Providing a “Health Passport”

for every child in Afghanistan

By Yu Sasaki
MNCH handbook
UNICEF Afghanistan/2018/Fazel
17 March 2019

This year, 1.2 million children are estimated to be born in Afghanistan. Imagine that you are a mother or father of an infant, or that you are pregnant, and if you are asked “do you want to know your baby’s health condition, so you can take good care of her/him?”, how would you respond? Every one of you will probably say “yes” in a heartbeat. In all the provinces of Afghanistan, the Ministry of Public Health (MoPH), UNICEF and partners are working to make this wish come true for Afghan families .

Good healthcare starts at home

Up to the age of five, and especially in the first weeks and months of a child’s life, protection against preventable illnesses and quality baby care are critical. However, access to health facilities is not easy for many families, especially in rural areas in Afghanistan. This country is in dire need for accessible health facilities with good equipment and medicines. But, good healthcare starts at home. What is critical for families are interventions and tools that can empower families to take control over children and mothers’ health and nutrition throughout development stages – pregnancy, birth, infant phase, and childhood. If mothers and families themselves can obtain basic knowledge on how to monitor their health conditions and know when they need to seek professional advice, it will be a significant change in promoting their health practices.

Launch of MCH handbook
UNICEF Afghanistan/2019/Fazel

“Health Passport”

Although Afghanistan has made significant progress over the last 15 years in terms of decreasing maternal mortality ratio and infant mortality rates, in 2016 one in 19 Afghan children died before their first birthday1. The country also has one of the world’s highest rates of stunting in children under the age of five – 41 per cent. Responding to this situation, the MoPH, the Japan International Cooperation Agency (JICA), UNICEF, the World Health Organization (WHO) and other partners have been working together to develop Afghanistan’s first ever Maternal-Child Health Handbook (MCH Handbook) since January 2016. The Handbook is a collection of standard essential health information and records for counseling on maternal and child health. This handbook aims to; improve linkages among community, family and healthcare providers; increase community awareness; increase knowledge of women and their families regarding key maternal and child health issues covering all stages of maternal, newborn, and child health (MNCH) from antenatal care to delivery, birth notification, postnatal care, vaccinations, growth monitoring and early child development.

The Handbook was developed in 2017, tested in two districts (Mir bacha Kot in Kabul and Kama in Nangarhar) and evaluated. According to the results, as many as 99% of mothers retained the handbook, and 90% used the book. Almost 80% took it to the health facilities. Some mothers call it “the Health Passport” which should be always taken with you to show and keep the health and nutrition records. Having confirmed the positive response from mothers, the Ministry is now ready to scaleup the project and distribute the handbook across all 34 provinces in Afghanistan over the period of three year!

In 2016 one in 19 Afghan children died before their first birthday

Proven Practice

The effectiveness of this initiative has already been proved in many countries. Based on a study conducted in Indonesia the Ratio of mothers who received at least four anti-natal care (ANC) had 11 % difference between those received MCH HB and those not received. Also, a knowledge attitude and practice (KAP) study results in Palestine indicates that the knowledge of mothers about danger signs of pregnancy improved from 26% (baseline) to 73% with the use of the handbook. 

Getting ready for distribution

To prepare for the distribution, implement NGOs and the Public Health Department officials gathered at the Training Workshop in Kabul City to learn about the MCH Handbook in depth in January 2019, so they can support mothers and children in their communities.

Launch of MCH handbook
UNICEF Afghanistan/2018/Fazel

“The introduction of the MCH Handbook has many benefits,” said Dr. Zelaikha Anwari, Director of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH), Ministry of Public Health. “For mothers and children, the quality of health services will be improved. Data from other countries show that mothers come to a health facility on a regular basis, and the book encourages them to visit clinics early when they witness something worrisome. There will be direct impacts on the health of newborn babies such as improved immunization practices and regular growth monitoring by health professional. Also, the handbook will strengthen the health system in Afghanistan through enabling the government to collect reliable data.”

Dr. Feda Mohammad Paikan, Deputy Minister of Health Care Service Provision, thanks the Government of Japan, People of Japan and JICA for their long-term contributions. “This handbook was created in Japan, and now will support mothers and children in all 34 provinces in Afghanistan. I am very grateful to Japan for its long-term support for this initiative and hope the generous support will continue.”

For Afghans, by Afghans

“The contents of the MCH Handbook capitalized on other countries’ experiences. But the texts and illustrations were developed in Afghanistan, and it is 100% original” said Dr. Shafiqullah Hemat, Director or Health Promotion. He explained that this country’s culture and social contexts were reflected in the book. Considering that there are some people who do not read, UNICEF and partners made self-explanatory illustration, so people who do not read can understand. The Ministry pretested the draft handbook with mothers, medical staff and others including people who do not read, and adjusted the contents based on their feedback. In a nutshell, this handbook was created for Afghans, by Afghans.

In 2019, the Handbook will be distributed in Kabul, Nangarhar and Bamyan. And the distribution will continue in the rest of provinces in 2020-2021. Pregnancy can be a stressful time if there are full of unknowns. This handbook is a significant step forward to give every mother an ability to navigate their own safety and health and give every child a fair start of life.

[1] UNICEF’s State of the World’s Children 2017