PRT/QALENOW: THE SPANISH BRING MODERN MEDICINE TO

UNCLAS SECTION 01 OF 03 KABUL 000955

SIPDIS

SIPDIS

DEPARTMENT FOR SCA/FO, SCA/A, S/CR, SCA/PAB, S/CT, EUR/RPM
STATE PASS TO USAID FOR AID/ANE
NSC FOR AHARRIMAN
OSD FOR KIMMITT
CENTCOM FOR CG CFC-A, CG CJTF-76, AND POLAD

E.O. 12958: N/A
TAGS: PGOV PREL EAID AF
SUBJECT: PRT/QALENOW: THE SPANISH BRING MODERN MEDICINE TO
BADGHIS


1. (U) SUMMARY: One of the primary objectives of the Spanish
Development Agency (AECI) is to expand and improve healthcare
throughout Badghis. AECI places a special focus on medical
care for women and newborns. It aims to transform the
central hospital in Qal-e Now into a fully functioning
provincial medical center and to increase access to medical
services for all Badghis residents by establishing EMT
service province-wide. In addition to these major
infrastructural improvements, AECI is concentrating on less
flashy, but equally important, issues such as increasing
human capacity and hospital space allocations. PRT Qal-e Now
is establishing an Afghan led provincial medical system that
could serve as a best practice for other provinces. END
SUMMARY.


2. (U) In May 2006, AECI began a three-pronged approach to
reform Qal-e Now's antiquated and disorganized hospital by
focusing on infrastructural improvement, increasing human
capacity, and reorganizing the hospital's staffing and space
allocations. The goal of the project is not simply to
present provincial authorities with a new hospital building,
but to involve them in the far greater task of developing a
sustainable medical system that will be Afghan-led and,
increasingly, Afghan-funded.

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Medical Facilities Being Rebuilt
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3. (U) The most noticeable parts of AECI's hospital reform
efforts are the many infrastructural improvement projects
being conducted on the hospital grounds. The old main
hospital building, the women's hospital, a number of service
buildings and the building used for laboratory and
administrative functions were all recently renovated.
Construction of a new hospital wing is almost fifty percent
complete. Construction of a new building to house
administrative offices and the province's first nursing
school will begin shortly. When completed, the hospital
complex will consist of a stand alone out-patient center, a
maternity and pediatric building, a main hospital ward with
surgery and emergency areas, a nursing school and
administration building, a laboratory building housing the
hospital's blood bank, and a series of outbuildings including
a mosque, laundry, restrooms and kitchen. The hospital
compound's capacity will increase from 62 beds to over 120,
and the level of care will be vastly improved.

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Office Reorganization Improves Effectiveness
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4. (U) The AECI manager of the hospital project, Luis de la
Fuente Martin, stresses that while the physical improvements
are impressive, operational and capacity building parts of
the reform effort will also contribute greatly to improved
medical care. During the initial assessment of the hospital,
Martin found the organization structure in complete disarray.
Administrative offices were intermingled with patient
treatment areas, wards and labs were located randomly
throughout the building, and newborn babies were co-located
with adults suffering from both blunt force trauma wounds and
infectious diseases.


5. (U) The massive remodeling project enabled AECI to
reorganize and reallocate space, which greatly improved the
hospital's functionality. One reorganizational highlight
includes relocating various labs into one central area.
Providing cross-training to the lab technicians ensures that
more than one lab technician who can perform a specific
function and that 24-hour laboratory assistance is available.
Separating pregnant women and newborns from the general
hospital population was also achieved, and a separate
out-patient facility was established.
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Building Staff Capacity Is Key Component
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6. (U) AECI is working to increase the human capacity of the
hospital with training and mentoring. In April, a Spanish
hospital management specialist will conduct a training needs
assessment and begin a month-long training program in medical
care. Six other specialists will subsequently conduct
month-long training programs in gynecology, anesthesia, and
general surgery. Martin mentors the hospital administrator
and leads medical staff on a wide-range of issue areas on a
daily basis.

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Goal: Afghan-Led and Funded Hospital
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7. (U) A key component of AECI,s reform plan is the agency's
financial commitment to establish and maintain the hospital
while ensuring that it transitions toward an Afghan-led and
eventually funded institution. Initially, AECI provided
almost all the hospital's operational funding, including
salaries, patient meals, medicine, generator fuel and large
amounts of donated medical equipment. The GOA now pays the
basic salaries of most hospital employees. AECI continues to
provide incentive pay and covers costs associated with meals,
medicine and many operational aspects. The hospital is a
long way from self-sufficiency, but steps are being made in
the right direction.

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Goal: Increase Hospital (vs Home) Births
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8. (U) Part of the challenge in reforming the hospital has
been improving the public's impression of the services
offered by the hospital. AECI has devised a program aimed at
encouraging more women to opt for giving birth in the
hospital, as opposed to choosing more traditional locations.
In 2006, 319 children where born at the hospital compared to
271 in 2005. This year, each baby born in the hospital will
receive a newborn kit that includes a blanket, towel, hygiene
supplies and Dari language health-related material. Based
upon initial reaction to this program, AECI estimates that at
least 600 babies will be born in the hospital this year.

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4WD Ambulances Will Reach Remote Areas
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9. (U) AECI is embarking on a project to create an EMS
system to increase the reach of the province's medical staff.
AECI will provide each district with a four-wheel-drive
ambulance complete with anti-mine protection, radio, and
basic life-support equipment. The Qal-e Now hospital will
also receive two ambulances, a mobile vaccination unit, and a
coordination center that will enable hospital staff to
monitor, advise and direct EMS operations province-wide.
AECI plans to conduct a month-long EMT course in May for all
ambulance staff to ensure that the ambulances are more than
merely a taxi service to the hospital. When fully deployed,
the EMS system will be able to reach individuals in need of
medical attention in remote areas, transport patients from
district hospitals and clinics to Qal-e Now, and transport
patients to the Herat hospital if their injuries cannot be
treated adequately in Qal-e Now. The infrastructural
improvements, including the EMS system and nursing school are
scheduled to be completed in 2008.

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COMMENT
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10. (U) AECI coordinators realize that the financial
support, mentoring and training aspects of their hospital
project will continue many years into the future. AECI is
not only committed to the long-term success of the medical
system in Badghis, but to the lengthy process of slowly
increasing Afghan control and responsibility for their
medical system. AECI,s long-term project to drastically
improve the quality of life for the average resident of
Badghis mixes a blend of rebuilding (and in many cases

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creating) infrastructure, increasing staff capacity, and
empowering locals in ways that could serve as a model for
other health sector reform efforts in Afghanistan. END
COMMENT.
NEUMANN