1. Health Policy Formulation
Afghanistan Experience
Najibullah Safi, MD, MSc. HPM
Primary Health Care Advisor
WHO Country Office - Afghanistan

2. 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 program 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
Source: http://www.afghanmed.org/dr_seraj_presentation.htm
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3. Cont...
Before 1978
• Throughout 1960s: health care system was limited to urban
areas/ hospitals
• During this time government began to establish BHC in rural
areas
During Soviet occupation and Mujahedin (1979-1996)
• Decentralization in health system
Taliban 1996-2001
• Consolidate most of the country politically
Source: Securing Afghanistan’s Future: Accomplishments and Strategic Path
forward. January 2004
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4. Level of health care
Tertiary Health Care:
RH, SH
Secondary Health Care:
DH, PH
Primary Health Care:
Health Post, Sub­center,
BHC, CHC
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5. What is policy?
Policy is defined as:
“ … a definite course or method of action selected from
among alternatives … to guide and determine present and
future decisions.”
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6. What is health policy?
“A formal statement which defines vision, outline priorities
and the parameters for action in response to health needs,
available resources, political pressures, expected roles of
different groups to build consensus and inform people.”
MoPH draft Health Policy 2012 - 2020
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7. History of health policy formulation
• The idea of formulating health policies is relatively new
• Until the end of the 1940s, national policies tended to be a
distinctive feature of planned economies
• As the Marshall Plan made the drafting of national plans a
condition for the financing of Europe's reconstruction,
national policies became a normal instrument of policy
• In poor countries, the drafting of national policies also
became a condition of access to aid
• In the health sector, it took the form of statements and
plans aiming at reaching the goal of Health for All by the
Year 2000
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8. Why health policies are needed?
• A health policy:
– Facilitate planning
– Can facilitate decision making
– Provides a framework for evaluating performance
– Can help to bring together professionals and other sectors
around health problems and to legitimize actions
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9. Policies influence health
• Health Policy – policies developed within the health sector
• Policies relevant to health – policies that impact on health
and health services, e.g. housing, food and tobacco
industries, public water supply, traffic control, social
security and the social determinants of health
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10. Health policy in Afghanistan
• Interim National Health Policy and Strategy 2003 -04
• National Health Policy 2005 -09
• National Health and Nutrition Sector Strategy 2008-13
• MoPH Strategic Plan 2011 – 15
• National Health Policy 2012 – 20 (yet draft, in the process
of development)
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11. Constitutional obligation of the Government
“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 the Afghanistan Constitution
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12. Process of health policy formulation in Afghanistan
• The example of health policy 2012 -20
– Establishment of a working group comprised of various
stakeholders
• Different departments of MoPH
• Donors e.g. USAID, EU, World Bank, CIDA
• Technical partners and UN agencies e.g. WHO
• Ministry of finance
• Representative of Parliament
• Representative of academia
• Representative of civil society
• Representative of the BPHS implementing NGOs
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13. Process of health policy formulation in Afghanistan
cont.
• Sub-groups of the working group: draft various segments
of the policy
• Present the draft of various segments of the policy to the
working group for review
• Present the draft of health policy to the group of senior
level health professionals (finalize the draft)
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14. Process of health policy formulation in Afghanistan
cont.
• Final draft will be presented to:
– Consultative Group on Health and Nutrition (CGHN)
– Technical Advisory Group (TAG) of MoPH
– Executive Board of MoPH
– Final approval by the health minister
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15. Outline of the national health policy 2012 - 20
• Introduction
– Country context and situation analysis
• Health and development
– The poverty context
– Millennium development goals
– Afghanistan National Development Strategy
• Health achievements and current challenges in health
sector
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16. Outline of the national health policy 2012 - 20
• Content of the policy:
– Vision
– Mission statement
– Values and guiding principles
– Goal
– Objectives
– Priorities
– Policy statements
• Stewardship
• Health financing
• Resource creation
• Health service delivery
– National health policy impact
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