Building on Early Gains in Afghanistan's Health, Nutrition, and Population Sector

Tekabe A. Belay

Description

This volume is the first of its kind to present a comprehensive assessment of the health sector in Afghanistan. Although health outcomes here are some of the worst in the world, the sector has made considerable progress since 2001. A nationwide survey conducted in late 2006 found that the infant mortality rate had fallen from 165 to 129 per 1,000 live births, and the under-five mortality rate had fallen from 257 to 191 per 1,000 live births. These figures represent a 22 percent and a 26 percent decline, respectively, from the end of 2001. Similarly, coverage of prenatal care has increased from less than 5 percent to 32 percent, and childhood vaccinations of DPT3 (diphtheria, pertussis, and tetanus) have increased from less than 20 percent to 35 percent between 2003 and 2006. Administrative data indicate that the number of functioning primary health care facilities has nearly doubled, from 498 in 2001 to more than 936 in 2008. Also, the quality of care in publicly financed facilities has increased by about 22 percent from 2004 to 2006. Although this progress is encouraging, it is not sufficient to ensure that Afghanistan will achieve the Millennium Development Goals (MDGs).
'Building on Early Gains in Afghanistan's Health, Nutrition, and Population Sector' presents specific policy options for Afghanistan's Ministry of Public Health to consider in advancing to the next level of care for its population. The guiding principles of these options are consistency with the ministry's vision and the feasibility of implementation. The specific challenges include revising the content of the basic package of health services (BPHS), rethinking the delivery of the BPHS, securing sustained and predictable financing, defining the role of the emerging private sector, addressing the shortage of human resources for health, and expanding the capacity of the ministry to enable it to effectively carry out its stewardship functions.
This book was prepared as a resource for policy makers, practitioners, and researchers in Afghanistan and other conflict-affected countries. It emphasizes the policy implications of the findings presented.

Sujets

• Afghanistan
• Health
• Poverty reduction
• Private sector development

Informations

• Publié par: world-bank-publications
• Publié le: 19 mai 2010
• Nombre de lectures: 26
• EAN13: 9780821383353
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

DIRECTIONS IN DEVEL OPMENT
Human De v elopmen t
Building on Early Gains in
Afghanistan’s Health, Nutrition,
and Population Sector
Challenges and Options
EUROPEAN UNIONBuilding on Early Gains in
Afghanistan’s Health, Nutrition, and
Population SectorBuilding on Early Gains in
Afghanistan’s Health, Nutrition,
and Population Sector
Challenges and Options
Tekabe A. Belay,
Editor© 2010 The International Bank for Reconstruction and Development / The World Bank
1818 H Street, NW
Washington, DC 20433
Telephone: [phone]
Internet: www.worldbank.org
E-mail: [e-mail]
All rights reserved
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This volume is a product of the staff of the International Bank for Reconstruction and
Development / The World Bank. The findings, interpretations, and conclusions expressed in this
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governments they represent.
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ISBN: 978-0-8213-8335-3
eISBN: 978-0-8213-8336-0
DOI: 10.1596/978-0-8213-8335-3
Cover image
Bagram, Afghanistan: JACK GUEZ/AFP/Getty Images
Library of Congress Cataloging-in-Publication Data
Building on early gains in Afghanistan’s health, nutrition, and population sector : challenges
and options / edited by Tekabe A. Belay.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-8213-8335-3 — ISBN 978-0-8213-8336-0 (electronic)
1. Public health—Afghanistan. 2. Medical care—Afghanistan. 3. Afghanistan—Statistics,
Medical. I. Belay, Tekabe A.
RA541.A3B45 2010
362.109581—dc22
2010013118Contents
Foreword xiii
Acknowledgments xv
Abbreviations xvii
Executive Summary xix
Introduction 1
Objectives 1
Scope and Methodology 2
Structure and Outline of the Book 2
Chapter 1 Background 5
Health, Macroeconomic Environment, and Poverty 5
The Health and Nutrition Sector Strategy 6
Security 7
Evolution of the Health System 8
Contracting Arrangements 11
Evidence for Future Directions 13
Chapter 2 Health Status and Performance of the Sector 17
Health Outcomes 17
Performance of the Health Care System 20
vvi Contents
Chapter 3 Financing of the Health Sector 31
Revenue-Generation Capacity 32
Level and Sources of Financing for the
Health Sector 33
Expenditure Priorities 41
Budget Process and Structure 48
Concluding Remarks: Findings and
Recommendations 53
Notes 56
Chapter 4 Participation of the For-Profit Private Sector
in Rural Afghanistan 59
Structure of the Private Sector 61
Demand for Services 65
Types and Quality of Service 70
Constraints and Future Outlook 76
Concluding Remarks: Findings and
Recommendations 77
Notes 79
Chapter 5 Human Resources for Health 81
Level and Structure of Human Resources
for Health 82
Demand for and Quality of Human Resources 91
Concluding Remarks: Findings and
Recommendations 95
Notes 97
Chapter 6 Strengthening the Basic Package of
Health Services 99
Improving Coverage, Access, and
Utilization 101
Enhancing Monitoring and Evaluation of
the BPHS 108
Balancing Stewardship and Managerial
Autonomy 111
Prioritizing Interventions for Inclusion in
the BPHS 114
Concluding Remarks: Findings and
Recommendations 117Contents vii
Chapter 7 Institutional Capacity of the Ministry
of Public Health 119
Setting Strategies and Objectives 120
Budget Preparation and Resource Mobilization 125
Monitoring, Evaluation, and Use of Data 128
Accountability and Responsiveness 130
Technical Guidelines and Supervision 131
Coordination of Development Partners 132
Information, Education, and Communication/
Behavior Change Communication 133
Emergency Response 134
Concluding Remarks: Findings and
Recommendations 135
Notes 140
Chapter 8 Concluding Remarks: Moving Forward 141
Specific Recommendations 142
Appendix A Domains and Components of the Balanced
Score Card 149
Appendix B Data Collection Issues and Presentation 151
Data Analysis and Presentation 151
Methodological Challenges 154
Note 155
Appendix C Afghan Calendar 157
Appendix D Survey of Private Health Providers 159
Survey Design and Sampling 159
Household Profile 161
Notes 169
Appendix E Private Sector Health Providers 171
Appendix F Human Resources for Health 173
Appendix G Descriptions of the Four Core Institutional
Development Programs of the Health and
Nutrition Sector Strategy 181
References 185
Index 189viii Contents
Box
7.1 Issues Addressed under Each Function of the
Ministry of Public Health 121
Figures
2.1 Trends in Infant Mortality Rate in Afghanistan,
South Asia, and Sub-Saharan Africa, 1960–2006
(1339–85 AC) 18
2.2 Trends in Under-Five Mortality Rate in Afghanistan,
South Asia, and Sub-Saharan Africa, 1960–2006
(1339–85 AC) 19
2.3 Effect of Distance to Health Facility on Utilization
of Skilled Birth Attendant and Antenatal Care 27
2.4 Maternal Mortality Ratio in Four Districts in
Afghanistan, 1999–2002 (1378–81 AC) 28
3.1 Sources of National Budget Funds, 2007/08 (1386 AC) 33
3.2 Total Public Spending (Core and External) by Sector,
2007/08 (1386 AC) and 2008/09 (1387 AC) 34
3.3 External Budget by Sector, 2008/09 (1387 AC) 35
3.4 Trends in External Assistance to the Health Sector,
2003/04–2008/09 (1382–87 AC) 36
3.5 Donor Contributions to External and Nondiscretionary
Development Budget, 2004/05–2008/09 (1383–87 AC) 37
3.6 Trends in Assistance by Main External Contributors to
the Health Sector, 2003/04–2008/09 (1382–87 AC) 38
3.7 Out-of-Pocket Health Care–Related Expenditures,
2006 (1385 AC) 39
3.8 Trends in Allocation of Health Care Budget by
Program, 2003/04–2008/09 (1382–87 AC) 42
3.9 Allocation of Health Care Budget by Program,
2008/09 (1387 AC) 42
3.10 Cumulative Allocation of External and Development
Assistance by Program, 2003/04–2008/09 (1382–87 AC) 43
3.11 Distribution of External Assistance by Activity,
2003/04–2008/09 (1382–87 AC) 44
3.12 Trends in Distribution of Health Care Funding by
Main Activity, 2003/04–2008/09 (1382–87 AC) 45
3.13 Wages and Salaries as a Share of the Operating Budget
of the Ministry of Public Health and the Government
of Afghanistan, 2005/06–2007/08 (1384–86 AC) 52