Objectives: To describe a successful medical engagement during counter-insurgency operations in Afghanistan, and to demonstrate that a full audit cycle can be used in this environment to support improvements to local healthcare delivery.

Methods: In the district of Nad-e-Ali, Helmand Province, Afghanistan, the management of children under five years of age (under-5s) who presented with diarrhoea to a Ministry of Public Health (MoPH) Basic Health Centre was audited. Staff then attended a training course on the Integrated Management of Childhood Illnesses (IMCI) in Kandahar. After further medical engagement to reinforce this training, the audit was repeated.

Results: A lack of knowledge of the Afghan government’s MoPH guidelines during the initial audit resulted in 90% of under- 5s with acute diarrhoea being given unnecessary antibiotics and none receiving zinc as recommended. Following the training course and on-going engagement, there was a 67% reduction in the number of under-5s prescribed antibiotics and a 74% increase in the number who received zinc.

Conclusions: Opportunities for successful medical engagement during operations are limited but this example demonstrates that in conjunction with host nation facilities, sustainable improvements in healthcare are possible. Secondly, it shows that use of the audit cycle can provide objective evidence that may help encourage local staff to improve their standards of patient care.