BPHS - 2010 - Final Final Final - 1

Islamic Republic of Afghanistan
Ministry of Public Health
A Basic Package of Health Services for Afghanistan – 2010/1389
Revised July 2010

A Basic Package of Health Services for Afghanistan – 2010/1389
Revised July 2010

Tables of Contents
Acronyms and Abbreviations

Foreword
1. The Process for the Development of the Second Revised Basic Package of Health Services 1
2. The Success of the BPHS 1
3. Future Challenges to the BPHS Strategy 2
4. BPHS 2010/1389—Changes made to the 2010/1389 BPHS (as compared with the 2005/1384 version) 3
5. Types of Health Facilities Used by the BPHS 4
6. BPHS: The Foundation of the Health System and Its Relationship to Hospitals 6
7. Flexibility in implementation 7
8. Health Care for difficult to reach populations 7
9. The Seven Elements of the BPHS and their Components 8
9.1 Maternal and Newborn Health 10
9.1.a Antenatal Care 10
9.1.b Delivery Care 11
9.1.c Postpartum Care 12
9.1.d Family Planning 13
9.1.e Care of the Newborn 14
9.2 Child Health and Immunization 15
9.2.a Expanded Programme on Immunization 15
9.2.b Integrated Management of Childhood Illness (IMCI) 16
9.3 Public Nutrition 18
9.4 Communicable Diseases 20
9.4.a Control of Tuberculosis primary entry point for VCCT 20
9.4.b Control of Malaria 21
9.4.c Control of HIV 22
9.5 Mental Health 23
9.6 Disability and Physical Rehabilitation 24
9.7 Regular Supply of Essential Drugs 25
10. Blood Transfusion Services to Support BPHS 34
11. Primary Eye Care Services 35
12. The Recommended Staffing Patterns for BPHS Facilities 36
13. Equipment and supplies for BPHS by type of facility 38
13.1. Equipment 38
13.2. Physiotherapy equipment 39
13.3. Renewable supplies 39
14. Diagnostic Services for BPHS by Type of Facility 43
15. Summary of Services, Staffing, Equipment, Diagnostic Services, Essential Drugs by Facility Type 44
15.1. Health Post 44
15.2. Health Sub-Center 47
15.3. Basic Health Center 50
15.4. Mobile Health Teams 53
15.5. Comprehensive Health Center 56
15.6. District Hospital 60
Annex A: Community-Based Health Care and Community Health Worker 65

1. Background 65
2. The Backbone of the BPHS 66
3. The Community Health Worker Job Description 67
4. The Community Health Supervisor Job Description 68
5. The Community Health Shura at Health Post level 70
6. The Health Shura at Health Facility level 70
7. Note on Traditional Birth Attendants 71
Annex B: Contents of Minor Surgery Kit by type of Facility 71
Annex C: Detailed List of Contents of Mini Delivery, Clean Delivery, and Midwifery kits 72
Annex D: Caesarean/hysterectomy set 73
Annex E: Laparatomy set 73
Annex F: Job Description of Physiotherapist 74
Annex G: Monitoring and Evaluating of the BPHS 75
Annex H: Proposed trainings for BPHS Health Service Providers 76
Annex I: Potential Weak links in the BPHS 77
Acronyms and Abbreviations
AFB Acid-Fast Bacilli

ANDS Afghanistan National Development Strategy
ARI Acute Respiratory Infection
ART Antiretroviral Treatment (HIV)
BCG Bacillus Calmette Guerin
BHC Basic Health Center
BPHS Basic Package of Health Services
CB Cold Box (EPI)
CBHC Community-Based Health Care
CGHN Consultative Group on Health and Nutrition
CHC Comprehensive Health Center
CHS Community Health Supervisor
CITC Client Initiated Testing and Counseling (HIV)
CTC Community Based Therapeutic Care
CHW Community Health Worker
DDH Developmental Dysplasia of the Hip
DEWS Disease Early Warning System
DH District Hospital
DMPA Depot Medroxyprogesterone Acetate
DOTS Directly Observed Treatment Short-course (TB)
DPT Diphtheria, Pertussis, Tetanus vaccine
EC European Commission
EOC Emergency Obstetric Care
EPHS Essential Package of Hospital Services
EPI Expanded Program on Immunization
FHA group Family Health Action Group
GAVI Global Alliance for Vaccines and Immunization
GBV Gender Based Violence
GMS Gender Main Streaming
GRR Gender and Reproductive Rights
HB Hepatitis B
HMIS Health Management Information System
HNS Health and Nutrition Sector
HNSS Health and Nutrition Sector Strategy
HCS Health Care Services
HP Health Post
HR Human Resources
HSC Health Sub-Centers
IEC Information, Education, and Communication
IMCI Integrated Management of Childhood Illnesses
IUD Intrauterine Device
IV Intravenous
M&E Monitoring and Evaluation
MDD Micronutrient Deficiency Diseases
MDR-TB Multidrug-Resistant Tuberculosis
MoPH Ministry of Public Health
MICS Multiple indicator cluster survey
MVA Manual Vacuum Aspiration
NHCS National Health Care System
NID National Immunization Day
NGO Non Governmental Organization
OPD Outpatient Department
OPV Oral Polio Vaccine
ORS Oral Rehydration Salts
ORT Oral Rehydration Therapy
PHC Primary Health Care
PHCC Provincial Health Coordination Committee
PMTCT Preventing Mother-To-Child Transmission (HIV)
PPHD Provincial Public Health Director
PPHO Provincial Public Health Office
SFP Supplemental Feeding Program
SFC-TFC Supplementary Feeding Center-Therapeutic Feeding Center
SMZ-TMP Sulfamethoxazole-Trimethoprim (Co-trimoxazole)
STD Sexually Transmitted Disease
TAG Technical Advisory Group
TB Tuberculosis
TBA Traditional Birth Attendant
UN United Nations
UNFPA United Nations Population Fund
UNICEF United Nations Children‘s Fund
USAID United States Agency for International Development
VAD Vitamin A Deficiency
VA Visual Acuity
VCCT Voluntary Confidential Counseling and Testing (HIV)
WB World Bank
WHO World Health Organization
________________________________________________________________________________________
Foreword
The Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan is very pleased to present this
newly revised Third Edition of the Basic Package of Health Services (BPHS) 2010/1389. This version
reflects the evolution in the health system since 2005 and includes new approaches to improve both the access
to and the quality of the basic health services. The MoPH believes that by continuing to focus on a Basic
Package of Health Services, it will be able to concentrate its resources on reducing mortality among its most
vulnerable citizens, especially women of reproductive age and children under five.
The BPHS continues to serve as the foundation of the Afghan health system and remains the key instrument
in making sure that the most important and effective health interventions are made accessible to all Afghans.
This edition of the BPHS continues the format used in previous editions. It clearly identifies what services
need to be available at each level of the primary health care system -health posts, health sub centers, basic
health centers, mobile health teams, comprehensive health centers, district hospitals- and lists the staff,
equipment, diagnostic services, and medications required to provide the services at each level. More attention
is given to the wide range of actual conditions experienced in the field in Afghanistan, due to geographical,
cultural and security factors, allowing flexibility in implementation in order achieve maximum impact given
the local conditions.
The BPHS itself is completely consistent with and based upon the principles contained in the Afghan National
Development Strategy (ANDS) 2008 -2013 and the Health and Nutrition Sector Strategy (HNSS) 2008 –
2013, which reflect the collective aspirations of the Afghan government and people. The BPHS in conjunction
with the Essential Package of Hospital Services remains the cornerstone of health service delivery in
Afghanistan.
Some services already included in the 2005 edition of the BPHS, like mental health and disabilities, have been
given more attention in this edition, clearly listing recommended interventions, staffing and equipment.
Likewise, more specific recommendations are included on how increase access to services for difficult to
reach populations, including nomads (Kochis) and prisoners. We invite all our partners to cooperate, under the
stewardship of the MoPH, to make sure that all Afghans, rich or poor, living in towns or remote villages or in
prisons will be able to receive quality services through this newly revised BPHS. Meanwhile, the MoPH will
monitor and evaluate what works best, and based on observed best practices, we will continue updating and
improving the BPHS.
We would like to express our appreciation for the tremendous effort provided by the members of the BPHS
Revision Core Group, and the members of the five sub-groups, who have preserved the spirit of the original
BPHS throughout the process of revision and improvement. The MoPH appreciates the continued financial
support for the BPHS implementation, and is especially grateful to European Commission and EPOS for
providing funding and technical assistance for the elaboration of this version of the BPHS, and to USAID and
MSH/TechServe for the assistance in the finalization of this version of the BPHS.
The joint effort of the staff of MoPH, the World Bank, UN and donor agencies, NGOs and other MoPH
partners has resulted in a document that will provide valuable guidance for further increasing access to quality
basic health services for all Afghans. Now we need to dedicate ourselves to make sure that this BPHS is
actually provided to all Afghans and that the quality of the provided services continues to improve. The
people of Afghanistan have the right to high quality basic health services.
Dr. Suraya Dalil

Acting Minister of Public Health
Kabul, Afghanistan
July 2010
MoPH – Basic Package of Health Services, 2010
1. The Process for the Development of the Second Revised Basic Package of
Health Services
In 2002, the Consultative Group on Health and Nutrition (CGHN) whose members included important
stakeholders such as donors, line ministries, NGOs, UN agencies, Embassies and International Assistance
Forces, proposed developing a Basic Package of Health Services to address the highest priority health
problems with services and interventions that would be available to all Afghans. The CGHN determined that
it was especially important for the BPHS to be provided to those living in remote and underserved areas. In
March 2003 the MOPH ratified the first version of the BPHS which had been developed collaboratively with
partner agencies. The purpose of developing the BPHS was to provide a standardized package of basic
services that would form the core service delivery package in all primary health care facilities.
In the first BPHS revision in 2005, the MOPH focused on obtaining better responses to emerging priority
health problems with essential services. The Government of Afghanistan (GOA) had developed a medium
term strategic plan, the Afghanistan National Development Strategy (ANDS), along with the Health and
Nutrition Sector Strategy (HNSS). Within these two umbrella strategies a number of important public health
considerations were recognized as falling within the GOA/MOPH mandate to address. To accommodate new
policy and strategic directions, as well as including evidence-based updates, the MOPH decided that the
BPHS would be reviewed every 3-4 years.
The process of the present review began in May 2008. The relevant stakeholders in the health sector were
requested to share their suggestions for revision of the BPHS_2005. A core group consisting of various
relevant partners and departments in MOPH was selected to oversee and guide the revision. The core group
further specified the essential criteria for any interventions proposed for inclusion in the revised BPHS:
1) Is the intervention relevant to BPHS?
2) Does the intervention have proven effectiveness?
3) Can the intervention be scaled-up to be implemented on a national scale?
4) Is the intervention affordable in the long term? (Sustainability)
5) Who will have access to and benefit from the intervention so as to be fair to all? (equity)
6) Is the set of proposed new services kept basic and essential?
7) Is the intervention acceptable to most Afghans?
8) Do the proposed new services have a significant impact on priority health problems?
The core group then established sub-groups for reviewing the different categories of comments that had been
received from the stakeholders. The sub-groups came up with recommendations for accepting or rejecting
suggested changes in the BPHS. A first revised draft was presented to the CGHN in January 2009 and after
incorporating inputs from both the CGHN and the Technical Advisory Group (TAG), the final
recommendations were submitted to the MOPH Executive Board for endorsement. The official approval of
the MOPH Executive Board was received in July 2009.
Delay in printing the document led to a quick updating with regards to new policies and strategies in June
2010 and final endorsement in July 2010.
2. The Success of the BPHS
Since the first edition in 2003, BPHS has provided the health sector with uniform standards found in the core
package of preventive and curative health services. It also provided the MoPH with tools to effectively
assume its stewardship role to coordinate and monitor the implementation of health care activities. As a
result, the BPHS has been the catalyst behind the establishment of strong understanding between the MoPH
and its major partners; namely the BPHS implementing NGOs and the donors.
The pre-occupation of the MOPH to make the BPHS available to all Afghans, has led to the introduction of
Health Sub-Centers and Mobile Health Teams, now part of the standardized classification of health facilities
that provide the basic services:
 Health Posts (HPs)
 Health Sub-centers (HSCs)
 Basic Health Centers (BHCs)
 Mobile Health Teams (MHTs)
 Comprehensive Health Centers (CHCs)
 District Hospitals (DHs)
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This standardized classification establishes a common language used by the MoPH and its partners. Being
based on measurable considerations such as population size and the locations of the target areas, the
standardized classification of facilities emphasizes the equitable distribution of health care all over the
country. In addition, the standardized classification has increased the ability of the MoPH to oversee, monitor
and manage the health system. It has been particularly important when one considers the number of key
donors of financial resources for provision of the BPHS with whom the MOPH has had to deal.
Soon after completion of the initial BPHS in 2003, the MOPH identified the need to address the hospital
sector of the health system in a similar manner in order to ensure a complete and integrated health system in
which a functioning hospital system existed that could accept referrals of complicated cases and conditions
from health posts, basic health centers, and comprehensive health centers. The Essential Package of Hospital
Services (EPHS) was endorsed by the MOPH in July 2005. For each of the three levels of hospitals—district,
provincial, and regional and specialty—the EPHS identifies1:
 The hospital services provided
 The diagnostic services that should be available
 The equipment necessary for providing the services in the hospital
 The elements of the Afghanistan Essential Drug List needed at each type of hospital
 The minimum and recommended staffing levels needed.
While BPHS 2005/1384 included the services provided by district hospitals as part of the BPHS, the EPHS
provides a complete and comprehensive list of services beyond the BPHS based services
The BPHS and EPHS together represent the basic and essential elements of the health system.
Increased availability and accessibility of basic health services is another profound success achieved through
the implementation of the BPHS. Six years of BPHS implementation have led to a significant increase in the
proportion of the population with access to basic health services. BPHS is implemented currently in districts
where 85% of population reside2. The increased access of population to the BPHS facilities has resulted in
very significant increase in the utilization of the various services of the package. The MoPH plans to expand
BPHS coverage to 90% by the year 2010. It is expected that the MHTs and HSCs, endorsed in this new
revision, will be instrumental in reaching this target.
The success of the BPHS is demonstrated in the significant improvement in key Afghan health indicators
compared with 2003. The following table displays the improvements achieved in some important indicators:
Table 1: Key Indicators of the Afghan Health System

INDICATOR Value Year Value Year
1 Outpatient visits per capita per year 0.61 2003 1.041 2008
2
2 DPT3 immunization coverage 29.9% 2003 82.9%2 2007
3
3 Skilled birth attendance at deliveries 6.0% 2003 18.9%4 2006
3
4 Infant mortality rate (per 1,000 live births) 165 2000 1294 2006
3
5 Under 5 mortality rate (per 1,000 live births) 257 2000 1914 2006
6 Number of health facilities 1241 2003 16881 2009
3
7 Skilled Antenatal Care (at least 1 visit, 4.6% 2003 32.3 %4 2006
excluding TT) (%)
1
HMIS
2
Expanded Program on Immunization, MoPH
3
MICS
4
Afghanistan Health Survey 2006
3. Future Challenges to the BPHS Strategy
While the achievements of the MoPH under the BPHS framework have been significant, the future holds a
number of challenges:
First, further expansion of the BPHS, as measured by the percentage of the population with access to BPHS
services, will become increasingly difficult. Extending access will require the MoPH to reach all remote areas
in the country plus 23% of urban dwellers. For the rural population coverage, increasing levels of access will
1
Essential Package of Hospital Services, MoPH, 2005.
2
Grants and Contract Management Unit, MoPH, 2008.
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require a great amount of effort; however, the MoPH is committed to the issue of equity and will strive to
increase the proportion of the population that has access to the BPHS.
The MoPH remains committed to building a sustainable nationwide health system that is appropriate for
Afghanistan. However, this will prove a challenge since current services are primarily provided through
funding from three major donors plus significant contributions by other donor agencies. The MoPH remains
dedicated to the principle of equity and to care being based upon need rather than ability to pay for services.
This commitment is reiterated in two of the six principles stated in the MoPH‗s draft ―National Policy on
Cost-Sharing and Sustainability‖:
 Everyone who needs care must receive care, regardless of ability to pay
 Quality of care must be the same for paying and nonpaying patients
Ensuring quality is essential to maintaining and expanding the BPHS. If the quality of services is inadequate,
the population will not continue to support BPHS, and the foundation of the health system will crumble. The
MoPH is working on establishing quality standards for BPHS service delivery and assessing compliance with
those standards. In this effort, the tools it is using include the HMIS, the National Monitoring Checklist and
the Balanced Score Card. In addition, other tools may become national tools, such as the Quality Assurance
Standards for BPHS, which are being used by health providers in certain provinces to ensure and monitor the
quality of health service delivery.
Insecurity is still another challenge which reduces population access to health care services. It also limits
monitoring visits to the provinces where BPHS is being implemented. This may result in a compromise of
the quality and possibly a lack of transparency in terms of quality service provision.
Location of the construction of health facilities in the provinces on the basis of political influence brings the
risk of mal-distribution of the health facilities. This is an ongoing and serious concern in developing an
appropriate infrastructure for BPHS delivery.
An additional challenge is to align the BPHS with the EPHS to develop a single, unified, and community-
based health system with appropriate linkages for referrals throughout the system. The BPHS rests on the
concept that all services in the package should be available as integrated whole, rather than piecemeal or as
individual services, or only through vertical programs. Integration also means that hospitals will not only
provide secondary services but also provide BPHS services, and that they will reach out to their communities
to ensure that basic health services are being provided. Further, hospitals need linkages to CHCs and BHCs,
not only to receive referred patients but also to provide clinical supervision of the health centers and much
needed in-service education on a regular basis to staff in health posts, health sub centers, BHCs, Mobile
Health Teams and CHCs.
Finally, retaining the commitment to the BPHS will be a challenge. As the emergency situation that the
health system faced in 2002 has diminished, increasing attention is being paid to the hospital elements of the
health system. Typically, hospitals primarily benefit the urban population, yet Afghanistan‘s population is
over 80 percent rural. It is the BPHS that will provide the foundation for an equitable health system that can
improve the health of the country‘s population. The MoPH remains committed to the BPHS as the foundation
for an equitable and sustainable health system. A commitment to primary health care is internationally
recognized as a sensible and appropriate approach, as stated in The Lancet editorial of March 5, 2005:
… it is important that the Ministry of Health’s current sensible course of prioritizing and strengthening basic
primary health care is strongly advocated within government and maintained despite a lack of immediately
visible results and overt outside recognition. Only then will these remarkable efforts and achievements benefit
the Afghan people and make Afghanistan the blue-print country for post-conflict health reconstruction.
4. BPHS 2010/1389—Changes made to the 2010/1389 BPHS (as compared with

the 2005/1384 version)
The following is a summary of the major changes introduced to the BPHS through a consultative process:
1. The Disability and Mental Health elements of the 2005 edition of the BPHS have not had any funds
or staff allocated to either program. In this new edition indicates required staffing, training,
services, supplies and equipment. Over the next three years these two services will be gradually
implemented, as funding becomes available. Different implementation mechanisms will be
document and reviewed for efficiency for the next edition of the BPHS.
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2. Primary eye care has been newly introduced as a BPHS component to be gradually implemented in
the form of more training, primary eye care services and referral services.
3. Two new categories of health facilities or delivery mechanisms—Health Sub Centers and Mobile
Health Teams—which have already been established based on need in different parts of
Afghanistan, have been integrated into the BPHS. It is anticipated that these will improve access
and quality of services for the people
4. Privacy for psychosocial counseling and for labor rooms is now recognized in CHCs and BHCs
5. More essential drugs and equipment have been added to all categories of health facilities, from
health posts to district hospitals.
6. Updated Intervention Tables regarding EPI, Malaria, Nutrition, Disability, Mental Health and
HIV/AIDS have been included
7. Introductory and explanatory notes to clarify different sections of the new BPHS document have
been added.
8. Creation of a linkage between the ANDS, HNSS and other program-specific strategies, policies and
the BPHS has been established
9. A ―flexibility clause‖ has been added to the BPHS document—it has been introduced to allow
implementers to address variations between localities, local demand, and other local conditions
requiring flexibility
10. A table providing specifications for medical supplies and another for physiotherapy equipment and
supplies have been added
11. The need to extend BPHS services to internally displaced persons, nomads and persons residing in
prisons is now explicitly mentioned.
12. A monitoring and evaluation framework and an indicator fact sheet have been introduced
13. Community Based Therapeutic Centers (CTCs) and Family Health Action (FHA) Groups have been
added to the BPHS. Modalities for establishing FHA groups in different parts of the country are
being testes, and, after evaluation, will guide the gradual establishment of FHA Groups throughout
the country.
14. Additional staff that are newly required at health facilities for this BPHS include one
physiotherapist in each DH, as well as the addition of a second physiotherapist where there is no
physiotherapy center in the vicinity of the DH. One psychosocial counselor (nurse) may now be
added to a CHC if required by a sufficiently funded mental health intervention. One of the existing
MDs of the DH will be trained and serve as psychosocial focal point. One driver will be added to
those CHCs which have their own ambulance. The addition of other staff categories will be
governed by the ―flexibility clause‖.
15. A Table on training needed for implementation of the BPHS has also been added
16. Restrictions on the use of antibiotics for the management of IMCI at BHCs have been reduced
17. Transportation cost for the community health workers have been taken into consideration.
18. The National Salary Policy has been revised.
5. Types of Health Facilities Used by the BPHS
The BPHS will be offered at six standard types of health facilities, ranging from community outreach
provided by CHWs at health posts, through outpatient care at health sub centers and basic health centers and
provided by mobile health teams, to inpatient services at comprehensive health centers and district hospitals.
The section below summarizes the services available at each type of facility.
Health Posts (HP) : At the community level, basic health services are delivered by CHWs from their own
homes, which function as community health posts. A health post, ideally staffed by one female and one male
CHW, cover a catchments area of 1,000– 1,500 people, which is equivalent to 100–150 families. CHWs offer
limited curative care, including diagnosis and treatment of malaria, diarrhea, and acute respiratory infections
such as pneumonia; distribution of condoms, oral contraceptives, and depot medroxy progesterone acetate
(DMPA) injections; community DOTS; growth promotion nutrition counseling; and micronutrient
supplementation., CHWs are responsible for treating minor illnesses and conditions common in children and
adults, for awareness-raising on disability and mental health, and for identification of persons with disabilities
and mental conditions (for a fuller explanation of CHW tasks, see the CHW job description in Annex A). The
routine management of normal deliveries is not part of the CHW‘s job description, but female CHWs focus
on promoting birth preparedness, safe home deliveries with a skilled birth attendant (when possible),
awareness of the danger signs of pregnancy, the need for urgent referral when delivery complications occur,
and basic essential newborn care.
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Health Sub-Centers (HSC) : The Health Sub-Center (HSC) is an intermediate health delivery facility to
bridge the services gap between Health Posts and other BPHS levels of service delivery and to increase
access to health services for underserved populations residing in remote areas. A HSC is intended to cover a
population of about 3,000-7,000. The maximum walking distance to a HSC is two hours for the consumer of
health services living in remote areas. HSCs are initially being established in private houses. This is a
precondition before construction of a permanent facility and reqires commitment from the surrounding
community. Priority HSC locations need to be determined, with the ultimate location approved by the PHCC.
The HSC will provide most of the BPHS services that are available in BHCs including health education,
immunization, antenatal care, family planning, TB case detection and referral, and follow up of TB cases in
coordination with community DOTS. In addition, HSCs will be able to treat infectious diseases such as
diarrhea and pneumonia. HSCs will refer severe and complicated cases to higher level facilities. Where
feasible, HSCs will support health posts and CHWs, CHWs will provide a copy of their monthly reports to
the HSC or the mobile team in their areas. In addition, the DHOs should supervise the heath posts in their
relevant districts. The HSC will be staffed by two technical staff (a male nurse and a community midwife), as
well as a cleaner/guard.
Basic Health Center (BHC) : The BHC is a facility offering primary outpatient care, immunizations and
Maternal and Newborn care. Services offered include antenatal, delivery, and postpartum care; newborn Care
,nonpermanent contraceptive methods; routine immunizations; integrated management of childhood illnesses;
treatment of malaria and tuberculosis, including DOTS; and identification, referral, and follow-up care for
mental health patients and persons with disabilities including awareness-raising. The BHC supervises the
activities of the health posts in its catchment area. The services of the BHC cover a population of about
15,000–30,000, depending on the local geographic conditions and the population density. In circumstances
where the population is very isolated, the catchment population for a BHC can be less than 15,000. The
minimal staffing requirements for a BHC are a nurse, a community midwife, and two vaccinators. Depending
upon the scope of services provided and the workload of the BHC, up to two additional health care workers
may need to be added to perform well-defined tasks (e.g., supervision of community health workers and
outreach activities).
A male/female ratio of 1/1 is recommended, and at least one female health worker should be part of the BHC
staff. The MOPH will allow a physician to be at a BHC only to replace a midwife or a nurse, when those
positions are not filled, and a physician is available and there is sufficient physician staffing at CHCs and
district hospitals. The doctors can be given the salary of the physician if they work in the BHCs. Hospital
physiotherapist should visit BHCs on an outreach basis from the district level.
Mobile Health Team (MHT) : The principal idea of mobile health services is to establish a limited number
of mobile health teams in each province by dividing the province into clusters of districts .1) to ensure the
provision of essential and basic health services in remote villages located in geographically hard to access
areas; 2) to expand and strengthen community-based health care (CBHC) through the identification of
additional CHWs in hard to access areas and to link community level interventions with BPHS facility-based
services; and 3) to encourage greater community participation and community ownership of health services.
It is expected that the work of mobile health teams will facilitate the further strengthening and expansion of
CBHC, by enhancing community participation and community ownership of their health services, particularly
as they will be involved in the monitoring and evaluating of the mobile health team‘s work and the work of
the CHWs. Intervals between visits of the MHT should be based on security, remoteness, and the needs of the
population, but should occur at least once every two months (For more information refers to MOPH MHT
concept paper). Based on the experience of the MHTs, the PHCC can revise the frequency of the visits.
Planning for mobile health services needs to be done together with community leaders to gain their support
and guidance. Their assistance in providing secure accommodations for overnight stays of the mobile team
staff will be very important for their success. EPI teams will assist the PHCC in determining the appropriate
sites for mobile health services. Mobile health services are an extension of BHC services; therefore, the
services they provide are in most cases those recommended for a BHC. The MHT ideally has the following
staff, male health provider (doctor or nurse), female health provider (community midwife or nurse),
vaccinator and driver.
Comprehensive Health Center (CHC): The CHC covers a catchment area of about 30,000–60,000 people
and offers a wider range of services than does the BHC. In addition to assisting normal deliveries, the CHC
can handle certain complications, grave cases of childhood illness, treatment of complicated cases of malaria,
and outpatient care for mental health patients. Persons with disabilities and persons requiring physiotherapy
services will be screened, given advice and referred to appropriate services in the area. The facility usually
has limited space for inpatient care, but has a laboratory. The staff of a CHC is larger than that of a BHC; it
includes both male and female doctors, male and female nurses, midwives, one (male or female) psychosocial
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counsellor and laboratory and pharmacy technicians. Physiotherapists will visit CHCs on an outreach basis
from the district hospital.
District Hospital (DH): At the district level, the district hospital handles all services in the BPHS, including
the most complicated patients. Patients referred to the district hospital level include those requiring major
surgery under general anesthesia, X-rays, comprehensive emergency obstetric care, and male and female
sterilizations. It offers comprehensive outpatient and inpatient care for mental health patients and
rehabilitation for persons requiring physiotherapy with referral for specialized treatment when needed. The
district hospital also provides a wider range of essential drugs, treatment of severe malnutrition renewable
supplies and laboratory services than do the health centers. The district hospital is staffed with a number of
doctors, including female obstetricians/gynecologists; a surgeon, an anesthetist, a pediatrician, a doctor who
serves as a focal point for mental health: psychosocial counsellors/supervisors; midwives; laboratory and X-
ray technicians; a pharmacist; a dentist and dental technician; and two physiotherapists (male and female).
Each district hospital covers a population of about 100,000–300,000.
A summary of all the services, staffing, equipment, and essential drugs for health post, SHC, BHC, MHT,
CHC, and district hospital is provided in Tables 11, 12, 13, 14, 15 and 16, respectively.
6. BPHS: The Foundation of the Health System and Its Relationship to Hospitals
Health services in Afghanistan operate at three levels: 1) Primary Care Services i.e. at the community or
village level as represented by health posts, CHWs, SHCs, BHCs and MHTs; 2) Secondary Care Services i.e.
at the district level, as represented by CHCs and District Hospitals operating in the larger villages or
communities of a province; and 3) tertiary care services at the provincial and national levels, as represented
by provincial, regional, national, and specialty hospitals.
BPHS is complemented by the EPHS which defines essential elements of hospital services and promotes a
referral system in synergy with the BPHS. Together, the BPHS and the EPHS represent a number of key
elements of the health system being built by the MoPH in Afghanistan. At the planning stage they have
illustrated where essential primary care and hospital services will be provided and have explained the referral
hospital system necessary to support the BPHS.
However the EPHS which was developed at a later phase cannot attain the coverage nor achieve the mortality
impact of the BPHS. The hospital sector is generally a less cost effective service of the MoPH, but provides
high profile and highly desired services to the population.
The initial expectation that the referral system will complete the synergy between BPHS and EPHS has not
materialized to the extent expected. This can be attributed to the sometimes inappropriate utilization of
hospital services and an unstructured referral system.
Page | 6
BPHS
Hospital Sector
MHT
BHC
RH
MHT
HSC CHC DH
HP
HP
HP HP
BHC PH
HP
HP
HP
HP
BPHS Hospitals
HP Health Post DH = District Hospital
HSC Health Sub-Center PH = Provincial Hospital
BHC Basic Health Center RH = Regional Hospital
MHT Mobile Health Team
CHC Comprehensive Health Team
DH District Hospital
Figure 1: The Link between BPHS and Hospital Sector
7. Flexibility in implementation
Flexibility in the implementation of BPHS was among the most important recommendations of the Health
Sector Strategic Planning Retreat of December 2008. Adopting the principle of flexibility in implementation
is meant to allow alternative solutions when the BPHS implementing agency faces local situations or
problems that require innovation, modifications, or alternative approaches. Those include, inter alia, staff
patterns, types of staff training, selection of brands and manufacturers of medical supplies, levels of health
facilities, incentive schemes and on-call arrangements for relevant staff members. The implementing agency
can also be flexible in response to changes in population growth or unusual population distribution.
Flexible adjustments in BPHS implementation must observe the following principles:
1. Each adjustment should have a strong justification (such as gender equity, geography, security) and
lead to tangible improvements in specific aspects of service delivery
2. Modifications should promote the availability and equitable access of BPHS
3. They should not undermine the quality of the BPHS services
4. They should be cost effective
5. They should be of limited nature, implemented only when and where necessary, to maintain the
consistency of BPHS implementation
8. Health Care for difficult to reach populations
Every BPHS implementer has to cover the nomadic population and the internally displaced population living
for even part of the year in their catchment area. Vaccinators must provide outreach services for them and
clinics for these groups must be integrated into the BPHS. Coverage must be based on accurate population
data and implemented according to their primary health care needs. There is the possibility of obtaining
hardship allowances for provision of health services for difficult populations by the implementing agency
over and above the provision of regular services. The Nomad Health Unit of the MoPH, through the PPHD,
will supervise these activities according to agreed-upon indicators.
Page | 7
Due to the limitations of the current health services provided by the Ministry of Justice, the Prison Health
Services reform currently underway includes the transfer of the provision of services from the Ministry of
Justice to the Ministry of Public Health, or NGOs as its agents, under the stewardship of the MoPH. Detainees
are a part of the target population of the BPHS who are temporarily found in a special location and while they
reflect the epidemiological pattern of the general population, for certain diseases and behavior patterns (such
as tuberculosis and drug use), detention can actually be an aggravating factor. The referral of these detained
population groups for illness or wounds to a hospital is notoriously difficult, owing to constraints of logistics
and security. Therefore, establishing access to solid primary care services for detainees in Afghanistan's 34
provincial central prisons by the BPHS implementers is also a pre-condition for the implementation of
disease- and problem-specific activities for which special funding is available (such as activities related to
HIV/AIDS and drug use). Special services requiring inputs beyond those normally provided by the BPHS,
such as activities related to HIV/AIDS and drug use are the responsibility of the MoPH through
implementation of the Prison Health Package but not the responsibility of NGOs or others who are providing
the BPHS.
9. The Seven Elements of the BPHS and their Components
The BPHS has seven primary elements. Six involve basic services but the seventh element is necessary for
the six service elements to succeed: the seventh element is the regular and dependable supply and availability
of essential drugs.
Before going into the details of these elements it is expected that the BPHS implementing partners will be
familiar with the specific policies and strategies of the various priority health streams of MoPH. The
Afghanistan National Development Strategy (ANDS), the Health and Nutrition Sector Strategy (HNSS) are
umbrella strategies supported by the specific service strategies with each supported by a service department
for implementation purposes. The BPHS, and to an extent EPHS, are service delivery packages which
identify only the essential, most cost effective and high impact interventions for priority service delivery
(these documents can all be obtained from the MoPH Resource Center, the Policy and Planning Department
or related departments). Similarly, support strategies (HR, M&E, HMIS, and DEWS), their procedures and all
relevant administrative procedures should be known to the relevant staff of implementing partners.
Dissemination trainings on these strategies and procedures will be provided to staff. Meanwhile, it is the
responsibility of the contracting NGOs, the Policy and Planning and the individual MoPH departments to
disseminate the information contained in all these documents in a logical sequence so that the implementation
is done in unison and in an integrated manner rather than in isolation. NGOs are required to follow MoPH
standards.
The seven elements of the BPHS and the relevant sub-elements are listed in Table 2. The number of the table
listing services provided at various levels is given in parentheses.
The HSC and MHT have been added to the BPHS but they are to be regarded as temporary facilities which
may be abolished or changed to other permanent types of facilities if the need arises.
Table 2 : The Seven Elements of the BPHS and their Components

1. Maternal and Newborn Care a. Antenatal care (Table 2.1)
(Table 2.1 – 2.5) b. Delivery care (Table 2.2)
c. Postpartum care (Table 2.3)
d. Family planning (Table 2.4)
e. Care of the newborn (Table 2.5)
2. Child Health and Immunization a. Expanded Program on Immunization (EPI) (Table 2.6)
(Table 2.6 – 2.7) b. Integrated Management of Childhood Illness
(IMCI) (Table 2.7)
3. Public Nutrition a. Prevention of malnutrition
(Table 2.8) b. Assessment of malnutrition
Page | 8
4. Communicable Disease Treatment a. Control of tuberculosis (Table 2.9)

and Control (Table 2.9 – 2.11) b. Control of malaria (Table 2.10)
c. Prevention of HIV and AIDS (Table 2.11)
5. Mental Health a. Mental health education and awareness
(Table 2.12) b. Case identification, diagnosis and treatment
6. Disability and Physical a. Disability awareness, prevention, and education
Rehabilitation Services b. Provision of physical rehabilitation services
(Table 2.13) c. Case identification, referral and follow-up
7. Regular Supply of Essential Drugs Listing of all essential drugs needed
(Table 2.14)
Blood transfusion and blood bank services are not one of the seven basic elements of BPHS but are an
important element of health services at CHCs and district hospitals. Table 3 on blood transfusion and blood-
bank services has been added to this version of the BPHS.
Table 4, detailing primary eye care services has been added to BPHS 2009.
Training pertaining to all the BPHS components and management issues e.g. maintenance of equipment or
training needed for building staff capacity should be provided to the relevant staff. Gender training up to the
BHC level should be conducted and training on blood transfusion, physiotherapy, nutrition and mental health
should be conducted and budgeted for in the proposals submitted by the implementing organizations.
For all the elements of the BPHS, implementers will adhere to certain principles of and requirements for
appropriate implementation:
a. Routine reporting using the standard formats and reporting intervals as required by the HMIS and
M&E of the MoPH;
b. Strict adherence at all levels and for all services to the MoPH recommendations for infection
control, safe injection practices, and proper waste disposal;
c. Regular and supportive supervision of lower levels by higher levels, according to the
recommendations and requirements of the concerned MoPH departments and national programs.
Page | 9
9.1 Maternal and Newborn Health

Maternal and Newborn Health Tables
9.1.a Antenatal Care
(A part of Component 1 of the BPHS, “Maternal and Newborn Health”)
Table 2.1. Antenatal Care Services by Type of Facility

Health Facility Level
Interventions and Services Provided Health Sub-
Health Post BHC MHT CHC Dist. Hospital
Center
Information, education, and communication (IEC) Yes Yes Yes Yes Yes Yes
Diagnosis of pregnancy Presumptive Yes Yes Yes Yes Yes
Antenatal visits—weight, height measurement No—referral Yes Yes Yes Yes Yes
Tetanus immunization Outreach Yes Yes Yes Yes Yes
Iron and folic acid supplementation to pregnant Yes Yes Yes Yes Yes Yes
women
Multi-micronutrient supplementation Yes Yes Yes Yes Yes Yes
Blood pressure measurement No—referral Yes Yes Yes Yes Yes
Simplified urinalysis No No No No Yes Yes
Diagnosis of anemia Yes—clinical Yes—clinical Yes—clinical Yes—clinical Yes—blood test Yes—blood test
Treatment of intestinal worms Yes Yes Yes Yes Yes Yes
Yes based on Yes based on
Treatment of malaria Yes Yes ‌ es
Y Yes lab findings lab findings
Treatment of asymptomatic urinary tract infections No Yes Yes Yes Yes - urinalysis Yes - urinalysis
Treatment of symptomatic urinary tract infections No—referral Yes Yes Yes Yes Yes
Treatment of anemia Yes—iron Yes—iron folate Yes—iron Yes—iron folate Yes—iron Yes—iron
folate folate folate/blood folate/blood
transfusion transfusion
Screening for and management of sexually transmitted No—referral Yes—clinical Yes—clinical Yes—clinical Yes—based on Yes—based on
diseases laboratory laboratory
findings findings
Treatment of hypertensive disorders of pregnancy No—referral Yes and refer Yes and refer Yes and refer Yes Yes
Treatment of pre-eclampsia/eclampsia No—referral Yes and refer Yes and refer Yes and refer Yes and refer Yes
Treatment of incomplete miscarriage/abortion No Yes—MVA Yes—MVA Yes – MVA Yes – MVA Yes –MVA
MVA
Treatment of ectopic pregnancy No—referral Stabilize and Stabilize and Stabilize and Stabilize and Yes
refer refer refer refer
Infection control, safe injection practices, and proper Yes Yes Yes Yes Yes Yes
waste disposal
Reporting Yes Yes Yes Yes Yes Yes
Supervision and monitoring No—referral Yes Yes Yes Yes Yes
Note: An infrastructure requirement is to ensure the privacy of clients before, during and after delivery by making partitions or making small changes in the delivery room
e.g. separate entry way, waiting area plus appropriate location of bathrooms in proximity to the delivery room, etc.
Page | 10
9.1.b Delivery Care

(A part of Component 1 of the BPSH, “Maternal and Newborn Health”)
Table 2.2. Delivery Care Services by Type of Facility

Center
Information, education, and communication Yes Yes Yes Yes Yes Yes
Monitor progression of labor No Yes— Yes— Assess—refer Yes— Yes—
partograph partograph partograph partograph
Identify fetal malpositions No Yes and refer Yes and refer Yes and refer Yes and refer Yes
Assist normal delivery (ONLY emergency cases at No Yes Yes Yes Yes Yes
home)
Vaginal delivery requiring additional No Yes and refer Yes and refer Assess—refer Yes Yes
procedures/equipment
Provide mini delivery kit (see Annex C for kit Yes No No Yes No No
contents)
Parenteral administration of oxytocin No Yes Yes Yes if called to Yes Yes
a delivery
Parenteral administration of anticonvulsants No Yes and refer Yes and refer Yes and refer Yes and refer Yes
Bimanual compression of the uterus No Yes Yes Yes Yes Yes
Controlled cord traction No Yes Yes Yes Yes Yes
Suturing tears (Emergency cases at home) No Yes—vaginal Yes—vaginal Yes Yes— Yes—
vaginal/cervical vaginal/cervical
Provision of intravenous fluids No Yes Yes Yes Yes Yes
Safe blood transfusion No No No No Yes Yes
Manual removal of placenta No Yes—manual Yes—manual Yes Yes Yes
Removal of retained products (e.g. MVA) No Yes MVA Yes MVA Yes MVA Yes MVA Yes
Curettage No No No No MVA Yes
Hysterectomy No No No No No Yes
Management of prolapsed cord No No No Assess & refer Yes Yes
Management of shoulder dystocia No Yes Yes No Yes Yes
Vacuum extraction(assisted vaginal delivery) No Yes Yes No Yes Yes
External cephalic version No No No No Yes Yes
Symphysiotomy No No No No No Yes
Caesarean section No No No No No Yes
Craniotomy No No No No No Yes
Parenteral administration of antibiotics (first dose) No Yes Yes Yes Yes Yes
Page | 11
9.1.c Postpartum Care

(A part of Component 1 BPHS, “Maternal and Newborn Health”)
Table 2.3: Postpartum Care Services by Type of Facility

Center
Vitamin A supplementation to mother Yes Yes Yes within 40 days Yes Yes
of delivery
Treatment of anemia To be Yes—clinical Yes—clinical Yes—clinical Yes—based Yes—based on
referred on lab findings lab findings
Treatment of puerperal infection To be Yes Yes Yes Yes Yes
referred
Antibiotics Yes—oral Yes—oral/IV Yes—oral/IV Yes—oral/IV Yes—oral/IV Yes—oral/IV
Breast examination (if privacy is not an issue) To be Yes Yes Yes Yes Yes
referred
Counseling on birth spacing and exclusive breastfeeding Yes Yes Yes Yes Yes Yes
Provide birth spacing methods Yes— Condom/Oral Condom/Oral Condom/Oral Condom/Oral Condom/Oral
condom or injectable or injectable or injectable or injectable or injectable
or inject able progesterone progesterone progesterone progesterone progesterone
progesterone
Case definition and referral of infertility cases to provincial Yes Yes Yes Yes Yes Yes
hospital
Page | 12
9.1.d Family Planning

Table 2.4. Family Planning Services by Type of Facility

Center
Counseling on family planning methods Yes Yes Yes Yes Yes Yes
Clinical examination No Yes Yes Yes Yes Yes
Screening for STD To be referred Yes - clinical Yes - clinical Yes - clinical Yes - lab Yes - lab
Treatment of STD No Yes - oral/IM Yes - oral/IM Yes - oral/IM Yes - oral/IV Yes - oral/IV
Promotion of LAM Yes Yes Yes Yes Yes Yes
Distribute condoms Yes Yes Yes Yes Yes Yes
Distribute oral contraceptives Yes Yes Yes Yes Yes Yes
DMPA injection Yes, including Yes Yes Yes Yes Yes
first injection
Intrauterine devices (IUDs) No Yes –if trained Yes –if trained Yes –if trained Yes –if trained Yes –if trained
person available person available person available person available person available
Female sterilization No No No No No Yes
Male sterilization No No No No No Yes
Page | 13
9.1.e Care of the Newborn

Table 2.5. Care of the Newborn Services by Type of Facility

Center
Stimulate, clean airway; clean, clamp, and cut cord; Yes Yes Yes Only Yes Yes
establish early breastfeeding emergency/
counseling
Prevention of ophthalmia of the newborn No Yes Yes Yes Yes Yes
Resuscitation of the newborn No Yes Yes Yes Yes Yes
Newborn immunizations No Yes Yes Yes Yes Yes
Kangaroo care No Yes Yes Yes Yes Yes
Incubator No No No No Yes Yes
Manage neonatal infections (omphalitis) Prereferral Prereferral Prereferral Prereferral Yes Yes
treatment, refer treatment, refer treatment, refer treatment, refer
Manage neonatal sepsis Prereferral Prereferral Prereferral Prereferral Yes Yes
treatment, refer treatment, refer treatment, refer treatment, refer
Manage neonatal jaundice Counseling Counseling Counseling Counseling Counseling Yes
Manage neonatal tetanus Refer Refer Refer Refer Refer Yes
Page | 14
9.2 Child Health and Immunization
9.2.a Expanded Programme on Immunization

(A part of Component 2 of the BPHS, “Child Health and Immunization”),
The EPI guidelines, as described in the National EPI Policy, must be observed during the implementation of the EPI program.
Table 2.6. EPI Services by Type of Facility

Interventions and Services Provided Health Sub- Dist.
Health Post BHC MHT CHC
Center Hospital
IEC Yes Yes Yes Yes Yes Yes
Storage of vaccines No Yes Yes Yes Yes Yes
(CB and VC) (CB and VC)
EPI routine (all antigens) Yes—support Yes Yes Yes Yes Yes
Yes (catchment
Yes—support Yes Yes Yes Yes
Outreach immunization service area)
EPI-plus (ORS+ De-worming) Yes—support Yes Yes Yes Yes Yes
Supplementary Immunization Activities Yes—support Yes Yes Yes Yes Yes
Disease surveillance and case reporting Yes Yes Yes Yes Yes Yes
VPD outbreak response Yes Yes Yes Yes Yes Yes
Vitamin A supplementation Yes Yes Yes Yes Yes Yes
Health Sub-centers will be linked with their related health facilities for referral and supply/logistics
Health Sub-centers will submit an EPI report to the health facility where they obtain vaccine supplies
Page | 15
9.2.b Integrated Management of Childhood Illness (IMCI)

(A part of Component 2 of the BPHS, “Child Health and Immunization”) IMCI targets all children under the age of 5 (0-59 months)
The IMCI and C-IMCI guidelines of the MoPH need to be observed during the implementation.
Table 2.7. Integrated Management of Childhood Illness (IMCI) Services by Type of Facility
Center Hospital
Counsel mother what to do at home and follow-up Yes Yes Yes Yes Yes Yes
Counsel mother when to return immediately for Yes Yes Yes Yes Yes Yes
assessment of the child.
a. Case Management of ARI
No pneumonia (cough or cold) Yes Yes Yes Yes Yes Yes
Pneumonia Yes Yes Yes Yes Yes Yes
Severe pneumonia or very severe diseases Pre-referral Pre-referral Pre-referral Treatment and Treatment
Refer to CHC or treatment and treatment and treatment and refer if and refer if
DH refer to CHC or refer to CHC or refer to CHC or necessary to necessary
DH DH DH DH to PH or
RH
b. Case management of diarrhea
No dehydration Yes Yes Yes Yes Yes Yes
Some dehydration (ORS and Zinc) Yes Yes Yes Yes Yes Yes
Severe dehydration (ORS and Zinc) ORS and refer Yes Yes Yes and refer Yes Yes
Severe persistent diarrhea ORS and refer Yes Yes Refer Yes Yes
Persistent diarrhea ORS and Zinc Yes Yes Yes Yes Yes
Dysentery Yes Yes Yes Yes Yes Yes
c. Ear problems
Mastoiditis Refer Pre-referral Pre-referral Pre-referral Pre-referral Yes
treatment and treatment and treatment and treatment and
Acute ear infection Yes Yes Yes Yes Yes Yes
Chronic ear infection Yes and follow Yes Yes Yes and refer Yes Yes
d. Fevers and Malaria
Very severe febrile diseases Pre-referral Pre-referral Pre-referral Assess and Pre-referral Yes
treatment and treatment and treatment and refer treatment and
Malaria Yes Yes Yes Yes Yes Yes
Fever malaria unlikely Yes Yes Yes Yes - refer Yes Yes
e. Measles
Severe, complicated measles Pre-referral Pre-referral Pre-referral Pre-referral Pre-referral Yes
Page | 16
Table 2.7. Integrated Management of Childhood Illness (IMCI) Services by Type of Facility
Center Hospital
treatment and treatment and treatment and treatment and treatment and
refer refer refer refer refer
Measles with eye or mouth complications Yes and refer Yes Yes Yes Yes Yes
Measles Yes Yes Yes Yes Yes Yes
Severe malnutrition and anemia, a secondary entry point No, Refer Pre-referral Pre-referral Pre-referral Pre-referral Yes
for HIV testing for infants and children treatment and treatment and treatment and treatment and
f. Malnutrition and Anemia
refer Yes-refer Yes-refer Yes-refer Yes-refer Yes
Severe malnutrition or severe anemia
Anemia or very low weight Refer Yes Yes Yes-refer Yes Yes
No anemia and not very low weight Yes Yes Yes Yes Yes Yes
Vitamin A supplementation Yes (NID) Yes if not given Yes, if not Yes, if not Yes, if not Yes, if not
by HP given by given by given by given by
previous levels previous levels previous levels previous
levels
Mebendazole (periodic) Yes Yes, if not given Yes, if not Yes Yes, if not Yes, if not
by HP given by HP given by given by
previous levels previous
levels
h. Immunization
See table 4.1. for details Yes (assist) Yes Yes Yes Yes Yes
i. Additional services for children under 2 months of age
Possible serious bacterial infection, possible secondary Pre-referral Pre-referral Pre-referral Pre-referral Pre-referral Yes
entry point for HIV screening treatment and treatment and treatment and treatment and treatment and
refer refer refer refer refer
Skin infection Yes Yes Yes Yes Yes Yes
Blood in stool Refer Yes and refer Yes and refer Yes and refer Yes and refer Yes
Not able to feed, possible serious bacterial infection Refer Pre-referral Pre-referral Pre-referral Pre-referral Yes
treatment and treatment and treatment and treatment and
Feeding problem Refer Yes Yes Counseling- Yes Yes
refer
Page | 17
9.3 Public Nutrition

(The Public Nutrition Policy and Strategy and the Infant and Young Child Feeding strategic plan need to guide implementation)
Table 2.8. Public Nutrition Services by Type of Facility

Center
a. Assessment of Malnutrition (Population Level)
Nutritional status Estimate prevalence of malnutrition (z-score using indices of weight for height [wasting], weight for age
[underweight], and height for age [stunting] as well as the underlying causes. Surveys conducted at district
or provincial level for purposes of baseline, monitoring, and evaluation or in case of obvious deterioration
in nutritional situation.
b. Prevention of Malnutrition
Vitamin A supplementation: Yes during No, except yes No, except yes No, except yes No, except yes No, except yes
To all children 6 months to 59 months NIDs after NIDs stop after NIDs stop after NIDs stop after NIDs stop after NIDs stop
Promotion of iodized salt Yes Yes Yes Yes Yes Yes
Promotion of balanced micronutrient-rich foods Yes Yes Yes Yes Yes Yes
Support and promote exclusive breastfeeding Yes Yes Yes Yes Yes Yes
Promotion of appropriate complementary feeding for Yes Yes Yes Yes Yes Yes
young children with behavior changes
Community food demonstration Yes Yes Yes Yes Yes Yes
Growth monitoring and promotion for less than 2 years1 Yes Yes Yes Yes Yes Yes
(Where applicable and linked with IMCI)
Iron/folic acid supplementation for pregnant, lactating Yes Yes Yes Yes Yes Yes
women
Vitamin A supplementation post-partum Yes Yes Yes Yes Yes Yes
Promotion of maternal nutritional status2 Yes Yes Yes Yes Yes Yes
Control and prevent diarrheal disease and parasitic Yes Yes Yes Yes Yes Yes
infections
Underlying causes: based on analysis of causes of BPHS NGO will demonstrate understanding of underlying causes and outline appropriate interventions to
malnutrition, support, and advocate for interventions to prevent and address malnutrition including, in areas of food security, social and care environment and health
address underlying causes. (including water and sanitation (see Conceptual Model of Causes of Malnutrition).
e. Treatment of Malnutrition
Micronutrient deficiency diseases diagnosis and treatment Identify and Yes Yes Yes Yes Yes
refer
Treatment of severe malnutrition based on MoPH No—refer Pre-referral Pre-referral Pre-referral Pre-referral Yes
protocols for 24-hour care for Phase I; day care/home- treatment and treatment and treatment and treatment and
treatment for Phase II3 and follow-up refer refer refer refer
Page | 18
Table 2.8. Public Nutrition Services by Type of Facility

Center
Treatment of severe malnutrition at community-based Yes Yes Yes Yes
Community Therapeutic Centers (CTCs)5: Community Yes (Pre- referral
mobilization and screening Refer treatment and
refer)
Out patient management (OPM) No Yes Yes Yes Yes Yes
Inpatient care /Stabilization Center (SC) No No No No No Yes
Moderate malnutrition: only where acute malnutrition No Where applicable
levels higher than 10% with additional risk factors.
d. Surveillance and Referral
Clinic-based surveillance: all children under 5 years No Yes Yes Yes Yes No
measured for weight for height (using HMIS forms),
monitor trends and children showing developmental delay
referred to physiotherapy services
Screening: Screening and referral of at risk using mid- Yes Yes Yes Yes Yes Yes to (H2)
upper-arm circumference (MUAC), or weight/height, or
clinical signs of micronutrient deficiency diseases (MDDs)
1. Growth monitoring and promotion (GM and P): During 2004 or 2005, The MoPH in collaboration with WHO carried out an assessment to identify what needs
(resources, training, skills, and adaptation) should be in place for GM and P to be effective in Afghanistan. As indicated in the IYCF strategic plan and the Public Nutrition
Policy and Strategy, approaches to growth promotion proven successful elsewhere will be adapted for each level and tested in the Afghan situation before careful scaling
up.
2. Maternal nutrition: Improving the nutritional status of women remains a priority, but a strategy for addressing the poor nutritional status of women is still being
developed.
3. Treatment of severe malnutrition: The MoPH currently has guidelines and a strategy to support hospital-based (24-hour/day care) treatment, which are implemented in
hospitals
4. Supplementary feeding points (SFPs): Emergency SFPs will only be implemented in those identified districts which have a prevalence of acute malnutrition > 10%
and/or high risk (see MoPH Guidelines for Supplementary Feeding).
5. Community Therapeutic Centers (CTC) with its components will be implemented where vertical input is provided by UNICEF in agreement with the Public Nutrition
Department.
Page | 19
9.4 Communicable Diseases
9.4.a Control of Tuberculosis primary entry point for VCCT

(A part of Component 4 of the BPHS, “Communicable Disease Treatment and Control”)
Table 2.9. Control of Tuberculosis primary entry point for VCCT Services by Type of Facility
Interventions and Services Provided Health facility Level
Health Post Sub-Center BHC MHT CHC Dist. Hospital
IEC Yes Yes Yes Yes Yes Yes
Case detection among self-reporting patients using Refer suspect Refer suspect Refer suspect Refer suspect Yes Yes
sputum smear cases cases cases cases
Short course chemotherapy, including DOTS Yes—follow-up Yes—follow-up Yes—follow-up Yes—follow-up Yes—diagnose Yes—diagnose
and treat and treat
Surveillance of cases of interrupted treatment Yes Yes Yes Yes Yes Yes
BCG vaccination Assist in Yes Yes Yes Yes Yes
outreach
X-ray for smear-negative patients No No No No No Yes
Algorithms of treatment for AFB(-) No No No No Yes Yes
Active case finding in OPD/community Yes and refer Yes and refer Yes and refer Yes and refer Yes
Preventive therapy for child contacts of TB patients To be referred Yes – chemo- Yes – chemo- Yes - Yes Yes
prophylaxis prophylaxis Counseling
DOTS-plus in multi-drug-resistant TB No Yes-follow-up Yes-follow-up Yes follow up Yes-if culture is Yes
available
Inpatient management of severe cases No No No No Yes and refer Yes and refer
Management of complicated severe cases No No No No No Yes and refer
Page | 20
9.4.b Control of Malaria

(A part of Component 4 of the BPHS, “Communicable Disease and Control”)
(For children under 5, see Table 2.2, IMCI)
Table 2.9. Control of Tuberculosis primary entry point for VCCT Services by Type of Facility
Interventions and Services Provided Health Facility Level
Health Post Sub-Center BHC MHT CHC Dist. Hospital
Information, education, communication Yes Yes Yes Yes Yes Yes
Clinical diagnosis Yes Yes Yes Yes Yes Yes
Microscopic diagnosis No No No No Yes Yes
Treatment of uncomplicated cases—first line treatment Yes Yes Yes Yes Yes Yes
Treatment of uncomplicated cases not responding to first Refer Yes Yes Assess -refer Yes Yes
line treatment
Treatment of severe and complicated cases Pre-referral Pre-referral Pre-referral Pre-referral Yes and refer Yes
management management management management
and refer and refer and refer and refer
Insecticide-treated mosquito nets (based on availability Yes Yes Yes Yes Yes Yes
and seasonal variations)
Intermittent presumptive therapy (since the prevalence of No No No No No No
Malaria is low in Afghanistan, intermittent presumptive
therapy is not recommended by National Treatment
Guidelines, and is therefore removed)
Page | 21
9.4.c Control of HIV

(A part of Component 4 of the BPHS, “Communicable Disease and Control”)
Table 2.11. Control of HIV by Type of Facility

Health Post BHC MHT CHC DH
Center
Referral to HIV counseling (and testing where indicated) Yes Yes Yes Yes Yes Yes
HIV testing for TB (PITC) No No No Yes Yes Yes
HIV testing for STI (PITC) No No No Yes Yes Yes
HIV testing for ANC (PITC) No No No Yes Yes Yes
HIV testing for diagnosis (CITC) No No No Yes Yes Yes
HIV testing for injecting drug use (PICT) No No No Yes Yes Yes
HIV testing for blood safety (PITC) No No No Yes Yes Yes
CTX (co-trimoxazole) prophylaxis No No Yes Yes Yes Yes
OI (opportunistic infections) and TB No No No Yes Yes Yes
Monitoring, supervision and support for ARV prophylaxis for PMTCT Subject to Subject to Subject to Subject to Yes Yes
training and training and training and training and
orientation? orientation? orientation? orientation?
Monitoring, supervision and support for ART (antiretroviral treatment) Subject to Subject to Subject to Subject to Yes Yes
training and training and training and training and
orientation? orientation? orientation? orientation?
Staff safety through vaccination for Hepatitis B Yes Yes Yes Yes Yes Yes
Referral to physical rehabilitation services (exercise training) if Yes Yes Yes Yes Yes Yes
required
Many CHCs and DHs are using rapid HIV testing now. A national protocol for VCCT is to be developed.
1. All HIV testing will respect confidentiality, informed consent, and voluntary action.
2. Provider initiated testing and counseling (PITC) is by recommendation of physician for improved medical care, to be performed on advice of physician and with
consent of patient fully respecting confidentiality.
3. Client initiated testing and counseling (CITC) is by voluntary request of patient fully respecting confidentiality.
4. HIV prevention, treatment, care and diagnosis in BPHS is based on 6 entry points-1) all blood donors, 2) TB positive patients, 3) STI patients, 4) injecting drug
users, 5) clients seeking HIV diagnosis, and 6) ANC patients who have blood samples taken (to be confirmed).
5. HIV testing requires HIV rapid tests with 3 tests of different assays for HIV positive diagnoses. First rapid test will be used for blood screening. Second (but
different assay) rapid test will be used for HIV positive results from the first test. Third (but different assay) rapid test will be used for HIV positive results from the
second test. Positive results on the 3rd test yields HIV diagnosis.
Page | 22
9.5 Mental Health

(BPSM = biopsychosocial management; PSM= psychosocial management)
Table 2.12. Mental Health Services by Type of Facility

Health Post BHC MHT CHC District Hospital
Center
Mental health awareness Yes Yes Yes Yes Yes Yes
Mental health education No No Yes Yes Yes Yes
Identification of suspected cases Yes Yes Yes Yes Yes Yes
Diagnosis and classification No No Yes Yes Yes Yes
Psychosocial problems/stresses PSM PSM PSM PSM PSM PSM
Common Mental Disorders (mild-moderate depression, Refer PSM BPSM BPSM BPSM BPSM
anxiety disorders, unexplained somatic complaints): suspected
cases
Severe Mental Disorders (psychosis, severe depression, Refer Refer BPSM * Referral BPSM BPSM
bipolar disorder, schizophrenia): suspected suspected cases
cases
Substance Abuse: Refer Motivation, Motivation, Motivation, Motivation, Detoxification,
suspected referral, follow referral, referral, referral, Referral to
cases up follow up follow up follow up specialized services
Childhood mental disorders (including enuresis) Refer Referral BPSM * BPSM BPSM BPSM
suspected
cases
Learning difficulties : Identification and education for No Yes Yes Yes Yes Yes
parents and teachers
Epilepsy To be referred Referral Yes * Yes Yes Yes
Self harm Identify, and Identify and Identify and Identify and BPSM BPSM
referral referral referral referral
Community based rehabilitation (linked to disability Yes Yes Yes Yes Yes Yes
component)
Inpatient treatment No No No No To be referred Yes
Monitoring and follow up Yes (treatment Yes Yes Yes Yes Yes
compliance)
* BHC staffed by doctor, otherwise only follows up

Funds will be provided for mental health training, drugs and psychosocial counselling in a phased manner
Page | 23
9.6 Disability and Physical Rehabilitation
Table 2.13. Physical Rehabilitation (including Persons with Disabilities) Services

Interventions and Services Provided Health Sub- District
Center Hospital
Information, education, communication1 Yes Yes Yes Yes Yes Yes
Identification of people with disabilities and referral to nearest Yes Yes Yes Yes Yes Yes
services for physical rehabilitation
Early identification and referral to physical rehabilitation services at Yes Yes Yes Yes Yes Yes refer on as
DH level for children with physical, sensory and intellectual needed
impairments.
Assess and treat persons with musculoskeletal conditions such as: No No No No No2 Yes
developmental dysplasia of the hip, clubfoot, low back pain;
neurological conditions such as cerebral palsy and sequels of
poliomyelitis and traumatic injuries from burns, accidents,
explosive devices, war
Provision of crutches, walking aids at CHC and DH3. Physical Refer to nearest Refer to Refer to Refer to Refer to nearest Yes
rehabilitation staff at DH can measure for wheelchairs and assistive rehabilitation nearest RC nearest RC nearest RC RC
devices for children with cerebral palsy and refer to Orthopedic centre (RC)
Workshops centers for prostheses, orthoses, assistive devices,
special seating, wheelchairs and management of club foot and DDH
1. Awareness and information package available with Disability and Rehabilitation Department of MoPH.
2. Physical rehabilitation staff can assess physical needs and advice on outreach visits from DH to CHCs subject to staff availability
3. Wooden auxiliary crutches and walking sticks can be made locally for low cost as an income generation project for persons with disability or low income families or
purchased. Measurement of correct height can be easily taught to staff in CHC.
Note: Disability services will be implemented gradually
Page | 24
9.7 Regular Supply of Essential Drugs
Table 2.14. Essential Drugs for BPHS by Type of Facility

Drug Dosage Form and Strength Health HS-C BHC MHT CHC Dist
Post Hos
=drug permitted at this level = drug permitted at BHC only if physician is present
1. Anesthetics
1.1 General Anesthetics and Oxygen
Ketamine Injection 50gms (as hydrochloride)/ml in 10-ml ampoule If anes-
-- -- -- -- 
thetist
Oxygen Inhalation (medical gas) --     
1.2 Local Anesthetics
Lidocaine injection solution 1% in vial --     
Lidocaine injection solution 2% in vial --     
Lidocaine Injection solution for spinal anesthesia 5% in 2-ml ampoule
-- -- -- -- -- 
to be mixed with 7.5% glucose solution
Lidocaine Topical forms 2% (hydrochloride) --     
Lidocaine Topical forms 4% (hydrochloride) --     
Lidocaine + Adrenaline injection solution 1% + epinephrine 1:200,000 in vial -- -- --   
Lidocaine + Adrenaline injection solution 2% + epinephrine 1:200,000 in vial -- -- --   
2. Analgesics, Antipyretics, Non-steroidal Anti-Inflammatory Drugs
2.1 Non-Opioid Analgesics/Antipyretics/ NSAID
Paracetamol (acetaminophen) Tablet 500 mg      
Paracetamol (acetaminophen) Syrup 120 mg/5 ml --     
Paracetamol (acetaminophen) Tablet 100 mg      
Acetyl Salicylic Acid Tablet 500 mg --     
Ibuprofen Tablet 200 mg --     
Diclofenac injection 25mg per ml in 3 ml ampoule --     
Tramadol injection 100 mg per 2 ml Ampoule -- -- -- --  
Morphine injection Morphine 10mg per ml in 2ml ampoule -- -- -- -- -- 
3. Anticonvulsants/Anti-Epileptics
Carbamazepine Tablet 200 mg -- -- -- --  
Diazepam injection 5 mg/ml in 2-ml ampoule --     
Magnesium Sulfate injection 500 mg/ml in 20-ml ampoule --     
Phenobarbital Tablet 15 mg -- --    
Phenobarbital Tablet 100 mg -- --    
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Post Hos
Sodium Valproate Tablet 200 mg -- --- -- -- -- 
4. Antidotes
4.1 Nonspecific Antidotes
Activated charcoal Tablet 500 mg      
Neostigmine Injection 0.5 mg per ml -- -- -- -- -- 
Naloxone Hydrochloride Injection 0.4mg per ml -- -- -- -- -- 
5. Antihistamines
5.1 H1-Receptor Antagonists
Chlorpheniramine Maleate (Chlorphenamine) Tablet 4 mg      
Chlorpheniramine Maleate (Chlorphenamine) injection 10 mg/ml in 1-ml ampoule --     
6. Anti-infective Medicine
6.1 Anti-helminthics
Mebendazole chewable tablet 100 mg --     
6.2 Antibacterials
6.2.1 Beta Lactam Medicines
Amoxicillin capsules/tablet 500 mg (anhydrous) --     
Amoxicillin capsules/tablet 250 mg (anhydrous) --     
Amoxicillin powder for oral suspension 125 mg/5 ml (anhydrous) --     
Ampicillin powder for injection 1g (as sodium salt) --     
Ampicillin powder for injection 500 mg (as sodium salt) --     
Benzathine Benzyl Penicillin powder for injection, 1.2 million IU in 5-ml vial --     
Benzathine Benzyl Penicillin powder for injection, 2.4 million IU in 5-ml vial --     
Phenoxy Methyl Penicillin (Penicillin V) Tablet 250 mg (as potassium-salt) --     
Phenoxy Methyl Penicillin (Penicillin V) Tablet 500 mg (as potassium-salt) --     
Phenoxy Methyl Penicillin (Penicillin V) powder for oral suspension 250 mg/5 ml (as potassium salt) --     
Procaine Penicillin powder for injection 2 million IU -- --    
Procaine Penicillin powder for injection 4 million IU -- --    
Erythromycin(Ethyl succinate) Suspension 100 mg per ml 100 ml bottles --     
Cloxacillin Injection 500 mg per vial 
Cloxacillin Capsule 500 mg  
6.2.2 Other Antibacterials
Silver sulfadiazine cream Cream      
Chloramphenicol capsule/tablet 250 mg --     
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Post Hos
Chloramphenicol powder for injection, 1-g vial --     
Chloramphenicol suspension 125 mg/5 ml --     
Doxycycline capsule/tablet 100 mg (hydrochloride) --     
Gentamicin injection 10 mg (as sulfate)/ml in 2-ml vial --     
Gentamicin injection 40 mg (as sulfate)/ml in 2-ml vial --     
Ciprofloxacin Tablet 250 mg -- -- -- --  
Ceftriaxone Injection 500 mg vial -- -- -- -- -- 
6.2.3 Tuberculosis drugs
Ethambutol Tablet 400 mg --   --  
Ethambutol/Isoniazide (EH) Tablet 400/150mg --   --  
INH Tablet 100 mg --   --  
INH Tablet 300 mg --   --  
Isoniazide (H) Tablet 100 mg --   --  
Pyrazinamide(Z) Tablet 500 mg --   --  
Pyrazinamide (Z) Tablet 400mg --   --  
Rifampicin (Rifampin) capsule/tablet 150 mg --   --  
Rifampicin (Rifampin) capsule/tablet 300 mg --     
Rifampicin/Isoniazide (RH) Tablet 150/75mg --   --  
Rifampicin/Isoniazide (RH) Tablet 60/30mg (Child) --   --  
Rifampicin/Isoniazide/Ethambutol (RHE) Tablet 150/75/275mg --   --  
Rifampicin/Isoniazide/Pyrazinamide (RHZ) Tablet 60/30/150mg --   --  
Rifampicin/Isoniazide/Pyrazinamide/Ethambutol Tablet 150/75/400/275mg
--   --  
(RHZE)
Streptomycin (S) powder for injection 1g (as sulfate) in vial --     
6.3 Antifungal
Nystatin drop 100,000 IU/ml --     
Nystatin coated tablet 100,000 IU --     
Nystatin coated tablet 500,000 IU --     
6.4 Anti-protozoal Medicine
6.4.1 Anti-amoebic and Anti-giardiasis
Metronidazole Tablet 250 mg, 200mg --     
Metronidazole Tablet 400 mg, 500mg --     
Metronidazole injection 500 mg in 100 ml vial -- -- -- --  
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Post Hos
Metronidazole oral suspension 200 mg (as benzoate)/5 ml --     
6.4.2 Antimalarial
Chloroquine Tablet 150 mg (as phosphate or sulfate)      
Chloroquine Syrup 50 mg (as phosphate or sulfate)/5 ml      
Primaquine Tablet 15mg -- -- -- --  --
1
Pyrimethamine + Sulfadoxine (Fansidar) Tablet 25 mg + 500 mg      
Quinine Tablet 300 mg (as bisulfate or sulfate), 2 2   
Quinine injection 300 mg (as dihydrochloride)/ml in 2-ml ampoule -- -- -- --  
Artesunate + Sulfadoxine +Pyrimethamine3 Artesunate 100mg (6 tabs) + Sulfadoxine
4 4   
500mg/Pyrimethamine 25mg (3 tabs)
3
Artesunate + Sulfadoxine +Pyrimethamine Artesunate 50mg (6 tabs) + Sulfadoxine
4 4   
Artesunate + Sulfadoxine +Pyrimethamine3 Artesunate 50mg (3 tabs) + Sulfadoxine
4 4   
Artemether for pre-referral treatment of suspected and Injection 20 & 80 mg in oil for intramuscular injection
confirmed severe or complicated malaria     
1Presumptive treatment for unconfirmed malaria is chloroquine and sulfadoxine / pyrimethamine, before referral to CHC for confirmatory diagnosis.
2 Quinine – 2nd line treatment and treatment for severe / complicated malaria require laboratory confirmation
3 Artemesinin combination therapy: Artesunate + SP (fansidar) as first line treatment for laboratory confirmed Falciparum malaria...
4 In BHCs where diagnostic services are available.
6.4.3 Antileishmania
Sodium Stibogluconate Injection 100 mg per ml. 5 5
Meglumine antimonate Injection 85mg per ml 5 5
5. Either Stibogluconate or Meglumine antimonate to be supplied
6.5 Sulfonamide/Related
Co-trimoxazole (Sulfamethoxazole + Trimethoprim) Tablet 100 mg + 20 mg      
Co-trimoxazole (Sulfamethoxazole + Trimethoprim) Tablet 400 mg + 80 mg      
Co-trimoxazole (Sulfamethoxazole + Trimethoprim) suspension 200 mg + 40 mg/5 ml      
Note: Co-trimoxazole is given to HIV-positive patients at CHC and DH
6.6 Urinary Antiseptics
Nitrofurantoin Tablet 100 mg -- -- --   
7. Medicines affecting the Autonomic system
Page | 28

Post Hos
7.1 Sympathomimetics and |Anticholinergics
Adrenaline injection 1 mg (as hydrochloride or hydrogen tartrate) in 1-
--     
ml ampoule
Salbutamol Tablet 4 mg (as sulfate) --     
Salbutamol Syrup 2 mg/5 ml (as sulfate) --     
Alcuronium Bromide Injection 5mg per ml in two ml ampoule -- -- -- -- -- 
Atropine Injection 1mg per ml . - - - -  
Trihexyphenidyl Tab 2 mg Tab 2 mg  
8. Drugs Affecting the Blood
8.1 Drugs Used in Anemia
Ferrous Sulfate Tablet equivalent to 60 mg iron --     
Ferrous Sulfate oral solution equivalent 25 mg iron (as sulfate)/ml --     
Ferrous Sulfate + Folic Acid Tablet equivalent to 60 mg iron + 400 mcg folic acid      
Folic Acid Tablet 5 mg --     
9. Cardiovascular medicines
9.1 Antihypertensive Agents
Atenolol Tablet 50 mg -- -- --   
Atenolol Tablet 100 mg -- -- --   
Methyl Dopa Tablet 250 mg --     
Nifedipine capsule/tablet 10 mg -- --    
Hydralazine Injection 20mg per ml - - - - - 
9.2 Antithrombotic Agent
Acetyl salicylic acid (Acetylsalicylic Acid) Tablet 100 mg -- --    
10. Dermatological Topical medicines
10.1 Anti-Infective, Topical
Gentian Violet (Methyl Rosanilinium Chloride) aqueous solution 0.5% (or crystals)      
Gentian Violet (Methyl Rosanilinium Chloride) aqueous solution 1% (or crystals)      
Silver Sulfadiazine Cream 1% --     
10.2 Antifungal, Topical
Benzoic Acid + Salicylic Acid cream or ointment 6% + 3% --     
Nystatin ointment 100,000 IU, vaginal --     
Nystatin tablet 100,000 IU, vaginal --     
10.3 Scabicides/Pediculocides
Page | 29

Post Hos
Lindane lotion 1% --     
11. Disinfectants and antiseptics
Chlorhexidine solution 5% (digluconate) for dilution      
Chlorhexidine+Cetrimide solution chlorhexidine gluconate 1.5% +Cetrimide 15% --     
Chlorine releasing comp., Powder for solution      
12. Diuretics
Hydrochlorothiazide tablet 50 mg --     
Furosemide Tablet 20 mg -- -- -- --  
Furosemide Injection, 20 mg in 2-ml Ampoule - - -- -- -- 
13. Gastro-intestinal medicines
13.1 Antacids
Aluminum Hydroxide tablet 500 mg --     
Aluminum Hydroxide + Magnesium Hydroxide chewable tablet aluminum hydroxide 200 mg + magnesium      
hydroxide 200 mg
Aluminum Hydroxide + Magnesium Hydroxide suspension aluminum hydroxide 225 mg + magnesium --     
hydroxide 200 mg/5 ml
Ranitidine Tablet 150 mg -- -- -- --  
13.2 Anti-Emetics
Metoclopramide tablet 10 mg (hydrochloride) --     
Metoclopramide injection 5 mg (hydrochloride)/ml in 2-ml ampoule --     
13.3 Oral Rehydration Solution
Low Osmolarity ORS 20.5gr/liter Glucose anhydrous 13.5g, Sodium chloride 2.6g, Trisodium      
citrate dihydrate 2.9 gm, Potatium chloride
1.5g for one liter
Note: Existing stocks of ORS 29.7gr/liter can be used till depletion
14. Hormones, other endocrine and contraceptives
14.1 Adrenal Hormones and Synthetic Substitutes
Hydrocortisone powder for injection 100 mg (as sodium succinate) in vial --     
Betamethasone + Neomycin Cream 1% + 0.5 % --     
14.2 Contraceptives
Ethinylestradiol + Levonorgestrel tablet 30 microgram +150 microgram      
Ethinylestradiol + Levonorgestrel tablet 50 microgram + 250 microgram      
Ethinylestradiol + Norgestrel tablet 30 microgram + 300 microgram      
Page | 30

Post Hos
Ethinylestradiol + Norethisterone tablet 35 microgram + 1mg      
Depot Medroxy Progestrone Acetate (DMPA) depot injection 150 mg/ml in 1-ml vial      
Progesterone Only Pills (POP) Tablet Norgestrel 75microgram      
Progesterone Only Pills (POP) Pill Norethindrone 0.35 mg      
Condoms      
IUD --     
15. Immunologicals
15.1 Vaccines
BCG 0.05 ml given subcutaneously to children between birth and --     
1 year old ( single dose )
DPT (diphtheria, pertussis, tetanus) 0.5 ml given intramuscularly to children between 6 weeks --     
and 1 year old
DPT/Hepatitis-B vaccine 0.5 ml given intramuscularly --     
Pentavalent DPTw-HB/Hib 0.5 ml given intramuscularly to children between 6 weeks --     
and 1 year old
Measles 0.5 ml given intramuscularly to children between 9 months --     
and 1 year old
OPV (oral polio vaccine) 2 drop PO for children under 1 year old, supplemental --     
doses given to all children under 5 years during NIDs
Tetanus Toxoid 0.5 ml given intramuscularly to women 15–45 years old --     
15.1 Antisera
Anti Tetanus Serum(ATS) Injection 1500 IU ampoule -- -- -- -- -- 
16. Ophthalmological Preparations
16.1 Anti-Infective Topical
Tetracycline eye ointment 1% hydrochloride      
Tetracaine Hydrochloride Eye drop 0.5% -- -- -- --  
Fluoresceine -- -- -- -- -- 
17. Oxytocics and anti-oxytocics
17.1 Oxytocics
Ergometrine tablet 200 microgram (hydrogen maleate) --     
Ergometrine injection 200 microgram (hydrogen maleate) --   --  
Oxytocin injection 10 IU in 1-ml ampoule --     
17.2 Antioxytocics
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Post Hos
Salbutamol tablet 4 mg (as sulfate) --     
Salbutamol injection 50 microgram (as sulfate)/ml in 5-ml ampoule --   --  
18. Psychotherapeutic Medicines
18.1 Medicines Used in Psychotic Disorders
Chlorpromazine 100 mg tablet (hydrochloride) -- -- -- -- -- 
Chlorpromazine injection 25 mg (hydrochloride)/ml in 2-ml ampoule -- -- -- -- -- 
Haloperidol tablet 5 mg -- -- -- -- -- 
Haloperidol injection 5 mg in 1-ml ampoule -- -- -- -- -- 
Thioridazine tablet 25 mg -- -- -- -- -- 
18.2 Medicines Used in Depressive Disorders
Amitriptyline tablet 25 mg (hydrochloride) -- --  --  
Fluoxetine Tablet 20 mg  
18.3 Medicines Used in Generalized Anxiety and
Sleep Disorders
Diazepam tablet 5 mg --     
Diazepam tablet 10 mg --     
19. Medicines acting on the Respiratory tract
19.1 Anti-Asthmatic Medicines
Aminophylline injection 25 mg/ml in 10-ml ampoule --     
Aminophylline tablet 100 mg --     
Epinephrine (Adrenaline) injection 1 mg (as hydrochloride or hydrogen tartrate) in 1- --     
ml ampoule
Salbutamol tablet 4 mg --     
Salbutamol inhalation (aerosol) 100 microgram (as sulfate) per dose --     
Salbutamol syrup 2 mg (as sulfate)/5 ml --     
Salbutamol respirator solution for use in nebulizers 5 mg (as sulfate)/ml --     
20. Solutions Correcting Water, Electrolyte and Acid-base Disturbances
20.2 Parenteral
Sodium Chloride injectable solution 0.9% isotonic (equivalent to Na+ 154 --     
mmol/1, Cl-154 mmol/1)
Compound solution of Sodium Lactate injectable solution --     
Glucose injectable solution 10% isotonic 5% isotonic --     
Glucose injectable solution 50% hypertonic -- -- -- --  
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Post Hos
Glucose with Sodium Chloride injectable solution 4% glucose, 0.18% NaCl (equivalent to --     
Na+, 30 mmol/l, Cl-, 30 mmol/l)
Potassium Chloride injectable solution 11.2% (112 mg) in 20-ml ampoule --     
(equivalent to K+, 1.5 mmol/ml, Cl-, 1.5 mmol/ml)
Sodium Hydrogen Carbonate (Sodium Bicarbonate) injectable solution 8.4% (840 mg), in 10-ml ampoule, -- -- --   
equivalent to Na+, 1,000 mmol/l, HCO3- 1,000 mmol/l)
Calcium Gluconate Injection 10% 10ml solution --     
20.3 Miscellaneous
Water for injection 5 ml      
Water for injection 10 ml      
21. Vitamins and Minerals
Iodine 0.57 ml (308 mg iodine) in dispenser bottle --     
Iodine capsule 200 mg --     
Retinol (vitamin A) sugarcoated tablet 100,000 IU (as palmitate) (55 mg)      
Retinol (vitamin A) capsule 200,000 IU (as palmitate) (110mg)      
Multi-micronutrients      
Zinc Zinc Dispersable Tablet 20mg strip of ten      
Vitamin K Injection 10mg per ml ampoule --     
Page | 33
10. Blood Transfusion Services to Support BPHS
Table 3. Blood Transfusion Services by Type of Facility

Center Hospital
Fresh blood donations No No No No Yes Yes
Immuno-hematology testing No No No No Yes Yes
Screen blood for transmissible diseases No No No No Yes Yes
Perform transfusion No No No No Yes Yes
Provide transfusion counseling No No No No Yes Yes
Infection control, safe injection practices, and waste Yes Yes Yes Yes Yes Yes
It is essential that WHO-qualified blood safety test kits are used.
The Central Blood Bank guidelines on blood transfusion should be followed.
HMIS must be updated to show blood safety screening of HIV, HBV, HCV, and syphilis.(Both Central Blood Bank and HMIS are to take coordinated action)
Note: Due to the low prevalence of syphilis within the general population close attention will be paid to the quantities and expiry dates of the reagents (kits).
Page | 34
11. Primary Eye Care Services

(Primary Eye Care = Eye care education, prevention and awareness, common eye diseases detection and referral, and simple treatment)
Table 4. Primary Eye Care Services by Type of Facility

Center Hospital
Eye Care education and awareness Yes Yes Yes Yes Yes Yes
Recognition of common blinding eye diseases in the community
Yes Yes Yes Yes Yes Yes
Recording Visual Acuity No No Yes Yes Yes Yes

Simple and early treatment of common eye diseases (Trachoma,
VAD, Conjunctivitis, Sty and Blepharitis)
Eye wash and removal of superficial conjunctiva foreign body

Remove superficial corneal foreign body No Yes Yes Yes Yes Yes
Timely referral of eye patients with significant eye symptoms
and visual impairment (VA <6/18) Yes Yes Yes Yes Yes Yes
Advice and counseling for people who require operation sand

glasses Refer Yes Yes Yes Yes Yes
Provide capacity building of each level of BPHS staff No Yes Yes Yes Yes Yes
Note: Primary Eye care will be implemented gradually
Page | 35
12. The Recommended Staffing Patterns for BPHS Facilities
Table 5. Type and Number of Health Workers by Type of Facility

Number of Health Workers in the Health Facility
Type of Health Workers and Health
Health District
Professionals Sub- BHC MHT CHC
Post Hospital
Center
Outreach Workers
Community health worker (male) 1
Community health worker (female) 1
Community health supervisor - - 1 - 1 1
Vaccinator - - 2 1 2 2
Health Providers
Nurse (male) - 1 1 - 1 5
Nurse (female) 1 5
Psychosocial counselor (nurse) -- -- -- -- (1) -
Community midwife 1 1 1 2
Midwife -- -- -- - - 4
Physician MD general (male) -- -- -- 1 1 2
Physician MD general (female) -- -- (1) - 1 2
Surgeon Male -- - 1
Surgeon Female -- -- - - - --
Anesthetist -- -- -- -- -- 1
Pediatrician -- -- -- -- -- 1
Dentist -- -- -- -- -- 1
Pharmacist -- -- -- -- -- 1
Physiotherapist -- -- -- -- -- 2
Paramedics, Ancillary Services Staff
Laboratory technician - - - - 1 2
Pharmacy technician - - - - 1 -
X-ray technician - - - - - 1
Dental Technician - - - - - 1
Support staff
Administrator - - - - 1 1
Cleaners, guards - 1 2 - 4 6
Driver 1 1 1
Notes:
Compliance with all MoPH HRD policies, strategies and procedures is required by the implementing NGOs.
These policies and procedures will be provided by the PPHD to the NGOs and the NGOs will disseminate the
relevant documents to their staff at all levels.
1. At Health Post level:
a. The implementing NGOs will develop processes to ensure supervision of female CHWs. Female CHWs
must be appropriately supported in accordance with local circumstances, gender, geography, security,
culture etc.
2. At BHC level:
a. Incentives are provided to the BHC staff in case they are asked to work over time or need to work
during the night.
b. A second midwife or community midwife and/or a pharmacy assistant in the BHC or any other staff
will be included only if the workload of the health facility is too much for one person to perform the
duties properly and the resources are available (available extra resources) (Covered by the Flexibility
Clause).
c. Physicians may be added to BHCs only to replace a midwife or nurse when those positions are not filled
and a physician is available and the CHCs and District Hospital are adequately staffed. In no case is
there to be more than one physician per BHC. Physicians employed in such a manner can receive the
salary and hardship allowance of physicians.
d. While appointing CHSs priority should be given to those candidates who have some health/medical
background and are local residents. CHSs should supervise up to 15 HPs. If a health facility has more
than 15 HPs to supervise, there should be more than one CHS.
Page | 36
e. Female CHSs, if available, will be trained and appointed as CHSs (if CHSs are couples, it is preferable).
Consideration will be given for couples (each one appointed to different but nearby facilities) to work
for 15 days in one facility and for the remaining 15 days in another facility located nearby.
3. At CHC level:
a. One of the 2 nurses of the CHC will be trained to work for Community Therapeutic Care (CTC) besides
his/her other nursing duties. UNICEF will provide food and training.
b. One driver at a CHC is to be included and budgeted for in 10% of the CHCs
c. Where a sufficiently-funded mental health intervention requires it, a psycho-social counselor (nurse)will
be added.
4. At DH level:
a. Two of the DH nurses will be specified to work in the Therapeutic Feeding Center (TFU). The
psychosocial counselor nurse can also provide counseling on nutrition.
b. It is recognized that there are insufficient physiotherapists in Afghanistan currently to fill all positions
in hospitals as well as provincial and regional hospital levels. More physiotherapists need to be trained.
Table 6. Descriptions of the Duties of Specific Categories of Health Workers

Type of Health General description of duties
Worker
Skilled birth These are health workers with midwifery skills, such as midwives, doctors, and nurses,
attendant who have proficiency in the skills necessary to manage normal deliveries and
diagnose, and manage or refer, obstetric complications. These workers must be
competent to manage normal childbirth and able to provide emergency obstetric care.
Not all skilled attendants can provide comprehensive emergency obstetric care,
although they should have the skills to determine when such interventions are needed
and the capacity to refer women to a higher level of care. Traditional birth attendants
(TBAs), whether or not trained, are not considered to be skilled birth attendants.
Note: Skilled birth attendance refers to the process by which a pregnant woman is
provided with adequate care during labor, birth, and the postpartum and immediate
newborn periods. In order for this process to take place, the attendant must have the
necessary skills and must be supported by an enabling environment at the household,
primary health care, or district hospital level. This includes adequate supplies,
equipment, and infrastructure, as well as an efficient and effective system of
communication and referral/transport. (Inter-Agency Group for Safe Motherhood,
Nov. 2000)
Midwife Works in the country‘s hospitals (district, provincial, and central) and CHCs, primarily
to deliver reproductive health care services to women. She assumes responsibility and
accountability for her practice, applying up-to-date knowledge and skills in caring for
each woman and family. She works as a member of a team that includes doctors
(including obstetric/gynecology specialists), nurses, paramedics, and CHWs. The team
offers comprehensive emergency obstetric care.
Community Works in the country‘s CHCs, MHTs, BHCs, and HSCs primarily to deliver
midwife reproductive health care services to women. She assumes responsibility and
accountability for her practice, applying up-to-date knowledge and skills in caring for
each woman and family. Depending on the presence of the skills of the other HWs, she
offers assistance with normal deliveries, and when skill permits, basic emergency
obstetric care.
Psychosocial These are midlevel health workers (for example nurses) with training in psychosocial
Counselor counselling according to the approved and standardized training manuals of the Mental
Health Department of MoPH. The training consists of 3 months intensive training and
9 months follow up training/supervision. They have knowledge and skills necessary to
do psychosocial interventions and counselling for patients with mental disorders and
patients who suffer from mental distress but do not have a formal disorder. They work
closely together with the MDs and are part of the referral system within BPHS
Page | 37
Their duties include the supervision of the basic psychosocial interventions to be

implemented by the staff of the BHCs and Health Posts
Mental Health These are health workers, usually doctors, with additional training in mental health
Focal Point care. They function as a reference person in a District Hospital. Apart from seeing
patients with mental disorders they also supervise the health workers in the BHCs and
(District
CHCs
Hospital)
Note: Several NGOs, mainly within urban areas, have good experiences with this type
of staff. The introduction of this type of health worker (psychosocial counsellor ) will
be gradually, based on evaluation of pilots
13. Equipment and supplies for BPHS by type of facility
13.1. Equipment
Table 7. Equipment for BPHS Facilities by Type of Health Facility

Health District
Type of Equipment and Supplies HSC BHC MHT CHC
Post Hospital
1. Basic Equipment
1 Scissors      
2 Forceps      
3 Thermometer      
4 Clean delivery kit (mini delivery kit for health
    
post—see Annex C for kit contents) 
5 ORS measuring jug/container      
6 Tape measure for ANC      
2. Simple Equipment and Supplies
7 Stethoscope -     
8 Sputum and blood specimen bottles -   -  
9 Vision testing chart -     
10 Sphygmomanometer -     
11 Dispensing counting tray -     
12 Pediatric(Salter) and adult scales -     
13 Cold box/refrigerator for EPI -     
14 Vaccine carrier and ice pack -     
15 Patella hammer -     
16 Diagnostic set or otoscope -     
17 Drip stand -     
18 Flashlight -     
19 Minor surgery kit (see Annex B for contents) -     
20 Stretcher -   Portable  
21 Specula -     
22 Lamp -     
23 Suction -   -  
24 Midwifery kit -   -  
25 Sterilizer Steam     
26 Examining table -   Portable  
3. Anthropometric Equipment
27 MUAC Tape ( Mid Upper Arm Circumference 
    
Tape) tool for measuring nutritional status
28 Height measuring board, --   Portable  
29 Growth monitoring chart -- --    
4. More Complex Equipment and Supplies
30 Oxygen gauge and cylinder - - - -  
31 Neonatal resuscitation trolley -   -  
32 Hearing screening equipment - - - -  
33 Basic emergency obstetric care kit - - - -  
34 Sterilization equipment - - - -  
Page | 38
Table 7. Equipment for BPHS Facilities by Type of Health Facility

Health District
Type of Equipment and Supplies HSC BHC MHT CHC
Post Hospital
35 Hemoglobin meter - - - -  
36 Hand crank centrifuge - - - -  
37 Microscope - - - -  
38 Nebulizer - - - -  
39 Cervical collar and oxygen in ambulances - - - -  
40 Hysterectomy set (already present but not
- - - - - 
mentioned)
41 ECG Machine - - - - - 
42 MVA (Manual Vacuum Aspiration) set -    
43 Resuscitation Trolley - - - - - 
44 Ambubag for infant, child, and adult -   -  
45 Pedal suction machine - -  -  
46 Torches -   - - -
47 Wheel Stretcher - - - - - 
48 Folding stretcher -     
49 Water bath - - - - - 
50 Wheel chair - - - - - 
51 Coagulating Cautery - - - - - 
52 Laparatomy set (already present but not
- - - - - 
mentioned)
53 Loop and lid retractor - - - -  
54 Cupboards for CHWs  - - - - -
55 All Physiotherapy Equipment - - - - - 
13.2. Physiotherapy equipment
Table 8. Physiotherapy Equipment

Cervical Traction
Desk/chair/store cupboard
Exercise Bicycle
Floor mat for children
Toys to stimulate children
Goniometer
Gas bottle and double boiler
Heat Packs
Pillow round
Pulleys/weights
Reflex hammer
Saw for cutting POP
Scale for weight measurement
Scale for traction
Sphygmomanometer
Stethoscope
Timer
Towels for hot pack
Traction table
Treatment table
13.3. Renewable supplies
Table 9. Renewable Supplies

Cotton, Gauze and Bandages
1 Absorbent cotton wool, 500 g { (a) 500 g, roll, non sterile. b) Surgical hydrophilic cotton, c)
Hospital quality }
Page | 39

2 Crepe elastic bandage 7.5cm x 5m, per (roll) { (a) 100% cotton, unbleached, b) Washable and
autoclavable, c) Elasticity; minimum of 150%, unstretched 3m, stretched 5m ) }
3 Gauze pad / compress 10cm x 10cm, 12 ply sterile, pack of 20, Absorbent gauze 100% cotton
4 Gauze bandage 5cmx10m, absorbent wow, pack of 10 rolls
5 Gauze roll 90cm x 100M non-sterile, with selvedges, absorbent 100% cotton { ( a) Gauze roll width
22.5cm after 4 folds, b) Weight 23 gm/m2, type 17 threads/cm2 ) }
6 Bandage, elastic cotton crepe, 7.5cm x 5m, roll ( 100 % cotton, unbleached, gauze bandage with
selvedge, washable and autoclavable, Elasticity: Minimum of 150% length unstretched
3m,stretched 5m )
7 Bandage gauze cotton, 10cm x 4m, with selvedge, pack of 10 ( Absorbent gauze, 100% cotton, ii)
Material: Warp 12 threads/cm,
weft 8 threads/cm )
8 Crepe elastic bandage, cotton (crepe) 5cm x 5 meter, roll { (a) 100% cotton, unbleached, b)
Washable and autoclavable, c) Elasticity: Minimum of 150%, unstretched 3m, stretched 5m ) }
Catheters and Tubes
9 a) Airway Guedel, rubber, adult, L 82mm, autoclavable with plastic insert
10 b) Airway Guedel, rubber, large adult L 110mm, autoclavable with plastic insert
11 c) Airway Guedel, rubber adolescent L 77mm, autoclavable with plastic insert
12 d) Airway Guedel, rubber child, L 67mm, autoclavable with plastic insert
13 e) Airway Guedel, rubber, infant L 54mm, autoclavable
14 f) Airway Guedel, rubber neonate, L 43mm, autoclavable
15 a) Chest catheters with flexible introducer, 24, 28, 32 Fg x L280mm, sterile, pack 10 ( i) Material:
PVC smooth, with radio-opaque line and markings )
16 b) Chest catheters with blunt tip trocar, sizes 8fg to 32fg, L280mm, sterile pack of 10 ( i) Material:
PVC soft, with radio-opaque line and markings )
17 a] Chest drainage kit, sealed unit when suction not required for ambulatory use, pack of 5 ( i)
Complete with 1700ml graduated drainage bag and flexible introducer , ii) Integral flutter valve to
prevent re-entry of air / fluid )
18 b) Chest drainage system, underwater seal type for use with or without suction ( i) Complete with
2000ml drainage chamber, tubing and floor stand (reusable) )
19 c) Chest drainage kit, sealed unit when suction not required for ambulatory use, pack of 5
20 a) Feeding tube CH 5, 40cm, luer, sterile disposable, for neonates/infants, pack 100 ( (i) PVC, with
cap, rounded tip with side holes, marking for first 20cm )
21 b) Feeding tube CH 6, 40cm, luer, sterile disposable, for neonates/infants, pack 100 ( (i) PVC, with
cap, rounded tip with side holes, marking for first 20cm )
22 a) Foley catheter, sterile CH 10, 40cm, balloon 3-5 ml latex silicone coated
23 b) Foley catheter, sterile CH 12, 40cm, balloon 10ml latex silicone coated
24 c) Foley catheter, sterile CH 14, 40 cm, balloon 10ml, latex silicone coated
25 d) Foley catheter, sterile CH 16, 40 cm, balloon 10ml, latex silicone coated
26 e) Foley catheter sterile, CH 18, 40cm, balloon 10ml, latex, silicone coated
27 a) Endotracheal tube 4mm (D),cuffed oral, red rubber, non-disposable
28 b) Endotracheal tube 5mm (D), cuffed oral, red rubber, non-disposable
29 c) Endotracheal tube 6mm (D), cuffed oral, red rubber, non-disposable
30 a) Tubes, nasogastric CH 12, length 125cm, sterile disp, box of 50 ( (i) Material: Polyvinyl
chloride (PVC) with marking and 4 side windows, (ii) For aspiration and feeding )
31 b) Tube, nasogastric CH 16, length 125cm, sterile disposable, box of 50 ( (i) Material: Polyvinyl
chloride (PVE) with marking and 4 side windows, (ii) For aspiration and feeding )
32 c) Tube nasogastric, child, CH 8, length 125cm sterile disposable, box of 50 ( (i) Material:
Polyvinyl chloride (PVC) with marking and 4 side windows, (ii) For aspiration and feeding in
children )
33 d) Tube nasogastric, CH 6, length 125cm, sterile disposable, box of 50 ( (i) Material: Polyvinyl
chloride (PVC) with marking and 4 side windows,
34 Rectal tube CH 20, length 30cm, polyvinyl sterile disposable, box of 50 { ( i) With central
opening and eye/window on one side ) }
35 Tube rectal CH 24, L30cm, polyvinyl sterile disposable, box of 50 ( i) With central opening and
Page | 40

eye/window on one side )
36 a) Suction tube CH 8, 50cm, sterile, disp, PVC, box of 50 ( i) Open distal end with side windows
and connector, )
37 b) Suction tube CH 10, 50cm, sterile, disp, PVC, box of 50 ( i) Open distal end with side windows
and connector )
38 c) Suction tube CH 14, 50cm, sterile, disp, PVC, box of 50 ( i) Open distal end with side windows
and connector )
39 d) Suction tube CH 16, 50cm, sterile, disp, PVC, box of 50 ( i) Open distal end with side windows
and connector )
Sutures ( Chromic, Dexon and Silks )
40 Chromic catgut1, 75cm with half circle taper cut 40mm needle, sterile, box of 12
41 Chromic catgut 0, 75cm, with half circle RB 35mm needle, sterile, box of 12
42 Chromic catgut 2/0, 75cm, with half circle taper cut 35mm needle, sterile, box 12
43 Chromic catgut 3/0, 75cm, with curved cutting 16mm needle, sterile, box of 12
44 Dexon 0 needled Suture synthetic absorbable 0.75cm, needle 3/8 triangular end, 36mm. Box of 36
45 Silk braided 1, 75cm with 60mm curved cutting needle, sterile, box of 12
46 Silk braided 2, 75cm with 40mm half circle RB heavy Mayo No 3 needle, box of 12
47 Silk braided 3/0, 45cm with 26mm 3/8 reverse cutting needle, sterile, box of 12
48 Silk braided 0, 75cm with 35mm curved reverse cutting needle, sterile, box of 12
49 Vicryl, 1 - 75cm with 35mm half circle taper cut needle, sterile, box of 12 ( a) Absorbable braided
suture, color violet )
50 Vicryl 2-0 needled 75cm with 30mm 1/2 circle round bodied needle, pack of 12 (a) Absorbable
braided suture, color violet )
51 Vicryl, 0-75cm with 35mm half circle RB needle, sterile, box of 12 ( a) Absorbable braided suture,
color violet )
52 Vicryl, 3-75cm with 45mm half circle RB needle, sterile, box of 12 (a) Absorbable braided suture,
color violet )
Syringes , Cannula and Needles
53 Syringe Luer disposable, 2 ml,
with needle 22G, sterile, box of 100 ( Two piece syringe (P/P or PEF) with central luer nozzle,
Needle: 23G (0.6mm x 25mm), bi-packed with syringe )
54 IV Cannula, short, 20G (1.1x32mm) { (a) Sterile, disposable, b) Trocar: Stainless steel, c) Injection
port, d) Cannula: Polypropylene or Teflon ) }
55 IV Cannula, short, 22G (1.1x32mm) (a) Sterile, disposable, b) Trocar: Stainless steel, c) Injection
port, d) Cannula: Polypropylene or Teflon )
56 IV Cannula, short, 24 G (1.1x32mm) (a) Sterile, disposable, b) Trocar: Stainless steel, c) Injection
port, d) Cannula: Polypropylene or Teflon )
57 Needle Luer, IM, disposable, 21G (0.8x38mm) sterile, stainless steel, box 100
58 a) Needle disp 19G (1.1x40mm), sterile, stainless steel, box of 100
59 b) Needle disp 21G (0.8x40mm), sterile, stainless steel, box of 100
60 c) Needle disp 22G (0.7x30mm), sterile, stainless steel, box of 100
61 d) Needle disp 23G (0.6x25mm), sterile, stainless steel, box of 100
62 e) Needle disp 25G (0.5x16mm), sterile. stainless steel, box of 100
63 Needle, scalp vein infusion set, disposable, 25 G (0.5x19mm) color orange, box of 50 ( Materials:
Stainless steel needle, PVC tubing (200mm) and wings )
64 Needle, scalp vein infusion set, disposable, 21 G (0.8x19mm),color green, box of 50 ( Materials:
Stainless steel needle, PVC tubing (200mm) and wings )
65 a) Spinal needle 20g (0.9x90mm) sterile disposable, box of 50 ( i) Cannula and stylet stainless steel
with Quincke type point )
66 b) Spinal needle 22g (0.7x90mm) sterile disposable, box of 50 ( i) Cannula and stylet stainless steel
with Quincke type point )
67 IV placement cannula, short, sterile disposable, 18 G, unit, pack of 50 ( Trocar stainless steel,
Cannula: Polypropylene or teflon with injection port )
68 Syringe 10cc, Luer, sterile disposable, two piece, ( P/P or PEF) box of 100
69 Syringe, 20cc Luer, sterile disposable, two piece, (P/P or PEF), box of 100
70 Syringe 5cc, Luer, sterile disposable, two piece (P/P or PEF), box of 100
71 Syringe 50/60cc, Luer lock sterile disp, concentric tip, box of 100
Page | 41

Gloves
72 Glove, examination, latex, non sterile, small, box of 100 ( Disposable, pre-powdered )
73 a) Gloves, examination latex, large, non sterile, powdered, box of 100
74 b) Gloves, examination latex, medium, non-sterile, powdered, box of 100
75 C. Gloves, plastic examination non-sterile, disposable, box of 100
76 a) Gloves surgical 6.5 sterile latex powdered, box of 50 pairs
77 b) Gloves surgical 7.0 sterile latex powdered, box of 50 pairs
78 c) Gloves surgical 7.5, sterile, latex powdered, box of 50 pairs
79 d) Gloves surgical 8.0, sterile, latex powdered, box of 50 pairs
80 e) Gloves surgical 8.5, sterile, latex powdered, box of 50 pairs
Surgical Adhesive Tapes
81 Sterilization / autoclave test tape for steam sterilization, width 18mm x 50m roll
82 a) Tape surgical, adhesive hypoallergenic, fabric, 5cm x 10m, box of 5
83 b) Tape surgical Leucoplast Zinc oxide, tanned 5cm x 9.2M, box of 12
84 Tape adhesive, Zinc Oxide, 2.5 cm x 5 meter, roll (Color white, non-stretch, Aerated textile strip
impregnated with adhesive. Storage: dry conditions and at less than 25 degrees C if possible )
85 c) Tape surgical, Zinc oxide, perforated, 10cm x 5m, box of 10
Bags
86 Colostomy bag/pouch closed unit opaque, 13mm starter hole, set. Box of 30 (a. Supplied complete
with adhesive, skin protector and integral filter, b) Small starter hole for cutting to required size )
87 Drain: Corrugated rubber drainage sheet, 30.5xx15cm (12 x 6 inches)
88 Urine collecting bag with valve, 2000 ml, plastic, graduated with 90mm tube, box of 10 (Supplied
complete with connector and suspension eyelets.)
89 a) Blood collection bag, adult for 450ml including 63ml of CPD and blood taking set
90 b) Blood collection bag, child for 250ml including 35ml of CPD and blood taking set
Blade and Razor
91 Razor safety, stainless steel, 3 piece
unit (handle and blade holder), reusable ( Razor blades, double edged, steel, disposable, pack of 5.
Box of 10 packs )
92 Scalpel blade No 10, sterile disposable small (for handle No 3). Box of 100 ( i) Material: Magnetic
/ Martensitic steel )
93 Scalpel blade No 22, sterile disposable, large (for handle No. 4). Box of 100 (i) Material:
Magnetic / Martensitic steel )
Others
94 Spare bulb for Heine otoscope
95 Battery dry cell alkaline AA size 1.5V or LR6 (for otoscope), single unit
96 Tablet bag, plastic size 10cmx15cm, self sealing with 3 white writing panels, ( 100 x 5) per 500 (
Self sealing minigrip type zip lock, moisture resistant closure, Material: Virgin polyethylene,
thickness 0.05 mm
97 Tongue depressor (wooden), disposable, box of 100
98 Apron, utility plastic reusable, unit ( Straight apron with bib and neckband back fastening,
Moisture proof and blood, water, chemical and stain resistant. Able to withstand extreme
temperature, Length 120cm, width 90cm, Re-usable and able to withstand disinfection. Material:
Opaque/transparent plastic, PVC, vinyl or polypropylene )
99 Bucket, plastic, approximately 12 liters, with lid. Unit
100 Infant coat
101 Resuscitator, adult, hand operated set with bag 1500-2000ml (balloon for oxygen )
X-Ray Radiology
102 a) X- ray film, blue sensitive, interleaved, 18 x 24 cm, box of 100
103 b) X- ray film, blue sensitive, interleaved, 24 x 30 cm, box of 100
104 c) X- ray film, blue sensitive, interleaved, 30 x 40 cm, box of 100
105 a) X-ray developer powder for 25 liters, 2.6Kg
106 b) X-ray fixer for 22.5 L, 3.3kg
Page | 42
14. Diagnostic Services for BPHS by Type of Facility
Diagnostic services, such as laboratory and radiology services, support health workers in their diagnoses of
patient conditions. As the BPHS comprises the most critical services and interventions, the primary role of
diagnostic services is to provide confirmation of a diagnosis. The services available for the BPHS are very basic,
as the more sophisticated diagnostic services are located in the provincial and regional hospitals. The radiology,
laboratory, and other diagnostic services available in the referral system at higher-level hospitals are outlined in
Table 10, ―Diagnostic Services by Hospital Level,‖ in the EPHS.
Table 10. Diagnostic Services by Type of Facility

Health District
Diagnostic Test HSC BHC MHT CHC
Post Hospital
1. Laboratory Services
1.1 Hematology
Hemoglobin - - - -  
Red and white blood cell count - - - -  
ESR and differential cell count - - - -  
Hematocrit - - - - 
Bleeding time and coagulation time - - - - 
Blood grouping and Rh factors - - - -  
Hepatitis B and C and syphilis tests - - - -  
HIV test - - - -  
White blood count (WBC and differential) manual - - - -  
Erythrocyte sedimentation rate (ESR) - - - -  
Malaria parasite smear (MPS) - - - -  
1.2 Bacteriology
Ziehl-Nielsen staining for acid fast bacilli (AFB) - - - -  -
Direct smear for AFB - - - - - 
Albert‘s staining for diphtheria - - - -  
Gram‘s staining - - - -  
1.3 Serology
Widal test - - - - - 
1.4 Clinical Pathology
Urine analysis: physical exam - - - -  
Chemical exam: Albumin (qualitative) - - - -  
Chemical exam: Albumin (quantitative) - - - - - 
Chemical exam: Glucose (qualitative) - - - -  
Chemical exam: Glucose (quantitative) - - - - - 
Microscopic (stool test) - - - -  
Macroscopic (stool test) - - - - - 
Pregnancy test - - - -  
1.5 Biochemistry
Blood-sugar test - - - - - 
Urea test - - - - - 
Creatinine test - - - - - 
Total protein test - - - - - 
Simple liver-function test - - - - - 
1.6. Gram Stain
Body fluids - - - - - 
2. Imaging Services
2.1. X-Rays
Chest - - - - - 
Abdomen - - - - - 
Skeletal - - - - - 
Page | 43
15. Summary of Services, Staffing, Equipment, Diagnostic Services, Essential Drugs by Facility Type
A summary of each type of BPHS health facility is provided in six tables, as outlined below. Each table catalogs the catchment population, all the services and interventions
provided, the type and number of health worker staff, an illustrative list of equipment, and a list of essential drugs at each type of facility. These are provided in the following
tables:
 Table 11. Health Post: Summary of BPHS Services, Staffing, Facility Features, and Essential Drugs
 Table 12. Health Sub Center: Summary of BPHS Services, Staffing, Facility Features, and Essential Drugs
 Table 13. Basic Health Center: Summary of BPHS Services, Staffing, Facility Features, and Essential Drugs
 Table 14. Mobile Health Team: Summary of BPHS Services, Staffing, Facility Features, and Essential Drug
 Table 15. Comprehensive Health Center: Summary of BPHS Services, Staffing, Facility Features, and Essential Drugs
 Table 16. District Hospital: Summary of BPHS Services, Staffing, Facility Features, and Essential Drugs
For all the services listed, implementers will adhere to the principles of and requirements for appropriate implementation as formulated by the MoPH:
1. Routine reporting using the standard formats and reporting intervals as required by the HMIS and M&E of the MoPH;
2. Strict adherence at all levels and for all services to the MoPH recommendations for infection control, safe injection practices, and proper waste disposal;
3. Regular and supportive supervision of lower levels by higher levels, according to the recommendations and requirements of the concerned MoPH departments and
national programs.
15.1. Health Post
Population Catchment Area Served: 1,000–1,500 (100–200 families)
Table 11. Health Post: Summary of BPHS Services, Staffing, Facility Features, and Essential Drugs
BPHS Core Area Interventions/Conditions Type and Illustrative Facility Illustrative Equipment and Essential Drugs
Treated/Services Provided Number of Staff Features Supplies
1. Maternal and  Provide antenatal and postnatal care; CHW (male) Private home of Scissors Analgesics:
Newborn Health refer complicated cases 1 CHW Acetaminophen
 Promote birth preparedness & safe Forceps
home delivery; refer complicated CHW (female) Antidotes:
cases 1 Thermometer Activated charcoal
 Identify sick newborns and refer after
first aid Mini delivery kit (see Annex C for Antihistamines:
 Provide micronutrient kit contents) Chlorpheniramine
supplementation Maleate
ORS Measurement jug
 Identify and refer babies with
Anti-bacterial:
physical anomalies such as club foot
Tape measure for nutrition Co-trimoxazole
 Provide counseling on family
Page | 44
planning and exclusive breastfeeding assessment
 Distribute condoms and oral Anti-malarials:
contraceptives, and provide DMPA, Health education teaching materials Chloroquine
including first injection of DMPA Fansidar
2. Child Health and  Promote routine immunization at the Disability awareness materials
Immunization facility and support EPI outreach (visual and written) Antenatal
Supplements:
 Disease surveillance and case Updated referral list of physical Ferrous Sulfate +
reporting rehabilitation service providers in Folic Acid
 VPD outbreak response region Sterilizer,
Anti-infectives:
 Vitamin A supplementation
MUAC Tape ( Mid Upper Arm Gentian Violet
 Infection control, safe injection Circumference Tap)
practices, and waste disposal Disinfectants:
 Reporting Cupboards for CHWs Chlorhexidine
Chlorine releasing
 Support campaigns comp
 Manage cases of ARI, pneumonia,
diarrhea, fever, malaria, provide Oral Rehydration
ORT, refer complicated cases. Salts: ORS and Zinc
 Support case management of measles tablets
 Identify gravely ill children and refer
3. Public Nutrition  Support for exclusive breastfeeding Contraceptives:
 Community-based malnutrition Oral, condoms,
management DMPA
 Multi-micronutrient Vitamin A and
iron Folic supplementation Anti-infectives:
 Community food demonstration Tetracycline
 Community-based growth promotion Vitamins and

 Community Mobilization and Minerals: Retinol
screening Zinc
4. Communicable  DOTS—For identified TB patients,
disease Treatment recommend for HIV test encourage Antacid
and Control compliance with DOTS determined Aluminum
treatment Hydroxide +
 Referral of self-reporting suspected Magnesium
Page | 45
TB patient Hydroxide
 Surveillance of cases of interrupted
TB treatment, active case-finding Anti Helminthes:
 Clinical diagnosis of malaria and Mebendazole
treatment of uncomplicated cases
 Provision of insecticide-treated
mosquito nets
 Information, education, and
communication
 Referral to HIV counseling (and
testing where indicated)
 Monitoring, supervision and support
for ARV prophylaxis for PMTCT
 Monitoring, supervision and support
for ART (antiretroviral treatment)
 Infection control, safe injection
practices, and waste
 Referral to physical rehabilitation
services (exercise training) if required
5. Mental Health  Mental health awareness
 Case detection (self-reporting) and
follow-up of chronic cases
 Support community-based self-help
groups for drug addiction including
harm reduction
6. Disability Services  Refer patients to nearest
physiotherapy and orthopedic
workshop services if required
 Refer disabled children with physical
anomalies to nearest physiotherapy
services
7. Regular Supply of (See last column)
Essential drugs
Page | 46
8.General-  Promotion of healthy lifestyles and
Information, care-seeking behavior
Education and  Work with Family Health Action
Communication Groups in order to spread important
messages and healthy behaviors
throughout the community
15.2. Health Sub-Center
Population Catchments Area served served 3000-7000
Table 12. Health Sub-Center: Summary of BPHS Services, Staffing, Facility Features and Essential Drugs
BPHS Core Area Interventions/Conditions Type and Illustrative Facility Illustrative Essential Drugs
Treated/Services Provided Number of Features Equipment and
Staff Supplies
1. Maternal and  Provide antenatal care; refer complicated The sub-center Private house Stethoscope Anesthetics: Oxygen,
Newborn Health cases will be staffed provided by the Lidocaine
as follows: community Analgesics:
 Refer all deliveries, if no referral Sputum and blood
specimen bottles Acetaminophen, Acetyl,
possible attend normal deliveries
Male nurse Examination room Salicylic Acid, Ibuprofen
 Identify sick newborns and refer after 1 Diclofenac
first aid Vision testing charts
Anticonvulsants:
 Provide micronutrient supplementation Community Delivery room Diazepam, Magnesium
 Provide counseling on family planning Sphygmomanometer
midwife 1 Sulfate, Phenobarbital,
and exclusive breastfeeding Antidotes: Activated
Dispensing counting
 Distribute condoms and oral Cleaner/Guard Wound dressing area charcoal, Calcium
tray
contraceptives, and provide follow-up 1 Gluconate
DMPA Antihistamines:
Pediatric and adult
2. Child Health  EPI routine (All antigens) Pharmacy scales Chlorpheniramine Maleate
and Immunization  Outreach immunization service Anthelminthics:
 EPI-plus ( ORS+ De-worming) Cold Mebendazole
 Supplementary Immunization Activities Patient registration box/refrigerator(flexibl Antibacterials:
 Disease surveillance and case reporting room e) for EPI Amoxicillin, Benzathine
Benzyl Penicillin, Phenoxy
 VPD outbreak response
Page | 47
Staff Supplies
 Vitamin A supplementation Vaccine carrier and ice Methyl Penicillin (Penicillin
 Manage cases of ARI, pneumonia, Waiting room (area) pack V), Procaine Penicillin,
diarrhea, fever, malaria, provide ORT, Chloramphenicol,
refer complicated cases Patella hammer Doxycycline, Ampicillin,
 Support case management of measles Medical records area Gentamycin,
Diagnostic set or Erythromycin
 Identify gravely ill children and refer
Otoscope Anti-TB drugs:
3. Public Nutrition  Support for exclusive breastfeeding
Health Education area Ethambutol, INH,
 Community-based malnutrition Drip stand Pyrazinamide, Rifampicin,
management Streptomycin,
 Multi-micronutrient and iron Disability materials Flashlight Antifungals: Nystatin
supplementation (Visual and written) Anti-amoebic:
 School feeding & Community food Minor surgery kit Metronidazole
demonstration Updated referral list (see Annex B for kit Antimalarials:
4. Communicable  TB case detection using sputum smear of physical contents) Chloroquine, Fansidar,
disease Treatment  Short course Chemotherapy , including rehabilitation services Quinine
and Control DOTS—For identified TB patients, providers in regions Stretcher Sulfonamide: Co-
encourage compliance with DOTS trimoxazole
determined treatment and HIV testing Specula Sympathomimetics:
 Referral of self-reporting TB patient Salbutamol, Adrenaline
Lamp Antenatal Supplements:
 Surveillance of cases of interrupted TB
Ferrous Sulfate + Folic Acid
treatment, active case-finding
Suction Antihypertensives:
 Clinical diagnosis of malaria and
Methyldopa, Nifedipine
treatment of uncomplicated cases
Midwifery kit (see Anti-infectives: Gentian
 Promotion and distribution of Annex C for kit Violet, Silver Sulphadiazine
insecticide-treated mosquito nets contents) Anti-fungal: Benzoic Acid
 Referral for VCCT by HIV prevention + Salicylic Acid, Nystatin,
education Sterilizer Scabicides/ Pediculocides:
5. Mental Health  Awareness raising & psycho-education Lindane
 Case identification and referral Examination table Disinfectants:
 Basic psychosocial support for Chlorhexidine
individuals, families and groups Scissors Chlorine releasing comp.,
 Follow up of chronic patients (Treatment Diuretics:
compliance Forceps Hydrochlorothiazide
 Support community-based self-help for Antacids: aluminium
Page | 48
Staff Supplies
drug addiction-harm reduction and Thermometer Hydroxide + magnesium
referral of IDUs for testing Hydroxide
 Mental health training for staff and Clean delivery kit (see Anti-emetics:
health workers Annex C for kit Metoclopramide
6. Disability  Disability and Physical rehabilitation contents) Oral Rehydration Salts:
Services awareness, prevention and education Low Osmolarity (ORS)
 Home visit program for paraplegic ORS measuring
patients (in urban setting) jug/container Adrenal Hormones
 Refer patients to nearest Physiotherapy Hydrocortisone
and Orthopedic rehabilitation services as Tape measure for Betamethasone + Neomycin
required nutrition assessment Oxytocics:
Oxytocin
 Refer disabled children with physical
Height measuring Contraceptives: Oral, POP,
anomalies to nearest Physiotherapy
Board, Condoms, IUD (if person
services
trained), DMPA injections
7. Regular Supply (See last column) Vaccines: BCG, DPT,
of Essential drugs Growth monitoring Hepatitis B, Measles, OPV,
General-  Promotion of healthy lifestyles and care- chart Tetanus toxoid, Pentavalent
Information, seeking behavior DTPw-HB Hib
Education and MVA (Manual Vacuum Ophthalmological
Communication Aspiration) Preparation Anti-
infectives: Tetracycline
Ambu bag for child, Anti-asthmatic:
adult and infant Aminophylline,
Epinephrine, Salbutamol
Parenteral:
Sodium chloride, sodium
Torches
lactate, glucose with sodium
Folding stretcher chloride, Potassium chloride
Miscellaneous:
Neonatal Resuscitation Water for injection
trolley
Vitamins and Minerals:
Iodine, Retinol, Multi-
micronutrients, Zinc,
Vitamin K
Page | 49
15.3. Basic Health Center
Population Catchment Area Served: 15,000-30,000
Table 13. Basic Health Center: Summary of BPHS Services, Staffing Facility Features and Essential Drugs
BPHS Core Area Interventions/Conditions Type and Illustrative Illustrative Essential Drugs
Treated/Services Provided Number of Staff Facility Features Equipment and
Supplies
1. Maternal and  Antenatal care; refer complicated cases Nurse (male) 1 Examination room Stethoscope Anesthetics: Oxygen,
Newborn Health  Assist with normal deliveries, Lidocaine
identification of danger signs and Community Sputum and blood Analgesics: Acetaminophen,
referral midwife 1 Delivery room specimen bottles Acetylsalicylic Acid,
Ibuprofen
 Detection of postpartum anemia,
Community Vision testing charts Diclofenac
puerperal infections
health supervisor Wound dressing Anticonvulsants/Anti-
 Identification of sick newborns and
1 area Sphygmomanometer Epileptics:
referral after first aid
Diazepam, Magnesium
 Promoting exclusive breastfeeding Vaccinator 2 Dispensing counting Sulfate, Phenobarbital
 Micronutrient supplementation Pharmacy tray Antidotes: Activated
 Counseling on family planning Physician (male charcoal,
 Screening for and treatment of STDs, or female) 1 Pediatric and adult Calcium Gluconate
HIV testing, condom promotion and Patient registration scales Antihistamines:
supply Cleaners, guards room Chlorpheniramine Maleate
 Contraceptive services: DMPA 2 Cold box/refrigerator Anthelminthics:
injections, distribution of condoms and for EPI Mebendazole
oral contraceptives, IUDs if trained Waiting room Antibacterials: Amoxicillin,
person available Vaccine carrier and ice Benzathine Benzyl Penicillin,
2. Child Health  EPI routine (All antigens) pack Phenoxy Methyl Penicillin
and Immunization Medical records (Penicillin V), Procaine
 Outreach immunization service area Patella hammer Penicillin, Chloramphenicol,
 EPI-plus ( ORS+ De-worming Doxycycline, Co-trimoxazole,
Diagnostic set or Ampicillin, Gentamycin,
 Supplementary Immunization Activities Health Education Otoscope Erythromycin(Ethyl
 Disease surveillance and case reporting area succinate)
 VPD outbreak response Drip stand Anti-TB drugs: Ethambutol,
 Vitamin A supplementation INH, Pyrazinamide,
Disability materials Flashlight Rifampicin, Streptomycin,
 Supervision and monitoring
(Visual and Antifungals: Nystatin
 Case management of ARI, pneumonia, written) Minor surgery kit Anti-Amoebic:
diarrhea, measles, fever/malaria;
Page | 50
Supplies
provision of ORT, referral of (see Annex B for kit Metronidazole
complicated cases (as per IMCI) Updated referral contents) Antimalarials: Chloroquine,
 Identification of gravely ill children and list of physical Fansidar, Quinine
referrals rehabilitation Stretcher Sulfonamide: Co-
3. Public Nutrition  Support exclusive breastfeeding services providers trimoxazole
 Growth monitoring and promotion in regions Specula Sympathomimetics:
 Diagnosis and treatment of malnutrition Salbutamol, Adrenaline
Lamp Antenatal Supplements:
 Multi-micronutrient and iron
Ferrous Sulphate + Folic Acid
supplementation
Suction Antihypertensives:
 School feeding Methyldopa, Nifedipine
 Improvement of sanitation Midwifery kit (see Anti-infectives: Gentian
 Community food demonstration Annex C for kit Violet, Silver Sulfadiazine
 Treatment of severe malnutrition at contents) Anti-fungal: Benzoic Acid +
community level (CTC): Community Salicylic Acid, Nystatin
Mobilization and screening Sterilizer Scabicides/Pediculocides:
 Out patient management (OTP) Lindane
4. Communicable  TB cases detection using sputum smear Examination table Disinfectants: Chlorhexidine,
disease Treatment (if lab available), HIV testing for TB Chlorine releasing comp
and Control patients w Scissors Diuretics:
 Short-course chemotherapy, including Hydrochlorothiazide
DOTS Forceps Antacids: aluminium
Hydroxide + magnesium
 Surveillance of cases of interrupted TB Thermometer Hydroxide
treatment, active case-finding Anti-emetics:
 Preventive therapy for children contacts Clean delivery kit (see Metoclopramide
of TB patients Annex C for kit Oral Rehydration Salts:
 Clinical diagnosis of malaria and contents) Low Osmolarity ORS
treatment of uncomplicated cases Adrenal Hormones
 Promotion and distribution of insecticide ORS measuring Hydrocortisone
treated mosquito nets jug/container Betamethasone+Neomycin
 Referral for VCCT for suspected Oxytocics:
HIV/AIDS patients HIV prevention Tape measure for Oxytocin
education, NTDC or non test dependent nutrition assessment Contraceptives: Oral, POP,
counseling and referral for V CCT Condoms, IUD (if person
5. Mental Health  Awareness raising & psycho-education Height measuring trained), DMPA injections
Page | 51
Supplies
 Case identification & diagnosis Board, Vaccines: BCG, DPT,
 Psychosocial assessment and basic Hepatitis B, Measles, OPV,
psychosocial interventions Tetanus toxoid, Pentavalent
 Basic treatment and referral of mental Growth monitoring DTPw-HB Hib
disorders chart Ophthalmological
 Support groups for people with Preparation Anti-infectives:
substance abuse, mental disorders and MVA (Manual Tetracycline
their family members Vacuum Aspiration) Antioxytocics:
Salbutamol
 Substance abuse: identification and
Ambu bag for child, Anti-asthmatic:
education
adult and infant Aminophylline Salbutamol,
 Community-based rehabilitation and Epinephrine (Adrenaline)
harm reduction Pedal suction machine
Medicine Used in
 Support group for drug addicts, Depression:
psychiatry patients/families and women Torches
Amitriptyline
 Folding stretcher Parenteral:
6. Disability  Disability and Physical rehabilitation Sodium Chloride, Sodium
Services awareness, prevention and education Neonatal Resuscitation Lactate, Glucose with sodium
trolley
 Refer patients to nearest physiotherapy chloride, Potassium Chloride,
or orthopedic rehabilitation services as Calcium Gluconate
required Miscellaneous:
 Identify and refer newborn and young Water for injection
children (i.e. Club foot, DDH) with Vitamins and Minerals:
physical anomalies to nearest Iodine, Retinol, Multi-
physiotherapy services micronutrients, Zinc, Vitamin
7. Regular Supply (See last column) K
of Essential drugs
General-  Promotion of healthy lifestyles and care-
Information, seeking behavior
Education and
Communication
Page | 52
15.4. Mobile Health Teams

Population catchments area served: depends upon the local situation
Table 14. Mobile Health Team: Summary of BPHS Services, Staffing, Facilities and Essential Drugs
Illustrative
Interventions/Conditions Type and Illustrative Essential Drugs
BPHS Core Area Equipment and
Treated/Services Provided Number of Staff Facility Features
Supplies
1. Maternal and  Antenatal care; refer complicated cases Female Health Examination Stethoscope Anesthetics: Oxygen,
Newborn Health Provider rooms Lidocaine, Lidocaine +
 Assist with normal deliveries, (Community Sputum and blood Adrenaline
identification of danger signs and Midwife or , Delivery Room specimen bottles Analgesics, Antipyretics,
referral Nurse) 1 Nonsterodial Anti-
 Detection of postpartum anemia, Wound dressing Vision testing chart Inflammatory Drugs:
puerperal infections Male Health area Acetaminophen (Paracetamol),
 Identification of sick newborns and Provider Sphygmomanometer Acetylsalicylic Acid, Ibuprofen
referral after first aid (Doctor or Pharmacy Anticonvulsants/Anti-
Nurse) 1 Dispensing counting Epileptics: Diazepam,
 Promoting exclusive breastfeeding
Patient tray Magnesium Sulphate,
 Micronutrient supplementation Vaccinator 1 registration area Phenobarbital
 Counseling on family planning Pediatric and adult Antidotes: Activated charcoal
 Screening for and treatment of STDs, Driver 1 Waiting area scales Antihistamines:
HIV testing, condom promotion and Chlorpheniramine Maleate
supply Medical records Cold box for EPI (Chlorphenamine)
 Contraceptive services: DMPA Table Anti-Infective Medicines:
injections, distribution of condoms and Vaccine carrier and Mebendazole,
oral contraceptives, IUDs if trained Health Education ice pack Antibacterials: Amoxicillin,
person available area Benzathine Benzyl Penicillin,
2. Child Health  EPI routine (All antigens) Patella hammer Procaine Penicillin,
and Immunization ((Disability Chloramphenicol, Doxycycline,
 Outreach immunization service
awareness) Diagnostic set or Gentamicin, Erythromicine,
 EPI-plus ( ORS+ De-worming otoscope Silver sulfadiazine
 Supplementary Immunization Activities Disability Anti-tuberculosis: Rifampicin
materials (Visual Drip stand (Rifampin),
 Disease surveillance and case reporting and written) Antifungal: Nystatin
 VPD outbreak response Flashlight Anti-protozoal Medicine:
 Vitamin A supplementation Updated referral Metronidazole
 Case management of ARI, pneumonia, list of physical Minor surgery kit Antimalarial: Chloroquine,
diarrhea, measles, fever/malaria; rehabilitation (see Annex B for kit Pyrimethamine + Sulfadoxine
provision of ORT, referral of services providers contents) (Fansidar), Quinine
complicated cases in regions)) Sulfonamide/Related: Co-
Page | 53
Illustrative
Supplies
 Identification of gravely ill children and Stretcher trimoxazole (Sulfamethoxazole
referrals +Trimethoprime)
3.Public Nutrition Support exclusive breastfeeding Specula Urinary Antiseptics:
 Growth monitoring Nitrofurantoin
Lamp Sympathomimetics:
 Diagnosis and treatment of malnutrition
Adrenaline, Salbutamol,
 Multi-micronutrient and iron Suction Atropine
supplementation Drugs Used in Anemia:,
 School feeding Midwifery kit (see Ferrous Sulphate + Folic Acid,
 Improvement of sanitation Annex C for kit Antihypertensive Agents:
 Community food demonstration contents) Atenolol, Methyl Dopa,
 Treatment of severe malnutrition at Nifedipine
community level (CTC): Community Sterilizer Antithrombotic Agent: Acetyl
Mobilization and screening salicylic acid (Acetylsalicylic
 Out patient management (OTP) Acid),
4. Communicable  TB cases detection using sputum smear Anti-Infective, Topical:
Diseases (if lab available), HIV testing for TB Gentian Violet (Methyl
patients Rosanilinium Chloride), Silver
 Short-course chemotherapy, including Examination table sulfadiazine
DOTS Antifungal, Topical: Benzoic
Scissors Acid + Salicylic Acid, Nystatin
 Surveillance of cases of interrupted TB
treatment, active case-finding Scabicides/Pediculocides:
Forceps Lindane
 Preventive therapy for children contacts
Disinfectants and Antiseptics:
of TB patients
Thermometer Chlorhexidine, Chlorine
 Clinical diagnosis of malaria and releasing compound
treatment of uncomplicated cases Clean delivery kit (see Diuretics: Hydrochlorothiazide
 Promotion and distribution of insecticide Annex C for kit Antacids: Aluminum
treated mosquito nets contents) Hydroxide, Aluminum
 Referral for VCCT for suspected Hydroxide + Magnesium
HIV/AIDS patients, HIV prevention ORS measuring Hydroxide,
education, NTDC or non test dependent jug/container Anti-Emetics: Metoclopramide
counseling and referral for V CCT Oral Rehydration Solution:
5. Mental Health  Awareness raising & psycho-education Tape measure for low-osmolarity ORS
 Case identification nutrition assessment Adrenal Hormones and
 Psychosocial assessment and basic Synthetic Substitutes:
Page | 54
Illustrative
Supplies
psychosocial interventions Hydrocortisone,
 Basic treatment and referral of mental MUAC Tap ( Mid Betamethsone+Neomycin
disorders Upper Arm Contraceptives:
 Support groups for people with Circumference Tap) Ethinylestradiol +
substance abuse, mental disorders and tool for measuring Levonorgestrel,
their family members nutritional status Ethinylestradiol +
 Substance abuse: identification and Height measuring Norethisterone, Medroxy
education Board, Portable Progestrone (DMPA),
 Community-based rehabilitation and Condoms, IUD
harm reduction Salter scale 25kg Vaccines: BCG, DPT
Portable, (diphtheria, pertussis, tetanus),
 Support group for drug addicts,
DPT/Hepatitis-B vaccine,
psychiatry patients/families and women
Baby scale, Portable Measles, OPV (oral polio
6.Disability  Disability and Physical rehabilitation vaccine), Tetanus
awareness, prevention and education Growth monitoring Toxoid(Pentavalent DPTPW-
 Refer patients to nearest physiotherapy chart HP/Hib)
or orthopedic rehabilitation services as Anti-Infective Topical:
required MVA (Manual Tetracycline,
 Identify and refer newborn and young Vacuum Aspiration) Oxytocics: Ergometrine
children (i.e. Club foot, DDH) with set Antioxytocics:Salbutamol
physical anomalies to nearest Sleep Disorder: Diazepam
physiotherapy services Ambu bag for child, Anti-Asthmatic medicines:
 Disability and Physical rehabilitation adult and infant Aminophylline, Epinephrine
awareness, prevention and education (Adrenaline), Salbutamol,
7. Essential (See last Column) Parenteral: Sodium Chloride,
Supply of Compound solution of Sodium
Essential Drugs Lactate, Glucose, Glucose with
General-  Promotion of healthy lifestyles and care- Sodium Chloride, Potassium
Information, seeking behavior Chloride, Sodium Bicarbonate
Education, and Miscellaneous: Water for
communication Pedal suction machine injection
Vitamins and Minerals:
Lamps and torches Iodine, Retinol, Multi-
micronutrients, Zinc, Vitamin
Folding stretcher K
Page | 55
15.5. Comprehensive Health Center
Population Catchments Area served: 30,000 – 60,000

Table 15. Comprehensive Health Center: Summary of BPHS Services, Staffing, Facilities and Essential Drugs
Illustrative
Supplies
1. Maternal and  Antenatal care, treatment of mild pre-
Newborn Health eclampsia/eclampsia, incomplete Inpatient beds Oxygen gauge and Anesthetics: Ketamine (if
miscarriage/abortion, if blood drawn for Nurse (male) 1 cylinder anesthetist), Oxygen, Lidocaine,
any reason to be tested for HIV Lidocaine + Adrenaline
 Assistance with normal deliveries, Neonatal
provision of basic emergency obstetric Nurse (female) 1 Minor surgery resuscitation trolley Analgesics: Acetaminophen,
care room Acetyl, Salicylic Acid, Ibuprofen
 Detection of postpartum anemia, Community Hearing screening Diclofenac
puerperal infection midwife 2 equipment
 Care for new born; management of Tramadol
neonatal infections and sepsis Community Holding beds EOC supplies and kit
health Anticonvulsants:
Supervisor 1 Sterilization
 Micronutrient `supplementation equipment Carbamazepine, Diazepam,
 Counseling on family planning Exam rooms Magnesium Sulphate,
 Screening for and Vaccinator 2 Hemoglobinometer Phenobarbital
 treatment of STDs, if present then HIV
testing condom promotion and supply Physician Hand crank Antidotes: Activated charcoal,
 Contraceptive services: DMPA (male) 1 Delivery room centrifuge Atropine
injections, distribution of condoms and Calcium Gluconate
oral contraceptives, IUDs if trained Physician Microscope
person available (female) 1 Wound dressing Antihistamines:
 Gender training area Stethoscope Chlorpheniramine Maleate
 Privacy for delivery rooms Laboratory
 EPI routine (All antigens) technician 1 Sputum and blood Anthelminthics: Mebendazole
specimen bottles
2. Child Health  Outreach immunization services Pharmacy Pharmacy Antibacterials: Amoxicillin,
and Immunization  EPI-plus ( ORS+ De-worming)
technician 1 Vision testing chart Ampicillin, Benzathine Benzyl
 Supplementary Immunization Activities Penicillin, Phenoxy Methyl
Psychosocial Sphygmomanometer Penicillin, Procaine penicillin,
 Disease surveillance and case reporting
Counselor ( if Laboratory area Co-trimoxazole,
 VPD outbreak response required for Dispensing counting Chloramphemicol, Doxycycline,
 Vitamin A supplementation funded mental tray Gentamicin,
Page | 56
Illustrative
Supplies
 Infection control, safe injection health activities) Erythromycin(Ethyl succinate)
practices, and waste management 1 Patient Pediatric and adult Cloxacillin, Ciprofloxacin,
Administrator 1 registration room scales
 Reporting Anti-TB drugs: Ethambutol,
 Supervision and monitoring Cleaners, Guards Cold box/refrigerator INH, Pyrazinamide, Rifampicin,
 Case management of ARI, pneumonia, 4 Waiting room for EPI Streptomycin,
diarrhea, measles, fever/malaria;
provision of ORT, referral of Driver (If Vaccine carrier and Antifungals: Nystatin
complicated cases ambulance ice pack
 Identification of gravely ill children and available) 1 Medical Records Anti-Amoebic: Metronidazole
referrals area Patella hammer
 Support exclusive breastfeeding Antimalarials: Chloroquine,
3. Public Nutrition  Diagnostic set or Fansidar, Quinine, Primaquine,
Growth monitoring
Otoscope Artesunate
 Diagnosis and treatment of malnutrition
Health Education Leishmaniasis:
 Multi-micronutrient and iron Area Drip stand Sodium Stibogluconate,
supplementation Meglumine antimonate
 School feeding Flashlight
 Improvement of sanitation Physiotherapy Sulfonamide: Co-trimoxazole
 Community food demonstration room Minor surgery kit Urinary Antiseptics:
 Treatment of severe malnutrition at (see Annex B for kit Nitrofurantoin
community level (CTC): Community Compartments or contents) Sympathomimetics:
Mobilization and screening rooms for Adrenaline, Salbutamol
psychosocial Stretcher Antenatal Supplements:
 TB cases detection using sputum smear consultations Ferrous Sulfate + Folic Acid
4. Communicable (if lab available) if TB positive then HIV Specula Antihypertensives: Methyl
disease Treatment testing Dopa, Atenolol, Nifedipine
and Control  Short-course chemotherapy, including Lamp Antithrombotic: Acetyl
DOTS, DOTS + in multi-drug resistant Salicylic Acid
(MDR) TB Suction Anti-infectives: Gentian Violet,
 Surveillance of cases of interrupted TB Silver Sulphadiazine
treatment, active case-finding Midwifery kit (see Anti-fungal: Benzoic Acid +
 Preventive therapy for children and Annex C for kit Salicylic Acid, Nystatin
contacts of TB patients contents) Scabicides: Lindane
 Clinical and microscopic diagnosis of Disinfectants: Chlorhexidine
malaria and treatment of complicated Chlorine releasing comp.,
Page | 57
Illustrative
Supplies
cases Sterilizer Diuretics: Hydrochlorothiazide
 Promotion of insecticide treated Antacids: aluminum Hydroxide
mosquito nets Examination table + magnesium Hydroxide
 Information, education, and Ranitidine
communication Scissors Anti-emetics: Metoclopramide
Oral Rehydration Salts: Low
Forceps Osmolarity (ORS)
 Referral to HIV counseling (and testing Adrenal Hormones:
where indicated) Thermometer Hydrocortisone
 HIV testing (PITC) for TB, STI, ANC, Betamethasone + Neomycin
injection drug use, blood safety Clean delivery kit Contraceptives: Oral,
 HIV testing (PITC) for diagnosis (see Annex C for kit Condoms, IUD, DMPA
 CTX (co-trimoxazole) prophylaxis contents) injections. Progesterone Only
Pills (POP)
 OI (opportunistic infections) and TB ORS measuring Vaccines: BCG, DPT, Hepatitis
 Monitoring, supervision and support for jug/container B, Measles, OPV, Tetanus
ARV prophylaxis for PMTCT toxoid, Pentavalent DTPw-HP
 Monitoring, supervision and support for Tape measure for Hib
ART (antiretroviral treatment) nutrition assessment Ophthalmological Preparation
 Infection control, safe injection Anti-infectives: Tetracycline
practices, and waste management Disability awareness Tetracaine Hydrochloride
 Referral to physical rehabilitation and prevention Oxytocics and Antioxytocics:
services (exercise training) if required materials (Visual and Ergometrine, Oxytocin,
written) Salbutamol
5. Mental Health  Awareness raising & psycho-education
Depressive disorders medicine:
 Case identification & diagnosis
Updated referral list Amitriptyline
 Biopsychosocial treatment of severe of physical Anxiety and sleep disorders
mental disorders, common mental rehabilitation service medicine: Diazepam
disorders, epilepsy, childhood mental providers in the Psychotherapeutic drugs:
disorders, substance abuse disorders regions amitriptyline, fluoxetine,
 Psychosocial counseling services chlorpromazine,
 Support groups for people with Basic physiotherapy haloperidol,
substance abuse, mental disorders and equipment list (see Trihexyphenedyl
their family members annex) Anti-asthmatic: Aminophylline
 Community-based rehabilitation Epinephrine, Salbutamol
 Follow-up of patients with mental Ephedrine Hydrochloride
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Illustrative
Supplies
disorders
 Teamwork on Mental Health and MUAC Tape ( Mid Parenteral: Sodium chloride,
Psychosocial Support with staff of DH Upper Arm Glucose, Potassium chloride,
and BHC Circumference Tape) sodium hydrogen carbonate
 Mental Health Training and supervision tool for measuring Vitamins and Minerals:
of BHC and HP staff nutritional status Iodine, Retinol, Multi-
 Reporting & documentation micronutrients
 Disability and physical rehabilitation Height measuring Zinc, Vitamin K
6. Disability awareness, prevention and education Board, Miscellaneous:
Water for injection
Services  Physiotherapy assessment and treatment
Growth monitoring
for patients including those with
chart
disability
 Providing home visits to patients as Nebulizer
needed
 Refer patients for corrective surgery, Cervical collar and
prostheses, Orthoses and mobility aids to oxygen in
orthopedic surgeon and orthopedic ambulances,
workshops in the regions MVA (Manual
 Promote early identification of children Vacuum Aspiration)
with physicals anomalies that is club set
foot, developmental Dysplasia of the Hip
Joint for treatment Ambu bag for infant
 Inpatient and outpatient physiotherapy, child, adult
orthopedics diagnosis Pedal suction
 Referral for fitting and training in use of machine
orthotics and prosthesis
Wheel Stretcher
7. Regular Supply  (See last column)
of Essential drugs Folding stretcher
8. Blood  Collect, test and screen blood
Water bath
Transfusion  Perform transfusion
General-  Promotion of healthy life-styles and care Loop and lid retractor
Education and  Community outreach and promotion of
Communication radio health dramas, messages and spots
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15.6. District Hospital
Population Catchments Area served: 100,000 – 300,000

Table 16. District Hospital: Summary of BPHS Services, Staffing, Facilities and Essential Drugs
Illustrative
Supplies
1. Maternal and  Antenatal care, treatment of mild pre- Anesthetics and related drugs :
Newborn Health eclampsia/eclampsia, incomplete Physician- Operating theatre Oxygen gauge and Ketamine, Oxygen, Lidocaine,
miscarriage/abortion. if blood drawn for general (male) cylinder Lidocaine + Adrenaline,
any reason to be tested for HIV 2 Recovery room Pancuronium Bromide, Atropine
 Assistance with normal deliveries, Neonatal Analgesics: Acetaminophen,
provision of comprehensive emergency Physician— Emergency resuscitation trolley Acetyl, Salicylic Acid,
obstetric care general (female) (Trauma) room Ibuprofen, Diclofenac,
 Detection and treatment of postpartum 2 EmOC supplies Tramadol, Morphine
anemia, puerperal infection Nursery Anticonvulsants:
 Care for newborns; management of Hearing screening Carbamazepine, Diazepam,
neonatal infections and sepsis, newborn Surgeon 1 Inpatient beds equipment Magnesium Sulphate,
incubator Phenobarbital
Anesthetist 1 Minor surgery Basic emergency *Sodium Valproate,
room obstetric care kit Antidotes: Activated charcoal
 Micronutrient supplementation Pediatrician 1 Neostigmine, Naloxone, Anti
 Counseling on family planning Holding beds Sterilization Tetanus Serum(ATS), Calcium
 Screening for and treatment of STDs if equipment Gluconate
present then HIV testing condom Dentist 1 Examination Antihistamines:
promotion and supply room Hemoglobin meter Chlorpheniramine Maleate
 Contraceptive services: DMPA Nurse (male) 5 Anthelminthics: Mebendazole
injections, distribution of condoms and Delivery room Hand crank Antibacterials: Amoxicillin,
oral contraceptives, IUDs if trained centrifuge Ampicillin, Benzathine Benzyl
person available Nurse (female) 5 Wound dressing Penicillin, Phenoxy Methyl
 Female and male sterilization (Out of five room Microscope Penicillin, Procaine penicillin,
 Gender training female nurses 2 Chloramphemicol, Doxycycline,
 Privacy for delivery rooms specified for Pharmacy Stethoscope Gentamicin, Erythromycin,
TFU) Cloxacillin, Ciprofloxacin,
 Delivery of EPI Services
Laboratory Area Vision testing chart Ceftriaxone
2. Child Health  Case management of ARI, pneumonia, Midwife 4 Anti-TB drugs: Ethambutol,
and Immunization diarrhea, measles, fever/malaria; Patient Sphygmomanometer INH, Pyrazinamide, Rifampicin,
provision of ORT, referral of Community registration room Streptomycin,
complicated cases health Dispensing counting Antifungals: Nystatin
 Identification and treatment of gravely ill Supervisor 1 Waiting room tray Anti-Amoebic: Metronidazole
children
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Illustrative
Supplies
3. Public Nutrition  Support exclusive breastfeeding Antimaterials: Chloroquine,
 Growth monitoring and promotion Pharmacist 1 Medical Records Pediatric and adult Fansidar, Quinine,
 Diagnosis and treatment of malnutrition Area scales Artesunate
 Multi-micronutrient and iron Vaccinator 2 For Leishmaniasis
supplementation Health Education Cold box/refrigerator Stibogluconate
Laboratory Area for EPI Meglumine antimonite
 Coordinate school feeding programs
technician 2 Space for Mental Sulfonamide: Co-trimoxazole
 Improvement of sanitation Health OPD and Vaccine carrier and Urinary Anteseptics:
 Running of TFC Dental Psychosocial ice packs Nitrofurantoin
 Inpatient care /Stabilization Technician 1 Counselling Sympathomimetics:
4. Communicable  TB cases detection using sputum smear Patella hammer Adrenaline, Salbutamol
disease Treatment  X-ray for smear negative patients X-ray technician Ephedrine
and Control  Short-course chemotherapy, including 1 Diagnostic set or Hydrochloride
DOTS, DOTS + in multi-drug resistant Otoscope Antenatal Supplements:
(MDR) TB Physiotherapist Ferrous Sulfate + Folic Acid
 Surveillance of cases of interrupted TB 1 (or 2 if no Drip stand Antihypertensives: Methyl
treatment, active case-finding physiotherapy Dopa, Atenolol,
 Preventive therapy for children and center near) Flashlight Nifedipine
contacts of TB patients Hydralazine
Administrator 1 Minor surgery kit Antithrombotic: Acetyl
 Clinical and microscopic diagnosis of
(see Annex B for kit Salicylic Acid
malaria and treatment of complicated
Cleaners, Guards contents) Anti-infectives: Gentian Violet
cases
6 Silver Sulfadiazine
 Promotion of insecticide treated
Stretcher Anti-fungal: Benzoic Acid +
mosquito nets
Driver 1 Salicylic Acid, Nystatin
 Counseling for HIV/AIDS Information, Specula Scabicides: Lindane
education, and communication Disinfectants: Chlorhexidine
 Referral to HIV counseling (and testing Lamp Chlorine releasing
where indicated comp.,
 HIV testing (PICT) for TB, STI, ANC Suction Diuretics: Hydrochlorothiazide
injection drug us, and blood safety Furosemide
 HIV testing for diagnosis (CITC) Midwifery kit (see Antacids: aluminium Hydroxide
 CTX (Co-trimoxazole) prophylaxis Annex C for kit + magnesium Hydroxide
contents) Ranitidine
 OI (opportunistic infections) and TB
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Illustrative
Supplies
 Monitoring, supervision and support for Anti-emetics: Metoclopramide
ARV prophylaxis for PMTCT Sterilizer Oral Rehydration Salts: ORS
 Monitoring, supervision and support for Adrenal Hormones:
ART (antiretroviral treatment) Examination table Hydrocortisone
Betamethasone
 Infection control, safe injection Scissors Contraceptives: Oral,
practices, and proper waste disposal Condoms, IUD, DMPA
 Referral to physical rehabilitation Forceps injections
services (exercise training) if required
5. Mental health  Awareness raising & psycho-education Thermometer Progesterone Only Pills (POP)
Vaccines: BCG, DPT, Hepatitis
 Diagnosis and bio psychosocial
Clean delivery kit B, Measles, OPV, Tetanus
treatment of severe mental disorders,
(see Annex C for kit toxoid, Hib
common mental disorders, epilepsy,
contents) Ophthalmological Preparation
childhood mental disorders, substance
Anti-infective: Tetracycline
abuse disorders
ORS measuring Tetracaine
 Psychosocial counseling jug/container Hydrochloride
 Brief hospitalization of patients with Flourosceine
severe acute symptoms of mental illness Tape measure for Oxytocics and Antioxytocics:
 Back referral to lower levels of health nutrition assessment Ergometrine, Oxytocin,
care system for follow up Salbutamol
 Training and supervision in mental Disability awareness Psychotherapeutics for
health and psychosocial support for staff and prevention psychotic disorders:
of CHC and BHC materials (Visual and amitriptyline, fluoxetine,
 Support groups for people with written) chlorpromazine, haloperidol,
substance abuse, mental disorders and thioridazine
their family members Updated referral list Anxiety and sleep disorders
6. Disability  Provide physiotherapy assessment and of physical medicine:
Services treatment for patients including those rehabilitation services Diazepam
with disabilities providers in the Trihexyphenedyl
 Awareness raising and education about regions Anti-asthmatics:
disability and physical rehabilitation Aminophylline, Epinephrine,
 Providing home visits to patients as Physiotherapy Salbutamol
needed materials and Parenteral: Sodium chloride,
 Refer patients for corrective surgery, equipment (see Glucose, Potassium chloride,
Prostheses, Orthoses and mobility aids to separate list in Sodium hydrogen carbonate
Page | 62
Illustrative
Supplies
orthopedic surgeons and Orthopedic annexes) Vitamins and Minerals:
workshop in the regions Iodine, Retinol, Multi-
 Promote early identification of children Growth monitoring micronutrients
with physical anomalies (i.e. Club foot, chart Zinc
Developmental Dysplasia of the Hip) for Vitamin K
treatment Nebulizer Miscellaneous: water for
7. Regular Supply  (See last column in this table) Cervical collar and injections
of Essential drugs oxygen in
8. Blood  Collect, test and screen blood ambulances,
Transfusion  Perform transfusion
ECG Machine
General-  Promotion of healthy life-styles and care
MVA (Manual
Education and  Community outreach and promotion of Vacuum Aspiration)
Communication radio health dramas, messages and spots set
Resuscitation Trolley
Caesarian
section/Hysterectomy
set (see Annex D for
set contents)
Ambu bag for child,

adult and infant
Pedal suction
machine
Wheel Stretcher
Folding stretcher
Water bath
Wheel chair
Page | 63
Illustrative
Supplies
Coagulating Cautery
Laparatomy set (see

Annex E for set
contents)
Loop and lid retractor
All Physiotherapy
Equipment
Height measuring
Board,
Page | 64
Annex A: Community-Based Health Care and Community Health Worker
1. Background
Community-based health care (CBHC) is the cornerstone of successful implementation of the BPHS. It
provides the context for the most comprehensive interaction between the health system and the communities
it serves. Its success depends upon community participation and a partnership between community and health
staff.
The implementation of CBHC recognizes first that families and communities have always looked after their
own health. Religion and cultural norms and beliefs play an important part in health practices, and families
are making decisions to maintain health or care for illness every day. In addition, community members
understand and have better information on local needs, priorities, and dynamics. The partnership of health
services with communities, therefore, has two aspects:
 To persuade families and communities to make appropriate use of scientific health services, and to
change certain behaviors and social norms for more healthy ones,
 To accept the guidance and collaboration of communities in the implementation of health programs
and the acceptable provision of health care, and encourage them to identify and solve their own
problems.
While there is no universally accepted definition of CBHC, global experience has identified three consistent
components of CBHC:
 Partnership between the community and the health facility staff,
 Appropriate and good quality care by community-based providers,
 Promotion of healthy practices and life styles.
Community-based Integrated Management of Childhood Illness (C-IMCI) is a very large and important
component of CBHC; it consists of the same three components.
Experience of the implementation of these components has produced a set of global principles of CBHC:
 CBHC focuses on major health problems for which solutions exist.
 The lowest-level health worker can provide the service at a reasonable standard of quality.
 Health workers are locally identified and recruited.
 Health workers are trained incrementally, one skill at a time.
 An established list of drugs and supplies is used.
 Supervision is regular and supportive.
 The health worker is accountable to the community.
 The community makes a financial or in-kind contribution for the services.
CBHC is not new to Afghanistan; it existed prior to the many years of war and conflict. However, in this post
conflict period, Afghanistan has reviewed the international concepts and developed an Afghanistan-specific
form of CBHC, which was adopted by the Ministry of Health following a national conference on CBHC in
September 2002. That policy on CBHC in Afghanistan is as follows:
1. The community must play the prime role; its participation is required to ensure both viability and
sustainability. CBHC and related CHWs are a community-based and community-owned program,
with essential technical and material support from both NGO and MoPH health services channeled
through community structures. These channels are often formalized by the establishment of a
community health committee made up of representatives from various parts of the community.
2. All levels of the health care system should receive orientation to the principles of CBHC and be
trained in responsiveness to referrals and other responsibilities.
3. The community must fundamentally agree with the adopted standardized CHW job description (see
below), including agreement to both preventive and first-level curative activities.
4. Quality training using sequential tasks will take place as close to the community as possible, with
national CHW standard curriculum guidelines defining needed competencies but methods being
locally determined.
5. Adequate supervision is to be assured before recruitment and training, preferably provided by the
person who does the training.
6. The closest health facility will regularly provide CHWs with a standardized drug kit adapted to the
local situation and approved for CHW activities.
7. Compensation must be sustainable, with full-time work to be paid and part-time work compensated
only by incentives. When possible, traditional compensation and in-kind contributions will be
maintained.
8. Community mechanisms for identifying needs are to include private-sector providers, both
traditional and modern.
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2. The Backbone of the BPHS
The Afghan CBHC system is shown in Figure 2, which illustrates the dynamic nature of this system.
Other Sectors
Referral/ Facility
Female &
Reporting
Male CHWs Shura-ye-
Other
Support
Health FacilitySehi
Gatekeepers
Outreach
COMMUNITY CHS
Private Community
Providers Action Groups Support
Shura-ye-
Sehi
Clinicians
TBAs
Pharmacists
Etc…
School teachers
Uniformed Services
Religious persons
Figure 2: Community-based Health Care: the Backbone of the BPHS
The components of the Afghan CBHC system include:
1. Health facility
The facility provides many case management, midwifery and preventive services that are not available at the
HP. Facility staff should work with community leaders and CHWs to optimize use of these services by the
community. Many facilities also provide outreach services to communities with poor access to the facility.
EPI is the main program delivered in this way because of the importance of achieving herd immunity.
2. Facility Shura (See details in section 4.)

The facility shura works with facility staff to assure the relevance of services to community needs, and good
quality of care and patient satisfaction at the facility.
3. Community Health Workers. (See section 3 for Job Description.)

CHWs are community volunteers. A health post has one male and one female CHW to serve a population of
100-150 families. The MoPH encourages the training of couples assigned to the same health post. At least
40% of CHWs should be female. A health post serves a population of between 1000 and 1500 people, but in
sparsely populated areas the population served may be as small as 400. Health program managers should give
special attention to the coverage of communities by CHWs and train more if required to give access to the
whole population. CHWs are trained to provide high impact primary care in the community, and to refer
severely sick patients and those needing preventive services or delivery care. They also promote healthy
behaviors and lifestyles in the community. CHWs maintain records of their activities and provide monthly
reports to the HMIS system.
4. Community Shura-e-sehie (See details in section 4.)

The community shura provides leadership and support to all health-related activities in their community.
They select, support and supervise the CHWs in the community; they monitor the community map with the
CHWs to be able to encourage families to make full use of preventive health services including outreach
services; they provide leadership in the adoption and promotion of new behaviors and social norms.
5. Community Health Supervisor (See job description in section 5.)
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Community Health Supervisors are members of the health facility staff. They are the main links between the
facility and the communities around the facility. They support and supervise all the CHWs, collect and
process all monthly reports from CHWs, meet regularly with Shura, and manage all community-based health
programs.
3. The Community Health Worker Job Description
No major changes are introduced to the job description of the CHW in this revision. Some changes are
introduced to the provision of birth spacing services and the management of diarrheal diseases. These are
being supported by in-service training programs and changes to the pre-service training.
 After appropriate training, CHWs will be allowed to counsel women on the use of DMPA and give
the first injection as well as follow-up injections
 CHWs are encouraged to promote the Lactation Amenorrhea Method (LAM) of birth spacing in the
first six months after a child is born, and then counsel women on the transition to another appropriate
birth spacing method.
 Adding Zinc therapy to ORS is introduced into the management of all diarrheal diseases.
 Cases of dysentery will need to be referred for treatment with Ciprofloxacin.
 CHWs will also be taught to be more aware of mental health and disability problems that can be
helped, and how to refer those patients.
Figure 3: Community Health Worker Job Description

Job Description for the Community Health Worker (CHW)
Adapted from the job description revised by the MoPH Community-Based Health Care Task Force, March
2005
The community health worker (CHW) is a person (female or male) selected by the community according to
selection criteria reflected in the Policy on Community Health Workers (June 2003). The CHW promotes
healthy lifestyles in the community, encourages appropriate use of health services, and treats and refers
common illnesses.
The CHW is accountable to the local Shura for performance and community satisfaction and technically
accountable to the community health supervisor (CHS) assigned by authorities from the nearest health
facility.
A. Community Collaboration and Health Promotion

1. Actively participate in community meetings and major community events.
2. Actively work with mother‘s groups (and Family Health Action Groups) to promote healthier
homes and maternal and child health.
3. Encourage and mobilize family/community participation in the immunization of children and
women of child-bearing age.
4. Support national initiatives at the village level and actively participate in all campaigns/activities
(e.g. National Immunization Days and surveillance for acute flaccid paralysis).
5. Promote good nutrition practices, encourage early and exclusive breastfeeding of children under
six months of age, encourage appropriate complementary feeding for children more than 6
months old and continued breastfeeding for children till the age of two.
6. Promote use of Oral Rehydration Salt (ORS) and Zinc, and other homemade rehydration fluids
for home management of diarrhea and dehydration.
7. Promote hygiene and sanitation, and the preparation and use of safe drinking water.
8. Encourage couples to practice birth-spacing and receive family planning services.
9. Promote psychosocial well-being and mental health in the community and raise awareness about
prevention identification of disability.
10. Create awareness within the community and provide information on the dangers of addictive
substances such as tobacco, naswar, opium, hashish, and alcohol.
B. Direct Services
1. Identify and manage acute respiratory infections, diarrhea, malaria, and other common
communicable diseases according to national protocols. Treat mild to moderate cases and refer
complicated cases to the nearest health center.
2. Implement Community-based IMCI.
3. Implement community-based growth promotion where FHA groups exist.
Page | 67
4. Counsel patients on correct use of medications included in the CHW kit.

5. The CHW should create awareness among the community on how to prevent TB and should refer
or accompany suspected cases to a health facility. Following completion by a tuberculosis patient
of the first phase of treatment at the health facility, the CHW should ensure compliance of TB
patients with the second phase treatment course in the community, based on DOTS.
6. Communicate the importance of antenatal and postnatal care. Distribute micronutrients and
antimalarials to pregnant women according to national policy. Encourage the community to make
regular and timely use of Maternal Child Health (MCH) services.
7. Encourage the use of skilled birth attendants, where possible, and help families to make birth
plans. Provide and teach the use of a mini delivery kit (see Annex C for kit contents). Teach
family members to recognize the danger signs of complications of pregnancy and childbirth, and
assist them in making preparations for emergency referral.
8. Distribute oral contraceptives and condoms to willing members of the target population
according to national policy. Promote LAM together with exclusive breastfeeding for the child‘s
health during the first six months of a child‘s life. Administer first and follow-up injections of
Depo-Provera. Encourage interested families to seek long-term family planning methods at a
health facility.
9. Provide first-aid services for common accidents at the family and community level.
10. Ensure administration of vitamin A to children aged six months to five years during NIDs.
C. Management
1. Meet regularly with the Shura to develop, implement, and monitor community action plans for
health improvement.
2. Meet regularly with the community health supervisor to review reports and action plans, receive
supplies, and for in-service training.
3. Collaborate with and support community midwife activities in the catchment area, including
health promotion and pregnancy-related referrals.
4. Regularly complete and submit the monthly Tally Sheets to the CHS for the HMIS.
5. Know the members of the community, and develop a community map of the eligible families in
the catchment area and the services they have used.
6. Report all deaths and other activities included in the report form of the health post. Inform the
health facility of any disease outbreaks.
7. Manage the health post, maintaining supplies and drugs given to CHWs and reporting utilization
of drugs and supplies.
8. The establishment of Shurai Sehi at the HP level.
D. Compensation for CHWs
CHWs should be compensated for legitimately incurred expenses (transport and food) when working
outside their community. Specifically, approved under this BPHS revision:
 Afs100 per month for routine work travel;
 Additional expenses (Afs50) for approved tasks like accompanying a suspected TB patient to a
facility with a laboratory.
The MoPH will not make regular payments to Community Health Workers (CHWs) from the MoPH
budget and does not recommend donors‘ resources be allocated for regular payment to CHWs because
such a policy is financially unsustainable. Communities are encouraged to support and compensate
CHWs in traditional ways.
4. The Community Health Supervisor Job Description
The post of the CHS was created in 2005 and adopted into the BPHS in the 2005 and 2009 revision. All
BPHS facilities that are supervising Health Posts should have at least one CHS, and preferably a male and a
female CHS (a couple is preferable). Currently, the supervision of female CHWs is poor because only about
10% of CHSs are females. BPHS implementers are encouraged to work out ways to improve the supervision
of female CHWs by increasing the number of female CHSs, sharing existing female CHSs between
neighboring facilities, or making time in the job of other female technical staff to support the CHWs.
Effective coverage of all health posts by male CHSs should also be considered. Many CHCs and DHs have
20, 30 or more health posts in their catchment areas. In general, CHSs can provide adequate supervision to
Page | 68
about 15 health posts depending upon travel conditions. Deployment of additional CHSs to cover larger
numbers of health posts around health facilities should be considered.
Figure 4 : The Job Description of the Community Health Supervisor
A. Qualifications:
 Graduate of high school. Professional qualification in health is preferred (a male or female).
 Respected, self-motivated resident of the local community
 Strong communication skills.
 Experience in community development, health care or management experience will be an advantage.
 Working knowledge of Pashto or Dari and fluent in local language if not Dari or Pashto
 Able and willing to travel to all parts of the area extensively
B. Overall Responsibility:
A Community Health Supervisor will be posted at all BPHS health facilities that supervise CHWs.
The CHS will supervise all community health activities, not only CHW activities. He or she will assist in
training, supporting and supervising CHWs and will also supervise public health programs and promote
collaboration between the facility and the community. He or she also assists in the formation and linkage of
community health committees (Shura-e-Sehie) with the CHW program and health facilities. He or she is
responsible for supporting the community in identifying and addressing their health problems. He or she
reports to the head of the facility.
C. Training:
 Assists in practical training during CHW training courses, including supervising the practical
experience of the CHWs in the community during their training
 Provides on-the-job and monthly in-service training to CHWs
 Reviews and evaluates the performance of the CHWs and identifies need for further training
D. Support and supervision:

 Assists the staff of the health facility in making plans for the community health programs in the
facility and its catchment area.
 Implements, supervises and evaluates the community health program activities in the catchment area
of the health facility.
 Identifies and reports immediately to the head of the health facility any problems that may interfere
in achieving program objectives
 Guides the CHWs in the development and implementation of their action plans.
 Conducts monthly supervisory meetings with CHWs.
 Ensures regular replacement of supplies in the CHW kits.
 Conducts regular visits to the CHWs in their communities to assess and assist their work.
 Encourages team work among CHWs, especially when they are working in the same catchment
population
 Provides regular reports on the CHWs to the head of facility
E. Health Management Information System:

 Supervises the quality of the pictorial registers and Community Maps maintained by the CHWs and
assists the CHWs where needed.
 Supervises completion of the MARs by CHWs and the completion of the facility MAAR.
 Consolidates the MAARs and assists the head of the health facility in preparing consolidated
monthly reports and assists in maintaining graphs to monitor the facility health programs.
 Assists in supervising any required community health survey
 Uses the reporting system and information received from village health committees (Shura-e-Sehie)
to monitor health conditions and submits findings to the person in charge of the health facility.
F. Facility-community collaboration:
 Assists formation of community health committees (Shura-e-Sehie)
 Provides orientation session on BPHS and on health topics of concern to the community Shura
 Guides information & implementation of community-based health activities
 Promotes support for CHWs
 Provides feedback from community to head of the health facility
Page | 69
5. The Community Health Shura at Health Post level
The MoPH has defined guidelines for the formation and roles and responsibilities of the Community Health
Shura.
Figure 5: MoPH Guidelines for the Community Health Shura

Composition and selection of the Community/health post level shura
The existing shura in the community will be considered for making up the community health shura for BPHS
activities. However, the existing shura may be reorganized to ensure more responsive to community health
needs. The decision of selection/election of the shura members will be depending on community opinion.
Health Facility/Health post will facilitate dialogue with different levels of people and beneficiaries of BPHS
programs to select/elect community health shura members. Members for the shura may vary from 6-9
depending on community size and opinion. The shura composition will be:
 Chairperson: 1
 Members: 5 – 8
 One third of the members should be women
The concern Trainer or supervisor will act as member secretary of the shura. The member secretary will be
responsible for recording and maintaining meeting minutes. At least attendance of two-third members is
essential for meeting quorum taking any decision.
The shura members will be selected /elected on the basis of the following criteria:
 Resident in the community that corresponds with the health post catchment area;
 Well known/reputed/influential/authentic formal and informal leaders from community (i.e. like
malik, mullah, teacher, etc.) and members from other development program (i.e. credit program,
Water Sanitation program, etc.)
 Ensure representation from all cucha (neighborhood)/mosque/corners/section/ of the community
 Beneficiaries of the health program
 Ensure female representation in the shura
Depending on local custom and culture, a separate female shura may be considered, if this more easily
ensures female participation in the decision processes regarding the community‘s health. The same criteria for
selection/election of members will be followed in case of separate female shura.
Roles and responsibilities

 Be knowledgeable on selected BPHS, CBHC policies and CHW‘s job description
 Review monthly progress/performance of CHWs‘ activities including his/her updating
community maps, completion of the monthly Tally Sheet, and referral clients to health facilities,
and give feedback to the CHS or CHWs regarding their performance.
 Develop, implement and review progress of annual action plan for popularizing BPHS activities,
 Support the CHWs in the promotion of healthy behaviors and appropriate use of health services
at community and facility level,
 Support outreach activities from the facility and mobilize the community to participate,
 Mobilize local resources for strengthening and sustaining BPHS activities
 Conduct monthly meetings and ad hoc emergency meetings
 Giving ideas and active participation in selection/election of CHWs
 Giving ideas and active participation in selection/election of Community Action Groups
6. The Health Shura at Health Facility level
The MoPH has defined guidelines for the formation and roles and responsibilities of the Health Shura at
Facility level.
Figure 6 : MoPH Guidelines for the Facility Health Shura

Facility Shura-e-Sehee formation:
The staff of each level health facility will facilitate the establishment of facility level ―Shura-e-Sehee‖. The
Shura-e-Sehee involves different users groups in the management of the health facility and also promotes
community-based activities which aim to improve the health status of the population living in the catchments
area of the health facility. The Shura-e-Sehee members will be selected /elected from the community health
shura at health post level as well as the catchment‘s area of respective facility. Members for the shura may
vary from 13-15 depending on community size (population and geographical distribution) and opinion. The
Page | 70
shura composition will be:

 Chairperson: 1
 Member 12 – 14
 One third of the members should be women if possible.
The shura members will be selected /elected on the basis of the above mentioned criteria for HP Shura
Roles and responsibilities:

 Be knowledgeable on selected BPHS, CBHC policies and CHW‘s job description
 Write and sign a constitution of the facility level shura. The constitution will record the names and
gender of the members and their location of origin (to ensure equitable representation of the
communities within the catchments area), the name of the elected chairperson and member secretary.
The facility in-charge will act as member secretary of the shura. The member secretary will be
responsible for recording and maintaining meeting minutes.
 Facilitate a health need assessment with the facility level shura members. The need assessment
should focus on the major health related problems perceived to be faced by the community.
 Based on BPHS and the health problems perceived by the communities they represent, they will
develop an annual action plan.
 In case of possibility organize an ―open door event‖ ( a specific day like Bazaar day, for visiting the
health facility to know about services provided and getting an idea of ownership and trust to people)
at the health facility for public in every 6 month
 Mobilize local resources for strengthening and sustaining BPHS activities
 Support facilities and community health shura in performing their responsibilities
 Conduct monthly meetings and maintain meeting minutes
 Monitor monthly performance of the facility and satisfaction of clients
 Review implementation status of annual action plan
Discontinuation of shura membership:

 A member will notify the respective shura if she/he wants to discontinue as a member of the shura.
The shura will replace her/him in consultation with people under catchments area.
 The shura may cease any member for the following reasons:
- Absent from 3 consecutive meetings
- Mentally/physically unable to perform his/her responsibilities
- Involved in activities, which may cause harm or against the BPHS activities.
7. Note on Traditional Birth Attendants
International experience has shown that trained TBAs have made no impact on maternal mortality without
very close integration into a health system. Since the 2005 edition of the BPHS, the MoPH recommends that:
 Traditional birth attendants (TBAs) will be replaced by female CHWs at all health posts.
 All existing TBAs should be encouraged to become CHWs.
 Training of all TBAs as female CHWs should be promoted.
 Eligibility criteria should be set for TBAs to become community midwives (CMW)/Community
Health Workers.
 Supervision of remaining TBAs should be performed by BHCs and CHCs.
 Female CHWs should partner with TBAs to deliver important health messages to families, in
particular those related to new born care.
Annex B: Contents of Minor Surgery Kit by type of Facility
Table 17. Contents of Minor Surgery Kit by type of Facility

District
Item Description HSC BHC MHT CHC
Hospital
Forceps, artery     
Forceps, dressing     
Needle holder     
Syringes and disposable needles     
Scissors     
Scalpel handle and blades     
Tourniquet     
Page | 71
Stethoscope     
Suturing silk     
Antiseptic solution     
Detergent     
Thermometer     
Kidney Trays     
Annex C: Detailed List of Contents of Mini Delivery, Clean Delivery, and Midwifery kits
Table 18. Detailed List of Contents of Mini Delivery, Clean Delivery, and Midwifery kits
Mini Clean Midwifery
Item Description
Delivery Kit Delivery Kit Kit
Present at Health Post 
Present at Health Sub- center  
Present at BHC  
Present at MHT 
Present at CHC  
Present at DH  
Scissor   
One umbilical cord clamp or sterile tape or sterile tie   
Suturing material   
Clean towels 
Clean razor blade   
Examination gloves   
Sterile cotton or gauze ( to clean baby‘s mouth and nose   
Hand soap or detergent   
Hand scrubbing brush  
Sterile tray  
Plastic container with a plastic liner for to dispose the placenta  
Plastic container with a plastic liner for medical waste  
( gauze, etc)
Stethoscope, adult  
Stethoscope, Pinard fetal  
Sphygmomanometer  
Kidney basin  
Steel bowl  
Protective apron and plastic draw sheet  
Tourniquet  
Two sterile towels (one to receive the baby, one for active  
management)
Baby scale (infant weighing scale )  
Forceps, artery  
Forceps, dressing  
Forceps, uterine 
Needle holder  
Syringes and disposable needles  
16-or 18 gauge needles  
Speculum, vaginal  
Clamps (hemostats)  
Suction pump, hand or foot operated   
Vacuum extractor 
Uterine dilator 
Curette, uterine 
Vaginal retractor 
Page | 72
Ambu bag 
Guedel airways – neonatal, child and adult 
Annex D: Caesarean/hysterectomy set

(National Standards for Reproductive Health Services Intra-partum and Emergency Obstetric Care
Standards, Reproductive Health Task Force, Department of Women and Reproductive Health, Ministry of
Health, Transitional Islamic Government of Afghanistan, 2004)
Abdominal retractors, double-ended (Richardson) 2
Curved operating scissors, blunt-pointed (Mayo), 17 cm 1
Hysterectomy forceps, straight, 22.5 cm 4
Mosquito forceps, 12.5 cm 6
Needle holder, straight, 17.5 cm 1
Round-bodied needles, No. 12, size 6 2
Sponge forceps, 22.5 cm 6
Stainless steel instrument tray with cover 1
Straight artery forceps, 16 cm 4
Straight operating scissors, blunt-pointed (Mayo), 17 cm 1
Surgical knife blades 4
Surgical knife handle, No. 3 1
Surgical knife handle, No. 4 1
Tissue forceps, 19 cm 6
Towel clips 5
Triangular-point suture needles, 7.3 cm, size 6 2
Uterine hemostasis forceps, 20 cm 8
Annex E: Laparatomy set

(WHO/FHE/MSM/94.1)
Curved dissecting scissors, 1 pair

Scalpel handle and blade, 1
Short dissecting scissors, 1 pair
Long dissecting scissors, 1 pair
Stitch scissors, 1 pair
Small, curved artery forceps, 6 pairs
Small, straight artery forceps, 6 pairs
Large, curved artery forceps, 6 pairs
Small, straight artery forceps, 6 pairs
Needle holder, long, 1
Needle holder, short, 1
Retractors (Langenbeck), medium, 1
Retractors (Langenbeck), narrow 1
Retractors (Deaver), medium, 1
Retractors (Deaver), narrow 1
Self-retaining retractor, 1
Dissecting forceps, toothed, 1 pair
Long dissecting forceps, non-toothed, 1 pair
Tissue forceps (Allis), 2 pairs
Tissue forceps (Duval), 2 pairs
Tissue forceps (Babcock), 2 pairs
Sponge forceps, 4 pairs
Malleable copper retractors (spatulae), 2
Occlusion clamps, straight, 2
Occlusion clamps, curved 2
Crushing clamps, large, 2; small 2
Syringe, 10 ml with needle, 1
Syringe, 20 ml with needle, 1
Sutures, No. 1, 0, and 2/0 chromic catgut and 2/0 plain catgut, ties and with needles
Sutures, No. 1, 0, 2/0, and 3/0 thread, ties and with needles
Sutures, No. 1, 0, and 2/0 nylon, ties and with needles
Suction nozzle, 1
Diathermy electrode, 1
Page | 73
Flexible probe, with round point, 1

Grooved director, 1
Nasogastric tube, 1
Towel clips, 6
Stainless steel bowls, 2
Kidney dishes, 2
Gallipots, 2
Linen tape
Gauze swabs
Abdominal packs, 5
Dissecting gauze rolls, 10
Antiseptic solution
Adhesive tape
Tubing for tension sutures
Drainage tubes
Safety pin, 1
Colostomy bags (optional)
Sterile drapes
Sterile gloves, at least 3 pairs
Annex F: Job Description of Physiotherapist
Position: Physiotherapist
Responsible to: Head of Department/Medical Supervisor or;
Senior Physiotherapist
Responsibilities
1. Assess the patient, taking care to write detailed assessment cards with history, problem list, long and
short term goals and treatment plan
2. Undertake suitable treatments and follow up as appropriate; treatment may include patient education, use
of exercises, mobilization and other physical modalities such as electrotherapy.
3. Undertake in-patient treatment and participate in ward rounds as appropriate3
4. Refer patients to other specialties such as orthopedic services as appropriate
5. Prescribe and measure suitable walking aids and wheelchairs as appropriate
6. Use all physiotherapy equipment, supplies and machinery properly and safely, take care of them and
keep them clean
7. Be punctual and professional in working practice and follow the requirements of the administration on
time-keeping, report writing and preparation of any necessary documents
8. Follow up patients in home based visits or outreach programs as appropriate
9. Cooperate with relevant medical and health personnel in the best interest of the patient
10. Educate medical doctors, other healthcare workers and local communities on the benefit of physiotherapy
11. Provide training to families, and community health workers on basic exercises as appropriate
12. Supervise PTAs in the treatment and follow-up of patients
13. Prepare monthly statistical reports
14. Any other duties commensurate with level as instructed by line manager
Professional qualification:
Have completed a recognized training course. In Afghanistan this will mean the person has followed the
curriculum set out by PTI at PTI, IAM, SCA, SGAA, PARSA, SERVE and ICRC.
Personal Qualification:
 Should be motivated to work in the profession and desire to help people, particularly the disabled
 Calm approach and good communicator with patients and staff
 Likes to work in a team and demonstrate professional appearance and honesty
Participation:
3
Physiotherapists working at District Hospitals
Page | 74
Will be required to participate in physiotherapy section meetings and general meetings, Commitment to
continued professional development.
Annex G: Monitoring and Evaluating of the BPHS
In order to effectively monitor and evaluate BPHS, the ministry focuses on results defined by the Health and
Nutrition Sector Strategy (HNSS) and Millennium Development Goals. National targets have been defined in
the HNSS to be achieved by 2013. However, specific targets should be set at the provincial level based on the
results of provincial household surveys.
Information and reports produced by the MoPH, other ministries, and agencies that are used to gather
information on performance and implementation of BPHS include:
1. Health Management Information System (HMIS) providing information in facility-based estimates
for select process indicators;
2. National Health Services Performance Assessment providing information on process and outcome
indicators;
3. Census figures provided by the Central Statistics Office provide population estimates at village,
district, province and national levels;
4. Household surveys such as the Afghanistan Health Survey (AHS), Multiple Indicator Cluster
Surveys (MICS) and National Risk and Vulnerability Assessment (NRVA) providing information on
selected primary health and nutrition indicators at population level;
5. Other special studies, like qualitative surveys, measurement of maternal mortality, etc.
The following table provides the framework linking the various aspects of M&E with what needs to be
measured and which tool provides the relevant information for effective M&E of BPHS implementation:
Table 19: Monitoring and Evaluation of BPHS

Terminology used What is Measured Available Data sources
Existing epidemiologic and
Existing knowledge, beliefs,
demographic reports (CSO,
attitudes and practices; target
HHS); special studies using
Formative
groups and subgroups; barriers

focus groups, in-depth
to action; levels of access to
interviews, direct
services, information, social
observation, etc…
support groups and a variety of
(Qualitative Survey;
resource channels
Mortality Survey)
Monitoring Funding, personnel, equipment,
Inputs HMIS, HRD, NHSPA
inputs supplies, infrastructure
Activities completed, units
produced: number of newly
trained personnel, number of
Process HMIS, HRD, NHSPA
personnel refresher trained, of
Process evaluation
community meetings held, of

Monitoring and Evaluation
immunization campaigns
Program Performance monitoring
Program evaluation
Quality of care, accessibility of

services: number BPHS
facilities per 10000 people,
number of BPHS facilities with
Service
certified personnel, percentage HMIS, NHSPA
Monitoring outputs
of BPHS facilities
outputs
implementing DOTS, number
of trained CHWs per 1000
people
Utilization of services: number
of patients seen, cases
diagnosed, number of specific
Utilization tests performed, number of
HMIS, NHSPA
outputs contraceptives sold/distributed,
Evaluation
number of ANC/PNC visits,

number of deliveries by trained
attendants
Monitoring Initial Knowledge, attitudes, beliefs Household surveys
outcomes Intermediate Behavior and practice Household surveys
Mortality, fertility, morbidity
Impact Health status: mortality,
Long-term studies (MICS, DHS, Census,
assessment fertility, morbidity
Special Studies)
Page | 75
Outcome indicators
The BPHS focuses on improving the targets derived from the HNSS. The following set of illustrative
indicators can be followed to monitor and evaluate the implementation of BPHS.
1. Contraceptive Prevalence Rate
2. TB treatment success rate
3. Proportion of newborns who were breastfed immediately /within one hour after birth
4. DPT3 coverage among children 12-23 months
5. Number of consultations per person per year
6. Proportion of births attended by skilled attendants
7. Proportion of caregivers of under-5 Y children who can identify at least 2 signs for seeking care
immediately
8. Coverage of antenatal care
9. Proportion of the lowest income quintile using BPHS services when sick in the last month
In addition, the ministry has adopted the Balanced Scorecard approach to measure and manage delivery of
BPHS in the country. It provides a uniform framework that looks at the principal areas of performance –
patients and community; staff; capacity for and of service provision; financial systems; and overall vision of
the ministry.
Annex H: Proposed trainings for BPHS Health Service Providers
The table below is only a guideline. The duration and number of participants may change depending
on the TNAs. The contractor NGO may do its own training needs assessment before submitting a
proposal.
Table 20. Proposed Training for BPHS Health Services Providers
Duration Trainers per
S.N Training (days) Participants training Remarks
Clinical Trainings
Rational Use of Drugs/Managing Drug
1
Supply (RUD/MDS) 5 25 3
2 Laboratory Skills Training 10 14 3
3 Blood Transfusion 10 14 3
4 Infection Prevention (IP) 5 25 3
5 EPI 12 15 3
6 Community IMCI 6 12 2
Common Diseases (Eye, infectious skin
7
disease)
8 Nutrition 6 15 3
9 Disablility 7 15 3
10 Advanced Newborn Care (ANBC) 10 20 3
11 Basic Newborn Care (BNBC) 10 20 3
12 IMCI 11 24 3
13 Family Planning (FP) 10 20 3
14 Postpartum Family Planning 4 20 2
15 Advanced EmOC 5 Weeks 16 4
16 Basic Essential Obstetric Care 21 16 4
17 Mental Health 14 20 3
Communicable Diseases (TB, Malaria,
18
HIV) 10 15 3
Non-Clinical Trainings
Human Resource Management for
19 Health Facility Staff (Head,
Admin/HR) 4 20 2
General Management (Head,
20
Admin/HR) 4 20 2
BCC (Behavior Change
21
Communication) 5 25 3
22 IPCC (Interpersonal Communication 5 25 3
Page | 76
Table 20. Proposed Training for BPHS Health Services Providers

Duration Trainers per
S.N Training (days) Participants training Remarks
and Counseling)
Effective Teaching Skills (ETS) for
23
CHW Trainers and CHW Supervisors 10 20 3
24 Partnership Defined Quality (PDQ) 5 25 3
Monitoring, Evaluation and
25
Supervision 5 25 3
26 Gender Awareness Training 5 25 3
27 HMIS 6 15 3
28 Equipment maintenance 14 12 4 Estimation
29 Primary Eye Care Training 2 -5 15 2
Annex I: Potential Weak links in the BPHS
The following potential weaknesses need attention from stakeholders in order to prevent or solve them
through practical, effective work planning and implementation:
1. Previous versions of the BPHS were somewhat rigid documents with limited flexibility, unless extra
resources were available. This version is more flexible but BPHS implementers need to keep their focus
on access and quality to help reduce preventable mortality among women and children. One important
focus should be the integration of vertical programs to achieve better coordination.
2. Underutilization of facility-based staff has been a problem during BPHS implementation. This may be
due to different reasons, e.g., living far from the HF, low staff capacity, security issues, etc. BPHS
implementers need to focus more on utilizing existing staff more effectively and efficiently.
3. Lack of involvement of technical MoPH departments in the contracting out process has sometimes been a
constraint, so that program implementation is not as effective as it could be.
4. Other problems with BPHS implementation have included inadequate strategies for implementation and
lack of necessary drugs, equipment, and supplies. With the revised BPHS there is an opportunity to
correct some of the deficiencies of the past.
5. Absence of proper training needs assessments has been a problem for the BPHS. We hope that BPHS
implementers will conduct appropriate and effective training needs assessments.
6. Inadequate dissemination to NGO BPHS implementers of the contents of various MoPH documents and
procedures has been a problem that needs to be corrected.
7. Weak feedback and follow up by MoPH departments has also been a problem that needs correction.
8. Weak ownership of BPHS activities by the Provincial Health Directorates (PHDs) needs to change so
that provinces feel they are a much more important part of the BPHS.
9. Weak referral systems and inadequate referral practices between levels in the BPHS and between BPHS
and EPHS facilities has been a recurring problem and needs focused attention.
Page | 77

Great Massoud Road, Kabul, Afghanistan
This publication was prepared by the Ministry of Public Health with the financial and
technical assistance from the European Commission (Support to the Institutional
Development of the Ministry of Public Health in Afghanistan Project) and fromPageUSAID
| 78
(Technical Support to the Central & Provincial Ministry of Public Health Project)

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Islamic Republic of Afghanistan

Ministry of Public Health

A Basic Package of Health Services for Afghanistan – 2010/1389

Revised July 2010

A Basic Package of Health Services for Afghanistan – 2010/1389

Revised July 2010

Acronyms and Abbreviations

Annex A: Community-Based Health Care and Community Health Worker 65

AFB Acid-Fast Bacilli

Dr. Suraya Dalil

2. The Success of the BPHS

Table 1: Key Indicators of the Afghan Health System

3. Future Challenges to the BPHS Strategy

4. BPHS 2010/1389—Changes made to the 2010/1389 BPHS (as compared with

5. Types of Health Facilities Used by the BPHS

Figure 1: The Link between BPHS and Hospital Sector

8. Health Care for difficult to reach populations

9. The Seven Elements of the BPHS and their Components

Table 2 : The Seven Elements of the BPHS and their Components

4. Communicable Disease Treatment a. Control of tuberculosis (Table 2.9)

9.1 Maternal and Newborn Health

Table 2.1. Antenatal Care Services by Type of Facility

9.1.b Delivery Care

Table 2.2. Delivery Care Services by Type of Facility

9.1.c Postpartum Care

Table 2.3: Postpartum Care Services by Type of Facility

9.1.d Family Planning

Table 2.4. Family Planning Services by Type of Facility

9.1.e Care of the Newborn

Table 2.5. Care of the Newborn Services by Type of Facility

9.2 Child Health and Immunization

9.2.a Expanded Programme on Immunization

Table 2.6. EPI Services by Type of Facility

9.2.b Integrated Management of Childhood Illness (IMCI)

9.3 Public Nutrition

Table 2.8. Public Nutrition Services by Type of Facility

Table 2.8. Public Nutrition Services by Type of Facility

9.4 Communicable Diseases

9.4.a Control of Tuberculosis primary entry point for VCCT

9.4.b Control of Malaria

9.4.c Control of HIV

Table 2.11. Control of HIV by Type of Facility

9.5 Mental Health

Table 2.12. Mental Health Services by Type of Facility

* BHC staffed by doctor, otherwise only follows up

9.6 Disability and Physical Rehabilitation

Table 2.13. Physical Rehabilitation (including Persons with Disabilities) Services

9.7 Regular Supply of Essential Drugs

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

Table 2.14. Essential Drugs for BPHS by Type of Facility

10. Blood Transfusion Services to Support BPHS

Table 3. Blood Transfusion Services by Type of Facility