

CHLOROQUINEi

i 30J f J

1. 10 3 25 1 5

ANTIHELMINTIC1

4 35 5 1 13

ANALGESICS 2 6.5 1 14 4 19.5 1 4 2 21 1 25 1 9 2 7.5

NOVALGIN s 17 3 23.3J

3 18 1 11

N-S-A-I-D 1 20 1 45 1 20 1 13

STEROIDS 1 4 2 22.5

ANTIHISTAMINICS 3 10.3 1 10 15 1 7

BRONCHODILATATORS 2 10 1 15 2 11 1 8.

ANTISPASMODICS 2 22.5 3 26 1 30 1 14 1 20 2 18.5 2 25

ANTIACIDS 2 12 1 30 1 13

ANTIEEMETICSI

1 10

DIURETICS 2 27.5

METHYL-DOPA 2 11 1 15 1 15

VITAMINS 2 10 4 15.7 1 3 4 49 2 30 3 33.7

102

Svruvi :.._ ;1.1,1) 1.--Ai.1::ibl, ,F1.: number ,..

,

1

1

PROVTCE'r; 1 7:DUZGAN 1 fA0-:. kA1A.7:GA': 1 ALCI BAGHLAN IIELAAND i OANDAHAP1i1

,.

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11AITAN

410

4 2

2 395

I 3

1 NO OF SHOPS 1-----'1___,

1

iVISITED 111 1 6

ill

I

i I I

4 AZDI,JIsiES::., 1 :,,

i1 700IMPICILLIN

I

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1

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1

:CHLORAHPHENICOL

INALIDIXIC ACID

1

IMETRONIDAZOL

I

ICHLOROQUINE

1ANTIHEVAINTICS

1ANALGESICS

NOVALGIN

ANTITUSSIF

I

EXPECTORANTS

1

3251

2 640

ti

, 1-.---

117 1

'..---11.---7

I 3

4

- h--1

111 1 6

F--13

t

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1:jI(..I

,2 It ,-2 ,l, .;,2 1H ,-7,,I.

i / 210 1 2501

3 400

r

1 450

3 433 1 400 j 1 500

1 600

1 COO

450 1. 450

250

443 2 670

3

450 I 1

1533 I 1

II

300 175 150

1 450 I

1000

1 650 3 363 3 437

BRONCHODILATATORS 2 525 1 800

ANTIHISTAMINIC 2 505 2 540 1 600 2 317 3 498 3 353r

ANTIVOMITICS

ANTIACID 3 660 9 761 2 605 2 730

ii

6 580 2 475

KAOLIN PECTIN 1 3601

VITAMINS 4 508 5 485 2 660 6 380 5 374 2 513

"TONICS" 8 1206 7 1620 2 1600 1 900 4 382 2 507 1 1150

1 03

ârenteral drugs available, "1: number of chops in which the medicipe was _wewent

PROVINCES11 tt

41:

B.41YANl)

URUZCAq CHOP. bA'1a.:GAN .( 3AL.:Hil q u :1

ii 1

;¡ BAGHL:1`: ;tHEL:Ty'.iD 1 äaNDAIíAP.,!

n ii ü

n It

NO OF SHOPS r-1 If- r¡-.'iSITED I11 I11 {{ 6

1 I

4 7-1 r--1 r--11---7

I 5 .115 {lii i 6 3n d

u 1 i. { 1

{I

1 li

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II I

i I i

It

1

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1 i il 1

1

.`1 1 _ !1:,:1 r !'l -:2 .1:1 .,l

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1_:IPICILLIN1

4 230 r

'

1- 210 1

I

1 230 ! i 5 344 Í` 111

t I

193 ! 1 1 300 j 1 1 1`01 t,

I

1

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Ii

1{-- 1 I 650 ij

}

1 ISOf

1

'PENICILLIN 1 4 215

1

il

236 1,11

I

4 1331

1 9

il

203 11 6

I-

303 280 L 230

1

ICHLOP..,tPHENICOL 1

i

1 180 1!

I

1 160f

1 1

i i

320 1 k 265 2 2901 1

t

1GENITAPTTCi_i11

t ,t

2 275 ) 211

3401

1

1 3 2661'

4 26S1

,I

1

1STftEPTOMYCIN 2 105 4 153 1 2 150 2 85!

1

1 6 110 5 65 (

METRONIDAZOL' Il

1 112 (

ANLGESIGS , 2 150 2 105 12 118 4 1051

1 1 70!

INOVALGIN

I

1 1 ISO i 1 180 2 175 I 31

230 1 11

150

'STEROIDS 2 300 1 4 355 1 2 300 1 1 2 140 , 2 110 1 120

IANTISPOSMODICS 2 180 1 180

!

3 190 i 3 223 ( 2 140

{

1

1

ANTIHISTAì-]INICS 2 951

2 180 1 3001

i

I I 1

BROCHODILATATORSi

1 100

!

1 80 1 180

i

DIURETICS1

2 190 1 2601

2 150

PROGESTERONE1

1

I 2 1000 1 170

1

Calcium i 1 300 2 135 3 110 2 171

ANTIVOMITIC 1 150

NaC1 iLITER 2 2500 2 1250 4 1987 2 1350

DEXTROSE ILITER 2 1155 3 1383

Vit C 4 160 1 120 3 107 2 230 5 138

Vit B-Complex 3 203 1 250 3 70 4 58 2 60 5 149 1 110

Vit B 12 1 30 1 150 2 100

104

_ - I IW Mame:

Vi 1 1 agA:

Date: / / Monitor:

Committee.:

Prov irir.e:

WHO-CMC HEALIHWOIìKER SKILLS CHECKLISIIABLE OF CON I EN I S

Nage

1. PRIMARY Hf=AI_II-1 1

11. HEAI_II-I EDUCA Irrrl: 'SKILLS __. 1

111. ENVIRONMENIAL HEALIH 2

IV. NUTRITION SKILLS 2

VI. IMMUNIZATION 2

VII. PREGNANc ;YVill. DELIVERY - 2

IX. POSTPARTUMX. --- NEWBORN CARE 3

XI. WOMEN'S CARE 3

XII. _ PEDJAIRIUS PAIHOLUGY 3

XIII. WOUND CARE & 1-1RS1 AID 3

XIV. FIRSI AID 3

XV. NURSING SKILL': 4

XVI. _NURSING PROCE1)1IRES 5

XVII. DERMA I ULUGY 5

XVIII. DENIAL 6

XIX. EYE 6

XX. ENI 6

XXI. RESPIRAIORY 7

XXII. CARDIOVASCULAR 1

XXIII. GEXXIV. GU ti

XXV. INFECIIUUS DISEASES 9

XXVI. MUSCULUSKELEIAL 9

XXVII. HEALTH SYSTEM/ MANAGEMENT SKILLS lU

XXVIII. NEURUPSYCHIAIRr lU

WiI(i I:HC IIFnI IIIWttItKllt (jKllIti (:I11-.(;Ill !SI

I. PRiMARY MALTA I / 5_ _ _

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I

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IS, IrroVF?tit.lort of: MnInrta, I)i, rll.ho1

cr)mmt n t i r,al) I.' diseases

14. YACCirlAtion: role in health I)romutr..n

15. RPfPrra t: IH, r1CH, othPr

Child spacing -

11. Pol IoW-Lp Instructions: Prevention, problems Rr home manngement

J

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Il. HEALIII Ei1l1CA11O11: SKILLS I 7 3 (;U11rIfiHI4

A. PIAIIn1.nÇl: (.'3CÌlitlq & (triori Lipiá

R. -Prr!hAr.! Appropriate lPeROr1R

C. identify teaching r'eHol.l) ces

U. ldPrStity epftrc>4')ri.ntq tr"erhlrK,t mel.luxln

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F. Hot.ivßtion of pel'Solt/tanti.ly/c:t)mmtnttty

O. 11tx1PI hehnvior in c.li.11ic practice

.

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3. PERIUSSIS4. IEIANUS

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1. CLEAN IECIINICNIE

2. SIERILE IECHNIQUE

r 3. APPL1CAt1UN OF DRESSINGS

4. 10 Si IX OF SIMPLE INFECIEU MUUNUS.-REFERS C(lNPL1CAIEU CASES

110111 i.rt;ll.ir'il r,t IIP91,/r.r11r1

6. MANAßEMENI OF A9CESSES: lb,U.ANI181011CS. ANALGESICS

1

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V. LOCAL ANAEBIIIESIAt,

11.1. RF.(Xl(iNI1IUN Ilr IX OF DUItN3: 1,9,5 1)1:(i. i f

XIV. F1R91 AID 1S (:1111ti1III:i

A. nirw/Iy, [email protected],lliI IVA , .g'1a,051 r;)r(7t11At.ihn

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C. IMMUHILIZAI ION or INJURY

U. (.'UNIROL OF BLEEUIN(I

E. ID 6t 11t OF MUCK: l'OSIIION, IV FLUIDS

F. PRIMARY IX UF SPRAINS / Fractures

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A l'n 1 11 11 1 n';'ll `;';I1( li l t

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' IEMI'ERA1Ul(E

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ri'ULSE

.RECOONl1lON OF ABNORMAL FINDINGSUSE OF UIOSCOPE

.

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i DOZE CALCULAIIUNCU(iRECI UItt1L AND IOPICAL MEDICINESIN.IECII(tltS: IM

SUB-UI N 1 RAUEItMAL

IV LINES: 91AR1MANAOEMENI

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XXIII. (i1

n. 1111 ff1l1 NI Int IIX 1L ix Ilf IIInRHllfn'

BLUUUY UTARR1tEA WIINIIUI FEVER9LUUUY UTARRIIEA MIIN FEVERAU BI.UWI, NO FEVER

^ MU BI(Xrl, MIIN fEVER

N. N1,. tPanllirlq [or 1)rr9VPtll.lrql clrr1r111Pi

11 , 11Pcrx11111,i(At of. c1111!twAn JV 11ag1'Pr?61 01rlally( It A l . ion

Il. Ilamr)na1.rA Fil) 11Ly (.() 11rPI1.9rP 1gGt:I . I101tu' (11(I1 Pr110111,vI. 1)I4:i I) k-kP I,n

F. II'PAI,mN111, of (Ielryllr,al,lral Wi1.I1:1. 1)I111 _`_.7. Nti 1.111w.

h. fV

CI 1t1t11- 11 1

Ir,1IPr /

W 1 1 1 1 1 : 1 1 1 : 111 r1I I IIw1 iltK l lt ;K 1 1 I a 1:111 1:K 1 I i I

J

J

Xxlll. ßl (x1111'u

t 1 I. pi 1 v, 9 1 1 1, n 1 /;1 , 1 1.,

I .. .;,1111 I,1 I. (, ,I 1

Ì. tly11111,.

5 H<,i 1 inrl mi Ik Ì<+I i:Ì it

1e 4 . WORMS

6. ßA31R1113/. IIr'Illrlr rl1<++rtAN. ItP1'1n1.i1,i, irle l. ltrnynnl.lli--

H. I I I r+) .acn t.P ahrlomr+I lI f'rn11m rnt.ro11 tot' 1.r ;it moor l.

J .. N1a It 'loot Iii I5.. AI't1.1111t-+1.¡r:5t AR nnrrinll -

I _ 1r^r`r'x;11111.ir+11 A I'M IPt t'n I r+I r

1- 1)1r111,11iq! . A'-lr' I t. 1 R

.1_ 111 r+l r:11<,Ireyr11 I.11,1s1I. IlliLin I.

7 Itn I< I I n I 101' g111 r11 en I I.x'tK_ Nr1al: rftr1.,1t y rv'1n1mn1 Inrl.

irinl II I

L

i

r

Recognition r71 R1(InP !L nx r,1 NI h1PPrIi'

W11.h iItt1.1R1 t.x 7:< rFtPI'1nI

1 . IIIq1,i lI I

7. 1 <+w't t:I

XXIV. ßu

(1. III, 111,. 1.r.le.fltlltl 14 Lx tlf1, 11 I I- 1+yn I ol tnl tl I r I 1.1 !1

CY3111131111thrlylli11,11t'Irr11.:11.1I.iry

Z. RENAL MAC

5. IIrr Illnry 4Lo110-1

A. IPnc-:Illilg rn: filPvnni,llHi (11 n11111,,/

I 1J t c,r': t, i t+l 1,1 , IV' . Itytl t,'tln , 1' 1 1111Í-A

5. III 111n1 y I P 1.P.11L 1rNt

6. Uil`f . dx of Ityt.11r,c.nlr' vA, o1.ho1

nr 1 (lLA I nlnngnn

/. liPh11.n.1 I Ps ionn/rl irehnl clnv t"`yt 1h i I t or Clr'1t irlr r 10.1

11:11111'51 1111i

1'nCl'' t

WIIt I r:111: III i11 I IIWt IItKI It ::K I I I:a (:I11 1:1( I 1:i

--XXIV. OU CCJNI .0 I ! 1 . t:I)11111 11I'I -1-

H. Identify & reIPr: -

L1. If"f(t lt'IIlrll 1,(11 °111111 ¡'f, 1111(Ir^^(t:i+lltlfa(I Ln!il.1f-Ir1LY, I("It`1 1I

t)V(^l' % y . (1

i . I@I)t)1,P1 K7" i 1 I l tf^ 1 1,1 I I Ly : f í

1---

_.._.---- _'-

i_(;_ 11P11'nl1ll t,'.1t'(:II111C115(1(111

XXV. INFECI IUUS UISEASES I I r'.(111Itrn1':

Ia. 111, prevention, Leaching, I.x rii -

* 1. MALARIA '

." 1

.

* T. MEMiMQ11ISI A. Septicemia1 i thl.r_1.,IUynI i I.i;1__..

'1 . t :11 1 f Ilrt l i N'Ix .

it. ntll,Ilt ax

I. itrtrr:nll(FtiR

* S. ti1(PII0I0 __ _.

* 9. CHOLERA* 10. NEPAIlI1S

H. itAh t.n.'i HI K t F l A r- ri ) ) nc l., t'01111uI t1l l l.y

' (;Orll,rOI 111nisllrPq

XXVI. MUSCULCISKELEIAL I 7(:Ilrtill-N1:;

A. leaching and use ot gcxxl body mech-Arti(^,q to prevent f11i1ii114 A strain,'

H. :3ymIILr)Inal.ir, Lx ot:

1. Sprains) . :31.1 nllln, 1IICI. MIA (lpîlì") 10,1I,,

inst. t mlp(Ih1 I i!ILifHI

A. tlClnnlrll holy pain '

__

4. CHFäIMIC & ACU1E BACK PA1M

C. iP1f:h basic rlhyal.O!,hPt'A1)y conceptsfor post-injury and polio

L). It) R refer pllyglCA I. CliRahi I 1 Lln9

E. ll), Lnrif:)tlnq. tx nt:

t. Arthritis- Septic arthritis_l.iv_

ih3lr^f)nrt.111'i 1, 1AHhfilnnRt.in arthritis

7. Osteomyelitis

F. I11 ti 1.x n t:

l . Common Fractures

`

2. Common dislocations

U. U]ffP.r"etllaal dx of arthritis vs.

Ar'1.hrR.lAlf1

lingo Y

40i11 1.111 tIl 111 11161111/1'I I 111 :( II11 hl 1I

r I 1 i 1

XXVII. HEALIH SYSiEN/ NANACiI:Hi'NI SRIL{S 1 I Y

j: I:IIÌitü771a

A. 11,11..1 (:)I Irct. Ir>II, n.+nP`l!AlIP-'111, OI (:r)Ilttllllll t 1,y 1 U71 1 t II-

--

I. i.`11CA ,1111'I l',W I.I >1 ) , W 1 1.I1 111 +t, 1 1 1

( 'fit 1rN1 01 DI (11101 .11 /1.1011 1LI1,->11 .

Y, I I OH. 111('1 111 F111 l'.n1 11.1, c11nrJilrv __----^'.5 I1. ti. )111v11.1H1 1>I 111. 11.1,111y II( "

'4. 011 IPAI 1E1'41/INPAI {ENI ItEClNt11S

1-----

* S. USE UF PROPER REFERRAL FORMS

f{, Clinic Matl.acanmra it, ' F:lc1 I 1 t.y . - __

* 1. ENSURING CLEANLINESS/HYGIENE

-

* 2. CORRECi DISPOSAL OF WASIE PRUUUCIS

(:. CI iltic 1-1alacanmPnt: St 111111 it., F. I:101111.

* 1. ENSURES Piä)PER SIURACiE* 2. 1'fA1N1A1N3 MRIiiEN 1HVENIURY.

- I201rc>i'rlrA O1' ItIP(Jtrltif:% mI,(x:k

- HPg1g)II I y OIYJPrI I1('1

-'itrxok l'nl..ltir)11. no Px111rr(I IUr(IrA'. -

H. 1;I iilil` Il0ill111eIIIr11t' 14,1 AO1111,1 ..

* 1. 9UPERYISES AUXILIARY PERSONNEL* 2. PRUYIUES IRA1NiNC1 ONLY IN LUM-

R1SK-lASK3 - - -

l'- Ilr),n>''viF111.i11(1/(:>>nlu11n11 ty 1111.1,'n'II* 1_ iiUf1E V 1 S 1 I S FUR 1 HE PURPOSE OF:

`

a. ;I:r)I 11)w-11) oI h(ln1P r:Arr trir-11i1(.1Or ariv iF,

h. I I( nur, lrarar»Nr,rl P.

c. initreach.for prhvc?rll.ivw II?.4ÌÌ,Íi

r8rF OItr17CM1PR, Po. IH, (:hllt.a(I)nitA

(lír.annn, ar,(-i(Ir,nl. I)1 vr11t.i.-11

F. Crr>I1111{al.ir)11 cll. Set V1(n,1* 1. Identify other healthworkera and

HEALiH FAClL111ES IN IHE AREA

* 2. Cooperates with other health carel'RUVIUERS AS NEEUEU, EU.:

A_',1111nh. ()they 11Wn, cliuic;g, hnal)i1.aJnc". ar1lli tnt,inlj hroqrriln'3(I, Vn''' i 1i;11. i 1 )Ì1 1)1 1 Ktl .1111A

r.. HIIWn .

XXVIII: NEUPoUPSYCHIAIRY I

......-.

,5(:UMMINIS

A. NP1111iIrKty

1. Ih:lrlar11-..__.

f. (;(111VIII.f;)hI19

A. tir: ir 1, t r;a

4 , (:ran9 ' -. -----

H. I)riyrhirrt.t y

1. ANXIEIY.

'l.. nUit.al.jnll

A. I»111n4Rirlli

(:. Wi I,IMII_ 11w.1 ( !iy1Nir,N11r,- _

..-

.

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