P139: Clean hands fact-finding mission 2012 to Afghanistan: good intentions, minor results, why?

Introduction

The Balkh Province Civil Hospital (BBCH), Mazar-e-Sharif, Afghanistan, has undergone a €20 million major reconstruction financed by KfW, Germany, a government-owned development bank, and is used as a teaching hospital by the Balkh Medical Faculty. In 2009, the German Government sponsored the modernisation of the BBCH leishmania centre (cutaneous leishmania is endemic in Afghanistan) with €0.1 million, which allowed to run wound-healing trials. In this outpatient clinic, wound-healing impairment typical of cutaneous leishmania may be aggravated if combined with neglected basic hand hygiene, particularly as a moist environment must be maintained for healing.

Methods

We conducted a fact-finding mission in April 2012 to Afghanistan to evaluate hand hygiene practices in selected hospitals, including the BBCH. Inspection tours to 5 Afghan hospitals were organized by the WHO Kabul Office. Lectures were given to medical students and hospital physicians to raise awareness and understanding of the importance of hand hygiene.

Results

On 11 April 2012, Afghanistan became the 130^th nation of the 194 UN Member States to sign the pledge of the WHO Global Patient Safety Challenge “Clean Care is Safer Care”. WHO posters promoting the “My 5 moments for hand hygiene” concept were displayed in most hospitals, but alcohol-based handrub was only available in 2 hospitals (Rabi Balkhi, Kabul and ANA Hospital, Mazar). This prompted the idea of installing a local plant for ethanol production from wheat at the Agricultural Faculty of the Balkh University to be financed by the German Ministry of Cooperation (BMZ) as a female gender project with refilling of handrub bottles according to the WHO Mali pilot site model. A requirement of BMZ funding was a written authorisation from the provincial governor for bio-ethanol production for medicinal purposes and his assurance to take responsibility for safe storage, but after more than 1 year this has not been forthcoming.

Conclusion

In a failed state environment, developmental aid in health care is not only facing ignorance and eventual religious constraints, but also corruption and a problem of smuggling, which impedes an easy solution to implement hand hygiene.

Disclosure of interest

None declared