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After the fall of the Taliban in 2001 and as a country recovering from conflict, Afghanistan had some of the worst health indicators in the world. More than one-in-two (54 percent) children under five were stunted and around four-in-ten (39 percent) children were underweight in Afghanistan in 2004.
In just 10 years, despite conflict and widespread poverty, Afghanistan made significant improvements in its health indicators: Under-five mortality reduced 29 percent, stunting declined from 54 percent in 2004 to 40 percent and underweight children declined from 39 percent to 20 percent in 2013.
Coverage of several maternal care interventions increased:
The reduction in stunting has a lot to do with the health ministry’s focus on early breastfeeding and convergence of various ministries and aid agencies to achieve the goal, according to Homayoun Ludin, director of public nutrition, Ministry of Public Health.
Ludin, 40, was in New Delhi recently for a conference on “Critical Public Health Consequences of the Double Burden of Malnutrition and the Changing Food Environment in South and South-East Asia.” Following are the excerpts from his interview with IndiaSpend:
It started in 2002, and we established the public nutrition department under the ministry of public health. For a few years, there was no clear understanding of how to achieve the targets. Then we organised one of the nutrition conferences in Kabul–South Asia Breastfeeding Forum in 2006.
Our minister and deputy minister and those involved in nutrition were mobilised on how to achieve specific actions, especially those which were well-studied like breast feeding, child feeding, complementary feeding and maternal feeding and initiatives like baby-friendly and mother-friendly ‘huspatal’ [hospital].
Those actions discussed in 2006 started a new movement. We then developed a declaration and started working on that.
Our first lady also gave a speech on the importance of breastfeeding to national channels showing commitment.
When we did not achieve our goals as we wanted or expected to achieve, we decided this is not just a health issue, and we need to involve other ministries as well.
After the chief executive officer (CEO) of our government released the names for all these ministries, we had a big gathering in 2017. During the day, ministries were called on to develop their plan. Each month, they meet and prepare a plan. We have another meeting called the executive committee meeting and a high level steering meeting in six months where all ministers of the 17 ministries under the leadership of the CEO review the action points of each executive committee for the next six months.
As most people follow religious leaders, we have close coordination with the ministry of religious affairs, which work with religious leaders on the importance of nutrition taking references mentioned in Koran. Now they [religious leaders] speak about nutrition in their speeches during different occasions. It shows the coordination and multi-sectoral approach.
We had the first national nutritional survey in 2004, and the second one after 10 years in 2013.
Increasing the food security situation as well as sanitation and water are linked with the reduction of stunting.
So, nutrition is not something to achieve in one year or six months. It takes effort, it’s a long process. Therefore, we conduct the survey after ten years or seven years.
As breastfeeding is fundamental for health and nutrition, whenever a mother is planning to have a baby, we train mothers about the importance of their [own] health. Religious leaders back the members in their community to support the efforts of mothers to have healthy babies.
Prophet Mohammed, in the Koran, says that a strong Muslim is better than a weak Muslim. So, we say “if we support mothers, strong baby will come to the world”.
Breastfeeding is very important for the baby to be well nourished, and it is equally important for mothers to prevent breast cancer and ovarian cancer. We are supporting maternal nutrition during six months of exclusive breastfeeding when there is no chance of treating babies for anemia.
We are supporting mothers to have nutritious food, and to be supported by family and religious leaders to eat appropriate food.
When men come for Friday religious gatherings, they [religious leaders] convey this to them for their wives because it is difficult to speak to women since they don’t come out of the house or visit health facilities even when there are problems.
It is not direct to the women, directly to the women, but to their husbands or religious leaders. In case there are [health] problems, there are female nutritional counselors at every facility.
The important thing is creating the demand, and the second is supply. If we don’t have supply, then creating demand is not solving the problem.
If we are monitoring growth or weighing a child or measuring the length of the baby, we need to inform mothers that the baby’s height should be 86 cm after six months. If your baby is less than 86 cm after six months, your baby is malnourished.
There is going to be a nutritional counsellor in every health centre in Afghanistan. The hiring for 18 provinces [of 34] is almost done.
We have limited financial resources in our country. So, we have used the available resource, which is human resource.
Therefore, we train two trainers for each hospital and ask them to train their own staff–in three days, one day or two hours each day for a week during lunch break. This is what we call zero budget.
It is mainly in two parts: Whenever a baby is born in the hospital, we will tell the mother to start early initiation of breastfeeding within one hour since support is available. A midwife or nurse will support the mother, and if there are issues like attachment or position issues, they can help them.
Also, no promotion of any kind of breast milk substitute is allowed in our hospitals. No advertisement, no free gifts, brochures or posters are allowed.
We counsel the mothers about early initiation of breastfeeding and each mother coming to the hospital is made aware about the importance of breastfeeding.
Till now, 80 hospitals have been certified as baby-friendly hospitals.
We work with both foreign and local agencies. While some of them have already received funds, some are looking for funds and developing proposals.
When we draft the national annual plan, we ask everyone to send us their plans and activities. We invite them for a meeting and discuss each point.
Each has a part to play in the plan – water and sanitation, family planning, nutrition–which they show to their donors. The government is facilitating, coordinating and leading the process.
(This article was originally published on IndiaSpend and has been republished here with permission.)
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