In the name of Allah The Most
Compassionate The Most Merciful
Presented by Asst Professor.Dr.Saliha Nabizada ENT
Lecturer .KMU
Health Situation in Afghanistan and
it’s Human Resources
Afghanistan Background



Afghanistan is located in South Asia, on the
crossroads of east and west civilizations.
Having a history of 20000 yrs from stone age,
since 5000 yrs Afghans has settled in towns and
villages according to the excavations of
Mandigak in North of Kandahar.
Due to it’s important geopolitics position has
attracted the greedy eyes of several invaders.
Cont…


Ariana is the ancient name of
Afghanistan mentioned in
Avestad( 1000BC) to (500
AD)' From 500 AD to 1747
was named Khurasan
meaning the Sunrise or
Orient.
Afghanistan is the name
employed since 1747 by the
founder of modern
Afghanistan Ahmad shah
Abdali.
Cont..


Afghanistan is the land where
wheat has been cultivated for
the first time in history.
Alexander the Great entered
through Persia to
Afghanistan in 330 BC who
faced fierce resistance from
our freedom loving people
contrary to his expectations.
He waited 4 years to conquer
this land. He was injured in
eastern Afghanistan.
Cont..

From 40BC to 220AD
Afghanistan was ruled by
Kushan Empire.Kanishka
was the most important king
who spread
buddhism.Bagram was his
summer capital and Peshawar
winter capital. He conquered
China. Buddha statues the
largest one in the world were
surprising the visitors
Buddha Statue in Bamyan destroyed
by Taliban
Buddhist stupa in Guldara north of
Kabul
In 661-746 Islam was introduced to
Afghanistan
Cont..


From 998-1030,
ADMahmood
Ghaznavid the great
Emperor of Ghaznavid
dynasty attacked 7 times
India and spread Islam.
Ghori dynasty ruled
India As Afghan
kingdom
In 1220 Mongol Changese Khan attacked Afghanistan and due
to fierce resistance of our people ruined and devastated the
whole country.
Cont..

Shir Shah Suri
Afghan King ruling
India with Justice and
discipline.
Modern Afghanistan Established by
Ahmad Shah Abdali in 1746



Under his rule Afghans
conquered 7 times India.
First nidus of British
colonialism was growing
miraculously in East India.
after his death his Kingdome
divided between his
descendents paving the way
for greedy British
intervention in Afghanistan.
Afghans fought heroically in 3 merciless wars
against British intruders.
Anglo-Afghan War
Last stand
A gallant Afghan Woman named Malalai
defeated British aggressors heroically in Maiwand.
Afghanistan gained it’s independence from
British Empire in 1919

Under the leadership of
King Ammanullah
through 3rd AngloAfghan War Afghans
Gained their
independence.
Attan
The Soviet Union invaded in 1979 touching off
a long and destructive war.
Under relentless pressure by mujahedin the USSR withdrew in
1989 and civil war erupted which subsequently Kabul fall to
the Taliban.
After the 11th September attack on WTO USA launched a
coordinated international battle against Taliban And Osama
Bin Laden but maintaining security is still a dilemma.
Cont..
Geography:

Location :Southern Asia, North And West of Pakistan, East of
Iran

Area: Total Land 647500sq km, Water:0sq Km, Land locked

Climate: arid to semi arid; cold winters and hot summers.

Terrain: Mostly rugged mountains; Plains in North and South
east
Natural Resources: natural
gas,perolium,coal,copper,chromite,talc,barites,sulfur,lead,zinc
iron ore ,salt,precious&semiprecious stones
Natural Hazards: damaging earth quakes occur in Hindukosh
mountains,flooding,draughts


Environmental Current Issues: Limited natural fresh water resources.
inadequate supply of potable water, soil
degradation,overgrazing,deforestation,desertification,air &water pollution







Population: 31,889,923 ( July 2007est )
Age structure: 0-14yrs44.6%, 15-64yrs53%,
65yrs over 2.4%
Population growth rate: 2.625%
Birth rate: 46.21 births/1000population
Death Rate: 19.96deaths/1000population
Net migration rate: 0 migrants/10000 population
Infant mortality rate: Total: 157.43deaths/live birth,
Male: 161.81/1000live birth,
Female: 152.83 deaths/live birth
Life expectancy at birth: Total
population:43.77yrs,male43.6yrs,female:43.96yrs

Total fertility rate:6.64 children born/woman

HIV/AIDS-Adult prevalence rate:0.01%

Major infectious diseases: food or water born disease

Malaria is at high-risk countrywide below 2000 meters
sea level from march through November

Animal contact disease: rabies
Cont..


Highly pathogenic avian influenza has been
identified among birds in the country or
surroundings
Literacy (definition :age 15 and over can read and write):
Total population 28.1%, Male 43.1%, Female 12.6%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Total
population
male
female
% of Literacy in Afghanistan
Economy Overview




Economy is recovering since 2001 largely due to the
infusion of international assistance.
Real GDP growth exceeded 8%.
Despite the progress Afghanistan is extremely poor,
landlocked, highly dependent on foreign aid, agriculture
and trade with neighboring countries.
Much of the population suffer from shortage of
housing, clean water, electricity, medical care and jobs.
Cont…


Criminality, insecurity, and Afghan Governments
inability to extend rule of law to all parts of the
country pose challenge to future economic
growth.
Will take the remainder of decades and
continuing donor aid and attention to
significantly rise Afghanistan’s living standards
from it’s lowest level in the world.
Challenges Afghan Government is
faced with:


Budget sustainability, job creation, corruption,
government capacity, rebuilding war torn
infrastructure
Eradication of poppy cultivation
Labor force 15 million
Labor force by occupation:
Agriculture:80%,industry:10%,services:10%



Unemployment rate:40%
Population below
poverty line:53%
Refugees and internally
displaced persons:136565
due to drought and
instability
80%
70%
60%
50%
40%
30%
20%
10%
0%
Agriculture
industry
services
Kochis
Kochis
Health Situation in Afghanistan


1.
2.
3.
4.
5 yrs ago Health services were in a deplorable state.
Situation appeared chaotic
4 major constraints to achieving an efficient and
effective national health system:
Lack of managerial &service delivery capacity within
the MOPH
Lack of physical infrastructure and qualified
personnel
Poor distribution of financial and human resources
Uncoordinated and undirected efforts of NGOs
Malnutrition in a child from north of Kabul and
neglect toward senile patients
Malnutrition
Malmutrition
Blast causualities
Surgeon Operating an ENT case at a district hospital
by own equipments due to limitations of BHPS
packages
Surgeon performing Amputation Operation at a
district hospital north of Kabul
A training course for Health Educators of
north & western provinces run by NGO
•In early 2002 MOPH and major donors developed: a Basic
package of Health services(BPHS) to form the technical
foundation of MOPH



Provided clear guidelines for infrastructure
reconstruction and rehabilitation and for staffing.
MOPH Agreement on effective and efficient
BPHS management and expansion through
Contracting with NGOs.
5 yrs on MOPH has made considerable
progress in making the BPHS accessible to most
Afghans.
Improvements occurred in:




Quality of care
Health management information system shows
consistent and significant increases in a number
of indicators.
Management capacity of MOPH
Funding for health sector has been relatively
satisfactory although Afghanistan remains highly
dependent on foreign assistance for years to
come.
Challenges Facing the government:





At central, provincial an community level.
Full integration of the Grants and Contracts
Management Unit(GCMU)
Strengthening the technical & managerial
competence in other essential MOPH
departments.
Maintenance of the level of technical assistance.
Strengthening linkages between central,
provincial and district level
Cont…




Defining roles ad responsibilities of the
provincial health offices.
Increasing access and quality especially in
remote areas.
IN SUM: Progress has been made in addressing
4 major constraints, which were measured by
process indicators
For the health status of the Afghan population
impact evaluation is needed in one or two years
Cont…



Further progress may be impeded by chronic problems:
such as uneven management, inadequate financial systems, and
inconsistent transparency and accountability.
Potential problems loom on the horizon as: ensuring
adequate and predictable levels of funding and technical
assistances
With respect to the larger context additional problems
include: Unstable security situation, the relative weakness of the
government and the difficult economic situation that for many
Afghans has minimally progressed since2002.
The role of Ministry of Higher education in training
of health workers



First nucleus of modern Medicine created in 1933by
Turkish Drs,and in 1934 Upgraded to Faculty of
Medicine in Kabul University, in 2004 expanded to
KMU.
During last yrs of war establishment of medical
faculties became a political bribe for warlords, hence
establishment of provincial MF without proper
facilities& standards.
Students enrollment was through different channels not
only through entrance examination.
Medical university Infrastructure rehabilitated
but no Lab Equipment available
Class rooms
Students
Teaching rooms built with the assistance of JICA in Maiwand
Hospital
PBL workshop in KMU
Students applying CBL introduced by JICA in KMU
Other human resources problems




Higher number of Medical
students (almost 8000 with
house jobbers)
Old curriculum stressing
more on lectures
Workforce imbalance: Ratio
of Doctors(3038) to Nurses
and midwives(3075)
almost1:1 with focus on
urban settings80:20
Lack of coordination
between educational
institutions,service,and policy
makers.
80%
70%
60%
50%
40%
30%
20%
10%
0%
Urban
rural
Seminars held by Ministry of Higher
Education to fill the gap
1.
2.
In June 2003,National workshop on Medical
education in Afghanistan was held stressing on
capacity building of teachers, investment in
infrastructure, investment in training
equipment,libraries.Affiliation with recognized
universities
Workshop on Curriculum Development concepts
stressing on review of KMU and its satellite faculties
curriculum according to the international standards
addressing the major health problems of the country.
National Workshop on Medical
Education in KMU
Thanks for your attention.