Syndicate content

Health

Securing a prosperous future for Afghanistan amidst challenges

Christina Wieser's picture
Also available in: دری | پښتو
 Rumi Consultancy/ World Bank
According to a recent report, just over half of Afghan children attend primary school and most of them were boys. Photo Credit: Rumi Consultancy/ World Bank


Fueled by unprecedented levels of aid, literacy, school enrollment, and access to basic services, Afghanistan made tremendous progress between 2007–08 and 2011–12. However, declining aid and increasing conflict during the period between 2011–12 and 2013–14 slowed progress, especially on education and maternal health outcomes, as documented by our recent World Bank report, the “Afghanistan Poverty Status Update: Progress at Risk.”

In this blog, we look at how Afghanistan has performed across several important development indicators in the last few years.

Towards a cleaner Bangladesh: Safe water, sanitation, and hygiene for all

Qimiao Fan's picture
 
 The World Bank
Bangladesh has made progress in recent years in the field known as WASH -water, sanitation access, and hygiene. Image courtesy: The World Bank

Community-Led Total Sanitation might be the greatest Bangladeshi export you’ve never heard of.  In countries across Asia, Africa and Latin America, a consensus has emerged that the best approach is Community-Led Total Sanitation, which is widely credited with changing people’s behavior around the world to no longer defecate in the open, which has greatly improved global health.

Bangladeshis can take plenty of pride in these far-away accomplishments. That’s because it is Northern Bangladesh - more specifically the Mosmoil village in Rajshahi district - that pioneered this approach seventeen years ago. Its success at home led to its widespread adoption abroad.

Safe drinking water is a right and proper sanitation is dignity of the citizens. Proper management of freshwater ecosystems and access to safe water and sanitation are essential to human health, environmental sustainability and economic prosperity. Water and sanitation are at the core of sustainable development critical to the survival of people and the planet. Goal 6 of Agenda 2030 not only addresses the issues relating to drinking water, sanitation and hygiene, but also the quality and sustainability of water resources worldwide.

The ‘Global Water Supply and Sanitation Assessment’ by World Health Organization (WHO), United Nations Children Fund (UNICEF), Water Supply and Sanitation Collaborative Council (WSSCC) reported that in 2012 about 40% (2.6 billion) of the world’s population was without access to safe water. Approximately 4 billion cases of diarrhea each year causes 2.2 million deaths, and majority of them are children under the age of five. This situation in Bangladesh is also challenging. A study by Water and Sanitation Program (WSP) wing of the World Bank reveals that Bangladesh incurred a loss of Tk295.48 billion in 2010 due to inadequate sanitation, which is 6.3% of the GDP.
 
Indeed, there is much to emulate in Bangladesh’s remarkable progress in recent years in the field known as WASH -water, sanitation access, and hygiene. Today, 98 percent of the population gets drinking water from a technologically improved source – water which comes from a manmade structure– up from 79 percent in 1990.  Bangladesh also largely succeeded in providing access to basic sanitation. It is estimated that only three percent of the population practice open defecation, down from 34 percent in 1990, thanks to behavior change campaigns and the building of many new toilets. 

But, much has yet to be done. Bangladesh has still a long way to go to meet the Sustainable Development Goal (SDG) of providing universal access to clean water and sustainable sanitation by 2030. The World Bank recently completed a study, the WASH Poverty Diagnostic, which examines the remaining challenges in ensuring access to safe water, sanitation, and hygiene. The findings are startling.

Engaging communities in the Golden 1,000 Days in Nepal

Kaori Oshima's picture
Field survey team in Nepal
A field survey team for the qualitative study holding a focus group discussion with women in one of the SHD project communities. Photo credit: World Bank

In Nepali, “Sunaula Hazar Din” means, “Golden 1000 Days” – which is a critical window of opportunity between conception and the age of two years that, with good health and nutrition, can mitigate the risks of malnutrition that hamper a child’s long-term physical and cognitive development.

Sunaula Hazar Din (SHD) is also the local nickname of the Government of Nepal’s recently completed “Community Action for Nutrition Project”, implemented by the Ministry of Federal Affairs and Local Development and  financially supported by the World Bank from 2012 to 2017. The project aimed to improve practices that contribute to reduced under-nutrition of women of reproductive age and children under the age of two and to provide emergency nutrition and sanitation response to vulnerable populations in earthquake affected areas.

The project used a “Rapid Results Approach (RRA)”, where target communities formed groups of nine members that would collectively select and work on an activity to address malnutrition for 100 days. RRA focused especially on the “1000 days” households– namely, households with children under 2 years and pregnant and/or lactating women and also had community -wide interventions targeted to address malnutrition.  

To better understand the local dynamics around the SHD design and activities, a qualitative study was conducted, with support from the South Asia Food and Nutrition Security Initiative (SAFANSI).

The study team gathered the voices of various stakeholders, including the community members, facilitators, and the village and district-level authorities. Listening to the voices of these stakeholders makes development practitioners and project teams recognize how participatory designs may work as expected – or not – in a specific context.

Karnataka Becomes India’s First State to Safely Dispose Biomedical Waste at all Public Health Facilities

Suresh Mohammed's picture

What happens when infected needles, syringes, plasters, surgical gloves and intravenous sets are disposed of carelessly? Well, for a start, they spread hepatitis and HIV, not only among the poor rag-pickers who unsuspectingly handle them, but also infect all the waste around, multiplying the hazard manifold.  Then, when the waste is not properly incinerated, it causes further damage, polluting the very air we breathe. Liquids wastes are particularly harmful; they can leach into the soil and contaminate the water supply, with often devastating consequences.

Yet it is heartening to see how a few dedicated individuals can make a difference.
 

Nurses using needle cutter to destroy used syringes

Providing better healthcare in Afghanistan – A view from the field

Fahimuddin Fahim's picture
Also available in: دری | پښتو


Although I have extensive project management experience in Daykundi Province, the scale and impact of the System Enhancement for Health Action in Transition (SEHAT) Program is truly inspiring—for example, the 39 centers that deliver the Basic Package of Health Services (BPHS) together serve over 77,000 outpatients per month. In October 2016, these centers managed the delivery of 615 babies, with as many as 69 deliveries in Temran Basic Health Center alone.
 
In fact, when it comes to female health, SEHAT has ensured that there is at least one female staff member in every health center. This has partly been possible because of the successful implementation of community-level education programs, such as the Community Midwifery Education (CME) and Community Health Nursing Education (CHNE). The program has also strengthened community-based health care by setting up health Shuras (councils) in all locations covered by SEHAT and implemented specific controls on qualifications and credentials of health workers.
 
SEHAT is a program of the Ministry of Public Health (MoPH), supported by the International Development Association (IDA), the World Bank Group’s fund for the poorest countries, and the Afghanistan Reconstruction Trust Fund (ARTF), in partnership with multiple donors. An NGO, PU-AMI, was contracted by MoPH between 2013 and June 2017 to deliver BPHS in Daykundi, in line with national health goals outlined by the ministry. These goals include reducing mother and child deaths and improving child health and nutrition. Thus, the program focuses on increasing access, building capacity, strengthening coordination, promoting use of monitoring and evaluation data, and enabling better support for pharmaceutical supplies.

تاثیرات مثبت برنامه صحت در ولایت دایکندی

Fahimuddin Fahim's picture
Also available in: English | پښتو



با آنکه من در بخش مدیریت پروژه در ولایت دایکندی تجربۀ زیاد دارم، اما مقیاس و تاثیرات برنامه صحت وزارت صحت عامه در این ولایت درحقیقت فوق العاده الهام بخش پنداشته میشد – بطور مثال می توانم از جمله ۳۹ مراکز صحی که بسته های خدمات ابتدایی صحی را ارائه می نمود، یاد آوری نمایم که اینها همه به صورت ماهوار بیشتر از ۷۷،۰۰۰ بیمار را مورد معالجه و مراقبت قرار میدادند. تنها در ماه اکتوبر ۲۰۱۶، این مراکز توانستند ۶۱۵ واقعه ولادت را  تحت پوشش کمک های مورد نیاز بیماران قرار دهند، که از مجموع نوزادان، بیش از ۶۹ نوزاد  تنها در مرکز صحی تیمران چشم به دنیا گشودند.
 
در حقیقت، زمانیکه محور بحث پیرامون صحت زنان متمرکز باشد، برنامۀ آموزشی صحت توانسته، تا در هر یک از این مراکز صحی زمینه حضور حد اقل یک تن از کارمندان صحی طبقه اناث را فراهم سازد. این امر قسماٌ از بابت تکمیل شدن موفقانۀ برنامه های آموزشی ماهران ولادی و دایه های صحی محلی میسر گردیده، که می توان از این برنامه های آموزشی و تعلیمی برای قابله به سطح جامعه و آموزش صحی برای نرس ها به سطح جامعه در این ولایت یاد کرد. همچنان این برنامه در تمامی ساحاتِ که تحت پوشش برنامه صحت قرار داشتند، یک عده مراکز صحی در سطح محلات را نیز به کمک شورا های محلی ایجاد و تقویت بخشیده و بالای صلاحیت وظایف و اعتبارنامه های کارمندان صحی نیز تدابیر نظارت و بررسی جدی را عملی مینمودند.
 
برنامۀ صحت یکی از برنامه های کلیدی وزارت صحت عامه می باشد که تمویل مالی آن توسط اداره انکشاف بین المللی گروپ بانک جهانی و صندوق بازسازی افغانستان در مشارکت با چندین نهاد تمویل کننده دیگر بین المللی صورت میگیرد. وزارت صحت عامه جمهوری اسلامی افغانستان از سال ۲۰۱۳ الی ماه جون ۲۰۱۷ موسسه غیر دولتی PU-AMI را در ولایت دایکندی قرارداد عقد نموده بود، تا در مطابقت با اهداف ملی صحی این وزارت، خدمات اساسی صحی  را ارائه و فراهم نماید. این اهداف در برگیرنده کاهش واقعات مرگ و میر مادر و نوزاد و بهبود صحت طفل و اتخاذ تدابیر مشخص به منظور تغذی معیاری میباشد. روی این ملحوظ این برنامه بر افزایش دسترسی به خدمات صحی، ظرفیت سازی، تقویت همکاری و هماهنگی، ترویج استفاده از اطلاعات نظارت و ارزیابی و فراهم آوری تسهیلات برای انتقال و دسترسی ادویه جات متمرکز است.

په ډایکندي ولایت کې د صحت برنامې مثبتې اغېزې

Fahimuddin Fahim's picture
Also available in: English | دری



که څه هم زه په ډایکندي ولایت کې د پروژو د مدیریت په برخه کې پراخه تجربه لرم، خو د عامې روغتیا وزارت له خوا په دې ولایت کې د صحت برنامې د تطبیق اغیز او پراخوالی په رښتیا هم ډېر الهام بښونکی دی – د بېلګې په توګه کولای شم په دغه ولایت کې د هغو ۳۹ روغتیايي مرکزونو یادونه وکړم کوم چې هلته لومړني روغتیايي خدمات وړاندې کوي، چې دا ټول په میاشتنۍ توګه د څه باندې ۷۷۰۰۰ ناروغانو درملنه او پالنه ېې ترسره کوله. د ۲۰۱۶ کال د اکټوبر په میاشت کې، دغو مرکزونو وکولای شول، تر څو د خپلو ناروغانو د زېږون ۶۱۵ پیښو ته رسیدنه وکړي، چې له دې ټولټال نویو زیږول شویو ماشومانو څخه څه باندې ۶۹ یې یوازې د تیمران په روغتیايي مرکز کې نړۍ ته سترګې راغړولې دي.
 
په حقیقت کې، کله چې د بحث محور د ښځو پر روغتیا باندې ولاړ وي، نو د صحت د زده کړې برنامه پر دې توانیدلی، تر څو په هر یوه دغه روغتیايي مرکز کې لږ تر لږه د یوې ښځینه روغتیايي کارکوونکې د شتون زمینه برابره کړي. دا کار تر یوه ځایه پورې د کلیو په کچه د ماشوم د زېږون د ماهرانو او روغتیايي نرس قابله ګانو د روزنیز پروګرام د بریالي پای ته رسیدو له کبله ممکن شوی ده، چې کولای شو له دغو روزنیزو او ښوونیزو پروګرامونو څخه په دې ولایت کې د کلیو په کچه د قابله ګانو  او د ټولنې په کچه د نرسانو د روغتیايي زده کړې په توګه یادونه وکړو. همداشان، دغه پروګرام د صحت د برنامې تر پوښښ لاندې ټولو سیمو کې، د کلیو په کچه یو لړ روغتیايي مرکزونه هم د سیمه ییزو شوراګانو په مرسته جوړ او پیاوړي کړل او د روغتیايي کارکوونکو د دندو پر صلاحیت او اعتبارلیکونو باندې یې څارنیز تدابیر او جدي څېړنه عملي کړه.
 
د صحت برنامه د عامې روغتیا وزارت یو له مهمو پروګرامونو څخه شمېرل کېږي، چې د هغې تمویل د بې وځله هېوادونو لپاره د نړیوال بانک د نړیوالې پرمختیايي ادارې له بودیجې او د افغانستان د بیارغونې صندوق لخوا د څو نورو نړیوالو تمویلوونکو ادارو په ګډ مشارکت تر سره کېږي. د افغانستان د اسلامي جمهوري دولت د عامې روغتیا وزارت له ۲۰۱۳ کال څخه د ۲۰۱۷ کال د جون تر میاشتې پورې د PU-AMI په نوم له یوې غیر دولتي ادارې سره تړون لاسلیک کړی وو، تر څو د ډایکندي په ولایت کې د وزارت له لوري د څرګندو شویو روغتیايي ملي موخو سره سم بنسټیز روغتیايي خدمات وړاندې کړي. په دغو موخو کې د مور او ماشوم د مړینې د پیښو راکمول او د ماشوم د روغتیا ښه والی او د معیاري تغذي په خاطر د تدابیرو نیول شامل وو. له همدې کبله، دغه برنامه روغتیايي خدماتو ته د لاسرسي د زیاتوالي، ظرفیت جوړونې، د همکارۍ او همغږۍ د پیاوړتیا، د څارنې او ارزونې د اطلاعاتو د کارونې دودوالي او د درملو د لېږد او ورته د لاسرسي په برخه کې د اسانتیاوو په رامنځته کولو باندې متمرکزه ده.

A path toward better health for India’s women

Parvati Singh's picture
 World Bank
In India, Members of a self-help group (SHG) like this one discuss women’s  health issues with female health workers. Credit: World Bank

A little over six years ago, Neelam Kushwaha’s first daughter was born weighing 900 gm at birth, severely underweight. Neelam went into labor while working at the local construction site in Jori village, Rewa, Madhya Pradesh, India. Many people work at such local construction sites in rural areas for daily wages ranging from INR 150-280 (about $2- 4$) per day. Her daughter Manvi, was preterm, and Neelam spent months recovering from child birth complications.

Three years later, when Neelam was pregnant with her younger daughter, Sakshi, she quit wage labor and sought employment at an incense manufacturing unit established by World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP) in 2011. At her new role, she earned more and did not engage in labor intensive work during the final months of her pregnancy. Sakshi was born a healthy 3 kilos.

In the course of my field work supported by South Asia Food and Nutrition Security Initiative (SAFANSI) in 2015, I came across several similar stories.

MPDPIP’s livelihood based approach offered several opportunities towards income supplementation for women self-help groups (SHGs) and rural households through agriculture, dairy/poultry farming and local enterprises, among others.

As evident by Neelam’s experience, MPDPIP’s benefits went beyond income and spilled over into health improvement as well.

I learnt that prior to MPDPIP, childbirth in hospitals was difficult due to prohibitively high costs of travel and hospital stay. Pre-existing government schemes such as the Janani Suraksha Yojana (JSY) offer about INR 1,400 ($20) to rural women who opt for hospital deliveries. However, this payment occurs post-partum, and pre-delivery costs have to be borne upfront by pregnant women.

Post MPDPIP, women were able to opt for hospital deliveries with greater ease due to access to credit from their SHGs. This is particularly relevant for Madhya Pradesh as it has consistently fared poorly with respect to institutional deliveries.

Local communities combat climate change in Bangladesh

Shilpa Banerji's picture
Mahfuzul Hasan Bhuiyan/World Bank
Bangladesh is among the most vulnerable countries to flooding and climate change impacts. Photo Credit: 
Mahfuzul Hasan Bhuiyan/World Bank

How can a country vulnerable to natural disasters mitigate the effects of climate change? In Bangladesh, resilient communities have shown that by using local solutions it is possible to combat different types of climate change impacting different parts of the country.
 
Every year, flash floods and drought affect the north and north-west regions. Drinking water becomes scarce, land becomes barren and people struggle to find shelter for themselves and their livestock. In the coastal districts, excessive saline makes it impossible to farm and fish.
 
The Community Climate Change Project (CCCP) has awarded grants to around 41 NGOs to address salinity, flood and drought-prone areas. With the help from local NGOs, communities innovated simple solutions to cope up with changing climate and earn a better living benefiting at least 40,000 people in the most vulnerable districts.
 
Raising the plinths of their homes in clusters has helped more than 15,000 families escape floods, and they continued to earn their livelihoods by planting vegetables and rearing goats on raised ground. Vermicomposting has also helped to increase crop yields. In the saline affected areas, many farmers have started to cultivate salinity tolerant crabs with women raising their income level by earning an additional BDT 1500 a month from saline tolerant mud crab culture in high saline areas.
 
Watch how communities use these three solutions to tackle climate change impacts.

د افغان کډوالو او بې ځايه شوو د بېرته يو ځاى کولو کاري پلان

Shubham Chaudhuri's picture
Also available in: English | دری
 یوه بې ځایه شوې کورنۍ د کابل د یوې ناحیې په یو کندواله ودانۍ کې. انځور: رومي شرکت/ نړیوال بانک

څرنګه چې د جون ٢٠مه د کډوالو نړيواله ورځ نومول شوې، بايد په ياد ولرو، چې د کډوالو ناورين  يوازې په يوه هېواد کې د پرمختګ مخنيوى نه کوي، بلکې يو بل داسې بحران، چې د ودې په حال کې دى، په خپل هېواد کې د ګڼو نورو خلکو کورنۍ بې ځايه کېدنه ده، دغه خلک د کورنيو بې ځايه شوو په نامه يادېږي. د دغې ستونزې د حل په موخه د سترو سياسي او ټولنيزو فشارونو تر څنګ، دا موضوع د نړۍ په څو هېوادونو کې د ودې په حال کې ده.

په افغانستان کې نږدې ۱،۲ميليونه بې ځايه شوي وګړي شته، چې د امنيتي او طبيعي پېښو په سبب د کورونو پرېښودو ته اړ شوي دي. شپږ ميليونه نور کډوال له ٢٠٠٢ زېږدیز کال راهيسې بېرته خپل هېواد ته راغلي، چې په پورتنۍ ياده شوې شمېره ور زيات شوي، کولى شو  ووايو، چې په هرو پنځو افغانانو کې يې يو راستنېدونکى دى. په ٢٠١٦ زېږدیز کال کې څه باندې ۶۲٠،٠٠٠ افغانان يوازې له پاکستان څخه افغانستان ته را ستانه شوي دي.  د بې ځايه شوو او راستنېدونکو دغه ستر هجوم د افغانستان پر ټولنه او اقتصاد ستر فشار راوړى او تر څنګ يې د هېواد سيمه ييز ثبات ته ستر خطر ګڼل کېږي.

کله چې په افغانستان کې د نړيوال بانک د مسوول په توګه وټاکل شوم، د بې ځايه شوو او بېرته را ستنو شوو ستونزو او د  دغوستونزو د افغان حکومت هڅو ستومانه او خپه کړم. د خپلو لومړيو کاري ورځو په ترڅ کې مې د ٢٠١٦ زېږدیز کال په نومبر کې د کډوالو لپاره د ملګرو ملتونو عالي کمېشنري مرکز څخه ليدنه درلوده. دې مرکز د افغان بېرته راستنېدونکو لپاره د لومړي مرکز په توګه دنده اجرا کوله. په همدې مرکز کې د بېرته راستنو شوو لپاره نغدي، غير نغدي مرستې، د عامه پوهاوي او ساتونکي پروګرامونه تر سره کېدل. 

Pages