The Parliamentarians’ Perception of the Public Health Sector in Afghanistan

First Global Symposium on Health System ResearchNovember 18, 2010

Overview

• Background• Methodology• Findings• Recommendations

Background

• Who should set health sector priorities?• Politicians views not systematically taken into

account• Objectives:– To assess the parliamentarians’ perception

regarding the public health sector– To measure and document political support

Methodology

• Questions– to what extent the parliamentarians agree with

the selected priorities in the public health sector– how the activities of the Ministry are perceived by

parliamentarians– how important the health sector is compared to

other sectors– what problems parliamentarians think people face

in accessing health services• Random sampling

Data collection

• Public health department of Kabul Medical University

• Data collected by medical students• Almost one third of the parliamentarians took

part in the survey• Funding from DelPHI

Findings

Quality of health services improved

1.5

72.1

1.5

20.6

4.4 Strongly AgreeAgreeDKNDisagreeStrongly Disagree

Amount of health services increased

4.4

63.2

5.9

22.1

4.4 Strongly AgreeAgreeDKNDisagreeStrongly Disagree

Access to health services increased

1.5

63.61.5

28.8

4.6 Strongly AgreeAgreeDKNDisagreeStrongly Disagree

People happy with public health services

1.5

23.5

8.8

58.8

7.4 Strongly AgreeAgreeDKNDisagreeStrongly Disagree

Provincial officials are competent

1.5

41.8

11.9

34.3

10.5Strongly AgreeAgreeDKNDisagreeStrongly Disagree

People know what the MOPH is doing

1.5

21.5

16.953.9

6.2 Strongly AgreeAgreeDKNDisagreeStrongly Disagree

MOPH provides enough information to parliament

1.516.4

10.5

58.2

13.4Strongly AgreeAgreeDKNDisagreeStrongly Disagree

MOPH successful in regulating private pharmacies

1.510.5

10.5

47.8

29.9

Strongly AgreeAgreeDKNDisagreeStrongly Disagree

MOPH successful in regulating private clinics

1.513.4

14.9

46.3

23.9

Strongly AgreeAgreeDKNDisagreeStrongly Disagree

MOPH successful in regulating private hospitals

1.5

16.9

13.9

36.9

30.8

Strongly AgreeAgreeDKNDisagreeStrongly Disagree

Top health problemsChild health problems 1Maternal health problems 2Mental health problems 3Drugs 4Tuberculosis 5Malaria 6Diabetes 7War related injuries 8Cardiac disorders 9Road accidents 10Cancer 11Disability 12Eye problems 13HIV/AIDS 14

29.4

25

19.1

26.5

Establish one of the Following

1 Hospital3 Large Clinics6 Medium Clinics20 Small Clinics

What to do with limited fixed resources

MOPH focus

7.4

69.1

17.7

5.9

Rural AreasUrban AreasBothDKN

36.8

1.560.3

1.5

Where it is Where it should be

User fees

23.5

76.5

ClinicsYesNo

19

69.1

2.9HospitalsYes

NoDKN

Continue working with NGOs

56.7

38.8

4.5YesNoDKN

Reasons for low utilizationReasons Ranking

Facilities too far 1Low quality of services 2Lack of female staff 3Poor roads 4Security problems 5Lack of transport 6Poor behavior of health workers 7Cost of services 8Cost of transport 9Lack of knowledge 10Family objection 11

Ranking of sectorsSectors RankingSecurity 1Health 2Education 3Agriculture and irrigation 4Transport including roads 5Administration reforms 6Electricity/energy 7Labor and public affairs 8Housing 9Industry 10

Proportion of budget spent on healthActually Spent Should be Spent

Median of responses 10% 19%

Recommendations

• Structured approach to incorporating parliamentarians and communities perspectives in policies, strategies and activities

• Scope for building new alliances• Regular provision of information• Follow up surveys