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June 02, 2021
Assessment Explores Improving Immunization Services in Afghanistan Through Public-Private Engagement

Through a for-profit, civil society health service delivery model operating in many provinces across Afghanistan, the Ministry of Public Health is working with Gavi, the Vaccine Alliance under the Partnership with the Private-for-Profit Health Service Providers (PPHSP) to strengthen routine immunization (RI) in hard-to-reach provinces: Farah, Nuristan, Paktya, and Urozgan. Implemented since 2009, the PPHSP is an example of the engagement of private health providers in RI delivery. This engagement is prioritized in both the Global Vaccine Action Plan’s strategic objectives and in Afghanistan’s two-year strategic plan for RI strengthening.  To explore means of enhancing public-private sector engagement to improve immunization coverage in hard-to-reach populations, GHD|EMPHNET supported the Ministry in conducting a rapid assessment of the PPHSP.

 

Containing a set of recommendations, the assessment was carried out in 40 public and private health facilities in Paktya province where conflict makes it more accessible to private rather than public providers. The study combined qualitative and quantitative research methods and used a multi-faceted and participatory method to see perspectives from all stakeholders. The components assessed were: 

 

  1. Monitoring, capacity building and quality improvement through key informant interviews at the national and provincial levels.
  2. Health facility status, Facility Health Information System (HMIS), EPI Cold chain, Supplies, supervision, and health workers knowledge assessment through observation and interviews with the health service providers.
  3. Health service providers satisfaction and patient satisfaction through exit interview.

 

The findings of the assessment were shared in a dissemination meeting that took place in Kabul on May 26, 2021. Over 30 participants attended from the Ministry, the World Health Organization, UNICEF, and other public health stakeholders.

 

Several recommendations were presented based on this assessment: the need to build capacities of both private and public providers, to strengthen project evaluation and monitoring, to enhance coordination mechanisms between provincial and national levels. The need for strengthened community role was also one of the recommendations, citing the role of influencers, community elders, mass media, and community health workers in creating and increasing demand. Specific points also related to logistics and equipment.

 

These recommendations were approved, and it was decided the engagement of private health providers be expanded to other provinces particularly to the insecure ones based on a standard implementation guide to ensure success.

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