Tag Archives: health

Enabling, promoting and demonstrating human rights

Nai Qala contributes to the improvement of human rights in Afghanistan

The capacity of the Afghan State to deliver critical services such as education and health care and to respect, protect and fulfill human rights is limited. The remote rural areas have been traditionally neglected by successive central governments in Kabul and today those remote communities particularly feel the absence of a strong state response. Basic infrastructure and institutions such as schools and health clinics are lacking, undermining the state’s ability to ensure good health and educational standards. Schools and clinics, where they exist, are difficult to access for most people. Staff of such institutions often have little training and low motivation. Few trained staff agree to work in remote regions where living conditions can be harsh. Not surprisingly, many people have left the country to try to make better lives elsewhere and this constant rural exodus makes the situation worse for those who remain as it weakens the social fabric of these communities.

Women and girls are still deprived of basic human rights, facing multiple restrictions and discriminations, abuses and various forms of violence, while efforts to raise the status of women face continued opposition. Women’s roles and their potential, as contributors to social and economic development, are still overlooked.

Right to education

Education is a human right, enshrined in the Universal Declaration of Human Rights and the United Nations Convention on the Rights of the Child. Every girl and every boy should have the right to a quality education so that they can have more chances in life, including employment opportunities, better health and also to participate in the political process. A basic education is also important to ensure that all individuals are aware of their rights.

In Afghanistan, 28% of school-age children are out of school and only 18% of girls 15 and older are literate. Our work on the root causes of low or no attendance of children, in particular girls, to school remedies the absence of decent learning conditions such as absence of a proper school building, the low qualification of teachers, absence of hygiene facilities (especially for menstruated girls), and the absence of a boundary wall, while preventing at the same time drop out through motivation talks with parents and the community, offering pre-primary classes, and reducing the distance to school in remote rural regions.

Right to health

As for education, health is also a human right enshrined in the Universal Declaration of Human Rights, in the United Nations Convention on the Rights of the Child, as well as in the International Covenant on Economic, Social and Cultural Rights. The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment.

 While 91 out of 1000 children still die before their 5thbirthday in Afghanistan, we improve health conditions by providing a health center (clinic) that positively impacts women and infant health, improves the vaccination coverage and provides basic health care to a population of >20’000.

Nai Qala teachers have received training on basic hygiene measures; they pass the message on to their students and the youngsters participating in the early childhood education classes learn why and how to wash their hands. Several gardening initiatives are promoted to enhance nutritional status of the entire family.

Empowering people to realize their rights

While the main goal of our teachers is to teach the children, we also want to seize the opportunity to help communities understand the concept of human rights, or why it is important to question old ideas and encourage girls’ education. We want the teachers to discuss issues such as education, health and equality with village elders and others. It takes time for people to accept new ideas, but they have shown a surprising interest so far.

Gender equality, enshrined in article I of the Universal Declaration of Human Rights, stands at the core of Nai Qala’s activities. Nai Qala’s vision is “aneducated, healthy and balanced society in which women and men lead social, cultural and economic changes in an inclusive manner that enables their children – boys and girls – to thrive”. Our path to realise our vision is inclusive, patiently convincing elders, fathers, men. We aim at inducing small changes in the society by developing the capacities, opportunities and resources of local communities so that men, women, boys and girls can participate equally in family life and decisions and expand their fields of opportunities. We promote the participation of women in society as equals with men in decision making on issues that concern them, such as the education of their children, health of all family members and family economic income, as well as the inclusion of the full community in collective decision making such as construction, use and maintenance of local schools and clinics.

Human rights are interdependent, indivisible and interrelated. This means that the violation of the right to health may impede the enjoyment of other human rights, such as the right to education or the right to work, and vice versa. Without education, one is less likely to find well-paid jobs, decent housing, to participate in the democratic process or to recognize the value of education for future generations. According to the World Bank, there is evidence that educated citizens care more about the environment, are more tolerant of those who are different and are more inclined to fight for gender equality. Through education initiatives and actions targeting health, supported by an inclusive approach, Nai Qala strives to reduce inequalities and promote human rights.

Nutrition and gardening

Improve nutritional status by promoting gardening

Although attention is focused on the country’s political and security transitions, malnutrition is a major concern in Afghanistan. Because the lack of adequate nutrition has crucial long-term effects on individuals and on the social and economic development, nutritional status deserves attention and appropriate action.

A national survey, conducted jointly by the Ministry of Public Health, UNICEF and the Aga Khan University [1], provides an overview of the nutritional status of women, children, adolescents and the elderly. In particular, it shows that the country has one of the highest stunting rates in the world, with 41% of children under five affected. Stunting is a sign of chronic undernutrition during the most critical periods of growth. Stunted growth prevents children from reaching their potential; affected children are more likely to develop diseases and have less success in school.

Chronic nutritional deficiency in Afghanistan is largely the result of poor nutrition. Inadequate dietary diversity and insufficient amounts of food, combined with poor hygiene, represent health risks and are a cause of mortality in older children. When mothers have an inadequate diet, a vicious cycle is created; malnourished infants grow up to become stunted mothers, generation after generation.

Nai Qala’s projects as a gateway to other nutrition-related actions

Poor feeding practices are common in Afghanistan and are not only a result of poverty, but also the result of the families’ limited knowledge or the way social norms influence decisions. Staff at the Nawur clinic are trained to help women acquire the knowledge and information they need to adopt healthy eating habits.

Early childhood education classes are also a means of transmitting health-related prevention messages, such as teaching children to wash their hands before eating together.

Several types of actions can be taken to address some of the causes of malnutrition. The community infrastructures built by Nai Qala represent a tremendous platform for communicating positive health prevention messages.

Carrot plantations in the surroundings of the Nawur clinic

The benefits of vitamin A no longer need to be proven; it prevents blindness and strengthens the immune system, especially in children. Carrots, apricots, spinach, or eggs are foods that are a source of vitamin A and are part of a healthy and diversified diet for children in many parts of the world. Unfortunately, even the least varied diets are still out of reach for more than two thirds of infants and young children in low-income countries and remote parts of central Afghanistan are no exception.

To increase children’s chances of survival, improve their development and prevent stunting, nutritional interventions must be implemented during the mother’s pregnancy and the early years of the child’s life. In Afghanistan, it is estimated that more than 80% of children receive vitamin A supplements in their first two years of life [2], and young children around the Nawur clinic benefit from national supplementation campaigns. Young mothers and the population benefiting from the clinic also receive gardening advice and vegetable seeds. This has led to a multiplication of carrot plants in the allotment gardens of the region, an important source of vitamin A for young and old.

School Gardening Competition

The Zeera Gag school, built a few years ago by the Nai Qala Association, is now one of the few green spaces in the region and is a source of inspiration for an entire population. Each class participates in a gardening competition. Children grow vegetables and fruit trees, ensure that they are well irrigated and take care of the land allocated to them. The children are happy that their school has such a green and clean environment, and are also very proud to see the result of their hard work. It is incredible to see how the culture and interest in food has changed. Children encourage their parents to grow vegetables at home too.

“Five of my children go to Zeera Gag school. Since they started school, my life has changed: they come home clean, rarely get sick, and are very motivated to plant vegetables and trees at home. Now we have a lot of vegetables in our garden, our diet has changed and we are used to eating more varied foods, I see my children happy, it makes us happy… ” says Zahra, mother of 7 children.

Gardening as a solution to malnutrition?

The results of a UKAid-funded study [3] show that ownership of irrigated land and garden plots is positively associated with household food diversity.

The FAO and WHO recommendations emphasize the benefits of food diversification in combating many nutrition-related diseases. Food diversity is used to assess food quality and food security. The vegetable garden is a practical addition to improve the nutritional content of the food and, ultimately, to improve the health of local populations. The presence of community infrastructure or the small actions of Nai Qala that encourage community gardening are a concrete contribution to improving the health status of local populations.

[1] National Nutrition Survey Afghanistan (2013): https://reliefweb.int/sites/reliefweb.int/files/resources/Report%20NNS%20Afghanistan%202013%20%28July%2026-14%29.pdf

[2] https://data.unicef.org/topic/nutrition/vitamin-a-deficiency/

[3] Kawsary, R., Zanello, G. and Shankar, B. (2018) The Role of Irrigation in Enabling Dietary Diversity in Afghanistan, LANSA Working Papers Vol 2018 No 26, IDS: Brighton

Children with carrots afghanistan

Nawur health center as a confirmed base for vaccination

Nawur health center is used as a platform for vaccination campaigns in the region

Afghanistan is one of the last three countries in the world where poliomyelitis is still endemic [1]. 14 polio cases were reported in 2017, and by the end of April 2018 there were 7 new cases reported in the country [2]. Polio mainly affects children under 5 years of age and one in 200 infections leads to irreversible paralysis.

Polio is one of only a limited number of diseases that can be eradicated and it can be eradicated because it affects only humans, because a cheap, safe and easy oral vaccine exists and immunity lasts a lifetime.

In March, the Afghanistan polio eradication initiative conducted its first national immunization campaign for eradication of the disease in 2018. In just a week, around 70,000 workers knocked on doors and stopped families in health centers, city streets and border crossings to vaccinate almost ten million children [3]. Monitoring data reflected more than 94% coverage in each vaccination campaign during 2017. The number of children missed due to inaccessibility went down since 2017 but an estimated 138 000 children were still missing in the national vaccination campaign of March 2018.

Without a clinic, a region like Nawur would have remained unknown to the health authorities; at its opening, the ministry of public health informed organizations such as UNICEF which registered the clinic as a vaccination center. The ministry and its partners have long been trying to reach isolated areas with vaccination campaigns and the health clinic gives them a base for this in the region. Before the establishment of Sar Assya clinic in the district of Nawur in 2011 [4], various illnesses remained untreated, the mortality rate among mothers and children was high, and children did not receive the requisite vaccinations. The Nawur clinic’s services have brought about significant improvements in the health situation of the population.

Since it registration in the national health care system, the Nawur clinic’s staff vaccinated thousands of children not only for polio, but other infectious diseases such as tuberculosis, diphtheria, tetanus, pertussis, etc. In 2017, 1,022 children and several hundreds of women were vaccinated in Nawur. During the March 2018 vaccination campaign, 142 young children received the polio vaccine.

Through its implementation in a remote region of central Afghanistan Nawur health center contributes to the reduction of mortality and serves as a base for vaccination and other prevention campaigns.

[1] http://moph.gov.af/en/page/polio-eradication/polio-situation-updates

[2] Note: No cases have been reported since 2016 in the central region of Afghanistan where Nai Qala operates.

[3] http://www.emro.who.int/afg/photo-essays/ten-million-children-70000-workers-five-days.html; http://www.emro.who.int/afg/programmes/polio-eradication-initiative.html

2011 – Sar Assya

A clinic focusing on women

In the Nawur clinic project, mothers and babies are the primary focus of Nai Qala.

Men with a health concern can travel to town to get treatment in a hospital, but the situation for women is more challenging. A woman who is ill must be accompanied to hospital by at least one other female family member and by a male family member. If the woman has children, she must leave them behind if she goes for treatment. Some health problems require a longer stay in hospital and some need medical follow-up over months. Furthermore, families are often reluctant to pay the costs of prolonged hospitalization. Consequently, women simply do not travel to clinics or hospitals that are far away. This is one reason for high female and child mortality rates and it is also why the Nai Qala Association built the Nawur clinic.

Inaugurated in November 2011, the clinic now has 11 staff providing health services for a population of 20,000 in the surrounding region. Since its opening, there have been more than 60,000 consultations, of which over 11,000 concerned children. Some 750 babies had been born in the clinic as of December 2017.

Nai Qala Association is proud to have been in direct contact with the Ministry of Public Health since the beginning of the project. Our original partnership with the ministry was from 2012 to 2016 and we were offered an extension to 2020. The administration of the Nawur clinic was transferred to the ministry in June 2015. In many official meetings the example of the Nawur health centre has been cited to show that it is possible to provide health services to one of the most isolated regions of Afghanistan.

Women in Nawur typically have large families. It is unusual to see a couple with fewer than five children. Most families have more, and it is not outside the norm to have 12 children. Observers may question why parents have such large families, especially given the economic limitations. However, where the survival rate of children is low, it is understandable that parents have more to increase the chance that some will survive. Limitations in care both during pregnancy and in the postpartum period leave mothers and babies at risk.

Reducing or eliminating these risks will reduce parents’ anxiety about their children’s survival and will foster a subsequent reduction in supernumerary pregnancies. The clinic is vital to reducing these pervasive risks.

As of the end of December 2017, 3156 women and 1022 children had been vaccinated in the clinic. Some 13,000 outpatient visits took place for a range of conditions that, without the clinic, would have gone untreated until they became far more serious, and the records show 125 cases of severe malnutrition receiving medical care. Some 175 Nawur patients were referred to other health facilities for more specialized treatment.

The local people have realized the clinic’s value – more women and babies are surviving – and they are determined not to give it up.

News from the clinic

The Nai Qala Association built the clinic at Nawur in 2011 and supported and ran it until 2015 when it was officially handed over to the state. Today the clinic is supported by the Organization for Research and Community Development (ORCD) in partnership with the Ministry of Public Health.

We visited the clinic in 2016 and were impressed to see how well the it is functioning; it has become part of Nawur’s identity and life. It is well-maintained and has become a normal part of the community’s life.

According to a report by the ORCD and the Ministry, the clinic with its 7 staff (2 women and 5 men) continues to provide a good service for the Nawur community. In 2016 alone, a total of 8’377 women, men and children were treated in this center. Over 100 babies were born in the clinic and vaccination is continuing for women and children.

ECD simple hygiene measures

Early Childhood Education program includes basic hygiene measures

During the early childhood education class, children learn how to wash their hands before going to class or before eating. Children are effective communicators and agents of change: they learn the habits of good hygiene at school and pass them on home and in the community. For children, this direct involvement in the promotion of hygiene inculcates a sense of personal capacity building.

According to Unicef, every day about 4,000 children under five die of diarrheal diseases worldwide. Washing hands with soap and water is one of the most effective and cheapest ways to prevent these deaths. Washing hands reduces the number of deaths associated with diarrhea by more than 40% and acute respiratory illness by around 25%.

Promoting good hygiene and health habits early in life can lead to lifelong hygiene behaviors.

Health

 

We improve the health conditions of thousands of people by providing access to health services and increasing hygiene and health awareness.

  • We provide access to health services:
  • We increase health awareness and improve hygiene practices:
    • by training thousands of schoolchildren who attend the schools we built or participate in our early childhood education programs on basic hygiene measures;
    • by promoting gardening initiatives to enhance the nutritional  status of the entire family.