JezK

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Envelope-to: ghani@jack.ngo,
 musawy@jack.ngo,
 mirzaee@jack.ngo,
 dr.amiri@jack.ngo
Delivery-date: Tue, 24 May 2022 23:32:45 -0400
From: "NOORI, Mohammad Taleb" <mnoori@who.int>
To: "ghani@jack.ngo" <ghani@jack.ngo>, Musawy <musawy@jack.ngo>,
	"mirzaee@jack.ngo" <mirzaee@jack.ngo>, "dr.amiri@jack.ngo"
	<dr.amiri@jack.ngo>
CC: "ALKOZAI, Aimal" <alkozaia@who.int>, "MUJADDIDI, Najeebullah"
	<mujaddidin@who.int>, "shafiqullahsediqis2@gmail.com"
	<shafiqullahsediqis2@gmail.com>
Subject: Tripartite Joint Monitoring Mission from Khanabad DH
Thread-Topic: Tripartite Joint Monitoring Mission from Khanabad DH
Thread-Index: AQHYb+MIr9C6YFSSP02w7r9nBxaguA==
Date: Wed, 25 May 2022 03:31:00 +0000
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Dear JACK colleagues,

Followings to the two back-to-back joint monitoring visits with participati=
on of recent WHO national team mission to Kunduz province "Dr. Aimal Alkoza=
i and Dr. Najibullah Mujadadi", Kunduz PHO team and your esteemed represent=
atives which was carried out from Khanabad DH and the below shortcoming iss=
ues are required attention and solution please:

1.  There were two (2) fully functioning ambulances with one driver that =
are available for use 24x7, whereas, sub-optimal referral systems in the ho=
spital for recording and provisioning of feedback to the lower level.
  2.  No triage areas, no mass casualty management plan for emergency respo=
nses and poor arrangement of the emergency room.
  3.  Lack of training for most of health facility staff (i.e. Vaccinators,=
 Midwifes, Nursing Care, and supportive staff basically IP training).
  4.  Emergency and other equipment which was supplied to hospital (i.e. La=
boratory chemistry machines named Slectra, Autoclave, Drinking water filter=
 and the available high-quality incinerator) were not used since the DH bui=
lding due to lack of Biochemical engineer to do installation.
  5.  Poor attention to the available hospital equipment=92s (e.g., patient=
 bed/bedside tables, morgue refrigerator) which has led to its oxidation.
  6.  Based on the complaint of health care providers due to no isolation r=
ooms for the communicable patients, which has led to more hospitalization o=
f the patients who were hospitalized non other diseases.
  7.  No standard beds/chair, shelves for proper filing system for the bloo=
d banks section.
  8.  Patients' files were not properly filled as required (e.g., discharge=
 sheet, nursing monitoring progress sheet, anesthesia medication given to p=
atient).
  9.  Sub-optimal supervisory visits were carried out from health facilitie=
s and the repeated findings were listed with no changes as observed in the =
hospital visit book.
  10. Hospital ground condition, ventilation of (wards, waiting areas, phar=
macy stocks and so on) was not satisfactory as observed.
  11. Poor stock management (i.e. inter of daily stocks update, stock in/ou=
t, filing system, near to expire list, patient consultation and feedback an=
d so on) was observed.
  12. Available SOP, guidelines and protocols were not studied by related h=
ospital staff.
  13. No safe drinking water as accessible to clients whereas, well water c=
ooler was supplied to health facilities and not used.
  14. There was no separate OT for clean and contaminated procedures.
  15. No dining room,  no visit was done by the hospital management team fr=
om kitchen, no dietitian for special cases (i.e. diabetes, hypertension and=
 so on),  no checkup of cook, no PPE kits and IP was an issue as he kept hi=
s shows along with the kitchen utensils.
  16. Due to low TB presumptive cases the health facility did not meet thei=
r TB SS+ cases. Rather than that no drop box and no shelves were in DOTS ro=
om for proper management of TB + patients.
  17. No clear geographical mapping in the hospital.
  18. IPD doors labeling was not sound clear for each ward (i.e. pediatric =
ward, but it was not clear is it IPD SAM, communicable disease room or so).
  19. No shelves, using disposable sets for multiple cases and semi functio=
n of the dental bed was an issue in the dental section.
  20. There was no separate Obs/Gyn patient file in the hospital.
  21. NSTG was not considered by the hospital professional=92s (i.e. in Mal=
e OPD) as observed.
  22. No electrical Massager, required hot packs, and Tenses were an issue =
of the Physiotherapy section.
  23. No Secka salter and growth monitoring board in the pediatric ward as =
it was the concern of the pediatrician.
  24.  As observed, it requires an AC to be installed for Blood bank, morgu=
e and female waiting areas of the hospital.
  25. No proper triage areas mass casualty management plan, no staff algori=
thm, no female staff, no resuscitation areas were found in the emergency se=
ction in hospital. and
  26. The health facility does not have a proper personal file (i.e. no per=
sonal file was for Male doctor) as well as no kindergarten in hospital whic=
h was suggested by the staff to be provided.

With best regards,

Dr. Mohammad Taleb Noori  MD, MPH

Regional Emergency Technical Focal Point

WHO Kunduz Northeast Region, Afghanistan

Cell phone: +93 700294741

[cid:63c0c4c3-f1cd-4df7-936a-a7728a7b523d]

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<div style=3D"font-family: Calibri, Arial, Helvetica, sans-serif; font-size=
: 12pt; color: rgb(0, 0, 0);" class=3D"elementToProof">
Dear JACK colleagues,
<div><br>
</div>
<div>Followings to the two back-to-back joint monitoring visits with partic=
ipation of recent WHO national team mission to Kunduz province &quot;Dr. Ai=
mal Alkozai and Dr. Najibullah Mujadadi&quot;, Kunduz PHO team and your est=
eemed representatives which was carried out
 from Khanabad DH and the below shortcoming issues are required attention a=
nd solution please:</div>
<div>
<ol>
<li>There were two (2) fully functioning ambulances with one driver that ar=
e available for use 24x7, whereas, sub-optimal referral systems in the hosp=
ital for recording and provisioning of feedback to the lower level.</li><li=
>No triage areas, no mass casualty management plan for emergency responses =
and poor arrangement of the emergency room.</li><li>Lack of training for mo=
st of health facility staff (i.e. Vaccinators, Midwifes, Nursing Care, and =
supportive staff basically IP training).</li><li>Emergency and other equipm=
ent which was supplied to hospital (i.e. Laboratory chemistry machines name=
d Slectra, Autoclave, Drinking water filter and the available high-quality =
incinerator) were not used since the DH building due to lack of Biochemical=
 engineer
 to do installation.</li><li>Poor attention to the available hospital equip=
ment=92s (e.g., patient bed/bedside tables, morgue refrigerator) which has =
led to its oxidation.</li><li>Based on the complaint of health care provide=
rs due to no isolation rooms for the communicable patients, which has led t=
o more hospitalization of the patients who were hospitalized non other dise=
ases.</li><li>No standard beds/chair, shelves for proper filing system for =
the blood banks section.</li><li>Patients' files were not properly filled a=
s required (e.g., discharge sheet, nursing monitoring progress sheet, anest=
hesia medication given to patient).</li><li>Sub-optimal supervisory visits =
were carried out from health facilities and the repeated findings were list=
ed with no changes as observed in the hospital visit book.</li><li>Hospital=
 ground condition, ventilation of (wards, waiting areas, pharmacy stocks an=
d so on) was not satisfactory as observed.</li><li>Poor stock management (i=
.e. inter of daily stocks update, stock in/out, filing system, near to expi=
re list, patient consultation and feedback and so on) was observed.</li><li=
>Available SOP, guidelines and protocols were not studied by related hospit=
al staff.</li><li>No safe drinking water as accessible to clients whereas, =
well water cooler was supplied to health facilities and not used.</li><li>T=
here was no separate OT for clean and contaminated procedures.</li><li>No d=
ining room, &nbsp;no visit was done by the hospital management team from ki=
tchen, no dietitian for special cases (i.e. diabetes, hypertension and so o=
n), &nbsp;no checkup of cook, no PPE kits and IP was an issue as he kept hi=
s shows along with the kitchen utensils.</li><li>Due to low TB presumptive =
cases the health facility did not meet their TB SS+ cases. Rather than that=
 no drop box and no shelves were in DOTS room for proper management of TB +=
 patients.</li><li>No clear geographical mapping in the hospital.&nbsp;&nbs=
p;</li><li>IPD doors labeling was not sound clear for each ward (i.e. pedia=
tric ward, but it was not clear is it IPD SAM, communicable disease room or=
 so).</li><li>No shelves, using disposable sets for multiple cases and semi=
 function of the dental bed was an issue in the dental section.</li><li>The=
re was no separate Obs/Gyn patient file in the hospital.</li><li>NSTG was n=
ot considered by the hospital professional=92s (i.e. in Male OPD) as observ=
ed.</li><li>No electrical Massager, required hot packs, and Tenses were an =
issue of the Physiotherapy section.</li><li>No Secka salter and growth moni=
toring board in the pediatric ward as it was the concern of the pediatricia=
n.</li><li>&nbsp;As observed, it requires an AC to be installed for Blood b=
ank, morgue and female waiting areas of the hospital.</li><li>No proper tri=
age areas mass casualty management plan, no staff algorithm, no female staf=
f, no resuscitation areas were found in the emergency section in hospital. =
and&nbsp;</li><li>The health facility does not have a proper personal file =
(i.e. no personal file was for Male doctor) as well as no kindergarten in h=
ospital which was suggested by the staff to be provided.</li></ol>
</div>
<div>With best regards,</div>
&nbsp;<br>
</div>
<div>
<div style=3D"font-family: Calibri, Arial, Helvetica, sans-serif; font-size=
: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div id=3D"Signature">
<div>
<div style=3D"color:rgb(34, 34, 34);font-family:Arial, Helvetica, sans-seri=
f;font-size:small;margin:0px;text-align:start;background-color:rgb(255, 255=
, 255)">
<p style=3D"font-size:small;margin:0px;background-color:rgb(255, 255, 255)"=
><a style=3D"margin:0px"><span style=3D"margin:0px"><b><span style=3D"margi=
n:0px;font-family:Cambria, serif;color:rgb(68, 114, 196)">Dr. Mohammad Tale=
b Noori&nbsp; MD, MPH</span></b></span></a><span style=3D"margin:0px"><span=
 style=3D"margin:0px"><span style=3D"margin:0px;color:rgb(68, 114, 196)"><u=
></u><u></u></span></span></span></p>
<p style=3D"color:rgb(0, 0, 0);font-family:&quot;Segoe UI&quot;, &quot;Sego=
e UI Web (West European)&quot;, &quot;Segoe UI&quot;, -apple-system, BlinkM=
acSystemFont, Roboto, &quot;Helvetica Neue&quot;, sans-serif;font-size:14px=
;margin:0px;background-color:rgb(255, 255, 255)">
<font color=3D"#222222" face=3D"Cambria, serif"><span style=3D"margin:0px;f=
ont-size:10pt">Regional<span>&nbsp;</span></span><span style=3D"margin:0px;=
font-size:13.3333px">Emergency</span><span style=3D"margin:0px;font-size:10=
pt">&nbsp;Technical Focal Point</span></font><span style=3D"margin:0px;font=
-size:small;font-family:Arial, Helvetica, sans-serif;color:rgb(34, 34, 34)"=
><span style=3D"margin:0px"><span style=3D"margin:0px;font-size:10pt"><u></=
u><u></u></span></span></span></p>
<p style=3D"font-size:small;margin:0px;background-color:rgb(255, 255, 255)"=
><span style=3D"margin:0px"><span style=3D"margin:0px"><span style=3D"margi=
n:0px;font-size:10pt;font-family:Cambria, serif">WHO Kunduz Northeast Regio=
n, Afghanistan</span></span></span><span style=3D"margin:0px"><span style=
=3D"margin:0px"><span style=3D"margin:0px;font-size:10pt"><u></u><u></u></s=
pan></span></span></p>
<p style=3D"font-size:small;margin:0px;background-color:rgb(255, 255, 255)"=
><span style=3D"margin:0px"><span style=3D"margin:0px"><span style=3D"margi=
n:0px;font-size:10pt;font-family:Cambria, serif">Cell phone: +93 700294741<=
/span></span></span><span style=3D"margin:0px"><span style=3D"margin:0px"><=
span style=3D"margin:0px;font-size:10pt"><u></u><u></u></span></span></span=
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<br>
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