Afghanistan Health System 2002-2010
Stronger health
systems
Greater health
impact
Dr. Mubarakshah Mubarak
Chief of Party Tech-Serve/MSH Afghanistan
Health Systems Building Blocks
Source: WHO
Afghanistan’s Broken Health System pre-2002
Weak health systems
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Inequitable distribution of health
services; clinics and hospitals
damaged by war, earthquakes and
neglect
Insufficient numbers of health
workers, especially female
Poor data on health
Chronic inadequate quality
drugs/damaged and outdated
equipment
Inadequate finances
Poor leadership and management;
little coordination among partners.
Poor health status
 Life expectancy: 47 for men
and 45 for women
 One in every four children
died before the age of 5
 Maternal mortality
estimated at 1,600 per
100,000 live births, one of
the highest ratios in the
world.
Afghanistan U5MR and U5MR in the Region
400
300
Afghanistan
200
South Asia
100
0
1960
1990 2002
2006
4
The Ministry of Public Health Response
 Stewardship role of
MOPH: Contracting out
to NGOs
 Basic Package of Health
Services
 Community Focus
Rebuilding the system: Stewardship
Increase of coverage to entire country
Service Delivery: all services through
NGOs
Health Workforce: capacity building
included in NGO contracts; civil
Service reform
Information: evidence-based decision
making for policy formulation
Medicines/Vaccines/Technologies:
centralized international procurement
of quality/low price pharmaceuticals;
few stock outs at facility level
Financing: by donors and government
Leadership & Governance: leadership
development for NGOs and public
sector
Rebuilding the system: BPHS
Reduce maternal and child mortality
Service Delivery: expanded
Health Workforce: standardized staffing
requirements
Information: standard indicators
Medicines/vaccines/technologies:
limited set of essential
Financing: contracting all BPHS out via
NGOs
Governance & leadership: close
coordination between NGOs and
MoPH/partners
Rebuilding the system: Community focus
Community as Foundation for Health
Service Delivery: Defined/focus TOR for
CHWs
Health Workforce: 21,000 CHWs ( male
and female)
Information: use of community maps;
pictorial tally sheets; linked to HMIS
Medicines/vaccines/technologies: CHWs
provide DMPA and ORS/zinc, and
cotrimoxazole
Financing: volunteers, non cash
incentives
Governance & leadership: policy and
Strategy, NGOs development on
CBHC
Rebuilding the system
Moving toward and integrated health system
system
Results of improved health systems
• Increase in functioning
health facilities:
• Year 2002 - 496
• Year 2009 - 1780
•Increase in percent of
facilities with skilled
female health workers:
• Year 2002- 24.8%
• Year 2007 - 82%
Source: National HMIS of Afghanistan
Results of improved health systems
% of pregnant women receiving care from a skilled provider
% of women delivering assisted by a doctor, nurse or midwife
35
30
25
20
15
10
5
0
2003
2005
2006
Source: MOPH/Johns Hopkins Afghanistan Household Survey, 2006
11
Results of improved health systems
Improvement in health systems metrics
2004
2005
2006
2007
2008
95
90
85
80
75
%
70
65
60
55
50
Availability of
Equipment
Availability of
Drugs
Source: JHU Annual Report on BPHS in Afghanistan
Availability of
Family Planning
Results of improved health systems
2000
2004/5
300
257
250
200
191
165
150
129
100
50
Under Five Mortality Rate (per
1000 live births)
Source: UNICEF and JHU Survey
Infant Mortality Rate (per 1000
live births)
Challenges
 High infant, child and
maternal mortality
 Quality of services
 Weak hospital sector
 Significant salary inequities
 High level of dependency
on international support.
 Insecurity
The things that mattered
Focus, focus, focus
Consistency in key policies
Bold leadership
Programmatic: use resources
that are there
High value placed on
monitoring