Hayat Burhani, Nadera, MD, MPH, MPPM (Fellow, Melbourne University)

Melbourne

7May 2015

Can Aid be delivered effectively in insecure contexts?

The MoPH, Donors and the NGOs Partnership and its Impact on Maternal and Child Health in Afghanistan

Outline:

Health sector Key information Health system Pyramid strategies for health services BPHS, success and challenges

Total Population (CSO) 27.5 MillionPopulation Growth (AMS ) 2.4%Women of Child Bearing Age(15-49) 5.5million

Literacy Rate (General Population) 29 – 38%Women Literacy Rate 14%

Indicators 2002

Maternal Mortality Ratio 1600Under five Mortality Rate 257Infant mortality rate per 165Life expectancy rate 42Number of midwives 462Coverage of Primary Health Care (1h walk from Health Facilities)

5%

Health Situation in 2002

National objectives

• To reduce maternal and newborn mortality

• To reduce under 5y mortality and improve child health

• To reduce the incidence of communicable diseases

• To prevent and reduce malnutrition

• To develop the health system

The MoPH Strategies for provision of health services and Number of Health facilities per year.

Basic Package of Health Services Supported by donors agencies Implemented by NGOs and SM Essential Package of Hospital Services Supported by Core budget Implemented by the MoPH Tertiary Services

Supported by government budget

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

500

1000

1500

2000

2500

496

1112

1281

1237

1420

1667

1803

1987

2016

2047

2160 2286

Aid Channelled through different agencies, 2007-2009

Success and Achievements

Increased access from 8% to 57% from 2003 to 2013 Defined all PHC service in a single package and provided opportunity

to holistic implementation Through contract out of service delivery MoPH focused on

stewardship role BPHS is a pro-rural concept and responded to health need of most

essential interventions for mother, child, under-served and hard to reach population

The establishment of 34 Community Midwifery programs, trained, 3334

The establishment of Community Nursing Programs started 2011, 360 graduated and 994 under training

Training of 28837 Community Health Workers

Continue

Indicators 2010 (AMS)

Maternal Mortality Ratio 327Under five Mortality Rate 97Infant mortality rate per 77Life expectancy rate 64Number of midwives 3334Coverage of Primary Health Care (1h walk from Health Facilities)

57%

Key National Indicators in 2010

Improve the quality of health service at all levels with intention to improve the health outcomes

Expansion of service to marginalized population (left out from BPHS, Nomades, IDPs, and highly mobile population)

Enhance the health services to under-served components of the package (mental health, disability, essential drugs)

Financial and programmatic sustainability of services in long term and defining an exit strategy for BPHS

Having special package to security compromised area in Afghanistan

Challenges

Thank you