Afghan Health & Development Services
A nonprofit, 501(C)(3), Tax ID: 54-1968322 committed to helping the Afghan people. Established in 1990.

For a healthy society


Recent Annual Report 

For the full report in PDF version click on Annual Report 2018

 

AHDS has served Afghan people, by tireless efforts of its staff and vigorous help of the supporters. AHDS has been able to take firm strides in the field through continuous support from our donors and technical support of partners; Ministry of Public Health (MoPH), Ministry of Economic, Ministry of Rural Rehabilitation and Development (MRRD), local authorities, NGOs, UN agencies and the community leaders. 

In 2018, AHDS provided emergency services and development projects concerning health, community development, immunization, nutrition, education and prevention of gender based violence in Kandahar, Kunar, Uruzgan and Zabul provinces. All the projects were aligned with the national policies and indicators of standards.

We believe that sustainable development is possible only through persistence and continued perseverance in the face of difficulties. A major part of our success was due to responsiveness of the projects, the acceptance we have gained from the communities and the supports they provide.

I would like to express our gratitude and appreciation to the board members and all the staff in the frontlines that make our services possible by their tireless dedication and hard work.

Dr M Fareed Asmand, Executive Director


Project in 2018

Essential Package of Hospital Services (EPHS)

The 100-beds Provincial Hospital of Uruzgan was run by AHDS & Cordaid joint venture. It was funded through MoPH-SEHAT/Sehatmandi program by the World Bank (IDA).

Essential Package of Hospital Services (EPHS)

The 150-beds Provincial Hospital of Kunar was run by AHDS & Cordaid joint venture. It was funded through MoPH-SEHAT/Sehatmandi program by the World Bank (IDA).

Basic Package of Health Services (BPHS)

In addition to the BPHS, it includes Integrated Management of Malnutrition (IMAM), Prison Health, Community Health Nursing Education (CHNE) and Community Midwifery Education (CME). The project was run by Cordaid as joint venture partner in Uruzgan. It is funded through MoPH-SEHAT/Sehatmandi program by the World Bank (IDA).

Emergency Health Services for White Conflict-Affected Areas

The project aims at provision of PHC services through two MHTs and one integrated FATP in Kandahar and Uruzgan provinces. The project was implemented in partnership with WHO funded by OCHA-Afghanistan Humanitarian Fund (AHF).

Provision of life-saving health, psychosocial, GBV, nutrition services

It was done through two MHTs for the people in hard to reach underserved areas of Uruzgan with focus on IDPs. The project was implemented in partnership with HN-TPO funded by OCHA- AHF.

Health, Nutrition and Protection for Vulnerable

The improve access to basic health, nutrition and protection for gender based violence victims (GBV) services through 6 mobile health teams (MHT) to conflict affected people in Kandahar. The project was funded by OCHA-AHF.

Kandahar Institute of Health Science (KIHS)

KIHS has four schools: midwifery, nursing, laboratory technician and pharmacy technician. Funded by Cordaid, KIHS provided human resource for the south region.

Targeted Supplementary Feeding Program (TSFP)

The project supports 22 BPHS facilities to treat acutely malnourished children, and pregnant and lactating women in Uruzgan. The project was funded by WFP.

Citizens’ Charter National Priority Program (CCNPP)

AHDS&SDO joint venture support the communities and their elected Community Development Councils (CDCs), extending from community mobilization to full utilization and monitoring of their block grants in Uruzgan and Zabul. The project is funded through MRRD by the World Bank (IDA).

Social Inclusion Grants (SIG)

As part of CCNPP, SIG is a pilot sub-program, to mobilize the communities and their CDCs stop seasonal hunger by establishing a simple safety net for the poorest in Uruzgan Province.  The project is funded through MRRD by the World Bank (IDA).  

Mor Birth Center

This was a financially sustainable birth center through user fee scheme in Kandahar City.

Malaria control

AHDS partnered with UNDP to control malaria in Uruzgan. The project was funded by the Global Fund.

Nutrition and mortality survey

In partnership with Action Against Hunger (ACF) a nutrition and mortality survey, based on standardized Monitoring and Assessment of Relief and Transition (SMART) methodology, was conducted in Uruzgan. The project was funded by OCHA-AHF.

 

  

Results

2018

 

Outpatient consultations

Mental health consultations

Children fully immunized

Armed conflict injuries stabilized

1,529,289

91,312

21,466

9,900

Malnourished children and women treated

Pregnant women immunized against tetanus

Deliveries by skilled birth attendants

Cesarean sections and major surgeries

28,223

26,104

21,883

3,470

Staff trained in short courses

470 male and 444 female volunteer CHWs

Health staff graduated (associated degree)

Health facilities handed-over

1,397

914

170

69

Community Development Council (CDC) established in two provinces

Community Development Plans (CDP) developed

Well Being Analysis (WBA) completed

Health facilities functional in three provinces

157

88

75

69

 

Nutrition Survey completed

 

 

1

 

               

Healthcare

 

AHDS provides healthcare services as part of development and humanitarian programs. The development part was funded through MoPH. The healthcare included the basic package of health services (BPHS), essential package of hospital services (EPHS) and emergency healthcare in Kandahar, Kunar and Uruzgan provinces. The services were further supported by vertical projects for control of communicable disease like polio eradication, tuberculosis and malaria control.  

The humanitarian part was funded by AHF that provided integrated emergency health, nutrition, psycho-social support and protection for gender based violence survivors.

The services were provided through 69 health facilities:

·    2 Provincial hospitals (PH).

·    1District hospital (DH).

·    1 Birth Center.

·    1 Prison health center.

·    8 Comprehensive health centers (CHC).

·    1 CHC plus (with surgery services).

·    9 Basic health centers (BHC).

·    33 Sub health centers (SHC).

·    12 Mobile health teams (MHT).

·    1 First aid trauma points (FATP).

The health facilities served 1,529,289 outpatients including mental health consultations for 91,312 people. Prime health messages were delivered to 1,235,437 people.

 

 

 

Vaccination/Polio

 

Polio endemic continues in Afghanistan; 21 wild poliovirus cases were detected in 2018 from southern and eastern regions. Two cases were reported from Uruzgan where AHDS was covering by routine immunization.

MoPH Provincial Public Health Directorate implements the polio eradication initiative (PEI); 3 National Immunization Days (NID) and 7 Sub-National Immunization Days (SNID) were conducted in 2018. Comparing to previous years, campaign qualities have improved. The report shows 92% coverage while finger mark monitoring shown 89% in Uruzgan Provinces. In Kandahar and Kunar provinces, AHDS’ target area was a small portion of the population.

AHDS provided technical support to the provincial PEI teams; in addition, facilitated intra-campaign monitoring.  

All the 69 health facilities of AHDS were providing vaccination in the centers, and outreach areas. Measles outbreaks were a challenge all over the country. AHDS controlled 7 outbreaks in Uruzgan where it was responsible to cover the whole province. In addition, having few facilities in Kandahar and Kunar, we took part in control of measles’ outbreaks there as well.

The challenges for full coverage of immunization are: limitations on house-to-house campaigns, pockets of inaccessible children due to insecurity, pockets of refusal, incompetent vaccinators and sub-optimal quality in the areas where supervision is not possible.  

Coverages of Penta-3 vaccine for under one children and Tetanus-2+ vaccine for pregnant women were 95%, and Measles vaccine for under two was 90% in Uruzgan.  In addition, 1,421 children were vaccinated during measles outbreaks.

 


Education

 

The higher education program of AHDS empowers and inspires youth to seize opportunities to enhance economic independence and expand human resources for healthcare.

The Kandahar Institute of Health Sciences (KIHS) as well as Community Midwifery Education (CME) and Community Health Nursing Education (CHNE) schools provided competency based education with appropriate skill labs and clinical training sites.

The graduates in this year:

·    Midwives; 26 females.

·    Nurses; 16 females.

·    Nurses; 24 males.

·    Pharmacy technicians; 33 males.

·    Laboratory technicians; 25 males.

·    Community midwives; 23 females.

·    Community health nurses; 23 females.

All schools were regularly assessed and accredited by the Afghanistan Midwifery and Nursing Education Accreditation Board (AMNEAB). Our schools received the awards of best performance several times from AMNEAB and authorities of the ministry of public health (MoPH).

 

 

 

AHDS has started higher education program to develop human resource for health sector since 2004 in Kandahar and Uruzgan provinces.

A total of 1,104 health staff with associate degree (14th grade) were trained with hands on knowledge and skills.  The deployment rate in their own field of proficiency was 90%.

The graduates from 2004 to 2018:

·    Midwives; 299 females.

·    Nurses; 105 females.

·    Nurses; 363 males.

·    Pharmacy technicians; 127 males.

·    Laboratory technicians; 132 males.

·    Community midwives; 107 females.

·    Community health nurses; 81 females.

These graduates played key role in improving access to maternal and child healthcare and quality of care in the region.  They have been serving the people in the cities as well as the remote rural areas that were lacking not only the professionals but literates as a whole.  

 

Public nutrition

 

 

AHDS implemented Integrated Management of Acute Malnutrition (IMAM) program and Targeted Supplementary Feeding (TSFP) in its three target provinces; Kandahar, Kunar and Uruzgan. The target groups were acutely malnourished under five children, and pregnant and lactating women (PLW).

Screening was done in the villages by CHWs and at the health facilities by the nutrition counselors, nurses and midwives. All the cases of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) were treated in the outpatient therapeutic program (OTP), while complicated cases were hospitalized in the stabilization centers.  

In 2018, AHDS health facilities admitted 28,223 acute malnourished women and children. Ready to use therapeutic and supplementary foods (RUTF and RUSF) were the main treatment regime. The average cure rate was 66% ranging from 78% for the hospitalized children to 56% for PLW. The rate for defaulters of the program was satisfactory low at 3%. The deaths were kept low to 0.2% that mainly happened to the severe cases.  

AHDS and ACF did a SMART survey of nutrition status in Uruzgan Province. It showed global acute malnutrition (GAM) rate 15%, severe acute malnutrition (SAM) rate 4.3% based on weight for height and global stunting 49% among children 6-59 months old; undernutrition among pregnant and lactating women (PLW) based on mid-arm circumference (MUAC) <23 cm was 14%. 

 

Strategic Plan

 

A team from AHDS’ Board of Directors and management staff were assigned to assess the progress towards last strategic plan, monitor new opportunities and challenges; then update and adjust our strategic plan accordingly for the coming five years.

The new strategic plan is based on our twenty-eight years’ experience of working with the Afghan society in various social and political circumstances. The strategic plan (2019-2023) was developed in consultation with the partners, beneficiaries, staff and literature review. In this participatory process AHDS’ vision, mission, core values and strategic directions were thoroughly reviewed and necessary changes were made according to the current situation in the country.

 

Based on the new strategic plan, AHDS services will contribute to the following sustainable development goals (SDGs) 2, 3, 4, 5, 6, 8, 13, 15 and 16.

AHDS’ theory of change describes how to ensure universal health coverage (UHC) and the right to the highest attainable level of health. It can be achieved through promotion of healthy lifestyle, provision of primary healthcare and addressing the root causes of environmental and social threats to health. AHDS’ theory of change stresses the need to improve its ability to identify and respond to such moments. AHDS play its role by advocacy, technical assistance, and provision of development and emergency relief programs. We convene like-minded organizations such as civil society organizations (CSO), private sector, government and the international community.

AHDS advances diversity, equity, and inclusion throughout its internal culture and programs. AHDS focuses on the people with special needs, internally displaced people (IDP), returnees and other marginalized and disadvantaged groups especially those with disabilities. AHDS recognizes the importance of gender equality; therefore, is committed to mainstreaming gender measures.

     


Humanitarian aid

 

Afghanistan was stuck in a worsening cycle of conflict and drought; more than 55% live under poverty line, about 250,000 people recently displaced due to violence. 

AHDS had three projects providing emergency health, nutrition and protection services for the conflict and drought affected people in Kandahar and Uruzgan provinces. The projects were funded by the Afghanistan Humanitarian Fund (AHF) that is managed by OHCA. The services were provided through first aid trauma points (FATP), mobile health teams (MHT) and sub-health centers (SHC).

The main activities were:

·         Essential life-saving trauma care.

·         Rehabilitative care and psychosocial support.

·         Primary healthcare (PHC) services.

·         Integrated Management of Acute Malnutrition (IMAM).

·         Protection services and psychosocial support.

·         Psycho-social support and health services to gender based violence (GBV) survivors.

The teams treated 7,155 war injuries; total outpatient consultations were 116,380. Health education and psychosocial consultation covered 25,849 people. Midwives attended the pregnant women; antenatal visit reports 2,372 visits. Number of acutely malnourished women and children treated was 1,554. Healthcare, psycho-social support and dignity kits were provided for 3,180 GBV survivors. 

Outbreaks of measles were controlled and reported to the national disease surveillance and response (NDSR). To protect further spread in the villages, 2,040 under five children received vaccination and vitamin A supplement.  

Do not harm and the four humanitarian principles (humanity, neutrality, impartiality and independence) led behavior of our teams in the field. The community health committees established in each target area facilitated access and security of the teams.

 

Community Development

 

AHDS aims at community empowerment to enhance economic and social services and community benefits from upgraded community infrastructures and productive assets operated mainly by communities. AHDS provides appropriate technical assistance and support from the start based upon prior experience with successful collaborations that mobilized residents. The emphasis is on democratic selection of office bearers, participation of households in community institutions, inclusion of poor households and addressing women’s issues.

AHDS is facilitating partner (FP) for the Citizens’ Charter National Priority Program (CCNPP) and Social Inclusion Grants (SIG) under pakage-1 in Uruzgan Province. This is a 3-year project.

 

 

In 2017, we were struggling to overcome the cultural taboo against women participation in voting and elections. The main achievement of this year was engagement of women in community development councils (CDC) and the sub-committees.

In 2018, 56 CDC with male and female members were functional, necessary capacity building workshops were conducted for them. As part of SIG activity, they could collect $ 20,000 which was matched with $ 40,000 by the government; it was distributed to 211 very poor families (women headed, disabled, returnees, internally displaced). 

The main challenge in 2018, was lack of access to further communities due to insecurity and restriction by the opposition militants. AHDS had tried several times mediation by the community elders of Uruzgan as well as the surrounding provinces to find a solution for this challenge. Although, in principle the opposition accepted expansion of the program, but unfortunately, the ongoing fighting prevents the result of negotiations to start practical steps.

     

Uruzgan; handover

AHDS entered Uruzgan Province when all other sectors including the health system were almost totally destroyed. In 1995, AHDS started its health works by establishing two comprehensive health centers (CHC) in Tirinkot and Dehrawud districts.  The undertaking of Uruzgan health infrastructure rehabilitation was indeed an enormous task that required day and night work, facing all odds and challenges.  In order to rehabilitate the primary health care system, we established health facilities one by one, trained the health staff, introduced voluntarism, attracted donors and at last expanded the program all over the province. AHDS constructed 14 facilities, rehabilitated 5 facilities badly destroyed and attracted stakeholders to build a provincial office and two other health facilities. It took more than 23 years’ tour to expand from the 2 health facilities to 56 different types of health facilities; supported by 470 male and 444 female CHWs.

AHDS had to compete with the harsh times of lack of professional staff, economic sanctions during Taliban regime, drought, security threats, martyrdom of a number of health staff, kidnaps and robberies on top of the cultural barriers prevailed in the area.

AHDS attracted interest of donors to contribute in rehabilitation of health system in Uruzgan. Our donors were WHO, UNICEF, European Commission, UNDP, UNHCR, Cordaid, Stichting Vluchteling, Mercy Corps, Bill & Millenda Gates Foundation, IOM, GAVI Alliance, the Global Fund, WFP, UNFPA, Direct Relief International, Americares, Help Germany, Aus-AID, Dutch Embassy, Save the Children and WB/IDA through MoPH. In addition, to improve the quality of care we had partnership with ADA, IbnSina, Save the Children, Action-aid, Healthnet-TPO, MI, ACTD, OHRD, BRAC and IPSO. The total fund absorbed to develop healthcare there was more than 39.7 million dollars in this period.

AHDS has increased access to healthcare services, improved the quality of services in the health facilities and strengthened community involvement and ownership of health services in Uruzgan Province.  Available service utilization and quality of healthcare depend on improving health seeking behavior and healthy practices by the population, especially women.

AHDS is proud of its trust built among the communities, recognition by the provincial and local authorities, respectful relations with all the stakeholders, and smooth and transparent hand over of the BPHS and EPHS projects to its successor NGO. The well-established basic package of health services (BPHS) and Essential Package of Hospital Services projects were handed over to MoPH and SHDP by end of December 2018. The huge provincial office, the provincial hospital, a district hospital, a prison health center, 8 comprehensive health centers, one CHC-plus, 9 basic health centers, 33 sub-health centers, 2 mobile teams, and 472 health posts were handed over.

Facing with the big challenges created by the funding mechanism through the MoPH and interferences of the local authorities, it was not possible to ensure quality of healthcare. Therefore, AHDS decided to withdraw from the EPHS/BPHS business in Uruzgan Province.

For sure, it is not the end of the journey; AHDS continues to serve the people of Uruzgan through its other running and planned programs.

 

Human Resource

 

AHDS could provide 910 job opportunities through its 12 projects in 2018; out of which 32% employees were female.

The staff gained desired knowledge and skill in 118 courses; 18 conducted in AHDS and 100 by other organizations. Training database reports that 1,203 including 711 male and 492 female participants used the training opportunities.

On the job training, internship, was provided for 17 midwives and 4 admin/finance trainees.

Volunteer community health workers (CHW) are the backbone of community based healthcare in the villages. A total of 470 male and 444 female CHWs received refresher training, supportive supervision and basic health kits to take care of their villagers.

 

 

 

 

 

The main challenges were:

·         Interference of both government and opposition authorities in staffing in Uruzgan.

·         Temporary closure of the health facilities during active fights.

·         Restrictions on types and quality of services due to insecurity limiting staff placement and movement. 

·         government army arrested the staff of a mobile health team for 5 days in Kandahar.

As aid workers we will continue to provide support and services to all Afghan people; armed parties must respect the international humanitarian law by not targeting civilians and aid workers.

Any attack, intimidation, violence or threat against aid workers ultimately result in delays in implementation of programs and have a negative impact on the welfare of the people of Afghanistan.

Finance

 

 

Sources of income: the financial supporters of AHDS projects in 2018 alphabetically were: ACF, Community, Cordaid, MoPH, MRRD, UNOCHA, UNDP, WB, WFP and WHO.

The total budget of 2018 equaled to USD 7,307,548.

Expenditure: total expenditure in the year 2018 was USD 5,993,060 that makes 80% of the revenue. The reasons for underspent were delays in fund release by the donors, slow expansion of CCNPP due to insecurity.

In-kind donations: summarized as following:

·          WFP donated foodstuff and medicines for nutrition; cost about US$ 71,498.

·          UNICEF donated foodstuff and equipment for nutrition and neonatal/mother kits; cost about US$ 76,750.

·          MoPH-National Tuberculosis Control Program donated medicines; cost about US$ 45,202.

·          WHO donated medicines and medical equipment; cost about US$ 172,654.

·          Provincial Public Health Directorates donated medicines, medical equipment and delivery kites; cost about US$ 14,764. 

·          Swedish Committee (SCA) donated disability tool; cost about US$ 5,000.

·          Dr Ali Mohammad donated medical material; cost US$ 641.

·          SAARC provided neonatology kits; cost US$ 179.

 

 

Budget/expenditure in 2018

بودجه و مصارف سال مالی 2018

N.

Project Name

Period

Partner

Donor

Budget of the projects for 2018

Expenditure 2018 (US$)

Status

Kandahar Province

1

Kandahar Institute of Health Science

Jan-Dec

2018

Cordaid

             233,558

             226,142

Completed

2

Mor Birth Center

Jan-Dec

2018

Community

AHDS

53,773

53,773

 

3

Emergency Health Services for White Conflict-Affected

Areas

Jul 17-May 18

WHO, UNOCHA, AHF

64,513

55,577

Completed

4

Health, Nutrition and Protection for Vulnerable

Oct 17- Oct 2018

UNOCHA, AHF

449,418

380,833

Completed

Uruzgan Province

5

Sehatmandi; Basic Package of Health Services  (BPHS)

Jun-Dec 2018

Cordaid, MoPH, WB

1,432,283

1,326,442

Completed

6

SEHAT-III; Basic Package of Health Services  (BPHS)

Jul 17-Jun 2018

Cordaid, MoPH, WB

2,047,248

1,628,549

Completed

7

Sehatmandi; Essential Package of Hospital Services (EPHS)

Jun-Dec 2018

Cordaid, MoPH, WB

379,628

346,063

Completed

8

SEHAT-III; Essential Package of Hospital Services (EPHS)

Jul 17-Jun 2018

Cordaid, MoPH, WB

452,588

395,077

Completed

9

Targeted Supplementary Feeding Program (TSFP)

Jan-Dec 2018

WFP

77,250

41,912

Completed

10

Implementation of Global Fund Malaria Grant in Afghanistan

Jan-Dec 2018

UNDP, TGF

67,866

37,505

Continues

11

Provision of life-saving health, psychosocial, GBV, nutrition services

Oct 17 -Oct 2018

HN-TPO, OCHA, AHF

169,548

115,903

Completed

12

Citizen Charter Afghanistan Project (CCAP)

May 17-May 2020

MRRD,

WB

792,068

203,754

Continues

13

SMART and SQUEACE Assessment

Jan -Jun 2018

ACF

31,874

17,551

Completed

Kunar  Province

14

Sehatmandi; Essential Package of Hospital Services (EPHS)

Jun-Dec 2018

Cordaid,

MoPH, WB

554,761

534,929

Completed

15

SEHAT-III; Essential Package of Hospital Services (EPHS)

Jul 17-Jun 2018

Cordaid,

MoPH, WB

501,172

497,641

Completed

 

 

Total Beneficiaries

527,070

 

 

Total Expenditure

USD 5,993,060

 

 

Cost per capital per year

 US$ 11.4

 

                     

 

 



News & Events

Calendar 1398 (2019-20)

AHDS received the AICS Certificate and Award of Best Practice during the Stakeholders’ Coordination for CSOs Empowerment and Certified CSOs Award Ceremony on 31 Mar 2019 in Kabul Serena Hotel. Click here for details. 

AHDS received appreciation letters from the Local Government Authorities. Click here for details 

Dr. Ferozuddin Feroz, Minister of Public Health of Afghanistan received the Best Minister Award in WGS 2019Click here for details. 

AHDS developed its five years Strategic Plan (2019-2023), Click here for details. 

Security incidents have directly harmed NGOs. We call upon  all  parties  to  the  Afghan  conflict  to  end  all  forms  of  violence  against Humanitarian Actors – including NGOs and their employees  click here 

AHDS received awards of best education programs from MoPH and AMNEAB in Kandahar and Urozgan provinces. Click here for details

Afghanistan's Ministry of Economics recognizes Afghan Health and Development Services (AHDS).   Click here to view certificate of recognition.

IRS form 990 click here

 

 

 

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