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Stronger healthsystemsGreater healthimpact
Dr. Mubarakshah Mubarak
Chief of Party Tech-Serve/MSH Afghanistan
Afghanistan Health System 2002-2010
Health Systems Building Blocks
Service delivery
Health workforce
Health information system
Medical products, vaccines and technologies
Health systems financing
Leadership and governance
Source: WHO
Afghanistan’s Broken Health System pre-2002
Weak health systems
Inequitable distribution of healthservices; clinics and hospitalsdamaged by war, earthquakes andneglect
Insufficient numbers of healthworkers, especially female
Poor data on health
Chronic inadequate qualitydrugs/damaged and outdatedequipment
Inadequate finances
Poor leadership and management;little coordination among partners.
Poor health status
Life expectancy: 47 for menand 45 for women
One in every four childrendied before the age of 5
Maternal mortalityestimated at 1,600 per100,000 live births, one ofthe highest ratios in theworld.
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Afghanistan U5MR and U5MR in the Region
The Ministry of Public Health Response
Stewardship role ofMOPH: Contracting outto NGOs
Basic Package of HealthServices
Community Focus
Rebuilding the system: Stewardship
Service Delivery: all services throughNGOs
Health Workforce: capacity buildingincluded in NGO contracts; civilService reform
Information: evidence-based decisionmaking for policy formulation
Medicines/Vaccines/Technologies:centralized international procurementof quality/low price pharmaceuticals;few stock outs at facility level
Financing: by donors and government
Leadership & Governance: leadershipdevelopment for NGOs and publicsector
Increase of coverage to entire country
Rebuilding the system: BPHS
Service Delivery: expanded
Health Workforce: standardized staffingrequirements
Information: standard indicators
Medicines/vaccines/technologies:limited set of essential
Financing: contracting all BPHS out viaNGOs
Governance & leadership: closecoordination between NGOs andMoPH/partners
Reduce maternal and child mortality
Rebuilding the system: Community focus
Service Delivery: Defined/focus TOR forCHWs
Health Workforce: 21,000 CHWs ( maleand female)
Information: use of community maps;pictorial tally sheets; linked to HMIS
Medicines/vaccines/technologies: CHWsprovide DMPA and ORS/zinc, andcotrimoxazole
Financing: volunteers, non cashincentives
Governance & leadership: policy andStrategy, NGOs development onCBHC
Community as Foundation for Health
Moving toward and integrated health systemsystem
Rebuilding the system
Results of improved health systems
• Increase in functioninghealth facilities:
• Year 2002 - 496
• Year 2009 - 1780
•Increase in percent offacilities with skilledfemale health workers:
• Year 2002- 24.8%
• Year 2007 - 82%
Source: National HMIS of Afghanistan
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Results of improved health systems
Source: MOPH/Johns Hopkins Afghanistan Household Survey, 2006
Improvement in health systems metrics
Results of improved health systems
Source: JHU Annual Report on BPHS in Afghanistan
Source: UNICEF and JHU Survey
Results of improved health systems
Challenges
High infant, child andmaternal mortality
Quality of services
Weak hospital sector
Significant salary inequities
High level of dependencyon international support.
Insecurity
The things that mattered
Focus, focus, focus
Consistency in key policies
Bold leadership
Programmatic: use resourcesthat are there
High value placed onmonitoring