I. PROJECT BACKGROUND
The overall objective of the EU-funded project “Technical Cooperation Programme to the Ministry of Public Health”, Afghanistan (EuropeAid/131612/C/SER/AF) is to support the Ministry of Public Health for strengthening its stewardship role it plays in various fields of afghan public health system. The main purpose of this project is to provide technical assistance to various departments of MoPH to enable them to develop sound policies, strategies and operation plan and oversee their implementation.
The project has the scope of assisting the various departments of MoPH in better defining and increasing its stewardship role for the roll out of the activities under its guidance. Good governance issues with a long-term vision have of course to be built in. This contract specifically aims at contributing to the provision of technical support to the different sections of MoPH and the sustainable managing of resources. It concentrates on the organisational and management capacity building of the target departments, as well as the development of technical/managerial skills amongst their staff.
The project started supporting Health Promotion Department (HPD)of Afghanistan National Public Health Institute (ANPHI) at MoPH in August 2014. The main objective of this support is to build capacity of (HPD) to develop sound strategies in order to improve health behaviour of the Afghan population. This term of reference is developed for a proposed study tour for key staff of HPD to visit Lithuania and health promotion structures newly established in Lithuania and learn from experiences of the projects and apply the lessons learned into future health promotion projects in Afghanistan.
II. RATIONALE FOR THE STUDY TOUR
In accordance with the ToR of the project and given the imminent need to improve the communication planning and implementation processes, it is proposed that a group of HPD officers make a week -long exposure visit to Lithuania. The visit is important for broadening horizons, motivating stewardship role and implementation capacity through getting first-hand information about successful implementation models. It is also according to the already developed work plan and results.
Lithuania has lately implemented a new Health Promotion Law as well as a structure of community-based intersectoral Boards on health promotion. This exactly refers to the aims of the Health Promotion Department and could provide an excellent example for Afghanistan. As no other sophisticated initiative is available anywhere else in the region the example from Lithuania could provide an excellent input for the planning and implementation of Health Promotion structures in Afghanistan.
III. OVERALL OBJECTIVE
The overall objective of the study tour is to enhance capacity of HPD in the planning and implementation of health promotion law and structures at the community-level for health promotion and through this strengthen the stewardship capacity of HPD.
Purpose and Objectives:
- Gain knowledge about the structure, contents, financing and organization of the health promotion law in Lithuania
- Gain knowledge about the implementation of community-based intersectoral boards, their set-up, structures and functional mechanisms
- Become familiar with the coordination/cooperation mechanism among relevant departments and sectors for various health promotion interventions especially health promotion projects
- Become familiar with approaches, procedures and the organization of health promotion campaigning in Lithuania
- Develop a memorandum of cooperation between the health promotion department, Ministry of Public Health, and health promotion of Lithuania, to address the issues of cooperation between the two organizations for further cooperation and collaboration in the field of health promotion.
- Strengthen the contacts and increase networking with the international health promotion partners for possible future cooperation and support.
It was planned that a team of four representatives of the Health Promotion Department from MoPH visit Lithuania from between January 26 and 30, 2015. Unfortunately, only three of the HPD staff could go on the tour because one of them couldn’t get a visa.
The participants met the following criteria:
- Working in the field of health promotion in the Health Promotion Department of the MoPH.
- More than two years of working experience in health promotion
- Have management, leadership and training responsibilities
- Involved in the designing, planning, overseeing, coordination and assessment of health promotion interventions
- Have the capacity to train others.
- Their hierarchical position enables implementation and/or advocacy for the experiences gained from the study tour.
- Knowledge of English language.
List of Participants:
|1||Shafiqullah Hemat MD, PhD||Director, Health Promotion Department, MoPH, Afghanistan|
|2||Dr. Sharifullah Alemi, MD||National Hygiene Communication Officer, Health Promotion Department, MoPH Afghanistan|
|3||Dr. Maihan Abdullah, MD, PGD, MPH||National Consultant, Health Promotion Department, MoPH Afghanistan|
International exposure is important for broadening horizons, and motivating implementation through learning first-hand about successful implementation models. The main objectives of this visit were:
- To gain knowledge about the structure, contents, financing and organization of the health promotion law in Lithuania (which directly relates to the result area 5.3 requiring MoPH to be able to advocate for the relevant laws and regulations);
- To gain knowledge about the implementation of community-based intersectoral boards, their set-up , structures and functional requirements (which directly relates to Result Area 5.2 requiring the MoPH to be able to advocate on a strategic plan to work with other sectors with private sectors and line ministries);
- To become familiar with the coordination/cooperation mechanism among relevant departments and sectors for various health promotion interventions especially health promotion projects;
- To become familiar with approaches, procedures and the organization of health promotion campaigning in Lithuania (which directly relates to Result Area 5.4 regarding implementing health promotion campaigns).
In Germany and Lithuania many of the required activities are being, or have recently been, implemented. This includes a health promotion legislation-change campaign, a health promoting hospital, and many other campaign activities.
On January 26, the HPD team visited the EPOS headquarter in Bad Hamburg, Germany, before leaving for Lithuania. The HPD team delivered a presentation about the HPD activities in Afghanistan and briefed the EPOS administration about the exposure visit to Lithuania.
The Exposure visit in Lithuania between January 27 and 30 was organized to orientate the HPD team about the various public health and health promotion programs at the institutional as well as community levels. In the institutions, the HPD team visited health promotion related directorates and officials and got oriented to different parts of the program. In addition, the team observed and explored various communication interventions carried out at the community level. The exposure visit agenda was as follows:
The program of the study tour included visit to Klaipeda, Plunge and Vilnius.
- KLAIPEDA TOUR
1. Klaipeda District Municipality:
On the first day of the exposure tour, the Afghan HPD team visited Klaipeda District Municipality where they had a meeting with the municipality administration including the Mayer, (Vaclovas Dackauskas), Head of Klaipeda District Municipality, Health Care Department (Laima Kaveckien.e), and Director of Klaipeda district Municipality Public Health Bureau (Neringa Tarvydiende ).
Subsequent to the introduction, the two sides talked about the government structure, especially the municipality structure, its role and responsibilities, and the health care department within the municipality. Mr. Dackauskas briefed the Afghan delegation about the various departments of the Municipalities. He also explained that the Mayer is elected for every four years and that local laws and ordinances are ratified by the elected council.
2. Klaipeda District Public Health Bureau
Following the meeting at the Klaipeda District Municipality, the HPD team visited Klaipeda District Public Health Bureau. The Bureau director, Ms. Neringa Tarydiene delivered a presentation about the organizational structure, financing, and different programs of Klaipeda District Public Health Bureau. She gave details about various programs and activities the staff performs in the community in addition to in the Bureau. After the presentation and Q&A session, the HPD team toured various divisions of the Bureau and met the staff.
3. Klaipeda City Public Health Bureau
The HPD team went to Klaipeda City Public Health Bureau in the afternoon following their visit to Klaipeda District Public Health Bureau. The team was welcomed by the director, Jurate Grubliauskiene, along with more than 10 staff members. In the meeting which lasted for nearly five hours, the staff delivered presentations on health promotion campaigns, mother and child health promotion/care programs, health education and behavior change communication programs for NCD risks.
In addition, one of the most interesting and useful presentations was about Klaipeda as one of the 100 healthy cities in Europe. The presentation covered the designing, planning and implementation of public health laws and activities that made Klaipeda one of the few healthy cities in Europe.
4. Klaipeda University, Health Science Faculty
On the second day of the exposure tour, the HPD team visited the Health Science Faculty of Klaipeda University. Ms. Indre Butience, Vice-dean for Development and International Relations of the Faculty, in her presentation explained there are 1200 students in 14 various programs taught by 102 lecturers. She added that the Public Health Department was founded in 1999 which is headed by Dr. Arnoldas Jurgutis since 2003. Considering the health system reform in Lithuania, public health has been playing an important role in preventing and controlling diseases and conditions. The undergraduates and graduates of Public Health Department of the Health Science Faculty are the main public health contributors working in municipal public health bureaus, public health centers, health care institutions, local administration health departments, regional sickness fund, educational institutions, and non-governmental organizations.
Following the presentation, the HPD team met with the Dean of Health Science Faculty at his office. The two sides discussed the educational system in their countries. The Dean mentioned that several international students are enrolled in various programs of the Faculty including the public health program. He stated that the Faculty has affiliation with various governments and universities, especially in Central Asia. He showed his willingness to provide educational and professional development opportunities to Health Promotion Department staff of the Afghan Ministry of Public Health.
2. PLUNGE DISTRICT TOUR
1. Plunge District Municipality
On the third day of exposure trip, the HPD team visited Plunge district municipality meeting the Mayor, Mr. Audrius Klisonis and other high level administrative staff in the presence of media. Subsequent to introducing his staff, the Mayor talked about the structure, activities, and plans of Plunge district municipality. The head of health care department at the municipality, Ms. Vida, gave a comprehensive and fascinating presentation covering the history, geography, demography, culture, and health system of Plunge district. Afterwards, the HPD team delivered a presentation about the achievements, plans, and objectives of HPD at the Ministry of Public Health in Afghanistan. At the end of the meeting, the media interviewed the HPD asking about the purpose of the trip to Lithuania.
2. Plunge Municipality Hospital
The HPD team along with the Mayor and other municipality administration visited Plunge Municipality Hospital to see the health promoting hospital initiatives. The team explored emergency, surgery, physiotherapy, reanimation, and pediatric departments of the hospital. Later, the HPD team and the Plunge district leadership were briefed about the history, organizational structure and services of the hospital. The hospital director, Antanas Martusevicius, stated that the first step in the implementation of health promoting hospital was the renovation of the hospital through a European Union grant. One of the other health promoting hospital interventions was establishment of a gym at the hospital where the staff could work-out.
3. Plunge District Municipality Public Health Bureau
Following the Plunge District Municipality Hospital tour, the HPD team visited the Plunge District Municipality Public Health Bureau located beside the hospital. The bureau director, Ms. Giedre Bubeliene, delivered a presentation about the programs and activities of the bureau in Plunge district. Ms. Giedre mentioned about the preventive programs in general and health s programs in particular performed by the Plunge District Municipality Public Health Bureau.
4. Inesa Health Care Center
Lastly, the HPD visited a private health care center “Inesa” to observe the health promoting hospital program. The head of the health center, Irena Tauciene, gave the HPD a tour of the various departments of the center including medical record, pediatric, ophthalmology, gyne & obs, immunization, and ophthalmology departments.
The head of the medical record department explained that the department has recently adopted the medical recorded system which has brought significant changes in data entry, retrieval, and follow up of patients. He, however, said that the medical record has not been adopted in its full because patients referred from and/to other institutions use paper pen files and records.
Health promotion interventions for primary, secondary and tertiary prevention were observable while visiting various departments of the Center. One of the health promotion programs for primary prevention was raising awareness of the people about cardiovascular diseases. Colonoscopy, mammography, prostate-specific antigen test, cervical cytological smear were in place to diagnose people at the earliest stages of colon, breast, prostate and cervical cancers. In addition, there was a comprehensive tertiary prevention program for diabetic patients. The physician informed the patients about various complications of diabetes and how to prevent them though lifestyles changes such as healthy diet, physical activity and regular check.
- MINISTRYOF HEALTH
On the fourth day of the Exposure trip, the HPD team visited the Ministry of Health in Vilnius. The team accompanied by Klaipeda District Public Health Bureau public health specialist, Vaida Vaiciuliene, met with the Health Promotion Department Director, Audrius Sceponavicius, along with his colleagues and the international Relation Department Head. Subsequent to introduction, Mr. Sceponavicius presented interesting data on various health and condition in Lithuania including the top causes and mortality and morbidity. He also explained the organizational structure of the Ministry of Health as well as the municipality public health bureaus. There was an interesting Q&A session at the end of the presentation covering the strengths and weakness, accomplishments, and challenges to health care system in both countries.
- Lessons learned
The main objective of HPD staff exposure visit was to observe the health promotion interventions and activities in Lithuania. Lithuania has conducted some successful public health interventions to prevent and control some of the most prevalent diseases and conditions in Lithuania such as suicide, road traffic accidents, and cardio vascular disease to mention a few. The health promotion activities at the organizational and community levels were fascinating and inspirational. The most important lessons leanred are summarized as follows
- The public health specialists working in public health bureaus can be health educators of specific programs in addition to running the respected programs. For example, nutrition specialist/officer at the Klaipeda City Public Health Bureau was responsible for designing, planning, organizing, and implementation of the program. In addition, she was responsible for delivering health education programs about nutrition at the individual and community level.
- The health promotion campaigns on various health issues were designed and conducted based on suitability of time and place. For example, to promote physical activity, the different interventions were scheduled considering the interest and convenience of the particular group of people. For elderly people, physical activity promotion campaigns were designed both indoor and outdoor. In addition, the participants were screened for their blood pressure, blood sugar level and lipid profile during the campaign.
- The Public Health Bureaus were also serving as health education centers. The bureaus were equipped with all health education materials and specific population groups were provided with health education through lectures and practical examples. For example, in Klaipeda City Public Health Bureau, there were special prenatal classes for couples. In those classes parents, especially mom are taught about the process of childbirth, nutrition during and after the pregnancy, natural feeding of baby, postpartum depression, dental care of pregnant women and children and about baby allergies.
- Presence of strong coordination and cooperation among various government agencies. This was made possible through creation of Health Committee of the Municipal Council. This committee not only coordinates various public health issues among various departments but also endorse public health policies at municipality level.
- Based on the Ottawa Charter statement that the government/non-government agencies work with the community rather for the community, there is Community Health Board of the Municipality in the organizational structure of the Municipality. This has established a direct and close relationship and strong coordination between the municipality and the community concerning various public health matters.
- Implementation of public health programs through a wide network of public health specialist. Considering the need for public health professionals to carry out public health tasks, undergraduate and graduate public health degree programs are established. After graduation, these public health specialist are employed in public health sector to develop, implement, and monitor public health programs.