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Strengthening the health system in Afghanistan

Strengthening the health system in Afghanistan. NEW APPLICATION FOR GAVI FUNDING 2012-2014. CONTENTS. Executive Summary Process of Developing Proposal National Health System Context HSS Objectives and Interventions Main Beneficiaries Performance M&E

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Strengthening the health system in Afghanistan

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  1. Strengthening the health system in Afghanistan HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011 NEW APPLICATION FOR GAVI FUNDING 2012-2014

  2. CONTENTS • Executive Summary • Process of Developing Proposal • National Health System Context • HSS Objectives and Interventions • Main Beneficiaries • Performance M&E • Gap Analysis, Detailed Work Plan And Budget • Implementation Arrangements, Capacities, and Program Oversight • Financial Management Arrangements • Governance and Oversight Arrangements • Risks and Unintended consequences HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  3. Executive Summary (1) Background • Since 2002, Afghanistan has made substantial progress in improving the accessibility of health care. • BPHS and EPHS • NGOs and Private Sector • Indications of Success HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  4. Executive Summary (2) Challenges • The hostile security situation • Tough geography, scattered population • Poor Water & Sanitation Coverage • High illiteracy rate • Low access for remote areas and kotchi • Lack of Sufficient Capacity at Peripheral Level • BPHS NGO Contracts vs Vertical Services • Inadequate Support to Hospital Care • HR availability and distribution • Limited Financing of Health Sector • Increasing public expectations and emergence of new demands (tertiary hospital care) • Limited contribution of the private sector in promoting health status • EPI Cold Chain and Equipment • Lengthy Gov administrative procedures HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  5. Executive Summary (3) Strategic Goal • To reduce maternal and child mortality by strengthening the health system through improving the access to, and utilization of, immunization, maternal and child health services. HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  6. Executive Summary (4) OBJECTIVES AND INDICATORS Objective 1: To improve access and increase the coverage of immunization and other essential health services particularly for the underserved population 1.1: To increase DTP3 coverage in Kochi children from 16% in 2010 to 30% in 2014 1.2: To establish partnership with for-profit private sector at different levels of health care delivery system 1.2.1: To continue and scale up the CSO type B project focused on the delivery of EPI and other essential maternal and child health services in remote and insecure areas of the country 1.2.2: To study the feasibility of partnership with private for profit private sector in the hospital sector 1.3: To implement the Community Integrated Management of Childhood Illnesses (CIMCI) program in the remaining 7 out of 34 provinces. HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  7. Executive Summary (5) OBJECTIVES AND INDICATORS Objective 2: To improve quality, effectiveness and utilization of health care and immunization services. 2.1: To improve quality and performance of EPI program at different levels 2.2: To do a critical analyses of the implementation of BPHS at different levels and improve contracting process to ensure EPI and other essential Maternal and Child health priorities are well managed through contracting process 2.3: To promote health through awareness raising initiatives HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  8. Executive Summary (6) OBJECTIVES AND INDICAORS Objective 3: To improve the ability of MOPH to fulfill its stewardship responsibilities at all levels with a more focus on peripheral level 3.1: Improving Monitoring and Evaluation processes at different levels with a more focus on peripheral levels 3.2: Streamlining procurement of non-consultancy services HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  9. Executive Summary (7) SUSTAINABILITY • interventions are aligned with the national health policy and strategies • The interventions build on and benefit from existing HS structures and activities. • The interventions foreseen to build the capacity of MoPH and to maximize the community support to the health sector. • The interventions benefit from the huge existence and capacity of the private sector. HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  10. IMPACT/OUTCOME INDICATORS • To reduce under five mortality rate by 5% (from 97/1000 live births in 2010) in 2014 • To reduce infant mortality rate by 5% ( from 77/1000 live births in 2010) in 2014 • To increase Penta 3 coverage from 87% in 2010 to 92% in 2014 (routine reports)??? • To increase Penta 3 coverage in Kochi children from 16% in 2010 to 30% in 2014 • To reduce dropout rate (Penta1- Penta 3) from 12% in 2010 to <10% in 2014 • To improve equity in immunization coverage: Percentage point difference between Penta 3 coverage in the lowest wealth quintile vs DTP3 coverage in the highest wealth • To increase % of women seeking care for ANC, delivery and postnatal from 27% in 2010 to 35% in 2014 • To increase proportion of provinces capable to implement the M&E strategy ( NMC implemented and replica provided) from 40% in 2010 to 80% in 2014 HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  11. NATIONAL HEALTH SECTOR (1) • A substantial improvement has been made in health care coverage and accessibility inducing noticeable positive impact on the health of the Afghan population. • The health sector in Afghanistan is characterized by the strong cooperation between the MoPH and the NGOs. • More than 75% of the total health care expenditures in Afghanistan are from private sources • The primary health care is delivered through Basic Package of Health Services which is a selective set of primary health care interventions. HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  12. NATIONAL HEALTH SECTOR (2) • The EPHS is delivered in almost 15 hospitals • NGOs have been a fundamental factor in rebuilding the Afghan health sector • Despite the significant role of the private sector, information about its structure and performance is poorly documented • Infant and child mortality rates have decreased from 165 and 257/1000 in 2002 to 129 and 191 respectively. Further the AMS shows a reduction to 77 and 97/1000 live births respectively. HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  13. NATIONAL HEALTH SECTOR (3) • These successful indications highlight the efforts made to increase the availability, coverage and utilization of various health services • According NRVA report 2008, 57% of the population live within one hour distance from the a HF • Routine coverage estimate s of immunization shows considerable increase in the proportion of targeted children covered by the various antigens HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  14. National Health Strategy (1) • HNSS (2008-2013) is developed with the goal to improve the health and nutritional status of the people of Afghanistan, with a greater focus on women and children and under-served areas of the country. • MoPH has adopted eighteen strategies for reducing morbidity and mortality and strengthening institutional development • These strategies are being worked on through nine core programs, five related to health care service provision and four related to institutional development • BPHS, the main strategic pillar of the health service delivery, is implemented mainly through a partnership between the ministry and NGOs through a contracting out agreements • To increase effectiveness of the BPHS, a number of strategies were implemented since 2005 (community midwives, Health sub-centres, CHWs) HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  15. National Health Strategy (2) • MoPH functions through a central body in Kabul the capital and directorates of health in the province. • MoPH established specialized technical working groups and taskforces to provide opportunity to its partners to contribute to policy and strategies formulation and to monitor the performance of the health projects and programs. • Due to the inadequate capacities of the provincial health directorates, most the MoPH functioning remains central. • MOPH has developed M&E strategy • BPHS & EPHS are evaluated by third party using BSC HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  16. National Health Strategy (3) • In 2008 the MOPH in response to security challenges, in limited scale, started to test the feasibility of partnership with for-profit providers • The results so far have been promising encouraging the expansion of the initiative. HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  17. Current HSS Efforts • MoPH has been tackling the main control buttons to provide guidance, consistency, coordination of the sector emphasizing, leadership, governance and stewardship • MoPH plans to continue BPHS arrangement to benefit from the capacity and experience of NGOs • MoPH plans to introduce regulations for PPP in hospital care • MoPH plans to expand PPP to new provinces • A new department was established within the MoPH to care for the kotchi health care • MoPH is occupied with establishing medical professional regulations • Training of community midwives and community nurses • Building the capacity of the peripheral health management structures HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  18. Main Beneficiaries • Objective 1, the Kochi population • Objective 2, the beneficiaries are the mothers and children throughout the country • Objective 3, the beneficiaries are the people of Afghanistan mainly mothers and children • all objectives have strong links with immunization indicating that main beneficiaries are the children and mothers HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  19. M&E arrangements • Indicators and targets are all in line with national reporting and M&E framework • The M&E Department will be in charge of monitoring the performance of the GAVI-Funded HSS activities • It is planned that during the course of the next two to five years that the necessary capabilities will become further resident within the MOPH’s Monitoring System to fully fulfill its mandates. HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  20. COORDINATION • intra-ministerial coordination • CGHN • HSS Steering Committee • Afghanistan has a network of CSOs • BPHS coordination • Role of HSS unit • WHO regional offices HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  21. Total Budget: • The needs to fully achieve all the objectives are immense • Current ceiling is 9.1 MU$ per year. • The proposed is in line with the ceiling for two years 18.2 MUS$ HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  22. RISKS HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

  23. Thanks ?/comments HSS GAVI Proposal Summary Afgh. CGHN Dec 28 2011

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