Situation Updates:
The Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS) have improved the delivery of basic health services, while less attention was paid to enhance the delivery of tertiary care over the last decade. There are 134 hospitals in Afghanistan, 26 of which are located in Kabul, among which 18 are mostly referral hospitals. The comprehensive assessments of national referral hospitals, conducted in 2012, demonstrated little improvement in the management of hospitals and the quantity and quality of health services. These 18 hospitals offer 2,669 beds with bed occupancy rate of 58 per cent and average length of stay of 9.1 days. The hospitals are run by 3,421 professional staff. MoPH and WHO have identified that strengthening laboratory services is an important tool for correct diagnosis, improvement the quality of care and medical research and surveillance.
Achievements:
- Expanded the patient safety programme to three regional hospitals and seven national hospitals after initial assessment on critical standards of patient safety.
- Conducted two training courses to build capacity of hospital staff on patient safety. Post-intervention assessments on patient safety critical standards in seven hospitals in Kabul indicated improvements on patient safety.
- Provided technical support for the development of a Standard Treatment Guideline for Secondary Health Care. Support includes provision of technical guidelines and supporting one technical person, who is leading the committee working on the guidelines.
- Provided technical and financial support to Patient Safety Focal Point, who has been looking after the implementation of the Patient Safety Programme in the targeted hospitals.
- Supported 25 hospital managers from MoPH hospitals to attend a TOT on hospital management for eight days, organized by WHO EMRO in Tabriz, Iran.
- Supported the development of a national strategy for laboratories.
- Strengthened the capacity of the Central Public Health Lab and regional labs through training of staff on Eliza laboratory testing, PCR, biosafety and biosecurity
Programme Risks and Challenges:
- Insufficient quality of tertiary care and low trust in public hospitals.
- Lack of standard models for public hospitals.
- Lack of a hospital accreditation system.
- Absence of continuous medical education programmes to improve clinical care in hospitals.
- Limited number of skilled laboratory technicians, particularly at provincial and district levels.
- Lack of drug supplies and necessary medical technologies in hospitals.
- Old infrastructure in national and some regional hospitals.
- Low capacity of hospital management.
- Lack of quality standards for laboratories and low-quality lab services.
- Poor regulation of private laboratories.
Way Forward:
- Expansion of patient safety standards to six more hospitals in Kabul and other regions.
- Roll out all modules of hospital mangement training with the aim of training all hospital managers in the country.
- Initiate and promote a medical errors reporting system in hospitals.
- Implement and expand infection prevention and control in existing and new hospitals.
- Improve of biosafety and biosecurity in the labs.
- Carry out laboratory accreditation and ISO certification where possible.
- Use the WHO Laboratory Quality Stepwise Implementation Tool to upgrade the Central Public Health Lab (CPHL) and advocate for its ISO certification.
- Carry out planning and capacity building activities aimed at improving hospital quality.
- Develop National Quality Standards for labs.
