Strategic Framework

Integrated Civ-Mil Campaign Plan• Expansion of Accountable and Transparent Governance – Expand coverage of basic public services, including

basic health and education services • Advancing Livelihoods and Sustainable Jobs – Increase access to vocational and technical training opportunities

that prepare a skilled and productive workforce which counters the insurgency and is able to contribute to the development of population centers and corridors . Social sector development enhances human capital.

Mission Strategic and Resource Plan• Building an Economic Foundation for Afghanistan’s Future –

– Improved government services, vocational training and basic strengthening of health and education systems.• Providing Health and Education Aid to Promote Long-Term Stabilization

– Support health and education initiatives designed to improve key indicators in these sectors, particularly maternal health and girls’ education.

Regional Stabilization Strategy• Advance the rights of Afghan women and girls across all areas of effort, with particular focus on expanding

economic opportunities; improving access to justice, improving basic service delivery in education and health, and increasing women’s participation in the political process.

• Service Delivery and Capacity Building - Improve service delivery at the sub-national level in the critical areas of health, education, and security (e.g., expand access to basic healthcare and schooling at the district level; expand vocational training opportunities at the provincial level).

1

Overall Assessment:Improving Health Status: Align USG and coalition efforts to support GIRoA goals to improve health for all Afghans to increase human capital, advance livelihoods and further economic and social development.

Nar

rati

ve:

Trend:

Indicators Status Data Source

Percentage of population with access to health services within 2 hours walking distance

60% Afghanistan Rural Health Survey, 2006

Number of health facilities providing basic services nationally 1972(USG-539)

MoPH

Health care utilization rate, national 1.3 (2010) MoPH

Percentage of program budget that goes to direct assistance $67 million planned for

FY2010 (46% )

USAID

Number of trained midwives 3100+(1640+ USG)

Afghan Midwifery Accreditation Board 2

The availability of basic health services and utilization of these services continues to increase steadily. Currently, 1,972 facilities provide basic services nationally; USG funding

supports 539 of these facilities. Numbers of trained female health care providers, including midwives, are also increasing. 3,100 trained midwives are currently in place; 1,640 of these

were trained with USG support. Health care utilization rose during the last quarter, with patients making on average 1.3 visits to a facility annually. On-budget assistance is

continuing to demonstrate good results, with on-budget support projected to expand in 2011 and on track for meeting the 50% Kabul process commitment by 2012.

Overall Assessment: Healthcare in Afghanistan

BPHS 2010Below BPHS Standard 14

Meets BPHS Standard 15

Exceeds BPHS Standard 57

Basic Package of Health Services (BPHS) Access & Quality 2009

Below BPHS Standard 41

Meets BPHS Standard 14

Exceeds BPHS Standard 31

Objective 1: Improved Access and Quality

2011 AOIsBelow BPHS Standard 1

Meets BPHS Standard 10

Exceeds BPHS Standard 31

2011 KTDsBelow BPHS Standard 2

Meets BPHS Standard 34

Exceeds BPHS Standard 57

Objective 1: Improved Access and Quality: 2011

Safe Drinking Water

1-1010-1919-2929-3939+

000-000-153

Farah

Herat

Badghis

Ghor

Faryab

Sar-e Pul

JowzjanBalkh

Nimruz

Helmand Kandahar

Zabul

Uruzgan

Daykundi

Bamian

Samangan

Kunduz

Baghlan

Takhar Badakhshan

Ghazni

Paktika

NangarharWardak

Nuristan

Parvan

Kabul

Panjshay

KonarLaghman

PaktiyaKhost

Kapisa

Lowgar

20

17

24

29

13

15

16

25

17

8

5

28

43

56

37

18

36

53

15

32

1524

12

10

18

35

11

19

1412

26

18

9

30

Objective 1: Access to Data Source: NRVA 2007/2008 Baseline

Objective 1: Access to Improved Water Baseline

Medical Training Advisor Group (MTAG) Training Sites

MTAG Training Courses

National Military Hospital

Regional ANA Hospitals

Forward Support Depots

ANP Medical Facilities

Kandahar

Mazar- e-Sharif

Herat

Gardez

209th Corps

203rd Corps

205th Corps

207th Corps

201st Corps

Kabul

215th Corps

Shor’ab

Objective 3: MTAG-Supported Key Institutions

Objective 3: Midwifery Program Map

Infant, child and maternal mortality remains among the highest in the world

Reaching insecure and remote areas

Numbers of facilities expanding faster than the trained workforce, esp. female providers

Lack of MoPH organizational and human resource development plan

Lack of adequate mental health services

Lack of MoPH decentralization and empowerment at the provincial level

Lack of licensure and accreditation systems for physicians or health care institutions

Insufficient MoPH salaries to attract and retain skilled staff

Continuing Healthcare Challenges/Constraints

Way Ahead: Healthcare in Afghanistan

Increasing coordination with military counterparts for the use of CERP funds for construction and water, sanitation and hygiene interventions

Supporting a multiyear strategic framework and operational plan for the MoPH, including organizational and workforce development

Fostering country-ownership by transitioning key programs and activities to the MoPH through increased on-budget support

Strengthening MoPH financial management and procurement systems

Assisting the MoPH to establish an Interim Steering Committee on Public-Private Partnerships, particularly focused on hospitals

Promoting the development of a semi-autonomous Afghan Medical Council responsible for accreditation and licensure

Exploring opportunities to unify inter-ministerial health systems and medical education and training programs (MoPH, MoHE, and MoD)

Building MoPH capacity in health economics and financing to identify sustainable financing solutions that reduce dependency on donors

Strengthening MoPH capacity to legislate, regulate, quantify, procure and distribute essential medicines to the people

Increasing capacity of Provincial Health Directorates to strengthen management and oversight of health programs and services

9

Afghan Health Services Structure

AFGHAN HEALTH STRATEGY

Health Post

Health Sub-Center

Basic Health Center (BHC)

Comprehensive Health Ctr (CHC)

District Hospital(DH)

Provincial

Regional

Covers 1,000-1,500 AfghansLimited care: treatment of malaria, diarrhea, acute respiratory infections. Education on nutrition, birth control, STDs, prenatal warning signs. Identification of persons with disabilities and mental health illness. 2 CHWs from their home.

3k-7kCreated to increase access within 2 hours walk. Routine immunizations, prenatal care, TB

detection, 1 male nurse & 1 community midwife. Supervises HP.

15k-30kComplex outpatient care, mental health. Full OB care, newborn care,

immunizations, childhood diseases. Treatment of malaria, TB.1 doctor, 1 nurse, 1 midwife, 2 vaccinators. Supervise CHW.

30k-60kLimited inpatient care, lab, pharmacy. Severe

childhood illness, malaria. Complex mental health. 2 doctors (male/fem), 2 nurses, 2 midwives.

100k-300kXRAY, surgery, OB, physiotherapy,

pediatrician, pharmacist, dentist.

10k-15kAn extension of the BHC. Visits remote villages every 2 months or as directed by

PHCC. 1 male doctor or nurse, 1 female midwife or nurse, 1 vaccinator, and 1 driver.

Mobile Health Team

447

99

813

378

67

30

5

11203

Basic Package forHealth Services in Afghanistan

Essential PackageFor Hospital Servicesin Afghanistan

Health & Nutrition Sector Strategy Volume II – Pillar V Health & Nutrition

AfghanistanNational DevelopmentStrategy (ANDS)

CERP Support FY2010

USAID: Resource Allocations Health & Education

Province

Est. Disbursements FY 2010 - 1st Quarter FY 2011

Health (in $ Million) Education (in $ Million) Total (in $ Million)

Badakhshan $6.36 $1.01 $7.36

Badghis $0.23 $0.00 $0.23Baghlan $1.99 $0.99 $2.98Balkh $0.23 $6.16 $6.39Bamyan $4.15 $2.06 $6.21Daykundi $0.10 $0.99 $1.08Farah $0.11 $1.09 $1.19Faryab $4.74 $0.76 $5.49Ghazni $5.64 $2.83 $8.47Ghor $0.02 $1.23 $1.25Hilmand $0.24 $0.44 $0.68Hirat $5.40 $7.09 $12.50Jawzjan $3.36 $3.13 $6.50Kabul $30.96 $31.51 $62.47Kandahar $3.10 $3.11 $6.21Kapisa $0.07 $1.80 $1.86Khost $3.44 $3.08 $6.52Kunar $0.26 $0.00 $0.26Kunduz $0.21 $0.96 $1.16Laghman $0.34 $0.99 $1.33Logar $0.18 $1.10 $1.28Wardak $0.28 $2.61 $2.88Nangarhar $0.34 $4.65 $5.00Nimroz $0.03 $0.00 $0.03Nuristan $0.01 $0.00 $0.01Paktika $3.47 $0.00 $3.47Paktya $4.51 $1.50 $6.02Panjsher $0.08 $1.61 $1.70Parwan $0.03 $2.21 $2.25Samangan $0.05 $0.13 $0.19Sari Pul $0.00 $2.62 $2.62Takhar $4.89 $0.60 $5.49Uruzgan $0.04 $0.19 $0.23Zabul $0.09 $0.00 $0.09

Grand Total $84.94 $86.46 $171.40

USAID: Resource AllocationsHealth & Education

USAID: ProgramsHealth & Education