Vikas Dwivedi

Reconstruction efforts to strengthen the capacity of the health system include the implementation of a basic package of health services to ensure optimal service delivery in Afghanistan. The performance of health services have been assessed through the national health services performance assessment conducted annually by the Ministry of Public Health. In 2006, 630 health facilities were selected through a stratified sampling methodology and assessments on quality of care were made on a random sample of 2912 sick children under-five years. Results: The primary complaint was fever, followed by diarrhea and cough or difficulty in breathing. A majority of the caretakers were mothers (67%) and only 6% of the caretakers were literate. Only 43% of the providers counseled the caretakers on signs for immediate return to the clinic, and 47% informed the caretakers the date of the follow-up visit. More than 50% of the caretakers reported receiving information on the disease and appropriate hom...

Since the events of 2001, the Ministry of Public Health and the international community have made considerable investments to reconstruct the health infrastructure in Afghanistan. To achieve optimal results for the predominantly rural population with some of the poorest health indicators the Basic Package of Health Services (BPHS) was introduced to improve access to and quality of health care. In 2004, MOPH in partnership with the Johns Hopkins University and the Indian Institute of Health Management Research, through funding from the World Bank, instituted national performance assessments on the BPHS which are conducted annually. Stratified random sampling methodology was used to select the health facilities which included district hospitals, comprehensive health centers and basic health centers. More than 600 facilities were selected in the 30 provinces in 2004 and 2005 to perform the health facility assessments. Results: Assessment of danger signs and presenting symptoms had impr...

A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. There were 1826 estimated deliveries during the se...