Islamic Republic of Afghanistan Ministry of Public Health Regional Consultation on "Family Planning in Asia and the Pacific Addressing the Challenges Dr. Nadera Hayat Burhani Deputy Minister of Public Health 8-10 December 2010, Bangkok
Pop n = 25 Million 650 000 km2 34 provinces GDP ~ 450 dollars/ capita/year Civil War since 1978 1-2 million people died >3 million refugees 80% rural Country Context
Health Indicators in 2002 Life expectancy at birth: 47 years for men and 45 years for women Under-five child mortality rate: 257 deaths per 1,000 live births per year Infant Mortality Rate 165 deaths per 1,000 LB/year Maternal mortality ratio estimated at 1600 per 100,000 live births per year, one of the highest in the world
The Ministry of Public Health Response Established the Basic Package of Health Services Signed contracts with NGOs on a very large scale 85% of Afghans live in areas served by NGOs Provinces have been assigned to donors facilitate coordination Competitively recruited Afghans to work in MOPH at market wages 4
The MoPH Response (2) Training of community midwives Training of Community Health Workers Established Essential Package of Hospital Services as complement to BPHS Invested heavily in monitoring and evaluation Household surveys done in 2003, 2005 and 2006 HMIS initially poorly functioning but improved Health Facility Surveys since 2004
Afghanistan Compact By end of 2010 inline with Afghanistan MDG: BPHS will be extended to cover at least 90% of population Maternal Mortality will be reduce by 15% Full immunization coverage for under 5 for vaccine preventable disease will be achieved and their mortality rate reduced by 20%
Percentage of Pregnant Women AmongCurrently Married Women, by Age 40% 35% 36.40% 30% 25% 20% 15% 10% 5% 0% 15-19 Y 20-24Y 25-29Y 30-34Y 35-39Y 40-44Y 45-49Y totally 7
Facilities providing normal delivery care 100.0 90.0 80.0 81.4 100.0 100.0 100.0 95.7 95.7 86.2 72.4 79.5 BHC 70.0 71.4 60.0 52.0 61.1 CHC 50.0 52.5 40.0 30.0 41.6 39.9 DH 20.0 10.0 0.0 2004 2005 2006 2007 2008 8
Facilities with parto-graph 100.0 90.0 80.0 89.4 88.4 83.0 CHC 70.0 60.0 55.8 61.9 64.6 50.0 40.0 30.0 38.3 DH 20.0 17.0 22.6 10.0 0.0 6.4 2004 2005 2006 2007 2008 9
Facilities providing caesarian section 100.0 90.0 88.4 80.0 70.0 71.4 77.3 60.0 50.0 53.5 DH 40.0 30.0 20.0 10.0 9.3 0.0 2004 2005 2006 2007 2008 10
CONTRACEPTIVE PREVALENCE RATE Contraceptive Prevalence Rate 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Y2003 Y2005 Y2006 Y2008 SURVEY 2003 MICS 2005 NRVA 2006AHS 2008 NRVA STATISTIC MEDIAN* MEAN MEAN MEAN Estimate (%) 5.1 10.4 15.4 23 11
SKILLED ANTENATAL CARE Proportion of Pregnant women with at least one ANC 40% 35% 30% 25% 20% 15% 10% 5% 0% Y2003 Y2005 Y2006 Y2008 SURVEY 2003 MICS 2005 NRVA 2006 AHS 2008 NVRA STATISTIC MEDIAN* MEAN MEAN MEAN Estimate (%) 4.6 12.6 30.3 36 12
SKILLED BIRTH ATTENDANCE Skilled Birth Attendance 30% 25% 20% 15% 10% 5% 0% Y2003 Y2005 Y2006 Y2008 SURVEY 2003 MICS 2005 NRVA 2006 AHS NRVA 2008 STATISTIC MEDIAN* MEAN MEAN MEAN Estimate (%) 6.0 8.4 18.9 24 13
U5MR in Afghanistan: Actual and MDG4 Target 300 260 250 200 191 150 Target Actual 100 50 0 1990 1995 2000 2005 2010 2015
Millennium Development Goal 5 and targets Goal Indicator MDG5 Maternal Mortality Ratio Proportion of births attended by skilled personnel Baselin e 1600 (2002) Target 2020 Current Status 800 Survey is going on 14.3% 50% 24% (NRVA 2007-08) Increase the use of contraception 5% 60% 15% Fertility Rate (No. of live births per woman) Proportion of women receiving professional ANC 6.6 4.7 6.3 4.3% 25% 36 (NRVA 2007-08)
Key strategies for increasing FP uptake Strengthen the capacity to provide of a full range of FP methods Expand Approaches for Community-based FP Increase IEC and advocacy for wider use of FP Strengthen monitoring and evaluation of FP activities
Step already taken: RHCS Situation Improved capacity of central and regional warehouse staffs on storage practices and Logistic Management. Introduced Channel database for RH commodities, its implementation and capacity building at central and regional level. National RHCS strategic plan developed, 2007-2010 Warehouse constructed for contraceptives and RH Commodities
Country needs Strengthening National Capacity (skills development, systems development) Long Term National Government and donors commitment for contraceptives and RH commodities Improve quality control for contraceptives
Country needs (2) Establishment of proper warehouse at regional level for storage of contraceptives and RH commodities. Proper system on logistics management and Supplies from central to regional and provincial levels Strengthening monitoring and evaluation system on RHCS.
Priorities for RHCS Ensuring the technical and managerial capacity at the country level about forecasting, financing, Procurement, and Distribution Establishment of Regional warehouse for storage of contraceptives and RH Commodities. Increase capacity of FP health providers for increasing demand. increase awareness through IEC/BBC
Challenges Infant, child and maternal mortality remain highest in the region and one of the highest in the world Insecurity is a major problem No Regional warehouses for contraceptives and RH commodities Low Capacity on logistic management (forecasting, financing, procurement and distribution Low budget on RHCS in government budget line
Strategic Focus or Next step Advocacy(parliamentarians, religious leaders, community elders). strengthening national capacity of RHCS to play leadership role in RHCS management at national level strengthening coordination among government and partners Establishment a proper logistic management system for RH commodity
Thank You