Afghanistan Health Survey 2012, some of the key indicators

Indicators			Remarks
Maternal Health	Knowledge of at least one method of  modern contraception in currently married women	48.8%
	% of  currently married women  use modern contraception	13.3%
	At least one ANC	52.9%
	Institutional delivery	38.8%
	Skilled birth attendants	48%
Child Health	BCG	80%
	3 doses of polio	49.6%
	Penta 3	46.1%
	Measles	58.4%
	All vaccine  (12-23 months)	29.5%
	Exclusive breast feeding	55.5%
	Complementary feeding	58.9%
Utilization of Health services	Private clinic or hospital	40%
	BPHS facilities	29%
	EPHS	16%
	Hospitalization rate	2.2%	EPHS 56.6%, Private 43.3%
Access to Health Services	BPHS Facility	31.2%
	EPHS Hospital	15.3%
	Private clinic/hospital	38.3%
	Pharmacy	12.82%
	Travel time of less than two hours to nearest health facility	81.8%
	Care seeking outside home	82%

Third Annual Public Health Conference, Health Services Academy, Islamabd, Pakistan

Role of NGOs in Addressing Social Determinants of Health

Najibullah Safi, MD, MSc.HPM

Social Determinants of Health (SDH) refer to broad social factors that lead to or influence health and development. They are the conditions in which people are born, grow, live, work and age, including the health system. These conditions are formed by the distribution of money, power and resources at global, national and local levels. The SDH are mostly responsible for health inequities seen within and between countries. In order to respond to the increasing concern about these persisting inequities in health, it is necessary to involve collaborative partners as catalysts for change at global, national and local levels. Partners can be NGOs, community based organization, government agencies, corporations, academic institutions, and faith communities etc.

Action on health must involve the whole of government, civil society and local communities, business, global fora, and international agencies. The Social Determinants of a Community Health or development may be unique to a particular community or group, or may be part of the larger society. Therefore, it is necessary to use participatory approach to analyze and address SDH.

Collecting community based data and holding consultation with grassroots are critical in understanding the bottlenecks for services delivery. NGOs are well positioned to partner with for data collection, bottleneck analysis and in addressing those barriers to social services delivery. 

The Rio Political Declaration on SDH (October 2011) re-emphased that civil society including NGOs can play an important role in ensuring transparent governance; participation in policy and planning; foster collaboration; advocacy; social mobilization; implementation of intervention addressing the SDH and the establishment of an appropriate monitoring system for measuring the progress.

NGOs are uniquely placed to reach out to communities, to express their needs, and to engage in a grass roots dialogue about SDH and the ways to address them. Experience from around the globe indicates that NGOs are playing an important role in addressing SDH through identifying the various social factors affecting health and development, mediation, community organization, health education and promotion, capacity building at the local levels, establishment of coalition and partnership and advocacy at local, national and global levels.  The role of NGOs in addressing SDH is gradually increasing as they are growing in size, quality and impact. They are shifting their focus from charity to development and advocacy; linked to marginalized groups and local communities on the grass root level; are focusing on alternative strategies in development and contributing to the development of innovative demonstrative models for addressing social and developmental issues.

In developing countries including Pakistan and Afghanistan due to limited capacity and growing perception of lack of transparency the public sector has failed to deliver the results according to the needs and expectations of the people. Therefore, the international partners are increasingly engaging the civil society and NGOs to address rampant poverty, illiteracy, poor access to health care and other social services.

Health related indicators NRVA 2011-2012 (mid-term results, preliminary figures)

No	Indicators		Remarks
1	Total settled population	25,490,000 (male 13177000,  female 12313000)
2	Population under 15	46.2%
3	Sex ratio	107%
4	Dependency ratio	102%	May be one of the highest in the world
5	Average household size	7.5 persons
6	Access to safe drinking water	48%
7	Access to improve sanitation	9%
8	Births attended by skilled health personnel	40%
9	Security assessment
	Very secure	44%
	Moderately secure	34%
	Not secure, not insecure	9%
	Moderately insecure	6%
	Very insecure	7%

Environmental Health

The country’s health care delivery system has been steadily progressing over the last ten years, with an increasing coverage of primary health care services throughout the country. The country has managed to develop its vision, roadmap and policy frameworks that guided its health development drive to extend adequate coverage of basic health service to the majority of the country’s population. Major priorities in the health sector are improve the nutritional status, strengthen human resource management and development, increase equitable access to quality health services, strengthen the stewardship role of MoPH and governance in the health sector, improve health financing, enhance evidence-based decision making, support regulation and standardization of the private sector to provide quality health services, support health promotion and community empowerment, advocate for and promote healthy environments, create an enabling environment for the production and availability of quality pharmaceuticals.

In spite of too many challenges the Ministry of Public Health in the light of the MoPH five years strategic plan 2011-2015, succeeded to develop the National Environmental Health Strategy for 2012- 2015. The strategy focuses on management and leadership, WASH, food safety, radiation safety/protection, environmental hygiene/sanitation, occupational health and house and urban hygiene. The strategy will guide the MoPH and its partners in their work over the next five years.

Access to safe drinking water, improved sanitation and air quality

Afghanistan faces a number of basic environmental health (EH) issues, such as unsafe drinking water; inadequate sanitation facilities, drainage and water supply; improper solid and hazardous waste management; chemical contamination; poor air quality and unhygienic food handling at all stages of supply, storage and transport.

Access to safe drinking water has increased over the last few years. 57% of households obtain drinking water from an improved source (urban 82% vs. rural 51%). However, the country has a long way to go in improving sanitation. Only 31% of households have an improved toilet facility, while another 20% do not have toilet facility at all. Less than half (43%) of households in Afghanistan have regular electricity supply.

Various studies have highlighted the gaps between knowledge and practice, in particular where people have acknowledged the need but could not follow recommended hygiene practices due to lack of water or other facilities.

Drinking water treatments rely only on disinfection by chlorination or some basic filters in certain places of the country. The quality of underground water, which has already been reported with contamination of ammonia and nitrate, is also threatened by construction of septic wells, particularly in urban areas.

To date, limited data has been compiled on air pollutant emissions. Preliminary data indicates high amounts of dust and polyaromatic hydrocarbons in the air, which is most likely originated from vehicle exhaust emissions. MoPH estimated that more than 3,000 people may die only in Kabul because of air pollution every year.

Total population (CSO 2012)	27,000,000
Access to improved source of drinking water*    %      Urban  % Rural    %	57 82 51
Appropriate treatment of drinking water** %	20
Population live in households using improved sanitation facilities*  % Urban  % Rural    %	31 60  25
Households use a specific place for hand washing*  % Urban  % Rural    %	60 83 55
Household with regular electricity supply**  %	43

                   

     *MICS 2010     **AMS 2010