Effective implementation of national health strategy 2016-2020 for achieving

Universal Health Coverage

Najibullah Safi, MD, MSc. HPM

Introduction

The presentation focuses on broader environment and action for the implementation of the national health strategy (NHS 2016-2020)

Specific issues and required actions related to each strategic area and its sub-components are beyond the scope of this presentation

The strategy thematic* area are: Governance, institutional development, public health, health

services, human resource, and information management

*The Ministry of Public Health, National Health Strategy 2016-2020, September 2016

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Implementation context Government health

expenditure (HE) as % of total government expenditure 4.3%* - relatively constant over the years

Per capita HE 70.9USD* -increased

THE as % of GDP 9.5%* -increased

Reduction in resource** GDP per capita remains almost

constant Per capita foreign aid declined

over the years

Security situation Number of security incidents

increased over the last 13 years***

142.4 130.670.7

755688 696

0

100

200

300

400

500

600

700

800

2014 2015 2016

Per capita aid $ Per capita GDP $

0

5000

10000

15000

20000

25000

SECURITY INCIDENTS

*NHA 2014, MoPH**Afghanistan at glance 2016-17, CSO***Improving access to and quality of health services: the Afghanistan Health Services Study, World Bank, May 2017

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Universal Health Coverage (UHC)

UHC means all people have access to health services they need without the risk of financial hardship while paying for them

In order to achieve UHC, we need: Strong, efficient, resilient, well run

health system that meets priority health needs through people centered integrated care

Affordability – a system for financing health services

Availability of essential medicines and technology

Well trained motivated health workers Integrated programs and interventions

to address social determinates of health

http://www.who.int/contracting/documents/QandAUHC.pdf?ua=1

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Identified main challenges for implementation

The national health strategy identified the following as major challenges*: Growing insecurity

Slow economic growth and diminishing aid follow

Widespread corruption

High total fertility rate

Difficult terrain

Poor human resource management

Poor referral system

Under utilization of health facilities

Under funded programs e.g. NCDs

High out of pocket expenditure

Gender inequalities

*The Ministry of Public Health, National Health Strategy 2016-2020, September 2016** The Ministry of Public Health, draft Afghanistan health sector development framework 2017-2022

• Draft Afghanistan health sector development framework 2017-2022** • Reaching underserved areas

• Addressing the growing burden of non communicable diseases (NCDs)

• Further improving hospital services

• Poor feeding practices

• Low use of family planning services

• Low level of literacy

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Key actions for effective implementation of the NHS (KA for EI)

Expand the package of health services

Review and revision of BPHS* and EPHS** in light of the national health strategy for addressing emerging problems (e.g. NCDs)

Prioritization and selection of cost effective high impact interventions

*Basic Package of Health Services** Essential Package of Hospital Services

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KA for EI: Expand the coverage

To reach the unreached and cover the so called white areas: Establishment of new health facilities

Redistribution/rationalization of existing health facilities

Partnership with private sector for the provision of tertiary care in urban areas and for PHC in remote, underserved and insecure areas

Enhancing the health of the poor * Better access through establishment of new health centers and

reducing the cost of seeking care (e.g. transportation in rural and under served areas)

Addressing insecurity Meaningful and active engagement with communities

Negotiating with different political parties and fractions, local influencers

Engaging ICRC and UN agencies

* The Ministry of Public Health, Afghanistan health sector development framework 2017-2022 04-Jun-17 7

KA for EI: Enhance financial protection

Reduce out of pocket expenditure * Initiate a prepayment financing mechanism

Explore options for health insurance

Enhance efficiency in service delivery

Develop resource mobilization strategy Increased financing and increasing the proportion of resources under

MoPH stewardship *

Investing more public resources in health sector * Invest at least 10% of public resources in health

Earmark taxation for health services on tobacco and other goods having negative impact on health

Mobilize additional resources from traditional and non traditional donors including private sector

* The Ministry of Public Health, Afghanistan health sector development framework 2017-2022 04-Jun-17 8

KA for EI: Improved coordination

Improve regional cooperation Its crucial for Polio eradication and control of other communicable,

emerging and reemerging diseases

Implementation of International Health Regulation (IHR)

Reinforce intersectoral collaboration

Strengthen coordination among different departments/program of MoPH

Strengthened communication and coordination with all key stakeholders including communities

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KA for EI: Strengthen accountability

Robust monitoring and evaluation of health services at all levels

Greater accountability for result * Enhance monitoring by MoPH and communities Effective use of sanctions including termination of contract in case of

poor performance Annual review of performance by senior government officials and

stakeholders Publication of data on performance of NGOs by province

Strengthen community participation through effective implementation of Citizen's Charter * Community monitoring of health services Getting more info from patients through surveys and complaint line MoPH officials to regularly meet communities and seek their opinion

about health services

* Ministry of Public Health, Afghanistan health sector development framework 2017-2022 04-Jun-17 10

KA for EI: Enhance efficiency

Avoid duplication, better alignment of the off-budget projects

Bring off-budget to on-budget and make sure they are in line with MoPH priorities

Effective purchasing of health services – focus on outputs**

Enhance opportunities for innovation and learning * Low cost, easily implementable, focus on priority challenges, pro

poor, rigorously evaluated

Effective implementation of anti corruption strategy

Reduce beaurucratic procedures particularly in procurement and fund disbursement

Strengthen supply management system

Effective use of collected data and evidence based decision making

* Ministry of Public Health, Afghanistan health sector development framework 2017-2022** Policy brief, improving access to and quality of health services: the Afghanistan health services study, World Bank, May 2017

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KA for EI: Cross cutting issues

Formulation of annual plan with specific and measurable targets for each strategic area

Considering the past experience, growing insecurity, and existing limited capacity in public sector, contracting out of health services to NGOs may continue as*: Contracting-out has performed well in high conflict setting Service delivery has been resilient to conflict under existing model of

implementation

Providing more flexibility and autonomy to service providers

Increasing the focus on behavioral change Active engagement with community and religious leaders for

promoting desired behaviors Promote the use of family planning Promote exclusive breast feeding and improve infant and young

child feeding behaviors

*Ministry of Public Health, Afghanistan health sector development framework 2017-202204-Jun-17 12

KA for EI: Cross cutting issues

Functional establishment of Medical Council Effective regulation of private sector

Standardization of medical education

Strengthen the functions of National Medicines and Health Product Regulatory Authority Ensure the quality of medicines and effective use of technology

Take appropriate measures for improving quality of care

Based on capacity gap analysis provide capacity building opportunities for private sector in key areas

Training of qualified staff particularly female (e.g. community midwives and community nurses)

Annual review of the implementation of health strategy

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