Leadership Management and Governance/Afghanistan Trip Report: Assessment of the Afghan Community Based Health Care (CBHC) Department of the Ministry of Public Health

The department's main objectives include assessing the capability of the CBHC department in terms of effective leadership, sound management, and transparent governance practices, examining the appropriateness of selected CBHC interventions, and assessing the role of CBHC in the improvement of community access to quality health services. The assessment of the CBHC department's capability revealed that the department has been successful in developing and strengthening the structure and basic functioning of the CBHC system. The department has also been successful in advocating for CBHC and for Community Health Workers (CHWs) nationally and internationally, maintaining morale and motivation among CHWs, and networking with other stakeholders. The department's Monitoring and Evaluation role is beginning to focus on bigger picture issues, but the process has not yet addressed the issues of low CBHC coverage or utilization in specific provinces. The assessment also highlighted the importance of the CBHC component of the Basic Package of Health Services (BPHS) in addressing the health needs of vulnerable groups, including women and children. The BPHS and its CBHC component have been designed to serve the most vulnerable groups, and the inclusion of women as CHWs has been a key innovation in this CBHC. The department's Capacity-building work has an impressive record of curriculum revision and training of trainers for training programs for CHWs, CHSs, FHA Groups, CBHC Officers, and shura-e-sehies over the past three-four years. However, the assessment also identified several gaps and challenges that the CBHC department may face without external support. These include the need for a more critical look at the CBHC system using available data, the dependence of the CBHC department on the General Directorate of Community Medicine and Urban Health (GCMU) for assuring that agreed numbers of CHWs are selected and trained, and the need for donor support for significant unfinished business. The main recommendations of this assessment include the need for a more intentional and integrated approach to setting and working towards targets for public health programs by the MoPH, including the CBHC department, and the need for the CBHC department to have official and direct access to the leadership of other technical and management departments in the MoPH that are stakeholders in CBHC. The assessment also highlights the importance of the CBHC component of the BPHS in addressing the health needs of vulnerable groups and the need for continued support for the CBHC department to ensure its continued effectiveness. The assessment was conducted from November 7-30, 2013, and involved visits to Kabul, Nangarhar, Balkh, and Herat provinces, as well as interviews with key MoPH staff and consultants, provincial health office officials, staff of NGOs implementing the BPHS, representatives of donor organizations, and Community Health Workers. The assessment also involved the review of key documents, articles, survey results, and reports, as well as Health Management Information System data. The Afghan Community Based Health Care (CBHC) Department of the Ministry of Public Health (MoPH) has made significant progress in developing and strengthening the structure and basic functioning of the CBHC system. The department's advocacy efforts have been successful in promoting CBHC and CHWs nationally and internationally, and its capacity-building work has been impressive in terms of curriculum revision and training of trainers. However, the department faces several challenges, including the need for a more critical look at the CBHC system using available data and the dependence on the GCMU for assuring that agreed numbers of CHWs are selected and trained.