Integrity Watch survey: Health facilities need urgent attention to help fight COVID-19 in Afghanistan

August 20 2020, Kabul—A survey of seven hundred health facilities in thirteen provinces shows that the procedures for screening of visitors at the health centers are very often not being followed. The survey also demonstrates that the Afghan Government and the Ministry of Public Health (MOPH) urgently need to improve their oversight and evidence-based decision making, enhance support for monitoring of health services by local communities and civil society organisations, and ensure that there is an adequate supply of medical equipment and medicines necessary for COVID-19 treatment and to properly prepare for a possible second wave of the virus.
 
Sayed Ikram Afzali, Executive Director of Integrity Watch, stated, “The survey shows that the Ministry of Public Health lacks a reliable system to collect accurate, comprehensive and timely data to enable its leadership to make decisions to respond proportionately to the spread of Covid19 throughout the country.” The current data on infected and death cases collected and used by the government is not reliable. For example, while the Ministry has recorded 37599 infected cases (as of August 19, 2020), another survey by the government shows that up to 10 million people might have been infected. Mr. Afzali warned that the Afghan government should reduce the risks and prepare for a possible second wave by prioritizing vulnerable areas as indicated by the survey conducted by Integrity Watch.
 
Mr. Ezatullah Adib, Head of Research at Integrity Watch, stated, “The survey findings show that in April 2020, 40% of hospitals did not respect basic screening procedures.” This included some larger hospitals, such as provincial and district hospitals in Herat and Kabul. He added, “When the data was updated based on the information provided by the health centers management in July 2020, it showed that the failure to follow proper screening procedures at health facilities has increased to 48%.” Availability of personal protection equipment (PPE) and the necessary drugs and other medical equipment such as ventilators and oxygen balloons were also issues. Supplies of oxygen and other intensive care materials vary between health facilities of between 1 to 4 days. There is a supply of oxygen at Covid19 health facilities and district health facilities for 2 days, at provincial hospital it is 4 days, and at regional hospitals it is only 1 day. Health facilities run out of masks and alcoholic solutions after three days, hats and aprons in two days and shoe-covers in 1 day at the country level.
 
Mr. Afzali concluded by calling on the Government to use the data collected to improve the effectiveness of its response to Covid19, in enhancing health facilities preparedness and in introducing smart lockdown measures.
 
Above the survey
The survey covered more than 700 health facilities in 60 districts and 13 Provinces. The provinces included: Balkh, Herat, Juzjan, Kabul, Kandahar, Kapisa, Laghman, Kunar, Nangarhar, Paktia, Parwan, Panjshir and Samangan. It included both public and private health service providers. The data collection started on April 19, 2020 and ended on June 30, 2020. The second round of the data from the same health facilities started on July 23, 2020 and ended in August 10, 2020. While the MOPH data focuses on the number of people infected and its geographical distribution, our data focuses on: 1) Health facility basic info: number of doctors, nurses, beds, etc. 2) COVID-19 related equipment (ventilators, oxygen, x-ray machines, test kits) 3) COVID-19 procedures: existence of a screening process and public awareness campaigns in each health facility 4) Personal protective equipment: days left with each item at the health facility level 5) Medicines: days left with medicine reserves COVID-19 symptomatic patients; days left with medicine for intensive care patients. Please see the key findings in Annex I.

Press conference link Dari and Pashto: https://youtu.be/L_x7yCJAmYw

For more information, please contact:
Erfan Erzaz, Advocacy Officer, Integrity Watch at 0797790700, e.erzaz@integritywatch.org

ANNEX I: Summary of the Covid 19 Survey Report

Integrity Watch and VoxMapp between April 2020 and July 2020 conducted a large collection of data on Afghan health facilities’ COVID19 preparedness levels. The collection of data is still ongoing. This short analysis is based on the data collection of 750 health facilities distributed in 18 provinces.

This short analysis summarizes findings on; 1) the implementation of Covid19 screening procedures for all incoming patients, 2) the availability of important medicines and protective equipment.
This data collection is a fundamental action to help the Ministry of Public Health make informed decisions and to help them give the needed attention to the areas of risk and to maintain the health facility protected from the spread of COVID 19.

Summary of the Survey findings;

1. Although Covid19 awareness campaigns were conducted, the survey data shows that, still, in over 48.3% health facilities, Covid19 screening procedures were not implemented for incoming patients. This percentage was 44.5% during the previous survey. This shows that there has been little or no adherence to the screening procedures and that health facilities must take the spread of the virus much more seriously.
In our analysis we observe that it is not only the small health facilities that are not implementing the screening procedures but also larger health facilities such as district and provincial hospitals. Only the dedicated COVID19 health facilities, that were set-up by the government, seem to be following the screening procedures in a systematic manner.

The failure to follow proper screening procedures also puts the health personnel at risk and could accelerate the spread of the virus to populations that are already vulnerable due to other illnesses and are therefore more exposed to severe reactions from Covid-19.
Analysis of the data shows a correlation between increased screening procedures and a decrease in health workers being infected.

2. Most hospitals have some protection available, but most are missing at least a part of the protection “set”, particularly aprons, and visors. In certain cases, even vinyl gloves, masks and hydro alcoholic solutions are missing or only available in very limited amounts.

Masks and sanitizers are used in all the provinces, but the use of visors is very rare which makes transmission of the virus through eyes a much higher risk. While there is a higher percentage of use of masks and sanitizers, the use of these two items is rare in the provinces north of Kabul.

Antipyretics, a medicine used to control fever, is available throughout the health facilities surveyed. Oxygen balloons are available through the country except provinces north of Kabul (Kapisa, Parwan, Panjshir). Also, anaesthetist and muscular relaxants are available throughout the country, but it is rare in the provinces north of Kabul. While it is a worrying sign that the provinces north of Kabul are not well-resourced, these provinces have an advantage that they can transport their patients to Kabul in an hour.

Recommendations

The speed & spread of the pandemic is not sufficiently countered by supporting the health facilities. The Ministry of Public Health should ensure that 100% of health facilities are applying Covid19 screening procedures for all the patients. This practice can save lives and slow down the spread of the virus.

Third party monitoring is needed: The Afghan Government should engage the citizens, Health Shuars, Civil Society Organizations to monitor the preparedness, progress and distribution of equipment to the provinces as per the population and need because the survey data shows that some provinces are well equipped but some others are least equipped.

Protective equipment should be distributed across the country. The MoPH should make sure there is 100% availability of protective equipment across the country but if there is only a limited amount, priority should be given to certain areas based on the data and information

Coordination with third party monitors is needed. The MoPH should work closely with all third-party monitoring teams/institutions to coordinate the efforts and fill-in the gaps and make data-driven decisions.