In the name of Allah The Most In the name of Allah The Most Compassionate The Most MercifulCompassionate The Most Merciful

Presented by Asst Professor.Dr.Saliha Presented by Asst Professor.Dr.Saliha Nabizada ENT Lecturer .KMUNabizada ENT Lecturer .KMU

Health Situation in Health Situation in Afghanistan and it’s Human Afghanistan and it’s Human

ResourcesResources

Afghanistan BackgroundAfghanistan Background

Afghanistan is located in South Asia, on the Afghanistan is located in South Asia, on the crossroads of east and west civilizations.crossroads of east and west civilizations.

Having a history of 20000 yrs from stone Having a history of 20000 yrs from stone age, since 5000 yrs Afghans has settled in age, since 5000 yrs Afghans has settled in towns and villages according to the towns and villages according to the excavations of Mandigak in North of excavations of Mandigak in North of Kandahar. Kandahar.

Due to it’s important geopolitics position Due to it’s important geopolitics position has attracted the greedy eyes of several has attracted the greedy eyes of several invaders.invaders.

Cont…Cont… Ariana is the ancient Ariana is the ancient

name of Afghanistan name of Afghanistan mentioned in mentioned in Avestad( 1000BC) to Avestad( 1000BC) to (500 AD)' From 500 (500 AD)' From 500 AD to 1747 was named AD to 1747 was named Khurasan meaning the Khurasan meaning the Sunrise or Orient.Sunrise or Orient.

Afghanistan is the Afghanistan is the name employed since name employed since 1747 by the founder of 1747 by the founder of modern Afghanistan modern Afghanistan Ahmad shah Abdali.Ahmad shah Abdali.

Cont..Cont.. Afghanistan is the land Afghanistan is the land

where wheat has been where wheat has been cultivated for the first cultivated for the first time in history.time in history.

Alexander the Great Alexander the Great entered through Persia to entered through Persia to Afghanistan in 330 BC Afghanistan in 330 BC who faced fierce who faced fierce resistance from our resistance from our freedom loving people freedom loving people contrary to his contrary to his expectations. He waited expectations. He waited 4 years to conquer this 4 years to conquer this land. He was injured in land. He was injured in eastern Afghanistan.eastern Afghanistan.

Cont..Cont.. From 40BC to 220AD From 40BC to 220AD

Afghanistan was ruled by Afghanistan was ruled by Kushan Empire.Kanishka Kushan Empire.Kanishka was the most important was the most important king who spread king who spread buddhism.Bagram was buddhism.Bagram was his summer capital and his summer capital and Peshawar winter capital. Peshawar winter capital. He conquered China. He conquered China. Buddha statues the Buddha statues the largest one in the world largest one in the world were surprising the were surprising the visitorsvisitors

Buddha Statue in Bamyan Buddha Statue in Bamyan destroyed by Talibandestroyed by Taliban

Buddhist stupa in Guldara Buddhist stupa in Guldara north of Kabulnorth of Kabul

In 661-746 Islam was introduced In 661-746 Islam was introduced to Afghanistanto Afghanistan

Cont..Cont..

From 998-1030,From 998-1030, 　　ADMahmood ADMahmood Ghaznavid the great Ghaznavid the great Emperor of Emperor of Ghaznavid dynasty Ghaznavid dynasty attacked 7 times attacked 7 times India and spread India and spread Islam.Islam.

Ghori dynasty ruled Ghori dynasty ruled India As Afghan India As Afghan kingdomkingdom

In 1220 Mongol Changese Khan attacked In 1220 Mongol Changese Khan attacked Afghanistan and due to fierce resistance of our Afghanistan and due to fierce resistance of our

people ruined and devastated the whole people ruined and devastated the whole country.country.

Cont..Cont..

Shir Shah Suri Shir Shah Suri Afghan King Afghan King ruling India ruling India with Justice and with Justice and discipline.discipline.

Modern Afghanistan Modern Afghanistan Established by Ahmad Shah Established by Ahmad Shah

Abdali in 1746 Abdali in 1746 Under his rule Afghans Under his rule Afghans

conquered 7 times India.conquered 7 times India. First nidus of British First nidus of British

colonialism was colonialism was growing miraculously in growing miraculously in East India.East India.

after his death his after his death his Kingdome divided Kingdome divided between his descendents between his descendents paving the way for paving the way for greedy British greedy British intervention in intervention in Afghanistan.Afghanistan.

Afghans fought heroically in 3 Afghans fought heroically in 3 merciless wars against British merciless wars against British

intruders.intruders.

Anglo-Afghan WarAnglo-Afghan War

Last standLast stand

A gallant Afghan Woman named MalalaiA gallant Afghan Woman named Malalaidefeated British aggressors heroically defeated British aggressors heroically

in Maiwandin Maiwand..

Afghanistan gained it’s Afghanistan gained it’s independence from British Empire independence from British Empire

in 1919in 1919 Under the Under the

leadership of King leadership of King Ammanullah Ammanullah through 3through 3rdrd Anglo- Anglo- Afghan War Afghan War Afghans Gained Afghans Gained their their independence.independence.

AttanAttan

The Soviet Union invaded in 1979 The Soviet Union invaded in 1979 touching off a long and destructive touching off a long and destructive war.war.

Under relentless pressure by mujahedin the Under relentless pressure by mujahedin the USSR withdrew in 1989 and civil war erupted USSR withdrew in 1989 and civil war erupted

which subsequently Kabul fall to the Talibanwhich subsequently Kabul fall to the Taliban..

After the 11After the 11thth September attack on WTO USA September attack on WTO USA launched a coordinated international battle launched a coordinated international battle against Taliban And Osama Bin Laden but against Taliban And Osama Bin Laden but maintaining security is still a dilemma.maintaining security is still a dilemma.

Cont..Cont..

Geography:Geography: Location :Southern Asia, North And West of Pakistan, East of Location :Southern Asia, North And West of Pakistan, East of

IranIran

Area: Total Land 647500sq km,Area: Total Land 647500sq km, Water:0sq Km,Water:0sq Km, Land lockedLand locked

Climate: arid to semi arid; cold winters and hot summers.Climate: arid to semi arid; cold winters and hot summers.

Terrain: Mostly rugged mountains; Plains in North and South Terrain: Mostly rugged mountains; Plains in North and South easteast

Natural Resources: natural Natural Resources: natural gas,perolium,coal,copper,chromite,talc,barites,sulfur,lead,zinc gas,perolium,coal,copper,chromite,talc,barites,sulfur,lead,zinc iron ore ,salt,precious&semiprecious stonesiron ore ,salt,precious&semiprecious stones

Natural Hazards: damaging earth quakes occur in Hindukosh Natural Hazards: damaging earth quakes occur in Hindukosh mountains,flooding,draughtsmountains,flooding,draughts

Environmental Current Issues: Limited natural fresh Environmental Current Issues: Limited natural fresh water resources. inadequate supply of potable water, water resources. inadequate supply of potable water, soil soil degradation,overgrazing,deforestation,desertification,aidegradation,overgrazing,deforestation,desertification,air &water pollutionr &water pollution Population: Population: 31,889,92331,889,923 　　 (( 　　 July 2007estJuly 2007est 　　 )) AgeAge structure: structure: 0-14yrs44.6%,0-14yrs44.6%, 　　 15-64yrs53%,15-64yrs53%, 　　

　　　　　　 65yrs65yrs 　　 over 2.4%over 2.4% Population growthPopulation growth raterate: 2.625%: 2.625% BirthBirth raterate: 46.21 births/1000population: 46.21 births/1000population Death RateDeath Rate: 19.96deaths/1000population: 19.96deaths/1000population Net migrationNet migration raterate: 0 migrants/10000 : 0 migrants/10000

populationpopulation Infant mortality rate: Infant mortality rate: Total: 157.43deaths/live Total: 157.43deaths/live

birth,birth, 　　 Male: Male: 161.81/1000live birth,161.81/1000live birth,

Female: 152.83 deaths/live Female: 152.83 deaths/live birthbirth

Life expectancy at birth: Total Life expectancy at birth: Total population:43.77yrs,male43.6yrs,femalepopulation:43.77yrs,male43.6yrs,female:43.96yrs:43.96yrs

Total fertility rate:6.64Total fertility rate:6.64 children born/woman children born/woman

HIV/AIDSHIV/AIDS-Adult prevalence rate:0.01%-Adult prevalence rate:0.01%

Major infectious diseasesMajor infectious diseases: : food or water born food or water born diseasedisease

MalariaMalaria is at high-risk countrywide below is at high-risk countrywide below 2000 meters sea level from march through 2000 meters sea level from march through NovemberNovember

Animal contact disease: rabiesAnimal contact disease: rabies

Cont..Cont.. Highly pathogenic avian influenza has Highly pathogenic avian influenza has

been identified among birds in the been identified among birds in the country or surroundingscountry or surroundings

LiteracyLiteracy (definition :age 15 and over can (definition :age 15 and over can read and write):read and write): Total population Total population 28.1%28.1%, , Male Male 43.1%,43.1%, Female Female 12.6%12.6%

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%

Totalpopulation

male

female

% of Literacy in Afghanistan

Economy OverviewEconomy Overview

Economy is recovering since 2001 largely due Economy is recovering since 2001 largely due to the infusion of international assistance.to the infusion of international assistance.

Real GDP growth exceeded 8%.Real GDP growth exceeded 8%. Despite the progress Afghanistan is extremely Despite the progress Afghanistan is extremely

poor, landlocked, highly dependent on foreign poor, landlocked, highly dependent on foreign aid, agriculture and trade with neighboring aid, agriculture and trade with neighboring countries.countries.

Much of the population suffer from shortage Much of the population suffer from shortage of housing, clean water, electricity, medical of housing, clean water, electricity, medical care and jobs.care and jobs.

Cont…Cont…

Criminality, insecurity, and Afghan Criminality, insecurity, and Afghan Governments inability to extend rule Governments inability to extend rule of law to all parts of the country pose of law to all parts of the country pose challenge to future economic growth.challenge to future economic growth.

Will take the remainder of decades Will take the remainder of decades and continuing donor aid and and continuing donor aid and attention to significantly rise attention to significantly rise Afghanistan’s living standards from Afghanistan’s living standards from it’s lowest level in the world.it’s lowest level in the world.

Challenges Afghan Challenges Afghan Government is faced with:Government is faced with: Budget sustainability, job creation, Budget sustainability, job creation,

corruption, government capacity, corruption, government capacity, rebuilding war torn infrastructurerebuilding war torn infrastructure

Eradication of poppy cultivationEradication of poppy cultivation

Labor force 15 millionLabor force 15 millionLabor force by occupation:Labor force by occupation:Agriculture:80%,industry:10%,services:10%Agriculture:80%,industry:10%,services:10%

Unemployment Unemployment rate:40%rate:40%

Population below Population below poverty line:53%poverty line:53%

Refugees and Refugees and internally internally displaced displaced persons:136565 persons:136565 due to drought and due to drought and instabilityinstability

0%

10%

20%

30%

40%

50%

60%

70%

80%

Agriculture

industry

services

KochisKochis

KochisKochis

Health Situation in Health Situation in AfghanistanAfghanistan

5 yrs ago Health services were in a 5 yrs ago Health services were in a deplorable state. Situation appeared chaoticdeplorable state. Situation appeared chaotic

4 major constraints to achieving an efficient 4 major constraints to achieving an efficient and effective national health system:and effective national health system:

1.1. Lack of managerial &service delivery Lack of managerial &service delivery capacity within the MOPHcapacity within the MOPH

2.2. Lack of physical infrastructure and qualified Lack of physical infrastructure and qualified personnelpersonnel

3.3. Poor distribution of financial and human Poor distribution of financial and human resourcesresources

4.4. Uncoordinated and undirected efforts of Uncoordinated and undirected efforts of NGOsNGOs

Malnutrition in a child from north of Malnutrition in a child from north of Kabul and neglect toward senile Kabul and neglect toward senile

patientspatients

Malnutrition Malnutrition

MalmutritionMalmutrition

Blast causualitiesBlast causualities

Surgeon Operating an ENT case at a Surgeon Operating an ENT case at a district hospital by own equipments due district hospital by own equipments due

to limitations of BHPS packagesto limitations of BHPS packages

Surgeon performing Amputation Surgeon performing Amputation Operation at a district hospital north of Operation at a district hospital north of

KabulKabul

A training course for Health A training course for Health Educators of north & western Educators of north & western

provinces run by NGOprovinces run by NGO

•In early 2002 MOPH and major donors In early 2002 MOPH and major donors developed: a Basic package of Health developed: a Basic package of Health services(BPHS) to form the technical services(BPHS) to form the technical foundation of MOPHfoundation of MOPH Provided clear guidelines for Provided clear guidelines for

infrastructure reconstruction and infrastructure reconstruction and rehabilitation and for staffing.rehabilitation and for staffing.

MOPH Agreement on effective and MOPH Agreement on effective and efficient BPHS management and efficient BPHS management and expansion through Contracting with expansion through Contracting with NGOs.NGOs.

5 yrs on MOPH has made 5 yrs on MOPH has made considerable progress in making the considerable progress in making the BPHS accessible to most Afghans. BPHS accessible to most Afghans.

Improvements occurred Improvements occurred in:in:

Quality of careQuality of care Health management information system Health management information system

shows consistent and significant shows consistent and significant increases in a number of indicators.increases in a number of indicators.

Management capacity of MOPHManagement capacity of MOPH Funding for health sector has been Funding for health sector has been

relatively satisfactory although relatively satisfactory although Afghanistan remains highly dependent Afghanistan remains highly dependent on foreign assistance for years to come.on foreign assistance for years to come.

Challenges Facing the Challenges Facing the government:government: At central, provincial an community level.At central, provincial an community level. Full integration of the Grants and Full integration of the Grants and

Contracts Management Unit(GCMU)Contracts Management Unit(GCMU) Strengthening the technical & managerial Strengthening the technical & managerial

competence in other essential MOPH competence in other essential MOPH departments.departments.

Maintenance of the level of technical Maintenance of the level of technical assistance.assistance.

Strengthening linkages between central, Strengthening linkages between central, provincial and district level provincial and district level

Cont…Cont…

Defining roles ad responsibilities of the Defining roles ad responsibilities of the provincial health offices.provincial health offices.

Increasing access and quality Increasing access and quality especially in remote areas.especially in remote areas.

IN SUM: Progress has been made in IN SUM: Progress has been made in addressing 4 major constraints, which addressing 4 major constraints, which were measured by process indicatorswere measured by process indicators

For the health status of the Afghan For the health status of the Afghan population impact evaluation is needed population impact evaluation is needed in one or two yearsin one or two years

Cont…Cont… Further progress may be impeded by chronic Further progress may be impeded by chronic

problems: problems: such as uneven managementsuch as uneven management, , inadequate financial systems, and inconsistent inadequate financial systems, and inconsistent transparency and accountability.transparency and accountability.

Potential problems loom on the horizon as: Potential problems loom on the horizon as: ensuring adequate and predictable levels of ensuring adequate and predictable levels of funding and technical assistancesfunding and technical assistances

With respect to the larger context additional With respect to the larger context additional problems include: problems include: Unstable security situation, Unstable security situation, the relative weakness of the government and the relative weakness of the government and the difficult economic situation that for many the difficult economic situation that for many Afghans has minimally progressed since2002.Afghans has minimally progressed since2002.

The role of Ministry of Higher The role of Ministry of Higher education in training of health workerseducation in training of health workers

First nucleus of modern Medicine created First nucleus of modern Medicine created in 1933by Turkish Drs,and in 1934 in 1933by Turkish Drs,and in 1934 Upgraded to Faculty of Medicine in Kabul Upgraded to Faculty of Medicine in Kabul University, in 2004 expanded to KMU.University, in 2004 expanded to KMU.

During last yrs of war establishment of During last yrs of war establishment of medical faculties became a political bribe medical faculties became a political bribe for warlords, hence establishment of for warlords, hence establishment of provincial MF without proper facilities& provincial MF without proper facilities& standards.standards.

Students enrollment was through different Students enrollment was through different channels not only through entrance channels not only through entrance examination.examination.

Medical university Infrastructure Medical university Infrastructure rehabilitated but no Lab rehabilitated but no Lab

Equipment availableEquipment available

Class roomsClass rooms

StudentsStudents

Teaching rooms built with the assistance of Teaching rooms built with the assistance of JICA in Maiwand HospitalJICA in Maiwand Hospital

PBL workshop in KMUPBL workshop in KMU

Students applying CBL introduced by Students applying CBL introduced by

JICA in KMUJICA in KMU

Other human resources Other human resources problemsproblems

Higher number of Higher number of Medical students Medical students (almost 8000 with house (almost 8000 with house jobbers)jobbers)

Old curriculum stressing Old curriculum stressing more on lecturesmore on lectures

Workforce imbalance: Workforce imbalance: Ratio of Doctors(3038) Ratio of Doctors(3038) to Nurses and to Nurses and midwives(3075) midwives(3075) almost1:1 with focus on almost1:1 with focus on urban settings80:20urban settings80:20

Lack of coordination Lack of coordination between educational between educational institutions,service,and institutions,service,and policy makers.policy makers.

0%

10%

20%

30%

40%

50%

60%

70%

80%

Urban

rural

Seminars held by Ministry Seminars held by Ministry of Higher Education to fill of Higher Education to fill

the gapthe gap1.1. In June 2003,National workshop on Medical In June 2003,National workshop on Medical

education in Afghanistan was held stressing education in Afghanistan was held stressing on capacity building of teachers, investment on capacity building of teachers, investment in infrastructure, investment in training in infrastructure, investment in training equipment,libraries.Affiliation with equipment,libraries.Affiliation with recognized universitiesrecognized universities

2.2. Workshop on Curriculum Development Workshop on Curriculum Development concepts stressing on review of KMU and its concepts stressing on review of KMU and its satellite faculties curriculum according to satellite faculties curriculum according to the international standards addressing the the international standards addressing the major health problems of the country.major health problems of the country.

National Workshop on National Workshop on Medical Education in KMUMedical Education in KMU

Thanks for your Thanks for your attention.attention.