In the name of Allah The Most Compassionate The Most Merciful

1. In the name of Allah The Most Compassionate The Most Merciful Presented by Asst Professor.Dr.Saliha Nabizada ENT Lecturer .KMU

2. Health Situation in Afghanistan and it’s Human Resources

3. 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.

4. 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…

5. 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..

6. 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 Cont..

7. Buddha Statue in Bamyan destroyed by Taliban

8. Buddhist stupa in Guldara north of Kabul

9. In 661-746 Islam was introduced to Afghanistan

10. 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 Cont..

11. In 1220 Mongol Changese Khan attacked Afghanistan and due to fierce resistance of our people ruined and devastated the whole country.

12. Shir Shah Suri Afghan King ruling India with Justice and discipline. Cont..

13. 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. Modern Afghanistan Established by Ahmad Shah Abdali in 1746

14. Afghans fought heroically in 3 merciless wars against British intruders.

15. Anglo-Afghan War

16. Last stand

17. A gallant Afghan Woman named Malalaidefeated British aggressors heroically in Maiwand.

18. Under the leadership of King Ammanullah through 3rd Anglo- Afghan War Afghans Gained their independence. Afghanistan gained it’s independence from British Empire in 1919

19. Attan

20. The Soviet Union invaded in 1979 touching off a long and destructive war.

21. Under relentless pressure by mujahedin the USSR withdrew in 1989 and civil war erupted which subsequently Kabul fall to the Taliban.

22. 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.

23. Cont..

24. 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

25. 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) • Agestructure: 0-14yrs44.6%,15-64yrs53%, 65yrsover 2.4% • Population growthrate: 2.625% • Birthrate: 46.21 births/1000population • Death Rate: 19.96deaths/1000population • Net migrationrate: 0 migrants/10000 population • Infant mortality rate: Total: 157.43deaths/live birth,Male: 161.81/1000live birth, Female: 152.83 deaths/live birth

26. 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

27. 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% % of Literacy in Afghanistan

28. 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.

29. 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.

30. Challenges Afghan Government is faced with: • Budget sustainability, job creation, corruption, government capacity, rebuilding war torn infrastructure • Eradication of poppy cultivation

31. Labor force 15 millionLabor 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

32. Kochis

33. Kochis

34. Health Situation in Afghanistan • 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

35. Malnutrition in a child from north of Kabul and neglect toward senile patients

36. Malnutrition

37. Malmutrition

38. Blast causualities

39. Surgeon Operating an ENT case at a district hospital by own equipments due to limitations of BHPS packages

40. Surgeon performing Amputation Operation at a district hospital north of Kabul

41. A training course for Health Educators of north & western provinces run by NGO

42. 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.

43. 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.

44. 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

45. 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

46. 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.

47. 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.

48. Medical university Infrastructure rehabilitated but no Lab Equipment available

49. Class rooms

50. Students