Afghanistan Health Care System

Najibullah Safi, MD, MSc. HPM. DMPPMPrimary Health Care Advisor

WHO Country Office - Afghanistan

History of health care system in Afghanistan

• During 19th: traditional healers (Hakim, Tabib,…)• During Amanullah Khan Kingdom first group of Afghan doctors

was trained in Turkey• In 1931: physician assistance programme was established in

Kabul• In 1932: (King Nader Shah) Kabul Medical College was

established• In 1938 Ali Abad University Hospital was inaugurated• In 1963: Jalal Abad Medical college was established

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Source: http://www.afghanmed.org/dr_seraj_presentation.htm

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Cont...

Before 1978• Throughout 1960s: health care system was limited to

urban areas/ hospitals• During this time government began to establish BHC in

rural areasDuring Soviet occupation and Mujahedin (1979-1996)• Decentralization in health systemTaliban 1996-2001• Consolidate most of the country politically

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Source: Securing Afghanistan’s Future: Accomplishments and Strategic Path forward. January 2004

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Community-level outreach activities

Small Health Center, C2 Sub Center,MCH Clinic

Large Health Center, C1 BasicHealth Center

Rural Hospital

Provincial Hospital

Health Post

Basic Health Center

Comprehensive Health Center

District Hospital

Provincial Hospital

Current health care systemPrevious categories of facilities

New standardized classification of facilities

Source: BPHS March 2003

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Current health care system

PrimaryHealth Post

BHC/CHC

SecondaryDistrict Hospital

TertiaryProvincial Hospitals

Regional/teaching hospitals

Private Public

Traditional Modern

Government NGOs Partnership

Source: BPHS March 2003, Securing Afghanistan’s Future:

Accomplishments and Strategic Path forward. January 2004

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Cont…

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Health Post/preventive and selected curative care

Cover 100-150 families or 1000-1500 individuals

Basic Health Center/ preventive and curative care

mostly OPD cover 15000-30000 population

Comprehensive Health Center/ preventive and curative care mostly OPD cover 30000-60000 population/limited inpatient care

District Hospital/preventive and curative care OPD and inpatient care up to 80 beds cover 100,000-300,000 population/up to four district

Provincial Hospital/in patient, out patient care 80-100 beds/cover 200,000-500,000 population

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Health indicators

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NO Indicator Coverage

1 Life expectancy (years) Total: 46, Male: 47, Female: 45

2 Annual growth rate (%)* 2

3 Dependency ratio (%) 92

4 Under 5 Mortality Rate (Deaths/1,000 live births)

191

5 Infant Mortality Rate (Deaths/1,000 livebirths)

129

6 Total Fertility Rate (Births/Woman) 6.3

7 Maternal Mortality Ratio (MaternalDeaths/100,000 live births)(2000 data)

1600

Source: HMIS, MoPH, Afghanistan 2006 Health Survey* Country Health Profile - WHO

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NO Indicator Coverage

8 Pregnant women who received 1+ ANC visits (%) 30

9 Deliveries attended by skilled health personnel (%) 19

10 Newborns immunized with BCG 2007 (%) 91

11 1-year-olds immunized with 3 doses of DTP 2007 (%) 83

12 Children under 2 years immunized with 1 dose of measles 2007 (%)

70

13 Pregnant women immunized with two or more doses of tetanus toxoid 2007 (%)

65

14 Percent of rural population with access to local health services 66

Source: HMIS – MoPH

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No Indicators Coverage

15 Physician per 10,000 population 2

16 Dentist per 10,000 population 0.3

17 Pharmacist per 10,000 population 0.3

18 Nurse and Midwife per 10,000 population 5

19 Hospital beds per 10,000 population 4.2

20 PHC unit and center per 10,000 population 0.6

Source: WHO, Country profile http://www.emro.who.int/emrinfo/index.asp?Ctry=afg

Constitutional obligation of the Government

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“The state is obliged to provide free means of preventive health care and medical treatment, and proper health facilities to all citizens of Afghanistan in accordance with the law … ”. Article 52 of Afghanistan Constitution

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Health financing options in Afghanistan

Health system is financed from a combination of sources and through a combination of financing mechanisms. The basic financing alternatives are:

Public financing External sources Private and community financing

Direct (out of pocket, user fee, charges for pharmaceuticals) Indirect (local charities – paying on behalf of individual consumers)

Insurance schemes (government or social insurance, employer-based insurance)

Health care financing indicators

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No Indicator Coverage

1 Health Share of total government allocation** Regular budget 3% Development budget 5%

2 Total expenditure on health as % of GDP (2006)*** 5.4

3 Per capita GDP US$ (2010 estimate of Da Afghanistan Bank) 572

4 Per capita total expenditure on health (Intl $, 2006)*** 29

5 Public expenditures on health (62% of which contributed by donors)**

17%

6 Private expenditures on health (WHO estimates) ** 83%

7 Out of pocket expenditures on health as a % of private expenditures on health**

98%

8 Per capita annual out of pocket expenditures on health * US$29

9 Private insurance 0%

* Household survey 2004** National policy on healthcare financing and sustainability 2009-2013*** WHO – world health statistics 2008

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BPHS coverage by Donors

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Patients

Population

Taxes

Treasury

Finance Ministry

Ministry of Health Provincial Health Directorate

District Hospital, CHC, BHC, HP

Out of Pocket Payment

Private Hospitals and clinics, Out Patient Care, Medicines

Employer Insurance

Health Care

Funds for NGOsDonor Assistance

Provincial Hospital

District Health Coordinator

Health care financing

Selective Services and Hospitals

Military Health Services

HEFD

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