The project has been implemented by Bakhtar Development Network (BDN) in Hirat province through 63 HFs (HSCs 17, BHCs 25, CHCs 17, CHC+1, DHs 3 and 810 HPs) to serve 1,052,103 populations for a period of PCH project.
BDN offered all components of BPHS through 3 DHs, 1 CHC+, 17 CHCs, 25 BHCs, and 17 SCs and 810 HP in the province. These services offered at 6 standard types of HFs, ranging from outpatient care at Sub Centers (SC) and Basic Health Centers (BHCs), to outpatient and inpatient services at Comprehensive Health Centers (CHCs) and DHs.
IBNSina a local NGO was partner in this project. The project was implemented with close collaboration with from the beginning till quarter 12th. IBNSina had withdrawn from project in quarter 12th and all 13 health facilities consisting of; 1 DH, 4 CHCs, 7 BHCs and 1 HSCs as well as 299 HPs that were run by IBNSina, the sub-contractor for BPHS implementation, in four districts of Herat (Shindand, Chesht-e-Sharif, Adraskan and Farsi) were taken over by BDN.
In addition, BDN have taken over responsibility of 9 SHCs in January 2014 for the BPHS service delivery from SM/MoPH/PPHD. In January 2014 the responsibility of mentioned SHCs is handed over to BDN and supported through PCH project till end project June 2015. Given these facts, BDN was perfectly in a better position to coordinate BPHS service delivery at all levels.
The general objective of this project was to enhance and improve accessibility of project coverage population to quality health care services in line with the BPHS (MoPH) strategies and policies.
The specific objectives are:
- To improve quality of services
- Expand access of the coverage population to the primary health care service delivery system
- To focus on strategic BPHS interventions and cross cutting issue
- To plan and implement cross cutting issues like behavior change communication, capacity development, M&E
- To ensure effective management and operation of the project
The project has been implemented according to BPHS by Bakhtar Development Network (BDN) in Hirat province through 63 HFs (through 63 health facilities including 3 District Hospitals (DHs), 1 Comprehensive Health Center-Plus (CHC+), 17 Comprehensive Health Centers (CHCs), 25 Basic Health Centers (BHCs), 17 Health Sub Centers (HSCs) as well as 810 Health Posts (HPs) to serve 1,052,103 populations for a period of PCH project.
These services offered at 6 standard types of HFs, ranging from outpatient care at Sub Centers (SC) and Basic Health Centers (BHCs), to outpatient and inpatient services at Comprehensive Health Centers (CHCs) and District Hospitals (DHs). These service are implemented in first three years of the project in partnership of IBNSina organization as sub parterre of BDN. Signed MoU with DAC) and PPHD other active partners to ensure the coordinated service delivery and referral system in there catchment area.
In January 2014 the responsibility of mentioned SHCs is handed over to BDN and supported through PCH project till end project June 2015. Given these facts, BDN was perfectly in a better position to coordinate BPHS service delivery at all levels. Aim of the project was to enhance and improve accessibility of project area population to high quality health care services in line with the BPHS (MoPH) strategies and policies.
The project mad extreme efforts to apply successfully proposed strategies with though there was challenges during the project life cycle.
The strategies were focused to three directions: I. Improve quality of health care services. II. Expand access to the services delivery through community based and outreach approaches. III. Focus on critical interventions & Gender.
In the first approach, which is improve quality of health care services encompasses; 1. Strengthening supervision and monitoring system through quality assurance mechanism, assessment of the quality standards and implementation of corrective actions against identified gaps. 2. Capacity building through Cascading Skills & Knowledge Transfers to the Health workers based on needs assessment/technical competency assessment through different method of training consisting of on the job and class based training for various type of health workers. 3. Use of accurate HMIS and other data for improving quality of services and performance. New available Information technology tools applied for strengthening project management. Maintaining a functional data management and reporting system in accordance with MOPH HMIS requirements was one of the major activities toward improving the quality of healthcare services. The second approach was EXPAND ACCESS TO THE SERVICE DELIVERY Through community based and outreach approaches consisting of: a. CBHC planning using Global Position System (GPS): b. Strengthening the CBHC system to promote health in communities. c. Period and regular outreach activities. The third was; FOCUS ON CRITICAL INTERVENTIONS & GENDER trough special focus on all critical interventions as outlined in the revised BPHS. Given the shocking maternal, infant and child mortality rates, more concentration was on child health and safe motherhood/reproductive health interventions.
The project managed by Project Management team including, Technical Manager, technical team and supervisors assisted Project Manager in monitoring, supervision. Totally 40 staff recruited in Hirat Sub office. At central level, the PCH lead Project Director based in Kabul along with its technical were responsible for providing the required technical and managerial support by overseeing the project activities. The project activities and its scope of work were coordinated closely with all stakeholders such as; community members, national and international agencies at province level, MoPH and PPHD.
Controlling mechanism was maintained thorough of project life cycle. The tools used for this purpose were: adherence to project work plan and its scope; observation and compliance to the organization policies in regard to operations services for logistic and procurement & supplies; standard operational procedures, policies and tools used in financing and approach for good pharmaceutical management and rational use of drug though strong supply management system established in the project.
Along with, monitoring and evaluation were applies through diverse dimension and tools. Annual Household Surveys was of theses and applied three times as follow; 2010, 2011, 2013. Catchment Area Annual Census were conducted through health workers of relevant HFs from their catchment areas every year. More importantly, external/external evaluation, monitoring and supervisions were conducted as per plan and need.
Generally, the summary results indicators consisting of Institutional deliveries, OPD, ANC, PNC reflect a good achievement during the project with few fluctuations.
Immunization services like PENTA3 in under one years old children and TT2+ in pregnant women shows an ascending trend along with CHWs family visits and CPR.
TB cases notification had its elevation in 2011 and remained flat for two consequent years and again flow it ascending trend in 2014 and 2015.
Through the aforementioned inputs the output results shows a positive changes and improvement in the e following indicators relevant to access and quality of the services like: number of HFs raised from 52 to 63, IBNSINA was responsible to implement BPHS in 13 HFs in first three years of PCH as sub partner with BDN, since January 2012 BDN carried out all HFs activates in Hirat PCH project after withdrawal of his sub partner. Number of active HPs also increased from 792 to 810. Indicators relevant to quality of services reflect significant good achievements such as; number of HFs with properly staffed as required by BPHS raised from 15 to 47 and Number of health workers (DH, CHC, BHC, SC) received NGO provided skills & knowledge transfer courses was 100% achieved. . Moreover, 23 different type of professional trainings were provided for 1792 participant during the PCH project
Though, the good achievement of the project the following challenges posed during the implementation; a. Shortage of technical staff, b. Shortage of female staff, c. Shortage Medical Equipment, d. Low level of monthly salary scale, e. High turnover of technical staff, f. Insecurity: were exist during the project in some districts.