LOGAR PROJECT : HISTORY
Printable text (updated May 31, 2008)
and Photo gallery
The implementation of BPHS by MRCA in the Logar Province started in December 2004, when
MRCA received a grant from the European Commission (EC) to implement the Basic Package of Health
Services (BPHS) according to the Afghan Ministry of Public Health (MoPH) requirements, in the Pol-e Alam, Mohammad Agha, Khoshi,
Azra and Kharwar districts of the Logar Province. As from 13th December 2004, MRCA started the fieldwork in establishing
the provincial Sub-Office and Training Centre in Pol-e Alam and in recruiting the key position staff for the field
activities.
After three months, most of the 18 existing health facilities then placed under its responsibility
had been taken over by MRCA. Most of the health facilities already have a building, or a building is under construction
for the facility, under the umbrella of the MoPH/USAID Program. Staffing for male staff is done and is going well for
female ones. MRCA encourages health workers from Kabul and other locations to move to Logar, providing, whenever possible
and with support of communities, accommodation facilities and a job to their spouse or a family member.
In August 2005, MRCA received funds from UNFPA (United Nations Population Fund) for the
building and the functioning of two Emergency Obstetrics Centers (EmOC) in Azra and in Kharwar districts.
As extremely bad roads - most of the time blocked by snow in winter and floods in spring - and unavailability of
obstetric services are indeed the leading causes of maternal mortality in those two districts located in remote areas,
the set-up of those two facilities is a major step forward to ensure access of pregnant women to safe and clean
delivery facilities.
In August 2006, the French NGO Aide Médicale Internationale (AMI) hands over to MRCA all the HFs run in Baraki Barak and Charkh Districts, including one District Hospital (DH). That means that about all of the Logar Province HFs are now placed under MRCA responsibility.
Renovation and equipment of all health facilities began in spring 2005 with special focus on the
two District Hospitals (DH) located in Pol-e Alam and Mohammad Agha, as there was no operation theater in both of them
and, in the second one, no In-Patient Department (IPD). MRCA's partner, GERES, installs energy saving devices in the
building of the two hospitals.
Renovation of Nayeb Aminullah Khan Hospital in Pol-e Alam started with the rehabilitation of the Operation
Theater and Radiography room, the installation of electricity, functionalizing the dental and laboratory units
and equipping the emergency and recovery rooms. Construction of both the female ward and the operation theater in
Shahid Shafiqullah Lodin Hospital in Mohammad Agha is also going on and it is expected that the construction work
will finish by December 2005.
At the end of June 2005, the Pol-e Alam Nayeb Aminullah Khan Hospital OT was ready for serving the emergency surgical cases as well as scheduled operations. A few months later, the first two caesarian sections ever made in the Logar Province are successfully performed in that hospital.
The renovation of buildings, the construction of surrounding walls and incinerators, and the equipment of all HFs continued until the end of year 2005 and during year 2006. Medicines were provided to all HFs according to their needs. Great care is taken in this regard as far as access to HFs in winter is concerned (Stock of medicine for six months is needed for Azra and Kharwar HFs and EOCs).
MRCA developed training action plans during the first quarter of year 2005 for CHW (Community Health Worker) Trainers/Supervisors, a long term action plan for CHW training itself, as well as an action
plan for the project's medical staff, both class oriented and on the job. Training action plans are developed
based upon the priorities and are supported by training need assessments.
MRCA selected two CHW Trainers/Supervisors (one male, one female) from each of the target districts -
except from Kharwar where only a male CHW Trainer/Supervisor was ready to work - and launched a two weeks initial
Training of Trainers (ToT) and CHW training course in April 2005.
Training activities continue during the second quarter of year 2005, with training of pharmacists, CHWs
(83 males and 59 females) and persons in charge of the Health Facilities (HF) for the HMIS (Health Management
Information System) implementation, according to the MoPH policy. MRCA staff are also receiving other, pregnancy or
immunization related, trainings.
MRCA opens a Community Midwifery School in August 2006 in Pol-e Alam thanks to UNFPA funding. The students are provided with theoretical and practical training, within the framework of the nation wide Community Midwifery Education Program (CMEP).
On December 25th, 2007, a graduation ceremony was held for the first batch of 20 midwifes, who were awarded with their diploma by HE Dr. S. Amin Fatimie, the Afghan Minister of Public Health. A second batch started its training during Spring 2008.
MRCA strengthens the provision of integrated outreach services in remote and scarcely populated areass.
Whereas BPHS is a quite successful policy that has resulted into satisfactory coverage of basic and secondary health services to the major proportion of the population, the geography and the rude climatic conditions in remote districts, the scattered pockets of population, the absence of basic infrastructure such as roads and bridges over the rivers, ethnic and cultural barriers and so on, all have posed questions to the definition of the BPHS HFs, which is based on the number of population in a given area. That led MoPH to propose the establishment of smaller size HFs, called Sub-Centers (SC) and to promote the provision of regular integrated outreach services, which well fits with Azra and Kharwar districts needs.
This considered, MRCA continues to manage Azra and Kharwar districts EOCs, and in June 2007 starts operating one Comprehensive EOC, two SCs and two mobile clinics, with the objective of strengthening the provision of outreach services for these specific districts where numerous nomadic people stay during the summer season.
After three years of operation 750,000 patients have attended MRCA run HFs in the Logar province, in pace with the buildings renovation, the HFs equipment, and the medical staff recruitment and training.
About 8,000 patients were hospitalized. Some 2,500 surgeries, 15,000 dental and 6,200 physiotherapy interventions, 18,000 laboratory exams and 530,000 immunizations were performed. There were more than 7,000 save deliveries in HFs. Almost 585,000 people received health education. Last, but not least, more than 1,500 health workers were successfully trained.
RECONSTRUCTIVE SURGERY UNIT (RSU) PROJECT : HISTORY
Printable text (updated May 31, 2008) and
Photo gallery
The Reconstructive Surgery Unit (RSU), embodied in the center Kabul Maiwand Hospital, is a 30-bed Unit dedicated to reconstructive and plastic surgery which has been operated non-stop by MRCA since February 1996. In December 2007 MRCA started a new such unit, the BRSU (Burnt Reconstructive Surgery Unit) on the Regional Mazar-e Sharif Hospital campus (Balkh Province), a 20-bed capacity unit including five beds dedicated to severely burned patients.
The RSU treats patients coming from all parts of the country including the remote areas. Most of the disabilities treated are congenital disabilities (cleft lip, cleft palate, clubfoot, etc.), burn after-effects and neoplasms. The RSU is the only teaching hospital habilitated for the training of plastic surgeons in the country, through a 3-year training curriculum. From its start, six surgeons, including two women, graduated from RSU, and three more are presently getting trained in this specialty.
Started in February 1996, the RSU operated on during the whole taliban era. Thanks to a grant from
the French Ministry of Foreign Affairs, in 1995 MRCA rehabilitated the thirties era old Maiwand hospital, when it had suffered
from post-communist civil warfare. The RSU had started its activity for six months when the Taliban siezed Kabul
and enforced draconian regulations against women circulation and activity. Considering that support to the most
vulverable population must continue, MRCA succeeded in solving the issue by a strict gender segregation for staff and
patients within the RSU premises. A formal agreement was then obtained from the Taliban to pursue activity with the
entire staff, including female workers. Despite numerous technical or financial aphazards, work proceeded throughout
the regime.
RSU Project now comes within the scope of the reconstruction of the Afghan health system. The reconstruction
of Afghanistan begins in November 2001, following the fall of the Taliban regime. MRCA re-opens discussions with Afghan
Authorities, donors and others humanitarian actors, in order to find the most efficient ways to provide support
within the scope of its activities, in particular within the RSU Project.
In May 2003, Mrs Chirac, the French First Lady, pays a visit to RSU with Afghan and French prominent figures,
greeting MRCA for the support given to the Afghan disabled population.
At the end of 2004, the Maiwand Hospital is handed over to MoHE (Ministry of Higher Education). Agreement is
signed in April 2005 between MRCA and MoHE, by which the management and the running of RSU is granted to MRCA,
within the same premises. Moreover, it is specified that, once plastic surgery curriculum will be finalized, RSU
will receive official recognition as Training Center in plastic surgery. Besides, the two RSU senior surgeons
receive official agreement as plastic surgery trainers.
MRCA is now in the process of reviewing its strategy for improving the services provided by RSU and for
developing the scope of its future activities.
Since 1996, more than 18,000 patients received medical treatment, 66 % of whom were women
and children. Near to 8,000 patients were hospitalized and more than 9,000 operations - 45 % concerning children -
were performed in plastic and reconstructive surgery.
At the end of 2007, four surgeons (2 male, 2 female) have successfully completed the 3-year training
course in reconstructive and plastic surgery. Three male surgeons are still under training. Besides, 11 surgeons received short term training in this specialty.
