On December 4, 2020, the National Advocacy Committee for Public Policy (NAC-PP), released the findings of the third cycle of “Monitoring Government COVID-19 Response in Nangarhar, Laghman and Kunar”. The monitoring was undertaken by Afghanistan Public Policy Research Organization (APPRO) and funded by UNDP and Danish Embassy.
The purpose of this monitoring round was to monitor the COVID-19 testing mechanism, particularly the testing process instituted by Directorate of Public Health and COVID-19 health centers in the target provinces. This monitoring round also highlights the improvements/changes made to ensure transparency and accountability in the use of government funds in COVID-19 health centers in Nangarhar, Laghman and Kunar.
Findings from this round of monitoring show that COVID-19 testing provisions has been inadequate from the onset of pandemic in Nangarhar, Laghman and Kunar. For the eastern provinces of Nangarhar, Laghman and Kunar, there is only one COVID-19 testing center in Jalalabad. Samples taken by District Hospitals and Comprehensive Health Centers from infected patients in Laghman and Kunar are taken to Jalalabad Regional Hospital, which takes around 3-7 days to be processed.
Among three provinces, Nangarhar has the highest positivity rate with 36.2 percent, followed by Laghman, 29.2 percent and Kunar with 26 percent. Nangarhar is also the fifth hotspot of COVID-19 in terms of overall death counts with 107 officially reported deaths after Kabul, Herat, Kandahar and Balkh.
Rapid Response Team (RRT), under the supervision of MoPH and DoPH Health Surveillance Department, are established. RRTSs are tasked with conducting contact tracing to map all individuals who have come in contact with COVID-19 infected patients. MoPH’s surveillance teams have been crucial in awareness raising and slowing the spread of wrong messages about the virus, such as one about Muslims being immune to COVID-19.
As of November 12, 2020, contact tracing teams and RRTs have stopped operations in Laghman and Kunar provinces, due mainly to implementing agencies’ (HealthNet TPO and ADDA) contract with the World Bank and Asian Development Bank having expired. The sample collection in Laghman and Kunar has paused since November 3.
Specific preparations by authorities for a potential second wave of the pandemic include the continuation of COVID-19 testing through RRTs, awareness raising through community health workers and an increase in the number of beds from 50 to 150 in Jalalabad Provincial Hospital.
Further, health officials in Nangarhar have received training on the usage of ventilators, handling of patients with intensive care needs, Continuous Positive Airway Pressure therapy (CPAP), Machines and Bi-level Positive Airway Pressure (Bi-PAP). There are some concerns, however, about the sufficiency of the expertise among health personnel in using the ventilators, CPAP and Bi-PAP machines and overseeing COVID-19 patients with critical conditions in Laghman and Kunar provinces.
Lack of coordination is a major issue in COVID-19 response efforts across Afghanistan. There are also reports of duplication in purchase of equipment due to weak coordination. In Laghman, for example, it was reported that MoPH and DoPH purchased the same set of equipment without consulting with each other, resulting in over purchasing of equipment associated with COVID-19 response in the province.
National Government Authorities (Particularly MoPH)
- Establish a PCR testing laboratory in Laghman and Kunar provinces and hire skilled health workers, nurses and laboratory technicians.
- DoPH must ensure personnel are adequately trained and that the laboratories are well-equipped to produce timely COVID-19 test results. Specifically, initiate training programs to health personnel in the target provinces on installing, assembling and using ventilators, CPAP and Bi-PAP on severe COVID-19 patients. At the beginning of COVID-19 pandemic, a majority of health workers in COVID-19 health centers did not know how to use ventilators.
- Strengthen the ongoing COVID-19 surveillance system by improving contact tracing and increasing the number of RRTs in the target provinces.
- Initiate training programs to RRTs on case identification, mapping potential cases, specimen collection and case investigation.
- Ensure RRTs are well-equipped particularly with cold chain storage for transportation of COVID-19 samples gathered from potential and infected individuals to COVID-19 diagnostic laboratory for maintaining accuracy of the results.
- Increase coordination between MoPH, Administrative Office of President (AOP), First VP Office, Office of State Minister for Disaster Management and Relief, IDLG and MoF.
- Maintain and increase public awareness efforts about COVID-19, its risks and symptoms and the effectiveness of personal hygiene and protection and social distancing in reducing the spread of the virus.
- Devise mechanisms for better coordination and management of international funds awarded to the government and non-government to fight the pandemic.
- Devise mechanisms to establish the impact of earmarked international funds on the pandemic in Afghanistan, with a specific focus on the ordinary citizens as the immediate and ultimate beneficiaries.
COVID-19 Health Centers
- Strengthen and engage local communities in monitoring COVID-19 health service delivery by HealthNet TPO and ADDA.
For the full report, please visit: http://appro.org.af/publications/monitoring-government-response-to-covid-19-in-nangarhar-laghman-and-kunar-cycle-3/
The National Advocacy Committee for Public Policy (NAC-PP) was established in March 2015 to serve as a policy advocacy and information-sharing platform for good governance. NAC-PP works closely with Provincial Advocacy Committees (PACs) and District Advocacy Committees (DACs) to coordinate advocacy and information sharing from district to national levels.
For more information on NAC-PP, please visit www.nac-pp.net or contact the NAC-PP Secretariat through Mr. Atiq Rahimi at firstname.lastname@example.org.
For more information on the Anti-Corruption Sub-Committee of NAC-PP, see: http://www.nac-pp.net/about-anti-corruption-sub-comittee/. On the Citizen’s Forum Against Corruption (CFAC), see http://www.nac-pp.net/about-cfac/