Medical and Health Cooperation in Afghanistan: Report by Hidechika Akashi, MD, PhD, MPH, DTMH

1. International Medical & Health Cooperation and Human Resource Development- Report from Afghanistan - Hidechika Akashi, MD, PhD, MPH, DTMH Graduate School of Medicine, Nagoya University Department of International Health

2. Health indicators of Afghanistan (UNICEF, 2000)

3. Health Personnel in Afghanistan（Total: 11,749 staff） National Health Resource Assessment

4. Referral System in Afghanistan • National hospitals in Kabul: WAH, Karte-se 500, Malalai Maternal hospital, Rabia-Balkhi Women’s hospital, ・・・ • Provincial hospitals • District hospitals • (Polyclinic) • CHC (Comprehensive Health Center) • BHC (Basic Health Center) Covered by EPHS (Essential Package of Hospital Services) Covered by BPHS (Basic Package of Health Services)

5. Conceptual Scheme of Health Sector Program Afghanistan Millennium Development Goals Increase coverage of health services • EOJ, JICA Office • 3rd country training • Long-term training WB, EC, USAID Afghan sector programs BPHS/EPHS/Int.Dev./Dz WHO, UNICEF Planning Cooperation plan indiv.experts JICA health sector program (Human resource development) Repro.H. project TB Proj. MCH Comm.dis.control Kandahar IHS MW proj. GF Program coordination UNICEF/JAPAN Child survival proj. WHO <JICA Afghanistan Health Sector Program Evaluation Report, 2007> UNFPA, WHO, UNICEF,USAID Medical education proj.

6. JICA Projects in Afghanistan

7. 3 components of RH Project • Human resource development of RHOs (Reproductive Health Officers) • Human resource development of service providers on RH (clinical practitioners) • Development of district health system on RH in Urban Kabul

8. Capacity development for strengthening RH program Cap. Develop. of RHO at central & provincial level System development of central RH administration National RH policy develop, implement, review, solve problems National RH service provider training system development Cap. Develop of provincial RH related persons System development of provincial RH related administration Provincial RH related admini. plan, implement, review,& solve problems Cap. Develop of trainers on RH service providers System development of RH service provider training at hospitals Mainly in Urban Kabul Training of RH service providers Provision of proper RH services System develop for community use of DHs/HCs Enough resources at site People use of RH services Structure of the Project ＜Capacity Development＞ ＜System Development＞ ＜Management Implementation＞ National level RHO training Provincial level Training centers On site（DH, HC, Community） CoC training

9. Hidechika Akashi Management Cycle(Kaizen Cycle) “Kaizen：改善” “Plan-Do-See” もこのたぐい

10. <MOPH> Check Check Check Check Check Check Check Action Action Action Action Action Action Ordinary works Plan revised Activities Establish SRS Do Do Do Do Solve problems Eval.? Revision of Training contents Planning of Training Plan Plan Plan Plan Feedback from Participants Plan revised Activities Implement Training Feedback from Supervision Go to Supervision Ordinary works Solve problems at site Bring back to PHD Solve through Internal discuss Discuss in PHD Plan revised activities Internal discuss Ordinary works Solve problems What’s happen in COC Training? Needs assessment in 1ry/2dary facilities Recognition of problems <SRS: Training Implementation body> <Kabul PHD> <Health Facilities> Community

11. Check Check Check Check Check Check Check Check Action Action Action Action Revision of Training contents Plan RHO Training Do Do Do Do Plan Action Implement RHO Training Do Check Plan Plan Plan Plan Feedback from Participants Info sharing among RHO Feedback to Training contents Supervision by MOPH staff Discuss problems internally Implement ordinary works Find out problems through supervision Plan revised activities Solve their problems at province What’s happen in RHO Training? Survey of background Information on RHO <RHO Training body: RHO+> <MoPH> Plan Action Do Check Ｆｅｅｄｂａｃｋ　ｔｏ MOPH RHD/ PH/Curative Community <Health Facilities> <Provinces>

12. PCC PCC PCC Aid Coordination Mechanismin Afghanistan Donor support Donor support Central level Donor support Donor Support + Contract -out Provincial level

13. Contracting to NGOs(Outsourcing of Tasks) Central Government Province A Province B Province C PH management PH management PH management to NGO X to NGO Y to NGO Z IHS build/manage IHS build/manage IHS build/manage to Donor/NGO S to Donor/NGO T to Donor/NGO U

14. Implementation: Which way? Public administrative management system on health was destroyed in the early stage of post-conflict. Now Contracting to International NGO Need different skills : Need different human resources or Continue the form of Contracting to NGOs, but to Local NGOs Public “health system” should provide health services. Future

15. Hidechika Akashi What is cooperation for developmentby JAPAN? Establish mutual good relationship Make structure IndividualInstitutional Capacity Building Make systemCapacity （How to catch fish） Development Run the system Promote awareness change Sustainability