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Afghanistan National Hospitals Policy_Workshop_19 Oct 09

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  • Dear Desmukh, as we cooperate with hospitals in Kabul this is a valuable insight into hospital development policy. Could you, please, send your ppt-slides to albrecht.kasper@albertinen.de? with regards - Albrecht Kasper
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  • Dear Desmukh, could you please send these slides to email address?

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  • 1. Policy and Guidelines for National Hospitals – 1 st Discussion Document Consensus Building Workshop 19th - 20th October 2009 - Dr. Michael Niechzial and Dr. Amol Deshmukh Support to Institutional Development Project Islamic Republic of Afghanistan, MOPH / EU
  • 2. Workshop Objective
    • Discuss, debate and recommend content
    • Resulting in
      • ‘ Policy on National Hospitals’
      • ‘ Strategic and Operational Plan for National Hospitals’
      • ‘ Minimum Requirements for National Hospitals’
  • 3. Workshop Outcome
    • Definition and Role
    • Policy
    • Guidelines for Strategic and Operational plans
    • Guidelines for Minimum Requirements
    • Recommend Hospitals - prioritisation and phasing if required
    • Establishing ‘National Hospitals Responsibility Team’and their ToR / Work Plan
  • 4. Challenges of Hospital Sector in Afghanistan
    • General Hospital Sector
      • Resource variation, utilisation, dependence and role of donors
      • Medical Supplies
      • Management – General, Financial and HR
      • Nursing
    • Potential National Hospitals / Tertiary Care Sector
      • Unorganised sector and unequal access for patients
      • Trained Human Resources
      • Quality of Care
    • Others
      • Categorisation of Kabul Hospitals
      • Bed requirement in Kabul
  • 5. Need for Tertiary Care and National Hospitals
    • Balance between primary, secondary and tertiary
    • Requirement as per HNSS: Strategy 2.1
    • Emergency Medical Services
    • Resource optimisation
    • Training healthcare professionals
  • 6. Definition and Role
    • Be Centres of Excellence in the respective speciality/specialities
    • Provide Evidence Based Medicine and guide other hospitals
    • Capacity building of healthcare professionals
    • Support MOPH in National Health Programs
    • Establish International linkages for academic and clinical excellence
  • 7. Autonomy
    • Legal framework to establish independent hospital entity e.g. trust
    • Establishment of Hospital Boards
    • Memorandum of Understandings with reputed international hospitals or hospital groups for supporting the National Hospitals
    • Establishing organisation for centrally directing and monitoring the professional training courses
    • Study the process of transfer of human resources from the Government rolls to the autonomous bodies.
    • Study and recommend accounting and finance systems to be adopted and implemented by autonomus bodies/hospitals
    • Option of MOPH establishing a autonomy unit and task force to mange the whole process.
  • 8. Recommending Guidelines for developing Min. Standards
    • To be developed speciality wise
    • To include essential requirements for each speciality
    • In line with the guidelines which are of high priority
    • Proposed general structure:
      • Emergency Medical Services and Ambulance
      • Staffing and Staff Performance
      • Financial Performance Requirements
      • Audits - Internal and External Financial
      • Infrastructure Requirements
        • PG Training centre
        • Bed Strength
      • Equipment Requirements (Speciality wise)
      • Drugs and consumables
      • Quality of care
      • Professional Education and Training requirements
  • 9. Guidelines and Minimum Requirement (Standards) High Qualifications required and selection of Medical, Nursing and Administration Directors 11 High Selection of Medical Director, Nursing Director & Director admin 10 High Essential committees to be functional in Hospitals 9 High Availability of essential supplies and medicines 8 Low Involvement of communities 7 High Donors supporting National Hospitals 6 Medium Cross utilisation of services between hospitals 5 Effective and efficient utilisation of resources like staff, budgets, beds and equipments 4 Low Annual Hospital Plans and conformity to the plan 3 High Governance and Autonomy to National Hospitals 2 Component II: Governance and Hospital Management High Licensing, Registration and Accreditation of National Hospitals 1. Component I: Licensing, Registration and Accreditation Prioritisation Guidelines No.
  • 10. Guidelines and Minimum Requirement (Standards) Medium Developing budgets & conformity to planned budgets 19 Medium Cash management, accounting standards, & financial audits 18 High Regulatory framework for financing, revenue generation and expenditure 17 High Financial management of National Hospitals 16 Component V: Financial Management Medium Planning annual hospital HR plan and conformity to the plan 15 Medium Minimum staffing requirements 14 Medium Minimum Requirements for Hospital Management Staff 13 Component IV: HR Management High Professional Training & Education for Medical, Nursing, Technicians & Management Staff 12 Component III: Professional Training and Education Prioritisation Guidelines No.
  • 11. Guidelines and Minimum Requirement (Standards) Medium Integration of National Hospitals into a national / regional referral system 27 Component VII: Integration into referral system High Essential Equipments, Supplies, and Drugs & Consumables 26 Medium Medical Record & HMIS 25 High Nursing Administration & Management; provision of uniform Nursing care; and Nursing care SOPs’ 24 High Diagnostic Services 23 Medium Clinical guidelines & protocols 22 High Infection Control & environmental hygiene 21 High Essential patient safety norms 20 Component VI: Quality of Clinical and Support Services Prioritisation Guidelines No.
  • 12. ToR for National Hospitals Responsibility Team
    • Study recommended National Hospitals
    • Study on Autonomy
    • Develop drafts for submission
      • ‘ Policy for National Hospitals’
      • ‘ Strategic and Operational Plan for National Hospitals’
      • ‘ Minimum Requirements for National Hospitals’
    • Other work as required
  • 13. Recommended Hospitals
    • General National Hospitals
      • Eastern Region / Kabul: Jumhoriat Hospital
      • Western Region / Herat:
      • Northern Region / Mazar-e-Sharif:
      • Southern Region / Kandahar: Mirwais Hospital
      • Central Region / Chagcharan: ?(Provincial Hospital)
    • Specialised National Hospitals
      • For Emergency Health Services: Ibn Sina Emergency Hospital
      • For Trauma & Orthopaedics: Wazir Akbar Khan Hospital
      • For Paediatrics: Indira Gandhi Institute of Child Health
      • For Obstetrics & Gynaecology: Malalai Hospital
      • For Ophthalmology: NOOR Eye Hospital
      • For Pulmonology and Cardiac Sciences: Ibn-Sina Chest Hospital
      • For Psychiatry: Mental Hospital
      • For Dentistry and Maxillofacial Surgery: Stomatology Hospital
      • For Burns and Plastic Surgery: Esteqlal Hospital
      • For Infectious Diseases: Antoni Hospital
  • 14. Recommended Hospitals
    • Hospitals suggested for status of secondary level care (EPHS):
      • Ataturk Hospital
      • Ehayi Mo Jadad Hospital
      • Kair Khana Hospital
      • Rabia Balkhi Hospital
      • The above shortlisted hospitals should further undergo prioritisation and phasing in view of sound allocation of resources in phased manner to develop the National Hospitals.
  • 15. Guidelines for the Establishment and Operation of National Hospitals
    • The National Hospitals of Afghanistan will provide tertiary care services as part of the comprehensive referral network of the health system.
    • The role of National Hospitals, as part of a unified national health system, will be:
      • To develop as Centres of Excellence in the respective specialities
      • To provide Evidence Based Medicine and guide other hospitals
      • To provide professional training for healthcare professionals
      • To support MOPH in National Health Programs
    • To establish international linkages for academic and clinical excellence
    • The National Hospitals must be rationally distributed so their services are accessible on an equitable basis for the entire population. The National Hospitals should collectively provide services in all specialities as per the disease prevalence and load.
    • The MOPH will carry out a detailed analysis and recommend Hospitals in Kabul, Regional Hospitals, and others for conferring status of National Hospital. The recommendation should include the resource planning for the hospitals including its recommendation on granting autonomy.
    The Draft Policy Statement
  • 16. Guidelines for the Establishment and Operation of National Hospitals
    • Emergency medical services for life threatening diseases should be provided as per need. The MOPH will recommend services which will be subsidised (completely or partially) by the government and those which will be paid for by the patients.
    • The MOPH will develop licensing and registration requirements for National Hospitals which will include minimum requirements (standards). Private hospitals and hospitals not under the MOPH can also be conferred the National Hospital status provided they satisfy the licensing and registration requirements.
    • The National Hospitals must undergo national accreditation within one year and international hospital within three years of acquiring National Hospital status. The accreditation standards should ensure financial, administrative and clinical efficiency and effectiveness so as to provide quality care to all patients.
    • The MOPH will develop and implement strategies, strategic plans and operational plans to achieve the desired outputs of the above mentioned policies. These should include the following areas:
      • Licensing, Registration and Accreditation
      • Governance and Hospital Management
      • Professional Training and Education
      • HR Management
      • Financial Management
      • Quality of Clinical and Support Services
      • Integration into the national referral system
  • 17. THANK YOU!
  • 18. Progress Milestones
    • June 2008 - Theme for Policy Presented
    • August 2008 - Guidelines for Policy Presented
    • 3 rd August 2009 - First draft of document Presented
    • Now Oct 2009 - Finalise Recommendations
    • End Oct 2009 - Submit second / final draft