Kabul evaluation report : draft only / by Jonathan Patrick and Hazel Simpson
many of whom are not particularly keen to share information and most are not interested to coordinate their activities. The MoPH are keen to coordinate health activities but lack cooperation from the players and while ACBAR is making a heroic effort it too lacks the cooperation and also the necessary technical manpower. Neither UNICEF nor WHO appear willing to take any responsibility for coordination. 2. Kabul is subdivided into 15 districts numbered one to 12 and 14 to 16. There are 19+
... ls, 40+ clinics and over 25 MCH clinics, 60 mini health centres, numerous basic health centres in Kabul city alone in addition to a central blood bank. There are also thought to be numerous undocumented and unreported private and public health facilities in the city. No survey was carried out on private health care in the city but it appears that where no public facilities exist private health services are available. 3. MoPH run almost all of the MCH services and general clinics throughout the city. Hezb-i-Wadhat run a few clinics in the west of the city. The clinics are, theoretically, comprehensive MCH clinics offering curative services, under 5 and antenatal. monitoring, and health education. AICF run feeding centres in 18 of the MCH clinics and MoPH with support from UNICEF have 16 fixed vaccination posts throughout the city . TDH are running a pilot midwife home visiting programme from 5 of the clinics. 4. UNICEF and MoPH work together to ensure EPI coverage in Kabul Province. Kabul City currently has 45 fixed vaccination centres and each district outside the city has 1. There is a plan to increase this number during 1996 and to train 65 mobile vaccinators in the villages. The fixed centres are all located in MoPH or Red Crescent MCH and polyclinics. MoPH feel they have enough staff to cover the EPI programme for the province and do not wish the involvement ofthe NGO's. Relations with AVICEN have deteriorated. 5. Both ICRC and MSF have good emergency capacity in Karte-se, Wasir Akbar Khan, Military and Jamhuriat hospitals. ICRC has emergency surgical supplies for 8 months under present security conditions. MSF has emergency surgical and drugs stocks for six months for 300 patients. MSF can also cope with cholera (500 patients) and measles epidemics in the city. Other agencies have buffer stocks for their own health facilities and can provide medicines and logistical support in an emergency although probably only ICRC and MSF are capable of taking the lead in an emergency response. At present no agency is collating basic health data and without this data it will be impossible for agencies to react in good time to any outbreak of disease. No agency has offered to take responsibility for data collation or dissemination. 6. All the health NGO's spoken to bring their drugs in from Europe. PSF have a large and comprehensive stock of drugs which they prefer to distribute via NGO's. UNICEF also provide kits to many ofthe health facilities. There are a large number of private pharmacies throughout the city and those visited by the team were well stocked with basic drugs although the pharmacists stated that it was difficult to get good stock into Kabul. The drugs were coming mainly from Iran, Pakistan, India and China. 7. While there were gaps in the current provision of services, many of these gaps were in preventative health care or else too disparate in scope resulting in a hoch poch programme filling gaps in a variety of geographical and sectoral areas. This raises the question, "Does Kabul need yet another international medical NGO or does it need better coordination and cooperation between agencies already working in the sector?" There is no work that MERLIN could do that another good NGO could not. It would better for NGOs already here simply to expand operations. Several NGOs have the logistical capacity and expertise to expand operations. Poor cooperation and coordination is the cause ofmany ofthe gaps in the current provision of services.