public health in afghanistan march 29 2010

Dr. Abdul Tawab Kawa Saljuqi (MD)MPH Student

Health Promotion and Health Behavior SectionMel and Enid Zuckerman College of Public Health

University of Arizona

Global Health Alliance Meeting

University of Arizona

March 29th 2010Tucson, Arizona, USA

Photo by Luke Powell

• A musical Slide Show

• Afghanistan�’s DemographicSituation

• Briefing on Public HealthSystem and Current situationSystem and Current situation

• Question and Answer


Afghanistan Map Located in South Central Asia

• The heart of Asia BetweenThe heart of Asia Between

• Pakistan ( south and East)

( )• Iran ( west)

• Tajikistan (North)

• Uzbekistan ( North)Turkmenistan ( North)( )China ( North East)


Afghanistan(647500 km2)

2.2 times

Larger than

Arizona(295,254 km2) Photo by Hussain Hassrat

• Population: 24 million CSO , 2007

– Female / Male Ratio : 49/51

• Literacy Rate : 35 40 %(Ministry of Education 2007)

• GDP : 426 USD (WB) 2008


• Life expectancy is 43years, compared to 59years for low incomecountries worldwide.

Photo from Google ImagePhoto from Google Image

Source : WHO

• Moreover only• Moreover, only13 percent ofAfghans haveAfghans haveaccess to safedrinking waterdrinking waterand 12 percent toadequateadequatesanitation

Photo from UNICEF website

UNICEF best estimates 2008

• Access to electricity :Access to electricity :among the lowest inthe worldthe world.

• The situation hashowever improved inhowever improved inKabul, Mazar andHiratHirat

• More than 7 million childrent h l 2 5 illi i lto school 2.5 million girls

• More than 4500 schools allover the countryover the country

• More than 170000 teachersMore than 170000 teachers

• Implementation of HealthyImplementation of HealthySchool Initiative since 2006with MoPH and UNICEF

Source: Afghan Ministry of Education website

Photo from UNICEF website

A i lt l P d tiAgricultural Production:wheat, fruit, nuts, wool, mutton, sheepskins, lambskinsMajor Agricultural Exports:Nuts, fruit, spices Agriculture: 31% of GDPAgriculture: 31% of GDP, 80% of employment

US Department of Agriculture/Afghanistan Photo from Afghanistan Land of Beauty and Culture

Photo from Afghanistan Land of Beauty and Culture

M th 80 % f i t ti l

•83000 US forces•45000 ISAF and NATO

•More than 80 % of international assistance spent on security

•70 000 Afghan gNational Army

•NATO website/Afghanistan•United States Accountability Office report on Security in Afghanistan

Islam (99%)Others (1%) ( Hinduism andOthers (1%) ( Hinduism and Christianity)

Source : Wikipedia / Religion in Afghanistan


Surprise Visit ofSurprise Visit of

Obama to Afghanistan

h l hto eat some healthy

Food!

March 28 2010

Photo from White House photo gallery

• Afghanistan NationalDevelopment StrategyDevelopment Strategyand Health andNutrition Sector Strategy2008 2013

• Two main strategies forh lth i ihealth care provision :Basic Package of HealthServices and EssentialPackage of HospitalServices , contracted out

• Two main strategies forhealth care provision :B i P k f H lthBasic Package of HealthServices and EssentialPackage of HospitalPackage of HospitalServices , contracted out

Present Health Situation

A five year communicationstrategy for Afghanistanstrategy for Afghanistan

Based on 8 Gaps

Proposes 8 Strategies

Supported by a Policy

And five year Action Plan

After 2 years of struggle

Ministry of PublicGovernmental

HealthDonors

Organizations

NGOsLegislation

UN

CommunityPrivate Sector

• % of GDP spend on% of GDP spend onHealth

• USAID• USAID

• EU

• WB

• Other : JICA, CIDA, DFID,, , ,AFD, ADB

• A very small amountA very small amountfrom national revenue Photo from Afghanistan Land of Beauty and Culture

Health Facilities and Referral System in BPHS

Health Post Comprehensive

Health CenterHP HP

HP

Health Center

HP HP

HP

Basic HealthCenter Referrals

HPHP

HP

30,000 peopleHP

HPHP

District or ProvincialHospital

HP

HP

HPHP

HP

Health Post Supervision & supplies from BHC, CHC & DH

Facility Level Key Staff PopulationCoverage

Health Post 2 CHW (male/female) 1,000-1,500Health Post ( ) 1,000 1,500

Basic Health Center

1 Nurse (male), 1 Midwife/Community Midwife, 2 Vaccinator, 1 Community Health S i (5 2)

15,000-30,000

Supervisor (5+2)

ComprehensiveHealth Center

2 Doctors (m/f); 2 Community Midwives; 2 nurses (m/f); 1 Lab Tech

30,000-60,000

2 nurses (m/f); 1 Lab Tech1 Pharmacy tech., 2 Vaccinator, 1 Administrator, 1 Community Health Supervisor(12+4)(12+4)

First ReferralHospital

4 Doctors (m/f), 1 surgeon, 1 anesthetist, 1 Pediatrician, 4 Midwife, 10 nurse, 1 X-ray tech, 2 Lab Tech, 1 Pharmacist, 2 Vaccinator, 1 Dentist, 1 Dental Tech, 1 Administrator, 1 Community

100,000-300,000

Health Supervisor(31+7)

Source : Basic Package of Health Services 2005

• Maternal and newborn healthMaternal and newborn health

• Child health and immunization

bli i i• Public nutrition

• Communicable diseases control

• Mental Health

• DisabilityDisability

• Supply of Essential Drugs

Source : BPHS of health services 2005

Progress of Health Indicators

Photo by Hadi Zaher

Ahmad Jan Naeem’s presentation in International Conference on Primary Health Care, Doha 2008

Key Developmenty pIndicators

• Infant mortality rate,per 1,000 live births:Down from 129 in 2006to about 111 in 2008.

• Under 5 mortality rate,per 1,000 live births:D f 191 i 2006Down from 191 in 2006to about 161 in 2008.

Ph t f H i H t

World Bank Report on Afghanistan 2009

Photo from Hussain Hassrat

• Prenatal care toPrenatal care topregnant women: Upfrom 11% in 2004 tofrom 11% in 2004 to49% in 2008.

• Child immunization• Child immunizationrates: Up from 12% in2005 to 33% in 20082005 to 33% in 2008.

World Bank Report on Afghanistan 2009 Photo from Afghanistan Land of Beauty and Culture

• Health service utilization increased among projectarea populations from a rate of 0.3 consultationsp pper capita annually at the outset to 1.64 per capitaby the mid 2009.


Childern Mortality Rates2002-2006

165

257

191200

250

300

00 li

ve b

irths

129

0

50

100

150

Dea

ths

per 1

00

2002 2006Years

Infant Mortality Rate Under 5 Mortality Rate

Health Information Management System (HMIS), Ministry of Public Health

Increased in Investment 2002 to 2006

Intestment in Health Sector (Million USD)

c eased es e 00 o 006

1200

1400

800

1000

illionUSD

200

400

600Mi

0

200

2001 2002 2003 2004 2005 2006 Total

YearsYears

Deputy Minister of Public Health’s Presentation for International Health Literacy Conference 2009

Progress in Percentage of Health Facilities with at least one female healthFacilities with at least one female health

worker, Afghanistan 2003, 2008

Health Information Management System (HMIS), Afghan Ministry of Public Health

• Presence of more than20000 CommunityH lth W kHealth Workers

• Communication andCommunication andvaccination Campaigns

Photo by CBHC Department, Ministry of Public Health

• CommunityCommunityinteraction byPartnershipPartnershipDevelopment Quality( PDQ ) and( PDQ ) andParticipatoryLearning Approach (Learning Approach (PLA) strategies

Photo from BRAC website

800000

1000000

1200000

1400000

ies

per y

ear

Delivery

200000

400000

600000

800000

mbe

r of d

ileve

ri Ante Natal Care

Family Planning

01383 1384 1385 1386 1387

Num

2004 20062005 2007 2008

Years


Polio vaccine Coverage

70.00%80.00%

40.00%50.00%60.00%

10.00%20.00%30.00%

0.00%10.00%

Y2003 Y2005 Y2006 Y2008


BCG coverage

75%

80%

65%

70%

55%

60%

50%Y2003 Y2005 Y2006 Y2008


Full Immunization in Afghanistan

35%40%

20%25%30%

5%10%15%

0%Y2003 Y2005 Y2006 Y2008


DPT Coverage in Afghanistan

40%45%50%

20%25%30%35%

5%10%15%20%

0%Y2003 Y2005 Y2006 Y2008


TashakorThank Tashakoryou

MannanaMannana


public health in afghanistan march 29 2010

Health & Medicine

unicef photo

answer photo

km2 photo

hinduism andchristianity

luke powell

afghanistan land of

white house photo gallery

afghanistan map