Hmis publication, june 2012

780 views

Published on

HMIS First Publication to give detail on HMS system and Perfromance indicator comparative review .

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
780
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
19
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Hmis publication, june 2012

  1. 1. HIS PUBLICATION No. 1 Month-06 Ministry of Public Health GD of Policy and PlanningIntroductionThis newsletter is designed to provide a basic synopsis of routine HMIS and is structured by first discussingbriefly HMIS performance indicators, some health status indicators by MoPH priority health areas and thenby discussing some service performance indicators. The primary data source is that of the HMIS, howeversome indicators are triangulated with those of the household survey and the Afghan Mortality Survey.There are over 120 MoPH-HMIS indicators which can be used by health professionals to monitor programprogress. This newsletter selects some of those indicators by MoPH priority areas including indicators forMaternal and Child Health, Tuberculosis, Malaria, Mental Health and the Hospital Sector.Some of the proxy MoPH indicators contained within this report include:  % 1 yr olds immunized with DPT3  % 1-yr olds w/ measles vaccine  % institutional deliveries  % of pregnant women received  1 ANC visit  Couple Month Protection  # delivered women receiving 1 PNC/total # delivered women  # of new TB SP+ cases found/est. prev TB  # TB cases cured (SP-)/ total # TB cases under Rx 8 months  # reported mental health cases  % HF with stock-out of 1 essential drug  % of HF with at least one FHW  # of acute malnutrition cases  % of acute malnutrition cases  Trend of Acute W. diarrhea in U5 page 1
  2. 2.  Trend of Pneumonia in U5This newsletter is designed to stimulate discussion amongst health professionals with regard to the directionof the health sector. It aims to build the capacity and confidence of people to begin to analyze information sothat they may ask questions, check their program data internal consistency checks and begin to monitor theirown program progress.Monitoring is the responsibility of everyone. Data Quality is the responsibility of everyone. Data Use is theresponsibility of everyone. The availability of timely and accurate information ensures that decision-makershave no excuse for not taking information into consideration while making decisions. Accountability withingovernance structure starts with examining vertical and horizontal program information. The informationwithin this newsletter could be used at central level by program or department managers during their regulardiscussions with stakeholders, at provincial level during the PHCC meetings and also shared with healthfacility staff.Description of the HMIS systemHealth system strengthening is related to the production and use of quality health information at all levels ofthe health system. Routine Health Information Systems (RHIS) are receiving increasing attention as asustainable strategy towards integrated, country-owned national systems.The HMIS is a system based on qualitative and quantitative indicators on which data is routinely collected,processed, analyzed, interpreted, disseminated, and used to improve the provision of health servicesaccording to the MOPH‟s priorities and ultimately to improve the health of the population. The followingdata is captured using the HMIS.BPHSFSR (Facility Status Report)  General Facility Status  Human Resource Status  Equipment Status  Status of Services providedMIAR (Monthly Integrated Activity Report)  OPD Services  Nutrition Services  Maternal and Neonatal Care  Stock Status  Immunization Services  Laboratory Services  TB Services  Community SupervisionMAAR (Monthly Aggregated Activity Report)/ Health Post Services  Family Planning  Obstetric Referral  Nutrition Screen page 2
  3. 3.  Under Five Morbidity  Stock Information  Community Health Meeting  Immunization ReferralsCAAC (Catchments Area Annual Census) with key target groups  Family Planning Coverage  Pregnancies  Immunization Coverage  Maternal and Neonatal deathEPHSHSR (Hospital Status Report)  General Status of the Hospital  Human Resources Status  Equipment Status  Status of Services Provided  SupervisionHMIR (Hospital Monthly Inpatient Report)  Inpatient Services  Nutrition Services for under fives  Imaging services Status  Stock Status  Cases and deaths StatusWhat HMIS can and cannot do I. The HMIS is limited to the collection of routine management information and as such is not able to capture all the information needs for all program areas. It provides trends to examine health sector performance. The HMIS is limited to priority indicators selected for monitoring progress in the implementation of the BPHS/EPHS. The HMIS does not capture information on notifiable diseases. II. There are limitations to the use of HMIS data. The population denominator is reduced by 25% because it was assumed that 75% of the population only has access to health services. This means that the HMIS does not capture information on 25% of the population, which may or may not have a higher morbidity and mortality thus could lead to over or under reporting of the services statistics or morbidity and mortality.III. The HMIS data quality, completeness, timeliness and accuracy, is validated by a third party which demonstrates accuracy of over 90% , which is almost double that found in Pakistan and Uganda, and similar to China and Mexico. National mortality survey (APHI et al 2010) data validated the trends in service coverage, infant and maternal mortality in HMIS data after accounting for underreporting. page 3
  4. 4. Information flowBelow is a diagram demonstrating the flow of HMIS information across the health sector. The diagramidentifies what forms are to be completed and the feedback and results which should be discussed withineach tier of the health sector. At the last health retreat in 2012 it was identified that there needed to bestrengthening of information sharing for planning and monitoring at Provincial Level. It will be the role ofthe HMIS Officers to ensure the appropriate dissemination of health information to both the community andat the Quarterly Provincial Health Coordination Committee meetings. The HMIS Officers will also need tocoach and mentor health facility staff to use information to improve the health outcomes of the population. National Indicator Analysis Annual Progress Reports Semi-Annual HMIS Report and Conference MoPH Executive Directorates MoPH 1. Facility Codes and Database Departments HMIS 2. Staff Codes and Database Maintains 3. Service Statistics Database UNIT 4. Grants Management Database 5. Training Database 1. Monthly reports by Facility 2. Quarterly reports by Facility 1. Feedback reports (Quarterly) 3. Staff changes in province 2. Reports/information on request 4. Training in province 3. Meetings (Semi-Annual) 5. Grants management reports 4. Supervision visits 6. Ad-hoc reports Analysis for 1. Facility Database Action/ provincial planning 2. Staff Database Maintains PHO 3. Service Statistics Database NGO 4. Grants Mgt. Database Hospitals 5. Training Database 1. Feedback reports (Quarterly) 1. Monthly reports 2. Reports/information on request 2. Quarterly Facility reports 3. Meetings (PHCC Quarterly) 3. Reports from Health Posts 4. Supervision visits 4. Community Survey reports SC/BHC/ CHC/DH Analysis for Health Post Action activity reports Annual Census Health Post Community page 4
  5. 5. Number and type of health facilities Health Facilities by projects: Program BHC CHC DH PH RH SH SHC mobile Other TOT PGC (EC) 178 83 13 5 1 82 13 6 381 HSS/GAVI 76 15 2 93 MoPH 60 24 3 11 3 13 11 3 33 161 Other 111 19 7 2 2 10 63 46 65 325 PCH(USAID) 267 169 27 5 1 70 11 550 SHARP(WB) 196 84 19 5 0 0 170 5 1 480BHC: Basic Health Centre, CHC: Comperhensive Health Centre, DH : District Hosptial, SHC: Sub Health Centre, PH: Provincial Hospital, RH: Regional Hospital, SH: Special Hospital page 5
  6. 6. Number of health facilities by Province-1390: Province BHC CHC DH MC PH RH SH SHC Other Total Badakhshan 33 13 2 21 1 35 5 110 Badghis 24 3 1 1 1 14 44 Baghlan 26 15 2 1 1 17 3 65 Balkh 44 14 5 1 1 1 1 33 6 106 Bamyan 23 10 3 3 1 29 6 75 Dykundi 14 8 2 4 1 13 1 43 Farah 5 11 1 1 17 2 37 Faryab 21 16 2 3 1 14 3 60 Ghazni 37 26 3 1 8 5 80 Ghor 21 8 2 1 1 20 2 55 Helmand 30 14 4 1 11 3 63 Hirat 38 25 4 4 1 25 3 100 Jawzjan 16 7 2 1 1 1 7 2 37 Kabul 74 38 8 10 22 3 26 181 Kandahar 19 20 1 3 1 2 6 52 Kapisa 15 8 1 1 1 15 1 42 Khost 10 12 1 9 5 37 Kunar 21 10 1 1 10 2 45 Kunduz 32 12 1 3 1 17 9 75 Laghman 17 8 2 1 13 1 42 Logar 20 7 2 7 1 6 4 47 Nangarhar 73 19 3 3 1 2 19 6 126 Nimroz 5 2 1 1 7 2 18 Nooristan 11 1 2 10 24 Paktika 18 4 2 1 7 1 33 Paktya 17 8 2 1 11 2 41 Panjsher 9 2 2 1 7 6 27 Parwan 32 10 1 2 1 22 1 69 Samangan 13 5 2 1 1 11 33 Sar-e-Pul 16 8 2 1 1 21 49 Takhar 37 13 3 3 1 15 4 76 Urozgan 7 6 2 1 1 17 Wardak 26 9 3 1 1 18 1 59 Zabul 8 7 1 1 5 22 Grand Total 812 379 69 82 28 6 24 472 118 1990BHC: Basic Health Centre, CHC: Comperhensive Health Centre, DH : District Hosptial, SHC: Sub Health Centre, PH: Provincial Hospital, RH: Regional Hospital, SH: Special Hospital page 6
  7. 7. Number of health facilities by service implementers-1390: Implementer BHC CHC mobile SHC DH PH RH SH Other TOL SCA 66 30 5 58 6 2 2 169 MoPH 61 24 3 11 3 11 3 13 33 161 SM (MoPH) 53 20 3 44 3 2 1 126 HN-TPO 69 37 1 34 5 2 1 2 151 CHA 39 25 4 60 6 1 2 137 BDN 42 31 3 24 5 1 2 108 AADA 37 24 4 21 3 2 91 CAF 53 20 1 9 4 1 88 BRAC 42 19 2 15 5 1 0 84 ACTD 33 14 1 25 3 1 77 SAF 34 23 1 12 4 3 77 AMI 29 17 3 21 2 2 1 75 Other 28 5 4 5 2 1 2 7 14 68 Merlin 27 11 12 11 1 2 64 AHDS 22 27 4 4 1 1 0 59 Kinder Berg 3 1 17 29 4 54 AKDN 18 8 1 23 1 1 1 53 ARCS 43 8 1 1 53 IMC 35 5 5 4 1 1 1 52 MRCA 18 7 2 5 2 1 1 36 Move 21 2 8 1 0 32 Ibn Sina 6 8 1 11 1 3 30 SDO 12 11 3 2 1 29 Emergency 2 1 20 23 DAC 8 2 8 1 1 20 CWS 7 2 7 0 16 STEP 1 1 7 0 9 MSI 3 6 9 HADAAF 7 0 7 Wadan 1 6 7 SHUHADA 1 4 1 0 6 LEPCO 5 5 AKHS 3 1 1 0 5 IAM 2 2 4 AIL 3 1 0 4 ToT 812 379 82 472 69 28 6 24 118 1990 page 7
  8. 8. HMIS Report submission:  94% of health facilities in Afghanistan submit their MIAR.  12447 health posts submitted their HMIS reports HMIS Submission 1390 Submission MIAR 94% FSR 89% HMIR 81% HSR 81% Number of health facilities submitting MAAR 1049 Number of health posts submitted MAR 12447Submission rate for Monthly Integrated Activity Report (MIAR):  The BPHS including SHC, BHC, CHC, DH had the highest MIAR submission in 1390. The lowest rate belonged to special hospitals (SH).  Among HMIS forms MIAR had the highest submission rate.  Mobile health facilities had the lowest FSR submission.  District hospitals had the highest rate of HSR submission in 1390. HMIS Report Submission By Type of Health Facility 98% 100% 94% 93% 91% 89% 90% 90% 81% 80% 70% 60% MIAR 50% FSR 40% HMIR 31% 30% HSR 20% 10% 0% BHC CHC DH SHC mobile PH RH SH BHC: Basic Health Centre, CHC: Comperhensive Health Centre, DH : District Hosptial, SHC: Sub Health Centre, PH: Provincial Hospital, RH: Regional Hospital, SH: Special Hospital page 8
  9. 9. HMIS Reports Submission by Province in 1390:Noorstan , Dykundi, Logar, Samangon, Paktya and Kunar had the highest HMIS reports submission. Provinces %MIAR % FSR % HSR %HMIR % MAAR # MAR Badakhshan 100% 87% 100% 100% 100% 417 Badghis 84% 81% 100% 100% 78% 310 Baghlan 94% 92% 100% 100% 92% 607 Balkh 93% 89% 63% 100% 84% 799 Bamyan 100% 83% 75% 98% 100% 406 Dykundi 94% 97% 100% 100% 100% 321 Farah 87% 100% 100% 100% 94% 369 Faryab 100% 89% 100% 100% 93% 513 Ghazni 92% 89% 75% 100% 88% 750 Ghor 98% 98% 100% 100% 77% 409 Helmand 93% 95% 60% 57% 77% 429 Hirat 98% 85% 100% 100% 78% 1010 Jawzjan 99% 97% 75% 100% 92% 333 Kabul 72% 43% 33% 44% 30% 420 Kandahar 100% 89% 100% 100% 74% 476 Kapisa 97% 92% 100% 100% 60% 169 Khost 99% 97% 100% 75% 97% 304 Kunar 97% 90% 100% 100% 100% 251 Kunduz 95% 92% 100% 100% 93% 318 Laghman 100% 98% 100% 75% 99% 277 Logar 94% 98% 100% 100% 100% 153 Nangarhar 88% 84% 83% 99% 84% 839 Nimroz 100% 100% 100% 100% 86% 105 Nooristan 92% 100% 100% 100% 100% 140 Paktika 95% 79% 100% 100% 83% 188 Paktya 97% 94% 100% 100% 96% 305 Panjsher 100% 89% 50% 67% 85% 115 Parwan 100% 100% 100% 100% 70% 336 Samangan 96% 93% 100% 100% 100% 140 Sar-e-Pul 98% 96% 100% 100% 93% 264 Takhar 99% 94% 100% 100% 94% 480 Urozgan 94% 100% 100% 100% 77% 185 Wardak 93% 94% 75% 94% 83% 156 Zabul 91% 90% 50% 100% 89% 154Monthly Aggregated Activity Report (MAAR) Submission Rate:Excluding Kabul province, Kapisa health facilities have the lowest health post and MAAR submission. % of Health Facilities Submit MAAR _ 1390 100% 80% 60% 40% 20% 0% Ghazni Kabul Hirat Baghlan Bamyan Helmand Kunar Kunduz Urozgan Zabul Balkh Kapisa Laghman Paktika Paktya Samangan Takhar Badghis Sar-e-Pul Kandahar Badakhshan Ghor Jawzjan Nimroz Panjsher Wardak Dykundi Khost Logar Nooristan Parwan Farah Faryab Nangarhar page 9
  10. 10. Linkages with other systemsCurrently the MoPH HIS databases are at the level that allows departments to easily search and extract datafrom their own databases or to do other queries using a common link.The MoPH HMIS database is the “common” database through which other departmental databases interactwith the core system. The MoPH HMIS Department is to take the technical lead in facilitating databasedevelopment. The diagram below briefly demonstrates the link between a number of the databases and theHMIS common database.Some of the databases being used in the MoPH include the M&E database, HMIS, DEWS, EPI database, HRdatabase, Procurement database, Expenditure Management Information System and Payroll system. Theseneed to be integrated, wherever feasible technically and required operationally, and brought under one datacentre control via a database warehouse. Improving connectivity to the database at provincial level will alsobe a priority of the MoPH. page 10
  11. 11. MoPH Priority Health Problems and Indicators:Health service policy for the national level is set at the central level by a mandatory minimum package ofhealth services, the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services(EPHS). In 2010, the MoPH identified key health indicators which could be used to measure progress againstthe key priority areas. This section reviews progress against some of those indicators.Below are the results of the most recent LQAS Household Survey conducted in USAID and EC provinces. Figure 2: Summary of PGC Household Survey 2011 page 11
  12. 12. 1. Reproductive HealthThis section covers important indicators for reproductive health include the provision and use ofcontraceptives, the provision of TT2, institutional deliveries and caesarian section rates.Percentage of service delivery points providing FP counseling and/or FP products:Less than 80% of health facilities in the following provinces are providing FP services: Farah,Helmand , Kabul, Kapisa , Panjsher and Zabul. Availability of Modern Contraceptive at Health Facilities (1390) 120% 100% 80% 60% 40% 20% 0% Zabul Nimroz Kapisa Laghman Panjsher Bamyan Kabul Khost Sar-e-Pul Urozgan Helmand Samangan Ghazni Kunar Parwan Badghis Hirat Paktika Farah Logar Wardak Balkh Dykundi Faryab Ghor Jawzjan Kandahar Takhar Badakhshan Paktya Baghlan Kunduz Nangarhar NooristanWomen Receiving TT2A woman receiving two or more injection of tetanus toxoid (TT2 or more) during pregnancy is an importantindicator of ANC service and preventing neonatal tetanus. Percentage of pregnant women receiving two ormore TT injections under HMIS data was close to that of the AMS findings as evidenced in the table below.In addition, the regional distributions of TT2 or more were also similar in HMIS and AMS, indicating thatAMS findings validate HMIS data. Percentage distribution of TT2 or more coverage, contraceptive use by regions in AMS 2010, HMIS 2010 and NRVA 2007-08 Domains TT2 or more coverage % Contraceptive use CYP 2010 is comparable to following % of % women using contraceptive for a year AMS HMIS NRVA AMS NRVA HMIS- CYP North 60 74 13 255948 19 Central 44 42 31 420282 22 page 12
  13. 13. South 47 53 15 338386 23 Total 50 55 33 20 15 1014617 22Number of Functional Emergency Obstetric Care (EmOC) Units:Emergency obstetric signal functions are defined as:  Administration of parenteral antibiotics;  Administration of parenteral oxytocic drugs;  Administration of parenteral anticonvulsants for pregnancy-induced hypertension;  Performance of manual removal of placenta;  Performance of removal of retained products (e.g. vacuum aspiration);  Performance of assisted vaginal delivery (e.g. ventouse, forceps);  Performance of surgery (e.g. Cesarean section); and  Performance of blood transfusion.Facilities are divided into those that provide „basic‟ emergency obstetric care (EmOC) and „comprehensive‟EmOC. If a facility has performed each of the first 6 functions, it qualifies as providing basic EmOC. If it hasprovided all 8 of the functions, it qualifies as a „comprehensive‟ EmOC facility. Comp. Basic Comp. Basic Provinces EmOC EmOC Provinces EmOC EmOC Badakhshan 2 56 Kunar 1 23 Badghis 2 19 Kunduz 1 53 Baghlan 3 50 Laghman 1 15 Balkh 5 74 Logar 3 20 Bamyan 3 34 Nangarhar 4 62 Dykundi 1 23 Nimroz 1 6 Farah 3 22 Nooristan 1 9 Faryab 6 33 Paktika 4 9 Ghazni 3 45 Paktya 3 21 Ghor 3 14 Panjsher 1 12 Helmand 3 24 Parwan 1 40 Hirat 6 37 Samangan 3 20 Jawzjan 2 27 Sar-e-Pul 3 33 Kabul 6 38 Takhar 4 54 Kandahar 2 28 Urozgan 1 9 Kapisa 1 8 Wardak 2 27 Khost 1 16 Zabul 1 9 page 13
  14. 14. Proportion of Institutional DeliveriesThe proportion of births delivered in facilities with basic or comprehensive EmOC.Caesarian Section Rate:The Caesarian section rate is the proportion of pregnant women who have a cesarean section in a specificgeographical area and time period. This indicator demonstrates the extent to which a particular life-savingobstetric service is being performed in EmOC facilities. It reflects the availability, accessibility and utilizationof services as well as the functioning of the health service system. The appropriate use of a cesarean sectionleads to a decrease in maternal mortality and morbidity, as well as decreasing perinatal morbidity andmortality. While cesarean sections may be performed solely for the health of the fetus or newborn,UNICEF/WHO/UNFPA recommend a C-section rate between 5 and 15 per cent of all births, based onestimates from a variety of sources. Rates less than 5 per cent may indicate inadequate availability and/oraccess to EmOC.Helmand, Kapisa, Faryab, Badghis, and Laghman had the lowest caesarian section rate in 1390. Kabul , Hirat,and Balkh had the highest caesarian section rate. page 14
  15. 15. Caesarian Section Rate (1390/2011) 6.0% 4.9% 5.0% 4.4% 3.7% 4.0% 3.0% 2.3% 2.2% 2.2% 2.0% 2.0% 1.4% 1.5% 1.2% 0.9% 1.1% 1.0% 0.9% 1.2% 0.8% 0.6% 0.8% 0.7% 0.7% 0.5% 1.0% 0.1% 0.4% 0.1% 0.0% Khost Hirat Kunduz Kabul Dykundi Kapisa Wardak Paktika Faryab Kunar Sar-e-Pul Farah Logar Nimroz Ghazni Parwan Helmand Zabul Urozgan Laghman Takhar Baghlan Paktya Bamyan Panjsher Badghis Ghor Balkh Jawzjan Badakhshan Nangarhar Samangan KandaharPostnatal Care (PNC):The first hours, days and weeks after childbirth are a dangerous time for both mother and newborn infant.Among women who die each year due to complications of pregnancy and childbirth, most deaths occurduring or immediately after childbirth. Care in the period following birth is critical not only for survival butalso to the future of mothers and newborn babies. Major changes occur during this period that determinetheir well-being and potential for a healthy future. Postpartum care for the mother has focused on routineobservation and examination of vaginal blood loss, uterine involution, blood pressure and body temperature.Similarly, postnatal care for the baby has focussed on cord care, hygiene and weight monitoring and feedingand/or immunizations.Over-reporting is seen in Logar, Nangarhar, Khost and Kapisa provinces. % PNC_1390 160% 140% 120% 100% 80% 60% 40% 20% 0% Khost Kunduz Hirat Kabul Dykundi Kapisa Wardak Kunar Logar Nimroz Sar-e-Pul Farah Ghazni Paktika Parwan Faryab Helmand Laghman Urozgan Baghlan Paktya Zabul Nooristan Ghor Takhar Balkh Bamyan Jawzjan Panjsher Badghis Badakhshan Nangarhar Samangan Kandahar page 15
  16. 16. 2. Child Health This section covers important indicators for child health including diarrhea and pneumonia cases, trendsimmunization and malnutrition.Diarrhea and Pneumonia CasesAcute respiratory infections, diarrheal diseases, malnutrition, neonatal tetanus and measles are the maincauses of death among children aged 0-59 months in Afghanistan. A review of data reveals diarrhea iswidespread throughout the year with an increase in the number of cases started from May, reaching thehighest levels in the months of June, July and August and gradually decreasing again from the month ofSeptember onwards  Kunar, Laghman, Nangarhar, and Nimroz had the highest rate of diarrhea and pneumonia cases per under 5 population in 1390. # of Diarrhea and Pneumonia Cases in Children Less than 5 Y per 1000 population (U 5Y) 1500 1000 500 0 Samang… Noorist… Nangar… Badakh… Badghis Hirat Laghman Ghor Ghazni Logar Faryab Baghlan Kapisa Nimroz Paktya Helmand Urozgan Sar-e-Pul Paktika Farah Dykundi Takhar Kabul Kunar Jawzjan Wardak Zabul Khost Bamyan Kandahar Balkh Parwan Panjsher Kunduz Diarrhea Pneumonia  Nangarhar, Kabul, Badakhshan and Kandahar had highest numbers of pneumonia and diarrhea cases in 1390.  More than 240000 cases and 160000 cases are seen in Nangarhar and Kabul health facilities. # of Pneumonia and Diarrhea Cases (1390/2011) 260000 240000 220000 200000 180000 160000 140000 120000 100000 80000 60000 40000 20000 0 Takhar Logar Sar-e-Pul Nimroz Zabul Panjsher Kabul Khost Urozgan Samangan Parwan Kapisa Ghor Faryab Ghazni Kunar Wardak Badghis Paktika Hirat Helmand Farah Dykundi Jawzjan Badakhshan Nangarhar Balkh Baghlan Kunduz Kandahar Bamyan Laghman Nooristan Paktya Diarrhea cases Pneumonia cases page 16
  17. 17.  Acute Respiratory Infection (ARI) and Diarrhoea Disease (DD) contribute to 40% of all OPD consultation.  29 % of consultations are due to ARI and 11% due to diarrhoea diseases Proportion of All DD and ARI among all OPD cases in 1390 Diarrhea Diseases 11% ARI 29% Other Cases 60%Immunization Coverage:The following graphs indicate that trends in immunization have not substantially increased despite increasesin deliveries at health facilities. This could represent a missed opportunity to encourage vaccination amongstmothers of newborns. HMIS Department, MoPH 06/24/2012 10 page 17
  18. 18. Measles:Nangarhar, Kabul, Khost, Kandahar, Ganzni, Kunar , Helmand and Paktya had the highest cases of measlesin 1390. # of measles cases-1390 (2011) 2000 1500 1000 500 0 Hirat Nooristan Laghman Logar Faryab Ghor Ghazni Urozgan Baghlan Paktya Helmand Samangan Paktika Nimroz Dykundi Kapisa Farah Takhar Kabul Nangarhar Zabul Khost Sar-e-Pul Wardak Parwan Bamyan Jawzjan Kunar Balkh Panjsher Badghis Kandahar Badakhshan KunduzLow Birth Weight:Malnutrition:In Afghan preschool children 6-59 months, 54% (39.9-60%) are suffering from stunting and 7 % fromwasting (Acute Malnutrition). This level of stunting or chronic malnutrition is the highest level in the world .The WHO classifies Afghanistan as country with “very high” prevalence of chronic malnutrition. page 18
  19. 19.  In terms of percentage, Panjsher, Sar e Pul, Kunar , Zabul, Bamyan and Paktya provinces show a high % of acute malnutrition. % of Acute Malnutrition (# of Cases/U 5Y population) 1390 30% 25% 20% 15% 10% 5% 0% Panjsher Helmand Nimroz Kabul Khost Sar-e-Pul Zabul Faryab Kapisa Ghazni Parwan Urozgan Samangan Badghis Hirat Farah Kunar Paktika Logar Wardak Dykundi Ghor Jawzjan Takhar Badakhshan Nooristan Baghlan Balkh Kandahar Paktya Kunduz Bamyan Laghman Nangarhar  In terms of absolute numbers Badakhshan, Baghlan, Faryab, Hirat, Kabul, Kunar, Kundoz, Nangarhar , Paktya and Sur e pul have the highest acute malnutrition cases in 1390. # of Acute Malnutrition by Province1390 25000 20000 15000 10000 5000 0 Panjsher Helmand Nimroz Kabul Khost Sar-e-Pul Zabul Kapisa Badghis Parwan Urozgan Farah Ghazni Hirat Kunar Paktika Samangan Logar Wardak Dykundi Faryab Ghor Jawzjan Takhar Badakhshan Paktya Baghlan Balkh Kandahar Kunduz Bamyan Laghman Nangarhar Nooristan3. TuberculosisTB is a major public health and development challenge in Afghanistan. The country is one of 22 TB high-burden countries in the world. The World Health Organization estimates that every year in Afghanistan, morethan 53 000 new cases of TB occur and more than 10,500 people die because of this curable disease. Women,already a vulnerable group in Afghanistan, account for 66% of cases. page 19
  20. 20. TB detection rate (from HMIS): TB Detection 1390 1 0.8 0.6 0.4 0.2 0 Sar-e-Pul Jawzjan Kandahar Wardak Nimroz Zabul Kapisa Panjsher Kabul Khost Helmand Paktika Samangan Urozgan Faryab Ghazni Kunar Parwan Badghis Hirat Logar Dykundi Farah Balkh Ghor Takhar Badakhshan Baghlan Bamyan Laghman Paktya Kunduz Nangarhar Nooristan4. Service WorkloadAverage New Out Patient Department per Month by Type of Health FacilityAmong BPHS health facilities district hospitals (DH) had the highest average OPD per month in 1390. New OPD Per Month by Type of HF 1390 6000 5276 5000 4000 3000 2341 2000 1369 1291 814 1000 0 Mobile Sub Center BCH CHC DHOPD per Capita by province:Consultation rates varied markedly by province, ranging from 2.6 in Logar to 0.8 in Kandahar. page 20
  21. 21. Trend of Patients/Clients per Month per Health Facility in last 8 Years:There has been a 95% increase in average number of Patients/Clients per month per health facility: Average Number of Patients/Clients per month per Health Facility 2000 1800 1878 1735 1779 1773 Number of visited cases 1600 1400 1404 1200 1275 1138 1000 960 800 600 400 200 0 Y 83 Y 84 Y 85 Y 86 Y 87 Y 88 Y 89 Y 90 Last 8 past yearsNumber of admissions by type of hospital  Provincial hospital had the highest admission in 1390 but bed turn over shows Regional Hospital and after District Hospital had higher bed turn over.  Overall 1378388 patients were admitted in Afghanistan hospitals during 1390. page 21
  22. 22. # Of Admissions by Type of Hospital (1390/2011) SH, 246358, 18% DH, 331089, 24% RH, 392424, 28% PH, 408517, 30%Bed Turnover Rate:Bed turnover rate is a measure of the extent of hospital utilization. It is the number of times there is a changeof occupant for a bed during a given time period. It is given by the formula:  Hospital bed turnover rate = Number of discharges (including deaths) in a given time period / Number of beds in the hospital during that time period Bed Turnover Per Month 12.0 9.8 10.0 8.0 7.5 6.9 6.0 4.0 2.0 0.0 DH PH RH page 22
  23. 23. Bed occupancy rate in hospitals:The occupancy rate is a calculation used to show the actual utilization of an inpatient health facility for agiven time period. Bed occupancy rates have been proposed to reflect the ability of a hospital to provide safeefficient patient care. A good hospital works well when bed occupancy rates are between 60 and 80%. Thiscreates the flexibility that is good for patients.By type of hospital: Regional hospitals are over-occupied. Bed Occupancy Rate by Type of Hospital 1390 120% 102% 100% 79% 80% 60% 62% 60% 40% 20% 0% DH PH RH all TyepBy province: Badakhshan, Baghlan, Jawzjan, Kandahar and Kunar hospitals are over-occupied Bed Occupancy Rate 1390 180% 160% 140% 120% 100% 80% 60% 40% 20% 0% Logar Takhar Nimroz Sar-e-Pul Zabul Kabul Khost Kapisa Panjsher Badghis Ghor Ghazni Parwan Urozgan Helmand Paktika Samangan Hirat Farah Faryab Kunar Wardak Dykundi Jawzjan Badakhshan Baghlan Balkh Kandahar Kunduz Nooristan Bamyan Laghman Nangarhar Paktya page 23
  24. 24. Consultation per Health Post per MonthZabul, Laghman , Nooristan and Kunar had the lowest figure for this indicator in 1390. Badghis, Faryab,Jawzjan and Farah had the highest figure for this indicator in 1390. Average Patient seen by HP Per Month -1390 140 121 122 111 117 120 95 100 100 91 90 92 86 87 92 74 77 75 80 67 70 68 59 60 60 53 41 43 46 45 37 31 40 30 33 26 18 13 14 20 11 0 Nimroz Kapisa Panjsher Sar-e-Pul Zabul Bamyan Kabul Khost Samangan Ghazni Helmand Kunar Urozgan Badghis Paktika Parwan Hirat Logar Wardak Farah Faryab Ghor Jawzjan Badakhshan Balkh Dykundi Kandahar Nangarhar Takhar Baghlan Paktya Kunduz Nooristan Laghman5. Mental Health ServicesThe following map shows utilization of mental health services by province. Mental health services are lessutilized in north, northeast and central region. page 24
  25. 25. 6. Staffing (by facility type)Proportion of health facilities with at least one female health worker: Proportion of HF with At Lest One Female Health Worker_1390 100% 80% 60% 40% 20% 0%Province population per clinical health worker:Province BPHS facility per Province BPHS facility perName 10000population Name 10000populationBadakhshan 1,18 Kunar 0,95Badghis 0,93 Kunduz 0,66Baghlan 0,70 Laghman 0,98Balkh 0,81 Logar 1,12Bamyan 1,67 Nangarhar 0,82Daykuni 0,95 Nimroz 1,08Farah 0,62 Nuristan 1,88Faryab 0,72 Paktika 0,79Ghazni 0,69 Paktya 0,76Ghor 0,85 Panjshir 1,60Hilmand 0,67 Parwan 1,16Hirat 0,55 Samangan 0,94Jawzjan 0,66 Sar-i- Pul 0,94Kabul 0,32 Takhar 0,77Kandahar 0,44 Urozgan 0,40Kapisa 0,99 Wardak 1,02Khost 0,58 Zabul 0,77 page 25
  26. 26. Registered health workers (from HR database):Physicians per 10,000 populationMidwives per 10,000 population page 26
  27. 27. Availability of recommended staffing according to BPHS and EPHS:Although there were almost 2, 000 graduated community midwives from various training programs (CMEsand IHSs) there remain concerns with the employment and retention of those newly graduated within thehealth sector. Trainees are selected by provincial teams. There may need to be a stronger selection process ofcandidates. Human Resource in Health Sector (1390/2011) Dentist Anesthesia Nurse Radiography Technician Dental Technician Pharmacist Pharmacy Technician Other Male Lab Technician Female Vaccinator Midwife Administration Nurse Doctor Suppor Staff 0 2000 4000 6000 80007. Infrastructure, Utilities and Transport  27% of BHC, 14% of CHC and 8% of DH are in temporary buildings.  24% of BHC , 5% of CHC and 2% of DH didn‟t have electricity at all in 1390  50% of BHC, 57% CHC and 72% of DH had appropriate waste disposal system.  13% of DH had no ambulance transportation in 1390. page 27
  28. 28. Infrastructure, Utilities and Transport-1390 for BPHS Facillities (BHC, CHC, DH) 100% 87% 90% 76% 80% 71% 72% 73% 64% 70% 54% 57% 58% 60% 50% 50% 40% 27% 28% 30% 14% 20% 20% 8% 14% 4% BHC 10% 0% CHC DH % BPHS Facilities (BHC, CHC , DH) with Temporary Building - 1390 70% 62% 60% 55% 45% 47% 50% 42% 38% 40% 31% 27% 29% 26% 31% 32% 30% 22% 23% 27% 30% 18% 17% 20% 11% 13% 13% 14% 18% 10% 10% 11% 14% 9%8% 8% 10% 4% 0%0% 0% 0% Sar-e-Pul Badakhshan Dykundi Ghor Faryab Balkh Khost Baghlan Ghazni Helmand Laghman Logar Nooristan Hirat Nimroz Paktya Urozgan Paktika Samangan Kabul Kapisa Farah Kunar Nangarhar Wardak Bamyan Kandahar Takhar Badghis Jawzjan Panjsher Parwan Zabul KunduzFunctioning laboratory:Blood transfusion capacity existed only in a minimum number of health facilities in Parwan , Bamyan, Zabul,Wardak and Panjsher provinces. % of HF with % of HF with % with Blood % with Blood functional Transfusion functional Transfusion Province Lab capacity Province Lab capacity Badakhshan 44% 28% Kunar 50% 42% Badghis 44% 7% Kunduz 49% 20% Baghlan 46% 19% Laghman 48% 22% page 28
  29. 29. % of HF with % of HF with % with Blood % with Blood functional Transfusion functional TransfusionProvince Lab capacity Province Lab capacity Balkh 21% 7% Logar 33% 33%Bamyan 39% 4% Nangarhar 67% 18%Dykundi 22% 12% Nimroz 31% 6% Farah 33% 20% Nooristan 63% 42% Faryab 41% 14% Paktika 48% 16% Ghazni 39% 33% Paktya 43% 13% Ghor 19% 8% Panjsher 28% 5%Helmand 35% 15% Parwan 25% 1% Hirat 38% 16% Samangan 26% 21% Jawzjan 48% 17% Sar-e-Pul 28% 10% Kabul 65% 10% Takhar 32% 25%Kandahar 62% 7% Urozgan 65% 41% Kapisa 35% 10% Wardak 31% 5% Khost 42% 25% Zabul 32% 5% Availability of Functional Lab and Transfusion Capacity in Health Facility- 1390 80% 60% 40% 20% 0% Kapisa Kunar Nimroz Panjsher Kabul Khost Sar-e-Pul Zabul Ghazni Helmand Parwan Urozgan Badghis Hirat Paktika Samangan Farah Logar Wardak Dykundi Faryab Ghor Jawzjan Takhar Badakhshan Paktya Baghlan Balkh Bamyan Kandahar Kunduz Laghman Nooristan Nangarhar % with functional Lab % of HF with Blood Transfusion capacity page 29
  30. 30. Blood Transfusion Reaction Rate:Samangan , Wardak , Paktika and Jawzjan experience a high rate of transfusion reaction. Blood Transfusion Reaction Rate (average per month in 1390) 4.00% 3.50% 3.00% 2.50% 2.00% 1.50% 1.00% 0.50% 0.00%Stock Out of Essential Drugs:Based on HMIS data essential drug stock out had a steady decrease from 1383 to 1390. % of BPHS HFs with at least One Essential Drug Stock Out 80 76 73 62 63 59 60 55 Y 1383 Y 1384 Y 1385 Y 1386 Y 1387 Y 1388 Y 1389 Y 1390 page 30
  31. 31. 8. Conclussion:Information to be of use needs to be discussed and shared. Some recommendations could be to reviewreferral practices between primary and tertiary care settings, to review in more detail the shifts in the burdenof disease within and between communicable and non communicable diseases, determine how better tostrengthen pharmaceutical supply and examine why new female graduates are not being retained or employedn the health sector. page 31

×