Shifo & Swedish Committee for Afghanistan are closing immunisation gaps together in Mehterlam District, Afghanistan - reduced workload for health workers

Health service delivery in Mehterlam District, Afghanistan gets a boost - with MyChild Card, Shifo and Swedish Committee for Afghanistan aim to facilitate the registration of children to receive preventive healthcare, and ameliorate health worker burden.

In October 2016, selected staff from Swedish Committee for Afghanistan in Kabul were trained to be District Health Innovators under a Shifo-developed programme wherein attendees gained practical skills in piloting, operationalising and sustaining MyChild Card at national/regional/district levels; and training health workers in its use.

Mehterlam Comprehensive Health Centre where MyChild Card is being used by health worker. (Photo: Dr. Muhammad Naeem Halimi, SCA)

Following the training MyChild Card was piloted in the Mehterlam Comprehensive Health Centre (MCHC) in Mehterlam District in Afghanistan, located in the east of the country 90km from Kabul. MyChild Card is now operational at 12 health service delivery points within the district served by MCHC, and replaces the current paper-based data collection systems in which child health data is split between four different forms/books, all of which have to be written and managed by hand. Ongoing support and peer training are being provided to health workers as they get used to new work processes.

After numerous years of conflict and political instability, Afghanistan’s health system is among the very poorest in the world, and in response the Ministry of Public Health has taken a systematic approach to health service delivery with a focus on women and children. There are many challenges, and despite a clear and inclusive vision, with progress made in the last ten years, health services do not reach all.

Chronic malnutrition is rampant with 40% of children underweight and 54% with stunted growth; and immunisation rates remain low – it is estimated that in 2015, 78% and 39% of one year olds have received the third dose of diphtheria-pertussis-tetanus (DPT3), and measles vaccines respectively, far short of national targets.

The health sector faces severe challenges, characterised by an acute shortage of skilled health workers, especially female; inadequate infrastructure; impaired access to health services due to difficult communications and poor security; and a poor information system. With a very low adult literacy rate of 31%, parental lack of knowledge and misconceptions are some of the barriers to access and utilisation to maternal and child health services. In addition, the low rates of child registration - just 37% of children under 5 are registered make it challenging to know exactly how many children should receive health services.

It is challenges such as these that Shifo is determined to combat with MyChild Card. Developed with support from IKEA Foundation, it enables child registration, ensuring effective follow-up of children; provides health workers with tools that reduce unnecessary administration, freeing them up to spend more time with families and children; and facilitates decision making on every level based on relevant, reliable and timely information. The Ministry of Public Health has endorsed MyChild Card, and entrusted Shifo and SCA to transition from current paper based registers to only MyChild Card in Mehterlam District.

Parents and health workers alike have shared their opinions about the new system. According to one mother visiting the Mehterlam CHC, "before, vaccinators have been busy writing with their heads down, now they have sufficient time to talk to us in a comfortable and relaxed manner, not in a hurry". Vaccinators have said that they are utilising their time better, and able to spend more time sensitising parents about preventive healthcare.

With reduced paper work, the engagement between parents and health workers has been strengthened. (Photo: Dr. Muhammad Naeem Halimi, SCA)

Dr Mohammad Naeem Halimi, MyChild System Senior Officer, Swedish Committee for Afghanistan, conveyed his positive feedback about the value of MyChild Card. “This programme has many benefits - it strengthens both child registration and follow-up of children, and in addition it decreases the number of children who drop out".

Dr. Muhammad Naeem Halimi, MyChild System Senior Officer, Swedish Committee for Afghanistan illustrating how MyChild Card vouchers are scanned, creating electronic medical records for each child. (Photo: Dr. Muhammad Naeem Halimi, SCA)

Shifo programme Manager of the Every Child Counts Afghanistan programme Shahnoza Eshonkhojaeva noted “the first months have been amazing in terms of feedback and impact. The health workers are all so engaged, they provide feedback on what was good or should be improved, which has been valuable in helping us to better localise MyChild Card".

For the latest information on the ongoing impact of our work please visit our website shifo.org.