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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
Photo by Luke Powell
Photo by Luke Powell
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)
Photo by Luke Powell
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
Photo by Luke Powell
• 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
Photo from Afghanistan Land of Beauty and Culture
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
Ahmad Jan Naeem’s presentation in International Conference on Primary Health Care, Doha 2008
Ahmad Jan Naeem’s presentation in International Conference on Primary Health Care, Doha 2008
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.
Photo from Afghanistan Land of Beauty and Culture
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
Health Information Management System (HMIS), Ministry of Public Health
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
Health Information Management System (HMIS), Ministry of Public Health
BCG coverage
75%
80%
65%
70%
55%
60%
50%Y2003 Y2005 Y2006 Y2008
Health Information Management System (HMIS), Ministry of Public Health
Full Immunization in Afghanistan
35%40%
20%25%30%
5%10%15%
0%Y2003 Y2005 Y2006 Y2008
Health Information Management System (HMIS), Ministry of Public Health
DPT Coverage in Afghanistan
40%45%50%
20%25%30%35%
5%10%15%20%
0%Y2003 Y2005 Y2006 Y2008
Health Information Management System (HMIS), Ministry of Public Health
Photo from Afghanistan Land of Beauty and Culture
TashakorThank Tashakoryou
MannanaMannana
Photo from Afghanistan Land of Beauty and Culture