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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
Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023
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
Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023
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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
Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023
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
Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023
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
Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023
Cont…
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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
Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023
Cont…
Wednesday, April 12, 2023
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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
Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023
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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
Wednesday, April 12, 2023 Training Course on Social Health Insurance, Seoul - Sep 2010 12
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
13
BPHS coverage by Donors
Training Course on Social Health Insurance, Seoul - Sep 2010
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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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15Training Course on Social Health Insurance, Seoul - Sep 2010Wednesday, April 12, 2023