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Health Planning and Implementation in post-conflict Afghanistan

Health Planning and Implementation in post-conflict Afghanistan. by Laurence Laumonier-Ickx, MD November 8, 2006. Health in Afghanistan in 2002. Building on what exists. A fghanistan N ational H ealth R esources A ssessment MOPH, multiple donors and NGOs

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Health Planning and Implementation in post-conflict Afghanistan

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  1. Health Planning and Implementation in post-conflict Afghanistan by Laurence Laumonier-Ickx, MDNovember 8, 2006

  2. Health in Afghanistan in 2002

  3. Building on what exists • Afghanistan National Health Resources Assessment • MOPH, multiple donors and NGOs • National Inventory of: functioning health facilities • Infrastructure • Qualified staff and equipment • Range of services offered • Major findings: • Close to 1000 facilities still provide services • Huge inequities in distribution of facilities and services • Severe female understaffing • Only 25% of facilities able to deliver BPHS • Only 7% of population with ready access to BPHS • NGOs contribute to service delivery in 80% of the facilities • Lack of standardization and questionable quality in service delivery

  4. Coordination and Transparency • At central level • Coordination Group for Health and Nutrition (MOPH, donors, NGOs, multinational and bilateral agencies) • Taskforces and working groups • Technical Advisory Group (technical review of proposed policies, strategies and interventions) • National Technical Coordination Committee (information forum for all MOPH partners) • Executive board (MOPH senior staff) • At provincial level • Provincial Public Health Coordination Committee (Provincial MOPH and all partners in a province)

  5. Policies and Strategies • Interim Health strategy and Draft Health Policy • Developed early on • Defines values and working principles • Defines priority target groups • Public Health Decision Framework: interventions should • Have proven impact on major health problems • Be affordable with available resources • Allow implementation at national scale • Attribute to more equitable distribution of health services • Policy and strategy for each intervention • Basic Package of Health Services (BPHS) • Essential Package of Hospital Services (EPHS)

  6. Basic Package of Health Services • Elements • Maternal and Newborn Care (Antenatal, Delivery, Postnatal, Newborn and Family Planning) • Child Health and Immunization (IMCI & EPI) • Public Nutrition • Communicable Diseases Treatment and Control (TB, Malaria, HIV) • Mental Health • Disability • Essential Drugs • Strong community-based component • Targeted coverage : one BPHS facility per 30,000 • Minimal staffing requirements(promotion of female health workers) • Recommended equipment, supplies and drugs at each level

  7. Essential Package of Hospital Services • Hospital expenditures limited to 40% of the health budget • Standardization of: • Services to be provided at each level • Staffing • Equipment, Supplies and Essential Drugs • Emphasis on referral function and system • Promotion of community ownership through hospital boards

  8. Stewardship role of the MOPH • Central Coordination of performance-based contracting out • ADB, EU, KFW, USAID, WB subscribe contracting out • Flexibility in actual implementation approach • Grants Management and Contracting Unit in the MOPH • Promote Provincial Public Health Coordination Committees • Oversight of standardized implementation of BPHS and EPHS • Monitoring and evaluation • Third party evaluation • National HMIS for BPHS and EPHS • Quality monitoring and improvement • Special studies and assessments

  9. Main achievements by July 2006 • Increase in number of service delivery points contracted out: • > 800 BPHS facilities (80% with female health professional) • > 6000 community health posts • Standardized training of midwives and community midwives • Routine service statistics available and used at local, provincial and national level • Standard national monitoring tool developed and implemented • Common quality standards applied nationally • Lot quality assurance sampling in 13 provinces shows improvement in health outcome indicators measured in 2004 and 2006 • CPR from 16.2% to 25.9% • DPT3 coverage from 14.7% to 37.4% • Births attended by a skilled attendant from 12.2% to 23.2%

  10. Population per BPHS facility in September 2002 Source: ANHRA 2002

  11. Population per BPHS facility in July 2006 Source: MOPH/HMIS

  12. Conclusion – key for success • Clear coordination mechanisms at the central level, with transparent decision making processes; • Assess what still exists and build on that; • Early development of policies and strategies, using available information; • Clear national priorities guiding the decision framework for interventions; • MPOH in stewardship role, negotiating funding mechanisms; • Use expertise of local implementers; • Promote coordination at provincial level • Insisting on standard-based management of facilities and services, allowing quality improvement parallel with expansion of services • Measure progress (or lack thereof) and use data for decision making

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