Stronger health systems

Greater health impact  

Dr. Mubarakshah Mubarak

Chief of Party Tech-Serve/MSH Afghanistan

Afghanistan Health System 2002-2010

Health Systems Building BlocksSe

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Med

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Source: WHO

Afghanistan’s Broken Health System pre-2002

Weak health systems 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drugs/damaged and outdated equipment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.

4

Afghanistan U5MR and U5MR in the Region

0

100

200

300

400

1960 1990 2002 2006

Afghanistan

South Asia

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

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

Increase of coverage to entire country

Rebuilding the system: BPHS

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

Reduce maternal and child mortality

Rebuilding the system: Community focus

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

Community as Foundation for Health

Moving toward and integrated health system system

Rebuilding the 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

11

Results of improved health systems

0

5

10

15

20

25

30

35

2003 2005 2006

% of pregnant women receiving care from a skilled provider

% of women delivering assisted by a doctor, nurse or midwife

Source: MOPH/Johns Hopkins Afghanistan Household Survey, 2006

Improvement in health systems metrics

50556065707580859095

%

Availability ofEquipment

Availability ofDrugs

Availability ofFamily Planning

2004 2005 2006 2007 2008

Results of improved health systems

Source: JHU Annual Report on BPHS in Afghanistan

257

165191

129

50

100

150

200

250

300

Under Five Mortality Rate (per1000 live births)

Infant Mortality Rate (per 1000live births)

2000 2004/5

Source: UNICEF and JHU Survey

Results of improved health systems

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