Summary of the case study
The case study “Leadership Development for Health Service Delivery: Making the Most of Limited Resources in Afghanistan” describes the implementation of LDP (leadership development program) in Afghanistan’s healthcare system (Alliance for Case Studies for Global Health, 2012). In addition, the study analysis the health benefits that accrue from the program and sustainability of the program. Over the years, the Afghan healthcare system has been faced by numerous challenges such as increased mortality, poor immunization and endemic episodes of infectious diseases particularly due to resource constraints as well as persistent warfare. However, the country has recently witnessed tremendous improvements in healthcare following dedicated efforts by the country’s MoPH (Ministry of Public Health) and other NGOs (Non-governmental organizations). The implementation of LDP is a huge milestone that has greatly impacted healthcare delivery in the country (Alliance for Case Studies for Global Health, 2012).
In the light of this, the United States Agency for International Development (USAID) works with various NGOs to implement various health programs in the country. Notably, since 2006, USAID has partnered with MSH (Management Sciences for Health) as well as MoPH to implement the LDP across the country’s healthcare system through the Tech-Serve project. As such, LDP is an approach that is action oriented and usually customized to meet the need of healthcare systems predominantly in developing countries. The LDP process is carried out for a period of about six months and involves small teams. The teams attend workshops where they learn various methodologies that can be used to solve various problems encountered in healthcare (Alliance for Case Studies for Global Health, 2012).
Starting in 2005, various teams comprising of five people mainly including NGO staff, government personnel as well as MSH representatives selected by PPHCC (Provincial Public Health Coordination Committee) were trained on LDP. Subsequently, the team members conducted LDP training among healthcare workers in their respective provinces. The LDP approach focused on empowering healthcare providers with various leadership as well as management skills that can be used in addressing the challenges encountered in care delivery. In regard to this, the LDP teams worked with their colleagues and liaised with other stakeholders such as religious leaders, health providers and traditional councils to come up with solutions to prevailing health problems such as family planning and vaccination. During this period, the teams organize resources, plan interventions, implement the planned strategies and evaluate the outcomes. Thereafter, the teams attend workshops on skills-building where they report the progress of the program and acquire information on how to enhance their interventions. As such, the program has provided numerous benefits to the country’s healthcare system such as enhanced care delivery and improved outcomes. For instance, the program has helped to address various issues in maternal health by educating the public on the health benefits associated with antenatal as well as postnatal care and encouraging pregnant mothers to seek medical intervention during deliveries.
The case study highlights some of the key challenges facing the Afghan healthcare system. Some of the predominant issues affecting the afghan healthcare system include; increased mortality, poor immunization as well as endemic episodes of infectious diseases (Alliance for Case Studies for Global Health, 2012). Although the country, is faced with persistent warfare as well as serious resource constraints, these problems can largely be attributed to inefficient leadership as well as management especially in healthcare delivery. In addition, the country lacks adequate resources especially in healthcare mainly due to persistent warfare. This greatly affects care delivery since the country mainly relies on NGOs for the delivery of healthcare services whereby this results to poor delivery of healthcare services especially in the remote areas due to poor accessibility and inadequate healthcare staff.
Moreover, the LDP team usually encountered numerous challenges such as security problems, social barriers and traditional attitudes whereby this affected implementation of the program as well as care delivery. Furthermore, most of the people especially in the remote areas of the country are extremely conservative and are reluctant to seek health services (Newbrander et al., 2014). Therefore, it is essential for the NGO staff as well as other healthcare workers to liaise with the community leaders and other stakeholders to create awareness on the potential health benefits of seeking healthcare interventions. Healthcare workers should encourage the community members to seek healthcare services so as to enhance their quality of life.
Additionally, efficient monitoring and evaluation (M&E) of the LDPs is quite challenging in the country since the information required for evaluation is usually unreliable. For instance, the baseline information established from previously collected data may be misleading as well as the currently collected data and poor coordination. Thus, inefficient M&E and poor mentoring may compromise expansion of the LDPs despite the numerous healthcare benefits associated with the program. More importantly, the country mainly relies on donor support for the delivery of healthcare services. Thus, withdraw of donor support or reduction in funding due to fiscal crises in the donor countries may greatly affect healthcare delivery in Afghanistan leading to serious health consequences (Newbrander et al., 2014).
Relevance of the readings to global health issues
The case study highlights various issues that are closely related to the global issues on health. Among the key issue highlighted in the readings is the increased prevalence of infectious diseases especially in the developing countries. In relation to this, the high rates of infectious diseases in Afghanistan mirrors endemic episodes of infectious diseases witnessed in other developing counties. Additionally, the high mortality rate in the country especially infant mortality is closely related to the increased mortality witnessed especially among the developed countries that is a key global health concern. In the light of this, increased mortality is closely associated with poor health status among the population. Moreover, the persistent warfare and civil unrest in Afghanistan is similar to other epidemic threats particularly on the health workers in various countries.
As such, wars as well as unrests results to massive killing of the population including the healthcare workers whereby this affects various health aspects such as health education and care delivery. In addition, persistent wars in a country usually results to mass depletion of resources whereby this affects resources allocation in healthcare leading to compromised care delivery and poor clinical outcomes (Kim, Farmer & Porter, 2013). Furthermore, issues relating to family planning as well as maternal health in Afghanistan are closely associated to similar global health problems that affect various countries. Family planning and maternal health issues can be largely attributed to lack of awareness on the issue and poor healthcare in the associated countries.
Solutions to these issues
Building on the information obtained on issues relating to global health, the aforementioned issues can be addressed by incorporating the appropriate interventions. Firstly, the healthcare workers should liaise with the other stakeholders to create awareness on the various health issues such as infectious diseases, family planning and maternal health and encourage them to seek health interventions to minimize these problems (Kim, Farmer & Porter, 2013). Secondly, healthcare workers should collaborate with the other stakeholders to educate the public on the importance of vaccinations as well as immunizations and encourage them to be vaccinated so as to minimize incidences of infectious diseases. Thirdly, the healthcare providers should partner with various international agencies and government agencies to enhance care delivery and lobby for increased funding and resource allocation so as to effectively provide the relevant healthcare services. Additionally, healthcare workers should foster leadership as well as management development in order to promote communication as well as collaboration in healthcare aimed at enhancing care delivery.
Furthermore, healthcare workers should develop a stronger patient-centered approach in care delivery in order to come up with patient-centered approaches that can be used to enhance care delivery (Kim, Farmer & Porter, 2013). More importantly, leaders in the healthcare sector should effectively collaborate with other leaders in the public sector and other agencies to come up with conflict resolution strategies to find a lasting solution to the persistent warfare and lobby for resource allocation in the health sector in order to enhance service delivery. Overall, effective solution to these issues requires a multidisciplinary approach and thus should involves all the stakeholders in the various sectors of the country as well as international agencies.
References
Alliance for Case Studies for Global Health. (2012). Leadership Development for Health Service Delivery: Making the Most of Limited Resources in Afghanistan » Case Studies for Global Health. Retrieved from http://www.casestudiesforglobalhealth.org/post.cfm/leadership-development-for-health-service-delivery-making-the-most-of-limited-resources-in-afghanistan
Kim, J. Y., Farmer, P., & Porter, M. E. (2013). Redefining global health-care delivery. The Lancet, 382(9897), 1060-1069.
Newbrander, W., Ickx, P., Feroz, F., & Stanekzai, H. (2014). Afghanistan's Basic Package of Health Services: Its development and effects on rebuilding the health system. Global public health, 9(sup1), S6-S28.
