Basic Package of Health Services (BPHS) is one of the major programs of Ministry of Public Health that aims to improve health condition of rural communities in all provinces of Afghanistan and decrease mother and child mortality.
BPHS is one of the successful projects being implemented since 2003 in four districts of Ghazni (Jaghori, Malistan, Deh Yak and Zanakhan). Under this program during 2007&2008 SDO operated 16 health facilities which include 5 Comprehensive Health Centers (CHC), 1 CHC+, 7 Basic Health Centers (BHC) and 1 Sub-Center. Under the Community Based Health Care (CBHC) component of this program SDO was able to establish 225 health posts at the village level. Each health facility in SDO's cluster is staffed based on the BPHS guidelines and supplied with essential drug, equipment and all necessary items needed for smooth running of each health facility.
Support of community was very important in implementation of the PBHS. Each of the health facility and health post were supported by a health Shura comprised of committed influential members of the community both men and women from the catchment areas of the respective health facility and health post.
There was a strong referral system between the HF’s and HP’s. The patient who could not be managed at  one level would be referred to a higher level through proper referral sheets that outlined signs, symptoms, diagnosis and treatment applied.
SDO's Proactive Planning in Essential Health Supplies and Emergency Response
The winter of 2007 was one of the harshest in the recent history of Afghanistan affecting thousands of people. SDO through its proactive planning managed to save the lives of thousands in Jaghori and Malistan districts. With proactive planning SDO was able to deliver the essential supplies to all the health facilities in these districts. To prevent HF’s and HP’s from facing stock out of drugs and other essential supplies and materials SDO delivered essential drug and all other required items and supplies six months prior to the arrival of winter.
Furthermore, SDO formed 16 mobile teams (one per each HF) in SDO's cluster in Ghazni in January 2008. These teams were going to the remote areas of their respective HF to provide health services to the people particularly to women and children suffering from health problems who could not come to the HF due to heavy snow falls and very cold winter. Field visit plan for the teams were developed in close coordination with CHWs of the target areas, health committee members and Ghazni health directorate.
In these 223 health facilities 373 people are working as health workers. BPHS project delivers its services to 254800 people among whom 58604 are pregnant women, 11221 children under one year old and 45864 are children under the age of five.

Project activities based on the indicators for basic health facilities in the year 2007 taken from the HMIS

Project activities based on the indicators for basic health facilities in the year 2008 taken from the HMIS

Challenges:
The deteriorating security situation in Ghazni province stood as number one challenge for SDO to implement the BPHS in this province. SDO's health staff members were the victim of three major security events mainly abduction and kidnapping for ransom. In all these three events, the community people in Zanakhan and Deh Yak districts shouldered SDO in safe release of the kidnapped employees of SDO. In spite all these challenges, all HF's of SDO remained functional and the service delivery continued as usual. The route from Ghazni city to Malistan and Jaghori districts are insecure too. By the grace of Allah, SDO's staff members managed to travel back and forth taking into account security measures and respecting local customs and traditions. 
Insecurity has resulted in the lowest turn out of female staff at the provincial level. Unavailability of key staff especially women is another major challenge in this program. SDO has managed to hire a number of key female staff. However, a few posts were vacant during 2007 & 2008.

HIV/AIDS Harm Reduction Project
In 2008, SDO was granted this project to be implemented for targeted intervention injecting drug users (IDU) in Pulicharkhi prison, Kabul city. This project covers the whole services of harm reduction for IDU's that will be applied along with its main component opioid substitution therapy (OST) for IDU's to assess the feasibility of OST operation in the country. This project is funded by the World Bank through Ministry of Public Health (MoPH) . Since this is a pilot project in Afghanistan, the role of MoPH/ National Aids Control Program is prominent. They have supported SDO in different aspects of this project.
Achievements:
Establishment of Drop in Center (DIC):
The drop in center was established in the facility of Pulicharkhi prison and equipped properly and supplied on regular basis. 2008 witnessed:
Identification of 140 drug users
Identification of 20 cases IDU's
Identification of 1 HIV positive case
Detection of 12 HCV positive  and  9 HBS positive cases
The project team attending  training workshops on HIV Harm Reduction both inside and outside Afghanistan including one in Iran and another in India
Trust building:
There is an obvious difference between work environment in closed settings like prisons and in the community outside prisons. It is because prisoners are faced with numerous stresses. They distrust any new intervention thinking that sharing their personal information will harm them. Thus, it is absolutely essential to gain their trust. Luckily SDO's project team was able to build trust among the prisoners especially drug using ones. The number of drug users who confidently gave  information about their injecting habits was on the increase.
Lab Services
In the period of project implementation we had regular lab services. The high risk individuals were tested for HIV, HBs, HCV, Syphilis and TB. The positive cases have been referred for treatment and consultations. Patients were also served with other necessary lab services such as required blood, urine and stool examinations. The following table summarizes the achievement of lab services:

Challenges:

The Methadone Importation Process

OST is a new practice in Afghanistan and OST drugs were not included in licensed drugs list. The project team managed to get OST drugs included in the licensed drug list. MoPH Drug Committee is working on how to pave the way for its importation to Afghanistan.