1. Afghanistan Health Care System Najibullah Safi, MD, MSc. HPM. DMPPM Primary Health Care Advisor WHO Country Office - Afghanistan

4. Community-level outreach activities Small Health Center, C2 Sub Center, MCH Clinic Large Health Center, C1 Basic Health Center Rural Hospital Provincial Hospital Health Post Basic Health Center Comprehensive Health Center District Hospital Provincial Hospital Current health care system Previous categories of facilities New standardized classification of facilities Source: BPHS March 2003 Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011

5. Current health care system Primary Health Post BHC/CHC Secondary District Hospital Tertiary Provincial Hospitals Regional/teaching hospitals Private Public Traditional Modern Government NGOs Partnership Source: BPHS March 2003, Securing Afghanistan’s Future: Accomplishments and Strategic Path forward. January 2004 Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011

6. Cont… Health Post /preventive and selected curative care Cover 100-150 families or 1000-1500 individuals Basic Health Center/ preventive and curative care mostly OPD cover 15000-30000 population Comprehensive Health Center/ preventive and curative care mostly OPD cover 30000-60000 population/limited inpatient care District Hospital/ preventive and curative care OPD and inpatient care up to 80 beds cover 100,000-300,000 population/up to four district Provincial Hospital/ in patient, out patient care 80-100 beds/cover 200,000-500,000 population Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011

7. Health indicators Source: HMIS, MoPH, Afghanistan 2006 Health Survey * Country Health Profile - WHO Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011 NO Indicator Coverage 1 Life expectancy (years) Total: 46, Male: 47, Female: 45 2 Annual growth rate (%)* 2 3 Dependency ratio (%) 92 4 Under 5 Mortality Rate (Deaths/1,000 live births) 191 5 Infant Mortality Rate (Deaths/1,000 live births) 129 6 Total Fertility Rate (Births/Woman) 6.3 7 Maternal Mortality Ratio (Maternal Deaths/100,000 live births)(2000 data) 1600

8. Cont… Source: HMIS – MoPH Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011 NO Indicator Coverage 8 Pregnant women who received 1+ ANC visits (%) 30 9 Deliveries attended by skilled health personnel (%) 19 10 Newborns immunized with BCG 2007 (%) 91 11 1-year-olds immunized with 3 doses of DTP 2007 (%) 83 12 Children under 2 years immunized with 1 dose of measles 2007 (%) 70 13 Pregnant women immunized with two or more doses of tetanus toxoid 2007 (%) 65 14 Percent of rural population with access to local health services 66

9. Cont… Sunday, July 10, 2011 Training Course on Social Health Insurance, Seoul - Sep 2010 Source: WHO, Country profile http://www.emro.who.int/emrinfo/index.asp?Ctry=afg No Indicators Coverage 15 Physician per 10,000 population 2 16 Dentist per 10,000 population 0.3 17 Pharmacist per 10,000 population 0.3 18 Nurse and Midwife per 10,000 population 5 19 Hospital beds per 10,000 population 4.2 20 PHC unit and center per 10,000 population 0.6

10. 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 Afghanistan Constitution Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011

12. Health care financing indicators Sunday, July 10, 2011 Training Course on Social Health Insurance, Seoul - Sep 2010 * Household survey 2004 ** National policy on healthcare financing and sustainability 2009-2013 *** WHO – world health statistics 2008 No Indicator Coverage 1 Health Share of total government allocation** Regular budget 3% Development budget 5% 2 Total expenditure on health as % of GDP (2006)*** 5.4 3 Per capita GDP US$ (2010 estimate of Da Afghanistan Bank) 572 4 Per capita total expenditure on health (Intl $, 2006)*** 29 5 Public expenditures on health (62% of which contributed by donors)** 17% 6 Private expenditures on health (WHO estimates) ** 83% 7 Out of pocket expenditures on health as a % of private expenditures on health** 98% 8 Per capita annual out of pocket expenditures on health * US$29 9 Private insurance 0%

13. BPHS coverage by Donors Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011

14. Patients Population Taxes Treasury Finance Ministry Ministry of Health Provincial Health Directorate District Hospital, CHC, BHC, HP Out of Pocket Payment Private Hospitals and clinics, Out Patient Care, Medicines Employer Insurance Health Care Funds for NGOs Donor Assistance Provincial Hospital District Health Coordinator Health care financing Selective Services and Hospitals Military Health Services HEFD Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011

15. Training Course on Social Health Insurance, Seoul - Sep 2010 Sunday, July 10, 2011