Health in Herat Province: An Interview with Dr. Rasheed

By: Hedayatullah Sahak, MD and Mahesh Shukla, MD, MPA. 

The following is an interview with Dr. Ghulam Saeed Rashed, MD, MPH, the Provincial Public Health Director of Herat, Afghanistan. Here Dr. Rashed shares his insights on being able to improve health leadership and management in Herat Province, and how that in turn has helped him and his team improve health services in Herat, Afghanistan. The interview was conducted by Hedayatullah Sahak, MD, Health System Strengthening Advisor within the Ministry of Public Health, Afghanistan, and Mahesh Shukla, MD, MPA, Public Sector Governance Senior Technical Advisor for the Leadership, Management & Governance Project.

Dr. Rashed Interview

LMG Staff: Thank you, Dr. Rashed, for agreeing to do this short interview with us. The health system in Afghanistan suffered a serious setback during the 30-year war. Tell us how the health system was rebuilt in Herat Province in the past 12 years. What has been done and what remains to be done?

Dr. Rashed: In the name of Allah The Most Beneficent, The Most Compassionate. As you pointed out, the 30-year war had created too many problems for the people in different ways. The health sector is also a sector that was devastated by this war and the people suffered from lack of health services for a long time. Fortunately, after 2001 the Ministry of Public Health identified the national priorities for its performance [on the basis of assessments]. For instance, the Basic Package of Health Services [BPHS—See chart below] was developed, and based on this strategy the Ministry of Public Health started its work of providing health services throughout the nation.

Herat province is one of the provinces where effective and efficient efforts have been made for implementation of the BPHS strategy. Among our achievements, I can mention the expansion of the health services, especially within the last six years when I have been responsible for the health directorate [in Herat]. Efforts have been made for establishment of the new health facilities in remote areas and in the areas where there is need. Over 30 health facilities have been established during this period where there was need.

Efforts have also been made for designing projects and obtaining resources for their implementation. Fortunately, we have established very good relations with the donors at the provincial level like the PRTs.[1]

One of the important factors that enabled us to obtain funding from our provincial donors and stakeholders and have good achievements, is the presence of technical partners like MSH [Management Sciences for Health. We have many accomplishments in Herat such as the capacity building of health workers and our staff, and strategy development in several areas. The strategies developed by the Herat team are now going to be implemented at the national level. We also established very good coordination and cooperation between the health partners and health stakeholders. We established the coordination through different meetings like Provincial Public Health Coordination Committee meetings. We conducted these meetings very effectively in order to ensure coordination for achieving the health objectives in Herat province.

Underserved areas still need to be covered by health services. Future planning and approaches need to be developed for this purpose. A second issue is that sometimes a concern is expressed that if donor support is discontinued, the Afghanistan government may face difficulties in providing services. We have established some mechanisms that will help us continue to deliver health services and maintain our successes and achievements.

LMG Staff: You have rich experience of working for public health in Herat. You have worked with national and international NGOs in your past career and now you are serving as Provincial Public Health Director of Herat Province for more than five years. You have been a leader of health system and public health in the province. Please tell us about your successes in public health, and also things that you wanted to accomplish for people in the province but are still working to achieve.

Dr. Rashed: I developed my leadership skills and art during my work with NGOs, and subsequently as a Provincial Public Health Director, I applied these in my work. Leadership development in health is one of the topics that cannot be ignored. I was one the participants of Leadership Development Program organized by MSH in Egypt. I learned about this program there and then implemented it during my work with national and international NGOs as well as during my work in a Provincial Health Office. I used the knowledge, skills, and art of leadership that I had learned in that LDP workshop by applying it in my work.

Well, I should mention that applying leadership practices is a secret of my success in health service delivery. Our team in the Provincial Health Office, after learning the leadership art and skills, developed a shared vision. We as a team planned our expected results after two, three, and 10 years. This was one of the leadership skills that we effectively used in our work. We developed our Challenge Model.[2] The Challenge Model enabled us to identify the key challenges and obstacles. We also discussed how and with what resources we can overcome the challenges we were facing.

Dr. Rashed InterviewWe did strategic planning, and encouraged the national and international partners to help us realize our vision and implement our plans. Our strategic plan for the department and the provincial health system helped our team mobilize USD 15 million. We allocated this amount to the areas in our strategic plan, and in keeping with the shared vision we had developed. It is worth mentioning that in Herat we truly work as team. Our decisions are neither individual decisions, nor do we implement them individually. We do it as a team. Fortunately, all of our programs are implemented in close coordination with relevant entities like local government, health shuras, district governors, and the community. Community engagement is another secret of our success in health service delivery and its sustainability. The second part of the question was about the work that we couldn’t accomplish, and work that continues. A number of programs depend on specific capacity that is needed. May be we still do not have enough capacity to accomplish what we desire. Another issue that needs attention is decentralization. The government still takes centralized actions, and this centralized management has caused obstacles and challenges for us in effective and efficient provision of services in the health sector as well as in other sectors. At this time, the Public Health Directorate of Herat is trying to convince the Ministry of Public Health, Parliament, and the Ministry of Finance in particular to make progress on decentralization and authorize us to take certain decisions on a decentralized basis. With this happening we will in the course of time, achieve another important step in leadership, management, and governance of health services. This will help us in providing quality and timely services to people.

LMG Staff: Many thanks. You had taken initiative in defining core public health management functions of Provincial Public Health Office. Your team is now working on enhancing governance for better health in the province. You are developing and testing a governance guide for the Provincial Public Health Coordination Committee. Tell us about this important and timely initiative.

Dr. Rashed:  The development of framework of Provincial Public Health Office (PPHO) core functions was a team initiative of the Herat PPHO team. It is worth explaining how we developed this framework. Herat team together with technical assistance of MSH colleagues defined the PPHO core functions, and based on these core functions we then helped defined the sub-functions—we call them tasks—and then we set performance standards for the tasks to enable us to measure our performance with regard to the respective tasks. We also carried out a self-assessment of our performance with regard to the set tasks and standards. Based on the result of the self-assessment, we developed a plan that helped us in implementation of this new core functions framework. In the self-assessment, a number of tasks were identified where we were performing at a lower level and we thought we could make extra efforts. Others were well-performed by our team. We shared our experience with other provinces in Afghanistan. So far, we’ve hosted PPHOs from 18 provinces of Afghanistan and we have shared with them our best practices and experience. Recently this core functions framework has been accepted and approved as a national framework by the Ministry. It has now been introduced in all provinces of Afghanistan for implementation.

On good governance in the context of health, we made a decision to introduce good governance practices in consultation with and with technical assistance from our MSH colleagues through the LMG project. Our objective is to improve the health and nutrition of the people of our province. Transparency and accountability to people, to the international community, and to the government are acutely needed. The technical team helped us in this regard with their valuable inputs. We are in the initial stages of this effort. Three months ago, we had a four-day workshop when we shared the fundamental and key concepts and practices of good governance with our Provincial Public Health Coordination Committee. In the past three months, the technical teams in the center as well as in select provinces have worked on and developed a governance guide, and we have finalized its initial version for field testing. We have planned to pilot test its implementation in the coming six months in Herat province. Inch’Allah the guide will become enriched with the experiences and ideas gained during this time. The gaps will be identified during this period and we will revise the guide accordingly. Regarding our governing practices, we performed a baseline self-assessment, and after six months we will do another assessment that will help us to identify our achievements as well as areas in which we did not make satisfactory progress. We will use our self-assessment results for improving our governance. We will also be able to introduce effective governing practices to the people of Afghanistan as well as to the Ministry of Public Health during our field testing period. If we end up with an effective governance guide and good results from its application, we can even share it with other countries that have context similar to Afghanistan.

LMG Staff: Thanks. As per our information, you have already started to apply the four effective governing practices that were developed by the USAID LMG project. Will you elaborate?

Dr. Rashed: Working in groups, we the PPHCC members have identified over 100 actions to improve our PPHCC’s governing practices over the next six months and Inch’Allah we will accomplish our aim of good governance. At this time, we have started applying good governing practices in our PPHCC.

Dr. Rashed shaking handsIn the future, our intention is to expand the application of effective governing practices to other ministries that influence health. As health is also socially determined and has close relation with other sectors like agriculture, education, and municipality, good governance in these sectors we hope will yield better health outcomes for our people. We will first apply effective governing practices and pilot these in our own area of work, and then invite other sectors and share our experiences. Thus, through inter-sectoral coordination, we will have good results and success in providing effective and efficient health services to our people.

LMG Staff: Thank you, Dr. Rashed. We wish you success in all of your endeavors.

[1] Provincial Reconstruction Teams or “PRTs” are civil military organizations designed to operate in semi-permissive environments usually following open hostilities. They were designed as a transitional structure to provide improved security, and to facilitate reconstruction and economic development. A PRT generally covers one province in Afghanistan, but some cover more than one.  PRTs seek to establish an environment that is secure and stable enough for the operation of international and Afghan civilian agencies to provide development support.  Due to their unique composition, PRTs are also able to deliver development and support to less secure areas. USAID’s programs attempt to work with PRTs to deliver services in less secure or underserved areas of Afghanistan.

[2] The Challenge Model, developed by Management Sciences for Health, offers a systematic approach for working together—as a team—to identify and face one challenge at a time and achieve results. The model leads health leaders and managers through a process of forming commitment to a shared vision that contributes to realizing an organization’s mission, defining and owning a challenge, prioritizing actions for implementation, and carrying out a work plan to achieve results.

Interview conducted by Hedayatullah Sahak, MD, Health System Strengthening Advisor, Ministry of Public Health, Afghanistan and Mahesh Shukla, MD, MPA, Public Sector Governance Senior Technical Advisor, Leadership, Management & Governance Project.

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