The poor health status of mothers and children living in Afghanistan as indicated by health indicators shows that the existing health delivery system has been unable to address health needs of all communities in located in Afghanistan . In addition to regular health facility services, the BPHS implementing NGO’s health team based in a health facility conducts mobile health services once every two months to provide mother and child health care services in remote and underserved areas. This has proved to be inadequate. In addition to training CHWs, establishing Health Sub Centres , frequent mobile health services taking place at least once a month are needed to offer safe motherhood, reproductive health, immunization and curative services along with health education on a regular basis.
The principal idea of mobile health services is to establish a number of mobile health teams in each province to ensure the provision of essential and basic health services in remote villages located in geographically hard to access areas; to link community level interventions with BPHS facility-based services; and to encourage greater community participation and community ownership of health services. The implementation strategy of mobile health services was partly based on recommendations from Provincial Health Coordination Committees (PHCCs) in the provinces
To guarantee support and protection to MHT staff, community elders and health shura members from each district will be invited to take part in the recruitment and interview processes. Applications of all candidates will be reviewed by a panel consisting of representatives from AARDO, , MoPH PHD and DHO, BPHS implementing NGO and a representative from health shura from each district. Interviews will be carried out by a panel consisting of technical staff from these stakeholders and a health committee representatives.
BPHS services through Mobile Health Teams
Safe motherhood services will include: antenatal care and postpartum care with a focus on newborn care. Safe delivery services will be provided if a need arises during MHT’s visit. Specific activities and services that the midwife will provide:
- Antenatal care services including physical examination to detect anemia, assess weight gain and progress of fetal growth and to exclude signs of acute or severe illnesses and risk factors; iron and folic acid supplementation; treatment of acute illnesses and counseling sessions to ensure proper home care and education sessions on birth planning.
- Safe Delivery services including active management of third stage of labor (administration of uterotonic agent within one minute after the baby is born; clamping the cord and delivery of the placenta by controlled cord traction with counter-traction on the fundus; and fundal massage after delivery of the placenta); management of complications such as hypovolumic shock, severe pre-eclampsia/eclampsia, and incomplete abortion. Other complications such as newborn resuscitation, prolonged delivery of placenta, and postpartum hemorrhage will also be managed.
- Postpartum care services including physical exam of mothers and newborns, iron and folic acid supplementation; and vitamin A supplementation (200,000 i.u).
- For all newborns, immediate postnatal care after birth which includes drying, warming, cord care, prophylactic eye care and breastfeeding. In addition, they will conduct early postnatal visits to examine all newborns and see if they are kept warm and breastfed properly, and to exclude any danger signs and needs for referral. These early postnatal visits are also an opportunity to immunize newborns and encourage exclusive breastfeeding.
Midwives will work closely with CHWs during mobile visits, especially female and educate pregnant women and their family members regarding the importance of antenatal care, birth planning, the importance of delivery with a skilled birth attendant and provide iron and folic acid tablets. Each mother (and her family members) will also be counselled for homecare; danger signs and the need to seek care outside the home; immediate and exclusive breastfeeding; birth spacing methods; and the importance of PNC visits at the nearest health facility. CHWs that have identified new potential clients or those requiring follow-up will be notified of the date the MHT is visiting as well as provide them referral slips to go to the nearest health facility.
Birth spacing services will also be provided during Mobile Health visits. CHWs will be proactive in finding eligible clients and educating them about the benefits of birth spacing and available methods. Interested clients will be counseled in an area that provides full privacy and maintains confidentiality and will be notified to get services on a particular day that MHT is visiting. Types of modern contraceptive methods that will be available the MHT are oral contraceptive pills (progestin-only pills and combination pills), injectable contraceptives (e.g. Depo-Provera) and condoms. Clients experiencing side effects or complications will be counselled and referred to the nearest health facility for a follow-up session and advice.
The male nurse and midwife will conduct case management of sick children using national IMCI algorithm and will assess a sick child and classify the illness, identify correct treatment, treat the child, counsel caregivers and facilitate proper home care. Interpersonal Communication and Counseling and health education will also be carried out by during consultation visits with messages on personal hygiene and key health protective behaviors such as hand washing; boiling drinking water; proper disposal of used water and solid waste will be
Vaccinators will conduct immunization sessions during MHT. EPI cards brought by caregivers will be screened to assess the immunization status of a child attending mobile health consultation sessions. The MHT will in consultation with BPHS health facility staff will also help implement supplementary immunization activities including periodic National Immunization Days (NIDs) for polio eradication, Measles Mortality Reduction Campaign (MMRC) and Maternal Neonatal Tetanus Elimination (MNTE) campaigns when these occur.
SHC will also implement growth monitoring and promotion activities. All children 0 to 5 years attending HFs will be weighed and their GMP cards prepared. In addition, exclusive breastfeeding will be promoted through counseling at HSC and through CHWs and health shuras. Vitamin A, iron and folic acid supplementation that have already been described earlier will be an integral part of nutrition intervention. In addition, health education sessions through CHWs will promote use of iodized salt.
The national TB program aims to reduce TB mortality and morbidity; reduce TB transmission; and prevent development of drug resistant strains of TB. Standardized Short-course Chemotherapy (SSC) under Direct Observation of Treatment (DOT) is the backbone of the program.