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Comprehensive Approach to Building Afghanistan Health Economics & Finance Directorate
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Comprehensive Approach to Building Afghanistan Health Economics & Finance Directorate

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Presenter: Ibrahim Shehata

Presenter: Ibrahim Shehata


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  • 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. Summary Challenges Planning comprehensive approach Transitioning to self-sustaining health systems
  • 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. Planning for ComprehensiveApproach Develop a comprehensive health financing strategy that emphasizes:  Mobilizing Afghan human resources  Gradual decrease on donor dependency  Aid coordination  Sustainability
  • 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. 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. 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. 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. 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. 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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