28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Mohammad Dauod Khuram MD, MPH...

28 – 29 September 2011Vedic Village Spa Resort Kolkata, India.

Mohammad Dauod Khuram MD, MPH

National Manager, Health Program

Aga Khan Foundation, Afghanistan


Afghanistan Health Status:

Live expectancy at birth:

Male : 44 years

Female : 43 years

Maternal Mortality Ratio: One of the highest in the world (1600 per 100,000 live births)

Infant Mortality Rate: 129 per 1000 live births

Under-five Mortality Rate: 191 per 1000 live births

One of the high prevalent country for communicable and vaccine preventable diseases.


Hospital-based Services:

There are 112 public hospitals in Afghanistan:

National Hospitals: 17

Regional Hospitals: 7

Provincial Hospitals: 34

District Hospital: 52

Total number of available hospital beds: 9133

Approximately 50% of the available hospital beds are at Kabul

The rest of the country has 0.35 beds per 1000 population

Badakhshan has 0.28 beds per 1000 population


National Policies for Health Care services:

In 2003 Afghanistan has adopted a standard package to deliver Primary Health Care and Hospital services

The Essential Package of Hospital Services was introduced by the Ministry of Public Health to:

Standardize hospital structure and service delivery

Improve quality of services and hospital management

Promote equitable distribution of hospitals

The implementation of this standard package was contracted out to Non-Governmental Organization under a partnership-based contract


Badakhshan:

Population: 574,800

Health Set up:

Provincial Hospital: 1

District Hospitals : 3

Other health facilities: 58

Faizabad Hospital:

No of beds: 100

Type of hospital: Provincial


Performance-based Partnership between the Ministry of Public Health Afghanistan and the Aga Khan Development Network for delivering Essential Package of Hospital Services at Faizabad Provincial Hospital, Badakhshan

Partnership contract with Roshan mobile company for operating the telemedicine at Faizabad Provincial Hospital

Contract of cooperation with KfW for upgrading the hospital setup at Faizabad Provincial Hospital

Service contract with Norwegian Ministry of Foreign Affairs for construction of MNCH ward at Faizabad Provincial Hospital


USAID: Funds the service delivery

Ministry of Public Health: Principle Recipient (Client)

KfW: Rehab/Constraction, equipment and e-health

Aga Khan Development Network: Implementing partner as well as funding partly

Roshan Mobile Company: Supporting telemedicine

Swedish Committee for Afghanistan: Supporting physiotherapy services

Norwegian Ministry of Foreign Affairs: construction & equipment of maternity ward

CHEF: for specialized eye services


To deliver a standard package of services

To improve the quality of patient care

To promote a comprehensive referral system with other hospitals

To increase efficiency of hospital operation


Hospital Board

Hospital Director

Administrator

AKHS(Afg)Country Program Director

Nursing Departments

Central Sterilization Unit

Kitchen

Finance & Accounting

Laundry

Finance Manager Nursing Manager Medical Directors

Cost Sharing

Human Resource

Procurement/ Medical Stores

Facility Management

Operating Theatre

Clinical Services

Medical records/HMIS

Diagnostic Services

Pharmacy


The performance of this partnership contract is evaluation based on the following milestones:

Bed Occupancy Rate

Average Legnth of Stay at Hospital

Average Number of Birth Deliveries per Month

Number of Out Patients received Services

Number of In-Patients received Services


Challenges Mitigation Recruiting and retaining qualified health workers

Various motivating for attracting and retaining qualified staffs are introduced such as capacity building opportunities, baby care taking facilities, annual bonuses and other

Balancing the local needs and available scope of services

The hospital has been connected with FMIC at Kabul and Karachi. New center for excellence will be established that can handle some of the critical cases

Hard geography and difficult communication

Post operative patients from the areas with difficult access (through donkey or hours) are kept for a longer period at the hospital

Ensuring optimal coordination among the actors in the partnership

Regular coordination meetings are organized, joint supervision and monitoring is conducted with the provincial MoPH officials and progress updates are shared timely


Increased the number of hospital beds from 85 to 100

Improved utilization

Increased the bed occupancy rate to 95%

Increased the number of child birth from the average of 183 to 222 per month

Linked through telemedicine with Kabul, Bamyan and Karachi for:

Staff capacity building through teleconferences

Consultation on complicated cases

Sharing complicated images for result

Build new Maternal, Neonatal and Child ward

Clinical training site for CMEP and CHNP


Community perception regarding the quality of services is key for optimal utilization of services

Maintaining proper coordination is critical for having good partnership

Staff motivation and acknowledgement of best practices is critical for staff retention and efficient output


Health Management Information Systems (HMIS)


Thanks

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Mohammad Dauod Khuram MD, MPH...

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