better systems, better health                          Comprehensive Approach to                          Building Afghani...
Summary Challenges Planning comprehensive approach Transitioning to self-sustaining health systems
Challenges Dependence on donor funding (85%) and no tax    base for revenue generation   High level of OOP (75%)   Limi...
Planning for ComprehensiveApproach Develop a comprehensive health financing strategy  that emphasizes:    Mobilizing Afg...
Mobilize Local Resources Build and institutionalize  the technical capacity of  HEFD staff:    Enrolled 7 HEFD staff in ...
Gradual Decrease on DonorDependency Develop revenue generation policy that introduces  “sin taxes” on interventions havin...
Improve Aid Coordination Coordinate technical support with WB, EC, and other  USAID projects    Expenditure management i...
Ensure Sustainability Implement the most comprehensive public program to  transition donor funded civil servant employees...
Reflection In some ways, it is easier to impact health systems in  post-conflict countries because often you are  designi...
better systems, better health                          Thank you                                       www.HealthSystems20...
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Comprehensive Approach to Building Afghanistan Health Economics & Finance Directorate

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Presenter: Ibrahim Shehata

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Comprehensive Approach to Building Afghanistan Health Economics & Finance Directorate

  1. 1. better systems, better health Comprehensive Approach to Building Afghanistan Health Economics & Finance Directorate Better Health Systems: Strategies that Work Presentation Series at the Global Health Council Ibrahim Shehata February 7, 2012Abt Associates Inc.In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health
  2. 2. Summary Challenges Planning comprehensive approach Transitioning to self-sustaining health systems
  3. 3. Challenges Dependence on donor funding (85%) and no tax base for revenue generation High level of OOP (75%) Limited capacity in budget execution (60%) Low public per capita expenditure (4%) Low capacity in applied health economics and resource management
  4. 4. Planning for ComprehensiveApproach Develop a comprehensive health financing strategy that emphasizes:  Mobilizing Afghan human resources  Gradual decrease on donor dependency  Aid coordination  Sustainability
  5. 5. Mobilize Local Resources Build and institutionalize the technical capacity of HEFD staff:  Enrolled 7 HEFD staff in master’s degree program in health economics  On-the-job training programs provided to HEFD staff  HEFD organizational and operational improvements
  6. 6. Gradual Decrease on DonorDependency Develop revenue generation policy that introduces “sin taxes” on interventions having negative externalities on health Support MOPH advocacy efforts Evaluate user fees Improve budget execution to 100%
  7. 7. Improve Aid Coordination Coordinate technical support with WB, EC, and other USAID projects  Expenditure management information system  Health financing policy  Costing BPHS, EPHS, and vertical programs
  8. 8. Ensure Sustainability Implement the most comprehensive public program to transition donor funded civil servant employees into the Afghan “tashkeel” (civil service system)  Cost tashkeel positions  Identifying staffing capacity needs currently missing in the tashkeel  Both take stock of and cost the training, which will enable “topped up” staffing positions to effectively and efficiently perform their functions  Increasing competitiveness of tashkeel salaries  Develop an action plan and timeline for the MoPH to implement changes  Design a five-year performance-assessment-monitoring and evaluation process and reporting framework
  9. 9. Reflection In some ways, it is easier to impact health systems in post-conflict countries because often you are designing the system from scratch without having to navigate the existing system and its bureaucracy
  10. 10. better systems, better health Thank you www.HealthSystems2020.orgAbt Associates Inc.In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health

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