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Successes and Challenges in SRMNCAH delivery in Afghanistan�Afghanistan Ministry of Health

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Outline

  • Background
  • Governments efforts
  • Successes
  • Challenges
  • Lessons learned
  • Next steps

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Background

  • Estimated population is around 30 million

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  • 76% lives in rural areas

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  • The average household size in Afghanistan is 7.4 persons

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  • Life expectancy is 62

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  • Total fertility rate is 5.3%

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  • About 40.9 % of children <5 suffering from chronic malnutrition

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  • About 36 % of the population is below the poverty line.

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Key Achievements

  • The number of functioning health facilities increased from 496 in 2002 to more than 2,200 by now.

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  • Number of registered Midwives increased from < 500 before 2000 to over 5,000 in 2015

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  • Standard Package of health services introduced in 2003-2005

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  • Commitments made to the MDGs, SDG and the Global Strategy for women’s, children’s and adolescents’ health, FP 2020

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Source: Trends in Maternal Mortality 1990 to 2013. WHO, UNICEF, UNFPA, WB, UN 2014

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Trends in Childhood Mortality

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Skilled Birth Attendance�Delivered in a health facility : 48.1 which 51% of births are delivered by a skilled provider

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Equity ?

Coverage?

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Trends in Antenatal Care from a Medically Skilled Provider

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Equity ?

Coverage?

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Trends in Family Planning

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Percent of married women who are using any modern method

Note: MICS 2003 urban and total refers to all methods.

Equity ? Coverage?

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Challenges

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  • Declining aid environment

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  • Insecurity

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  • Geographical access

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  • Maintaining momentum and commitment

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  • Demand-side barriers

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  • Improving quality of care

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  • HR gaps (quantity and quality), lack of female staff

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  • Gap between translating policy into action

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  • Ensuring equitable access

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Options for Improving SBA

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Family health house

Community midwifery an nursing training

Community outreach teams

Task shifting, rational allocation of health facilities

Maternity waiting home

Community ambulance

CHW involvement in birth prepared-ness, NBC

Established accountability mechanism

Rights holders

Health services/ duty bearers

Learnings & Way forward

Greater flexibility to adapt to changing circumstances

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Service Delivery

Health Systems Strengthening

2015

2030

2002

Beginning post-Taliban period

  • Procurement
  • Cash support
  • Direct implementation
  • Health facility infrastructure
  • Training of health workforce
  • Humanitarian response
  • Equity focus (target provinces based on deprivation analysis)
  • Scale-up high impact interventions
  • Individual and institutional capacity
  • Quality of care
  • Strengthen community based services,
  • Enhanced Aid Coordination
  • People Centered, Integrated Health services
  • Universal Health Coverage (Financial Risk Protection)
  • SWAp
  • Strong Government Stewardship

STABILIZATION & REBUILDING

IMPROVE ACCESS

UHC & SUSTAINABLE DEVELOPMENT

Health system

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Thank You

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