November 2021 - The Health Cluster in Afghanistan is ensuring health service continuity to the entire population of the country. At the beginning of 2021, the humanitarian situation was already critical due to protracted conflict, frequent natural disasters, drought, disease outbreaks and population displacement, worsened by the COVID-19 pandemic. Even prior to August when the Taliban seized control of the country, nearly half of the population – 18.4 million people – were in need of humanitarian and protection assistance. As of the beginning of November, more than 682 891 individuals have been internally displaced due to ongoing conflict and natural disasters. Current immediate humanitarian needs continue to be the provision of health services, food, hygiene kits, safe drinking water, sanitation and shelter.
The Health Cluster, led by the WHO, has been active in Afghanistan since 2007 supporting health sector coordination and service delivery targeting 10.3 million of the 14.5 million people in need of health assistance in 2021. The Health Cluster has 52 partners[1] of which 27 are delivering health assistance through static and mobile health service modalities in 34 provinces, coordinated through 7 sub-national hubs in Gardez, Herat, Jalalabad, Kandahar, Kunduz, Mazaar-e- Sharif, and Bamyan.
The Sehatmandi Project provides quality health, nutrition and family planning services across Afghanistan. The delivery of health services is contracted out to nongovernmental organizations (NGOs) and uses a pay-for-performance approach to incentivize a focus on health outcomes, particularly for women and children. Due to pause in funding by development donors for the Sehatmandi project, the functionality of health facilities providing the Basic Package of Health Services has been compromised in all regions. The Sehatmandi project was considered the backbone of the Afghanistan health system, as it supported more than 2 300 out of 3 500 health facilities in country, including primary and secondary health care facilities. Without this funding, health care workers have not been receiving salaries for the past 4-5 months and medical supply stocks have been depleted.
© Just for Afghan Capacity and Knowledge (JACK). JACK – a national NGO and Health Cluster partner – delivering services to Internally Displaced People at one of the supported health facilities in Kabul.
To address the critical needs, the Health Cluster immediately started to map and assess health facilities functionality to identify gaps, plan and advocate for the resources needed to ensure continuity of health services. At the end of September, the Health Cluster reported that only 17% of the 2 300 health facilities of the Sehatmandi project were fully functional, 79% were partially functional and 4% had closed. This situation has severely impacted health service delivery and left an estimated 30% of the population without essential health services. Top up funding from the World Bank to support COVID-19 treatment hospitals was also stopped resulting in nine of the 37 COVID-19 hospitals being closed, resulting in disruption of all aspects of the COVID-19 response including surveillance, testing, and vaccination.
Based on needs assessment, the Health Cluster and WHO elaborated the health section of the Flash Appeal: Immediate Humanitarian Response Needs (Sept-Dec 2021) and the WHO Afghanistan Emergency Plan: Meeting the health needs of Afghanistan’s crisis-affected populations. The appeal calls for US$ 66 million to supply priority life-saving aid to 3.4 million of the most vulnerable people, of which WHO needs US$ 38.45 million. On 23 September the Emergency Relief Coordinator Martin Griffiths released US$ 45 million in life-saving support from the UN Central Emergency Response Fund to help prevent Afghanistan’s health-care system from collapse. In addition, the Global Fund committed 15 million US$ to be administered by UNDP. Thanks to the funding raised, all Sehatmandi health facilities are now being supported. At the same time, health partners have scaled up service delivery through static and mobile health teams and reached more people with health assistance in October as compared to previous months.
The Health Cluster provides a valued platform for existing humanitarian partners to share information, coordinate and jointly plan for health service delivery, with the ultimate aim of bridging gaps and maintaining operational health facilities. Prior to the crisis, the Sehatmandi affiliated NGOs were funded and coordinated through the development sector and somewhat detached from humanitarian coordination. The current crisis has proved catalytic in aligning health sector coordination as their activities are currently incorporated within the scaled up humanitarian response and the 16 Sehatmandi NGOs are participating regularly in the Health Cluster meetings.
“The Health Cluster is a solid and stable coordination mechanism. Donors and partners can build on it – says Jamshed Tanoli, Health Cluster Coordinator - to ensure the coordination of the humanitarian response to this health emergency is predictable, effective and efficient. The Health Cluster is advocating for additional flexible and timely funding to mitigate avoidable deaths and respond to the rapidly rising health needs triggered by the escalation of the humanitarian crisis. Without support to the Sehatmandi project and non Sehatmandi health facilities, it is clear that in the coming year the health system and services will collapse bringing a devastating impact, leading to increased morbidity and mortality. In addition, the safe and unrestricted engagement of female staff in humanitarian health activities remains essential to deliver timely, lifesaving services for Afghan women and girls.”
© EMERGENCY. Injured patient being treated at Surgical Centre run by Health Cluster partner EMERGENCY in Kabul.
RELATED LINKS
Flash Appeal: Immediate Humanitarian Response Needs (Sept-Dec 2021)
Humanitarian Response - Afghanistan
[1] 14 international nongovernmental organizations, 28 national nongovernmental organizations, 4 UN agencies, 1 national authority, 3 donors, and 2 observers