The document provides an overview of healthcare facilities and services in Parwan and Kapisa provinces of Afghanistan. In Parwan, various legacy facilities have been built by public and private entities, but the facilities are not well coordinated. The provincial budget requests funding for only two new Basic Healthcare Centers. Several other priority projects, like upgrading a hospital, are not included in the budget. Health facilities in Parwan are understaffed, with only 59% of the required minimum staffing levels. In Kapisa, the budget requests funding for two new district hospitals, but several other priority projects are not budgeted. Health facilities are also understaffed at 55% of required minimum levels. Both provinces face challenges in ensuring healthcare facilities are properly supplied
The document provides an overview of the Medical Department of the Navy. It describes the roles and responsibilities of the Chief of the Bureau of Medicine and Surgery and their staff in ensuring personnel and material readiness. It discusses the different components of the Medical Department including the Medical Corps, Dental Corps, Nurse Corps, and Hospital Corps. It also summarizes the responsibilities of the various assistant chiefs and divisions that oversee functions like health care operations, logistics, personnel management, and plans/evaluation. Finally, it briefly outlines policies regarding medical treatment facilities, off-duty employment, court testimony, and ambulance usage.
Ajay Kurude has over 27 years of experience working as a nurse, paramedic, and occupational health nurse. He currently works for Qatar Petroleum Healthcare Department, where his responsibilities include providing emergency medical care, managing the occupational health center, and conducting training programs. Previously, he worked for Relene Petrochemicals and Kharafi National Company/KBR, where he was responsible for occupational health services, emergency response, and safety management. He has extensive training in areas such as ACLS, PHTLS, and NEBOSH.
Troy Stockman is a healthcare leader seeking a new leadership role. He has over 25 years of experience in healthcare administration, including managing physician practices, designing new hospitals, and leading regional service lines. His resume summarizes his roles as CEO of a spine hospital and director of neuroscience and diagnostic services. He demonstrates expertise in areas like population health, EHR implementation, and quality programs.
The document summarizes an interview with the Chief of Party/Project Director of the HSFR/HFG Project in Ethiopia.
In the past fiscal year, the project focused on consolidating first generation health care financing reforms and preparing for universal health coverage through activities like building implementation capacity and expanding community-based health insurance. The project performed well, with achievements like graduating supported health facilities, expanding CBHI to more areas, and conducting evaluations.
Looking ahead, the project will focus on further expanding CBHI, launching social health insurance, strengthening supported health facilities, and generating health financing evidence to support policymaking. The Chief of Party expressed gratitude for partnerships while noting ongoing challenges like staff turnover and expanding initiatives to new areas
Hm 2012 session-iii planning & developing a hospitaldrbhutto
The document discusses planning and designing a new hospital or department. It covers conducting a feasibility study to determine needed facilities and services. The study should assess the local patient population, existing competition, and financial viability. It also provides guidelines on hospital size based on catchment population, occupancy rates, and average length of stay. Additional sections cover factors like location, access, flexibility, and allocating space between patient areas, support services and more.
Cost analysis and accounting are important management tools for hospitals. Cost analysis involves rearranging and reclassifying cost and income data to reveal relationships and allocate costs to departments based on services rendered. It provides an accurate financial picture for management to take corrective actions. Marginal costing ascertains costs by differentiating fixed and variable costs to determine the effect of changes in volume or output on profit. Cost accounting collects, classifies, and analyzes expenditure data to determine total and per-unit costs of products and services. It provides data to set prices, control costs, and assist in planning and decision-making.
The document outlines the process for planning a new hospital, including forming a planning team, conducting feasibility studies, and implementing the project. Key steps involve assessing community health needs, selecting an appropriate site, developing construction plans, procuring equipment and staff, and commissioning the new facility once built. The planning process aims to establish adequate healthcare services through strategic planning and consideration of factors like infrastructure, resources, and community demographics.
This document provides guidelines for implementing performance-based incentives (PBIs) for health workers in India's 184 high priority districts. It aims to motivate health workers to improve performance and retain staff in remote areas. The PBIs are designed to maximize outputs and outcomes for key maternal and child health interventions. Implementing PBIs is intended to address issues like absenteeism and lack of performance monitoring. The guidelines were developed through discussions between various departments of India's health ministry with support from partners like the Bill and Melinda Gates Foundation. PBIs focus on critical services like emergency obstetric and newborn care to reduce maternal and infant mortality, especially in underserved areas. States are encouraged to use the framework but tailor incentives to local
The document provides an overview of the Medical Department of the Navy. It describes the roles and responsibilities of the Chief of the Bureau of Medicine and Surgery and their staff in ensuring personnel and material readiness. It discusses the different components of the Medical Department including the Medical Corps, Dental Corps, Nurse Corps, and Hospital Corps. It also summarizes the responsibilities of the various assistant chiefs and divisions that oversee functions like health care operations, logistics, personnel management, and plans/evaluation. Finally, it briefly outlines policies regarding medical treatment facilities, off-duty employment, court testimony, and ambulance usage.
Ajay Kurude has over 27 years of experience working as a nurse, paramedic, and occupational health nurse. He currently works for Qatar Petroleum Healthcare Department, where his responsibilities include providing emergency medical care, managing the occupational health center, and conducting training programs. Previously, he worked for Relene Petrochemicals and Kharafi National Company/KBR, where he was responsible for occupational health services, emergency response, and safety management. He has extensive training in areas such as ACLS, PHTLS, and NEBOSH.
Troy Stockman is a healthcare leader seeking a new leadership role. He has over 25 years of experience in healthcare administration, including managing physician practices, designing new hospitals, and leading regional service lines. His resume summarizes his roles as CEO of a spine hospital and director of neuroscience and diagnostic services. He demonstrates expertise in areas like population health, EHR implementation, and quality programs.
The document summarizes an interview with the Chief of Party/Project Director of the HSFR/HFG Project in Ethiopia.
In the past fiscal year, the project focused on consolidating first generation health care financing reforms and preparing for universal health coverage through activities like building implementation capacity and expanding community-based health insurance. The project performed well, with achievements like graduating supported health facilities, expanding CBHI to more areas, and conducting evaluations.
Looking ahead, the project will focus on further expanding CBHI, launching social health insurance, strengthening supported health facilities, and generating health financing evidence to support policymaking. The Chief of Party expressed gratitude for partnerships while noting ongoing challenges like staff turnover and expanding initiatives to new areas
Hm 2012 session-iii planning & developing a hospitaldrbhutto
The document discusses planning and designing a new hospital or department. It covers conducting a feasibility study to determine needed facilities and services. The study should assess the local patient population, existing competition, and financial viability. It also provides guidelines on hospital size based on catchment population, occupancy rates, and average length of stay. Additional sections cover factors like location, access, flexibility, and allocating space between patient areas, support services and more.
Cost analysis and accounting are important management tools for hospitals. Cost analysis involves rearranging and reclassifying cost and income data to reveal relationships and allocate costs to departments based on services rendered. It provides an accurate financial picture for management to take corrective actions. Marginal costing ascertains costs by differentiating fixed and variable costs to determine the effect of changes in volume or output on profit. Cost accounting collects, classifies, and analyzes expenditure data to determine total and per-unit costs of products and services. It provides data to set prices, control costs, and assist in planning and decision-making.
The document outlines the process for planning a new hospital, including forming a planning team, conducting feasibility studies, and implementing the project. Key steps involve assessing community health needs, selecting an appropriate site, developing construction plans, procuring equipment and staff, and commissioning the new facility once built. The planning process aims to establish adequate healthcare services through strategic planning and consideration of factors like infrastructure, resources, and community demographics.
This document provides guidelines for implementing performance-based incentives (PBIs) for health workers in India's 184 high priority districts. It aims to motivate health workers to improve performance and retain staff in remote areas. The PBIs are designed to maximize outputs and outcomes for key maternal and child health interventions. Implementing PBIs is intended to address issues like absenteeism and lack of performance monitoring. The guidelines were developed through discussions between various departments of India's health ministry with support from partners like the Bill and Melinda Gates Foundation. PBIs focus on critical services like emergency obstetric and newborn care to reduce maternal and infant mortality, especially in underserved areas. States are encouraged to use the framework but tailor incentives to local
The document provides operational guidelines for critical care units and high dependency units in West Bengal. It outlines strategies and objectives for establishing 72 critical care units and high dependency units across the state. Key points include establishing units within 50km of any patient to minimize delays in emergency care, reducing out-of-pocket expenditures, decreasing mortality and morbidity, and ensuring round-the-clock emergency treatment and critical care support for all patients.
Rajbhra Medicare Pvt Ltd proposes outsourcing the operations of community health centers and district hospitals in remote areas of Himachal Pradesh on a revenue sharing basis. They have experience successfully managing rural hospitals in other states. They will take over management, recruit staff, upgrade facilities to meet IPHS standards, implement IT systems and provide services 24/7 to transform rural healthcare delivery. In return, the government would provide capital grants and an operating grant structured as a fixed amount plus a share of any revenue generated, with the shares adjusted over time to incentivize increased revenues that cover costs. Strict monitoring will ensure targets are met.
Central hospitals in Malawi face challenges including inadequate staffing, especially specialists, and poor quality of care. Reforms are proposed to address this, including establishing public trust hospitals with autonomous governance boards. This would give hospitals more control over management and finances while still remaining publicly owned. The objectives are to improve quality, access, and efficiency as well as strengthening support for districts and urban health services. A roadmap outlines steps for implementation over several years.
This document outlines a business plan for a proposed 100-bed obstetrics and gynecology hospital in Jaipur, India. The plan seeks 23 crore INR in funding over 5 years. It provides information on the company and management team, services offered, market analysis demonstrating need, and financial projections expecting profitability. The hospital aims to provide high quality maternal and child healthcare and become a leading provider in the region.
The document summarizes the Ayushman Bharat Yojana (ABY) health insurance program in India. It has two main components: (1) creating 150,000 Health and Wellness Centers to provide comprehensive primary healthcare, and (2) the Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance coverage to over 100 million poor families for hospitalization costs up to $7,000 per year. The goals of ABY are to reduce out-of-pocket healthcare expenses, improve access to quality care nationwide, and mitigate the financial risks of illnesses for vulnerable populations.
1) The document discusses the implementation of comprehensive primary health care through Ayushman Bharat Health and Wellness Centers (AB-HWCs), which aim to shift primary care from selective to comprehensive and from illness to wellness.
2) Key elements of transforming Sub Centers/PHCs/UPHCs to AB-HWCs include an expanded package of services, human resources, capacity building, essential drugs and diagnostics, use of technology, and community involvement through Jan Arogya Samitis.
3) Grants through the 15th Finance Commission and PM-ABHIM are being used to strengthen infrastructure, human resources, and other gaps at primary, secondary and tertiary care levels through various
Malawi Mid-Year Review 2014-2015 Health Sector Overviewmohmalawi
The document summarizes the mid-year review of Malawi's health sector for the period of July-December 2014. It outlines key highlights including a continued focus on maternal, neonatal and child health as well as responding to emergencies like floods, cholera outbreaks, and the Ebola threat. It provides details on health sector financing, performance of health systems and service delivery, and reforms being pursued to improve quality and efficiency. Overall resources for the 2014/15 fiscal year were mapped at MK278.8 billion, with the government contributing 92% of the required funding for the health sector pool.
The document summarizes upcoming improvements to health services in the Northern Emirates of the UAE. Specifically, it states that five new medical facilities costing a total of 1.25 billion dirhams are under construction in Sharjah, Ajman, and Ras Al Khaimah to address shortages. This will provide quicker access to care for locals and expats in the region, especially in Umm Al Qaiwain which has experienced an acute shortage. The new hospitals aim to boost services and retain medical practitioners by improving facilities and staffing levels.
The document discusses improvements to health services in the Northern Emirates with the opening of new hospitals. Specifically, it notes that 5 new medical facilities costing a total of 1.25 billion dirhams are under construction in Sharjah, Ajman, and Ras Al Khaimah to address shortages of medical services and facilities in the area. This will provide quicker access to healthcare for locals and expats in the Northern Emirates like Umm Al Qaiwain, which has experienced an acute shortage of services.
Assessment of labor room facilities in Community Health Centers, Taluk hospit...BRNSSPublicationHubI
This document summarizes a study that assessed labor room facilities in community health centers, taluk hospitals, and a district hospital in Gadag district, Karnataka, India. The study found that while most facilities had adequate infrastructure and equipment to provide labor room services, no facilities fully complied with LaQshya guidelines for human resources. Specifically, community health centers lacked specialists like obstetricians, pediatricians, and anesthesiologists required by the guidelines. The study also found that apart from one taluk hospital and the district hospital, no other facilities had blood banks as required. In conclusion, most facilities met requirements for infrastructure, equipment, drugs, and services, but were deficient in human resources and blood storage as
The document outlines standards for primary healthcare facilities in India called the Indian Public Health Standards (IPHS). It discusses:
1) The need to establish standards to ensure a minimum level of quality, accountability, and effective healthcare delivery across primary care institutions in India.
2) The process used to develop the IPHS, which involved expert committees, stakeholder consultations, and revisions based on facility achievement and state needs.
3) The IPHS provide guidelines for infrastructure, services, manpower, and monitoring at different levels of primary care facilities - subcenters, primary health centers (PHCs), and community health centers (CHCs). Standards are tailored to available resources but aim to improve functionality over time.
This document provides an overview of the health budget and services in Bihar, India. It details that in the 2011-12 budget, health received 21.15% of the state plan allocation of Rs. 24,000 crore or Rs. 5,075 crore. Major funding comes from the National Rural Health Mission, international organizations, and private foundations. The budget is expected to exceed projected needs. Key goals are to reduce infant mortality, maternal mortality, fertility rates, and increase institutional deliveries. Strategies to achieve these include improving access to prenatal care, increasing institutional deliveries, strengthening referral systems, immunization programs, and raising awareness about health and family planning issues.
Health Sector in India - Possibilities & GrowthTaru Bakshi
The document outlines strategies to improve India's health sector. It discusses India's achievements in health care to date, current challenges, and actions being taken. Five strategies are proposed: 1) increasing medical tourism, 2) boosting investment, 3) improving infrastructure, 4) increasing organ donation, and 5) greater societal integration and responsibility for health issues. The strategies aim to address lack of resources, unequal access to care, and low societal contribution to health issues.
This document provides information about Nimai Community Hospitals, including its directors, services offered, expected market growth rates, franchise model details, total project costs, HR requirements, estimated monthly expenses, and projected profit and loss over several years. The hospital aims to break even within 2 years and achieve a 10% return on investment within 4 years through its franchise model focused on maternity, childcare, and general healthcare services.
This document provides information about Nimai Community Hospitals, including its directors, services offered, expected market growth rates, franchise model details, total project costs, HR requirements, estimated monthly expenses, and projected profit and loss over several years. The hospital aims to break even within 2 years and achieve a 10% return on investment within 4 years through its franchise model focused on maternity, childcare, and general healthcare services.
This document proposes a public-private partnership model to improve access to primary healthcare in India. Key aspects of the model include enlisting private hospitals to provide subsidized care for low-income patients, making generic drugs more widely available to reduce costs, and using technology like mobile clinics and telemedicine to reach remote areas. It also addresses increasing healthcare infrastructure and workforce. The model could face challenges in securing adequate funding, overcoming reluctance to generic drugs, and difficulties executing and maintaining the technical aspects.
1) The document discusses Odisha's efforts to establish a dedicated public health cadre to better manage public health functions and address high disease burdens.
2) A multi-year process involved establishing the need, developing the cadre structure, training public health professionals, and restructuring existing medical officer positions to include public health roles.
3) While challenges remain around finalizing job roles and training, the commitment of state leadership and technical support from institutions have helped progress the public health cadre in Odisha.
County perspectives 2018 health workforce dr. nelson muriu. director, depar...Emmanuel Mosoti Machani
Dr. Nelson Muriu. Director, Nyeri County Department of Health. Presentation on the county Health Workforce in 2018 and teh task ahead for new county governments.
The document provides operational guidelines for critical care units and high dependency units in West Bengal. It outlines strategies and objectives for establishing 72 critical care units and high dependency units across the state. Key points include establishing units within 50km of any patient to minimize delays in emergency care, reducing out-of-pocket expenditures, decreasing mortality and morbidity, and ensuring round-the-clock emergency treatment and critical care support for all patients.
Rajbhra Medicare Pvt Ltd proposes outsourcing the operations of community health centers and district hospitals in remote areas of Himachal Pradesh on a revenue sharing basis. They have experience successfully managing rural hospitals in other states. They will take over management, recruit staff, upgrade facilities to meet IPHS standards, implement IT systems and provide services 24/7 to transform rural healthcare delivery. In return, the government would provide capital grants and an operating grant structured as a fixed amount plus a share of any revenue generated, with the shares adjusted over time to incentivize increased revenues that cover costs. Strict monitoring will ensure targets are met.
Central hospitals in Malawi face challenges including inadequate staffing, especially specialists, and poor quality of care. Reforms are proposed to address this, including establishing public trust hospitals with autonomous governance boards. This would give hospitals more control over management and finances while still remaining publicly owned. The objectives are to improve quality, access, and efficiency as well as strengthening support for districts and urban health services. A roadmap outlines steps for implementation over several years.
This document outlines a business plan for a proposed 100-bed obstetrics and gynecology hospital in Jaipur, India. The plan seeks 23 crore INR in funding over 5 years. It provides information on the company and management team, services offered, market analysis demonstrating need, and financial projections expecting profitability. The hospital aims to provide high quality maternal and child healthcare and become a leading provider in the region.
The document summarizes the Ayushman Bharat Yojana (ABY) health insurance program in India. It has two main components: (1) creating 150,000 Health and Wellness Centers to provide comprehensive primary healthcare, and (2) the Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance coverage to over 100 million poor families for hospitalization costs up to $7,000 per year. The goals of ABY are to reduce out-of-pocket healthcare expenses, improve access to quality care nationwide, and mitigate the financial risks of illnesses for vulnerable populations.
1) The document discusses the implementation of comprehensive primary health care through Ayushman Bharat Health and Wellness Centers (AB-HWCs), which aim to shift primary care from selective to comprehensive and from illness to wellness.
2) Key elements of transforming Sub Centers/PHCs/UPHCs to AB-HWCs include an expanded package of services, human resources, capacity building, essential drugs and diagnostics, use of technology, and community involvement through Jan Arogya Samitis.
3) Grants through the 15th Finance Commission and PM-ABHIM are being used to strengthen infrastructure, human resources, and other gaps at primary, secondary and tertiary care levels through various
Malawi Mid-Year Review 2014-2015 Health Sector Overviewmohmalawi
The document summarizes the mid-year review of Malawi's health sector for the period of July-December 2014. It outlines key highlights including a continued focus on maternal, neonatal and child health as well as responding to emergencies like floods, cholera outbreaks, and the Ebola threat. It provides details on health sector financing, performance of health systems and service delivery, and reforms being pursued to improve quality and efficiency. Overall resources for the 2014/15 fiscal year were mapped at MK278.8 billion, with the government contributing 92% of the required funding for the health sector pool.
The document summarizes upcoming improvements to health services in the Northern Emirates of the UAE. Specifically, it states that five new medical facilities costing a total of 1.25 billion dirhams are under construction in Sharjah, Ajman, and Ras Al Khaimah to address shortages. This will provide quicker access to care for locals and expats in the region, especially in Umm Al Qaiwain which has experienced an acute shortage. The new hospitals aim to boost services and retain medical practitioners by improving facilities and staffing levels.
The document discusses improvements to health services in the Northern Emirates with the opening of new hospitals. Specifically, it notes that 5 new medical facilities costing a total of 1.25 billion dirhams are under construction in Sharjah, Ajman, and Ras Al Khaimah to address shortages of medical services and facilities in the area. This will provide quicker access to healthcare for locals and expats in the Northern Emirates like Umm Al Qaiwain, which has experienced an acute shortage of services.
Assessment of labor room facilities in Community Health Centers, Taluk hospit...BRNSSPublicationHubI
This document summarizes a study that assessed labor room facilities in community health centers, taluk hospitals, and a district hospital in Gadag district, Karnataka, India. The study found that while most facilities had adequate infrastructure and equipment to provide labor room services, no facilities fully complied with LaQshya guidelines for human resources. Specifically, community health centers lacked specialists like obstetricians, pediatricians, and anesthesiologists required by the guidelines. The study also found that apart from one taluk hospital and the district hospital, no other facilities had blood banks as required. In conclusion, most facilities met requirements for infrastructure, equipment, drugs, and services, but were deficient in human resources and blood storage as
The document outlines standards for primary healthcare facilities in India called the Indian Public Health Standards (IPHS). It discusses:
1) The need to establish standards to ensure a minimum level of quality, accountability, and effective healthcare delivery across primary care institutions in India.
2) The process used to develop the IPHS, which involved expert committees, stakeholder consultations, and revisions based on facility achievement and state needs.
3) The IPHS provide guidelines for infrastructure, services, manpower, and monitoring at different levels of primary care facilities - subcenters, primary health centers (PHCs), and community health centers (CHCs). Standards are tailored to available resources but aim to improve functionality over time.
This document provides an overview of the health budget and services in Bihar, India. It details that in the 2011-12 budget, health received 21.15% of the state plan allocation of Rs. 24,000 crore or Rs. 5,075 crore. Major funding comes from the National Rural Health Mission, international organizations, and private foundations. The budget is expected to exceed projected needs. Key goals are to reduce infant mortality, maternal mortality, fertility rates, and increase institutional deliveries. Strategies to achieve these include improving access to prenatal care, increasing institutional deliveries, strengthening referral systems, immunization programs, and raising awareness about health and family planning issues.
Health Sector in India - Possibilities & GrowthTaru Bakshi
The document outlines strategies to improve India's health sector. It discusses India's achievements in health care to date, current challenges, and actions being taken. Five strategies are proposed: 1) increasing medical tourism, 2) boosting investment, 3) improving infrastructure, 4) increasing organ donation, and 5) greater societal integration and responsibility for health issues. The strategies aim to address lack of resources, unequal access to care, and low societal contribution to health issues.
This document provides information about Nimai Community Hospitals, including its directors, services offered, expected market growth rates, franchise model details, total project costs, HR requirements, estimated monthly expenses, and projected profit and loss over several years. The hospital aims to break even within 2 years and achieve a 10% return on investment within 4 years through its franchise model focused on maternity, childcare, and general healthcare services.
This document provides information about Nimai Community Hospitals, including its directors, services offered, expected market growth rates, franchise model details, total project costs, HR requirements, estimated monthly expenses, and projected profit and loss over several years. The hospital aims to break even within 2 years and achieve a 10% return on investment within 4 years through its franchise model focused on maternity, childcare, and general healthcare services.
This document proposes a public-private partnership model to improve access to primary healthcare in India. Key aspects of the model include enlisting private hospitals to provide subsidized care for low-income patients, making generic drugs more widely available to reduce costs, and using technology like mobile clinics and telemedicine to reach remote areas. It also addresses increasing healthcare infrastructure and workforce. The model could face challenges in securing adequate funding, overcoming reluctance to generic drugs, and difficulties executing and maintaining the technical aspects.
1) The document discusses Odisha's efforts to establish a dedicated public health cadre to better manage public health functions and address high disease burdens.
2) A multi-year process involved establishing the need, developing the cadre structure, training public health professionals, and restructuring existing medical officer positions to include public health roles.
3) While challenges remain around finalizing job roles and training, the commitment of state leadership and technical support from institutions have helped progress the public health cadre in Odisha.
County perspectives 2018 health workforce dr. nelson muriu. director, depar...Emmanuel Mosoti Machani
Dr. Nelson Muriu. Director, Nyeri County Department of Health. Presentation on the county Health Workforce in 2018 and teh task ahead for new county governments.
County perspectives 2018 health workforce dr. nelson muriu. director, depar...
CURRENT BRIEF
1. Bagram PRT Medics
RC-East Joint Surgeon’s
Conference
Major Tim Gacioch
TSgt Deborah Taylor
SRA Joshua Tolaro
2. Overview
●PART I: What has been built to date (public & private)?
•PART II: What is planned / budgeted?
•PART III: Are health facilities being staffed?
•PART IV: Are Health Facilities supplied & equipped?
•PART V: What are the challenges for these provinces?
… Conclusions
3. Setting the Stage
RIPTOA complicated
Flooding
Hasty departure
Organizational Deficiencies
No BDE SG
No Maneuver BDE – SECFOR issue
No USAID or USDA representatives
CA understrength
4. PART I – Taking Stock
What has been built to
date, to include legacy
and private facilities?
15. PART II: Parwan Budget
What is planned / budgeted?
Parwan Province
FY '08 Budget Submission Project Cost
Mandikol BHC $105,000
Shengarian BHC $105,000
Total $210,000
16. List of Projects- Awaiting funding
Parwan Province
FY '08 Budget
(NON-SUBMITTED ITEMS)
Project Cost
20-Bed DH (#1 Priority MoH) Unknown
Lolanje Upgrade to DH Unknown
Repair Women’s Clinic of Sia Gerd Unknown
17. PART II: Kapisa Budget
What is planned / budgeted?
Kapisa Province
FY '08 Budget Submission Project Cost
Kohistan II DH at Kulala Kanda $370,000
Tag Ab DH at Tamir $370,000
Total $740,000
18. List of Projects - Awaiting funding
Kapisa Province
FY '08 (NON-SUBMITTED ITEMS) Project Cost
Sadq Abad Facility $500,000
Midwife Learning Center
Public Health Office
EPI Office
QC Lab & Pharmacy Stock
BHC (Sayiad, Shokhi, Zahikhel & Pashai, Dara
Kalan, Giaweh, Shpi, Koti, Skain, Budrab, Shenkay)
$900,000
(10 BHC @90,000 ea)
Dara Pachagan CHC $130,000
Total $1,700,000
20. Parwan Key Staff
There are 400 Health Care staff for all the following:
Provincial District CHC BHC Health
Hospital Hospital Post
1 1 8 31 148
NOTE-“Minimal Staffing” is defined in the following:
1) Essential Package of Healthcare Services, 2005
2) Basic Package of Healthcare Services, 2005
Minimal staffing required is 678
Parwan is staffed at 59% of minimal need
22. Parwan Excess Capacity
Provincial District CHC BHC Health
Hospital Hospital Posts TOTALS
1 1 8 31 148 189
MIN Capacity 100,000 240,000 465,000 148,000 953,000
MAX Capacity 300,000 480,000 930,000 222,000 1,932,000
Population 550,200
MIN Excess 402,800
MAX Excess 1,529,200
23. Kapisa Key Staff
There are 322 Health Care staff for all the following:
Provincial District CHC BHC Health
Hospital Hospital Post
1 1 8 15 100
NOTE-“Minimal Staffing” is defined in the following:
1) Essential Package of Healthcare Services, 2005
2) Basic Package of Healthcare Services, 2005
Minimal staffing required is 582
Parwan is staffed at 55% of minimal need
24. ▲
▲
●
●
Kapisa Staffing
▲
▲
▲
▲
▲
▲
▲
▲
▲
۞
● ▲
●
●
●
▲
▲
▲
LEGEND
Provincial Hospital
District Hospital
● CHC
BHC
◘
●●
●
●
▲▲
▲
▲
▲
▲
▲
▲
●
●
▲
◘
♦
▲
◘
♦
Positive Note:
Staffing Adequate
Despite insurgency
Sultan of Brunei did not
Deliver funds … 3+ yrs.
If built who staff 100 beds?
Surgical Suite
Never staffed
◘
25. Kapisa Excess Capacity
Provincial District CHC BHC Health
Hospital Hospital Posts TOTALS
1 1 8 15 100 125
MIN Capacity 100,000 240,000 225,000 100,000 665,000
MAX Capacity 300,000 480,000 450,000 150,000 1,380,000
Population 367,400
MIN Excess 297,600
MAX Excess 1,082,400
26.
27. PART IV – Parwan Supplies & Equip
Are Healthcare facilities supplied & equipped?
31. PART V – Parwan Challenges
What are the health
challenges for this
Parwan province?
… OR What areas need
improvement?
Distribution of Assets
Insufficient staff
Insufficient supplies
Austrian Hospital
Western Parwan
clinics vs Kohi Safi
Emergency Transport
Training Pipeline
Professionals
Paraprofessionals
Support Personnel
32. PART V – Kapisa Challenges
What are the health
challenges for Kapisa
province?
… OR What areas need
improvement?
Access to care
Provider Distribution (Nijrab)
Tag Ab & Alasay
PH Funding (Sultan of Brunei)
Emergency Transport
Training Pipeline
Professionals
Paraprofessionals
Support Personnel
Active Insurgency
34. MoPH Policy Statement on Hospitals
1. Hospitals provide necessary curative and emergency services which complement BPHS,
including disability care
2. Must be rationally distributed so are accessible for entire population
3. MOH will plan #, location, # & type of beds to ensure maximum impact on population health
status
4. Care must be provided based on need and not ability to pay.
5. Must be managed in an efficient manner IAW basic clinical and managerial standards
6. The proportion of the government's annual operational budget for hospital will not exceed
40% of the total health budget
7. MOH will develop financial systems, such as BoD, for budgetary accountability &
transparency.
8. To enable sustainability, cost-sharing strategies appropriate to Afghanistan will be
developed.
9. Hospitals will provide training and supervision of lower health care facilities
10. Private hospitals are allowed, part of the system and must meet the same standards as other
facilities.
Feb 2004
35. Providing Care in Active Insurgency Areas
Continue supply push for BHC and HP in disputed areas
Use MEDCAPS in 24-hour period after kinetic ops
Work through elders to access children for vaccinations
Withhold large projects in disputed zones as cannot staff
or guarantee construction worker safety
Increase project spending at margins of disputed zones
to increase access for allies
Advocate women’s health careers
36. Sources of Data (where not otherwise stated)
Afghanistan National Development PollAfghanistan National Development Poll
3600 respondents in every province of the country
The Measure of Progress Study
1000 qualitative and in-depth interviews
Direct formal Medical Assessments of healthcare facilitiesDirect formal Medical Assessments of healthcare facilities
performed by PRT BN Surgeonperformed by PRT BN Surgeon
40. Health Post
HP- Outpatient community health center for 1,000 – 1,500 people
Community-Based and owned w/ essential technical and material support from
NGO & MoH. Often Community Health Committees oversee the functioning of
Health Posts, which operate out of a privately owned home. Employees must live
FT in the community they serve.
HP employees work under supervision, and in concert with, BHC staff. Training is
to be local, use sequential tasks & a standard curriculum.
Compensation. FT work is paid, PT workers receive only incentives.
A.K.A. Health Post = Community-level Outreach
Community Health Worker (CHW) Dx/Tx Malaria, diarrhea, & ARI, distribute condoms &
OCP, and micronutrient supplementation. Also Tx common illnesses.
Traditional Birth Attendants (TBA) oversee normal deliveries, ID danger signs, refer to
higher HC facilities
41. Basic Health Center (BHC)
BHC – 15,000 -30,000 people
Staffed Nurse, Midwife or Auxiliary (Community) Midwifes, CHW/Vaccinators, and
support personnel (janitors, guard)
Antenatal, delivery, post-delivery care, growth monitoring, mgmt of Child DS,
routine EPI, Tx malaria & Tb (DOTS), drug distribution.
A.K.A. Small Health Center, C2 Sub-Center, MCH Clinic - Outpatient Care only
42. Community Health Center (CHC)
Inpatient Care & Lab for a community of 30,000-60,000 people
First level of care with physicians (male & female) and nurses (male & female).
Open 24-hours per day for emergency access
Can handle some complicated deliveries, grave childhood DS, complicated malaria,
inpatient/outpatient physiotherapy for disability.
HIV, Hep B/C, Ziehl Nelson for Tb, Diphtheria, Hgb, RBC, WBC, ESR, UA (w/ glu,
protein, albumin), microscopy.
A.K.A. CHC, Large Health Center, C1 Basic Health Center
43. District Hospital
Inpatient Care - 25-75 beds, population of 100,000 - 300,000, Serves 1-4 districts
Provides all BPHS and can care for the most complicated cases: Includes major
surgery under general anesthesia, X-ray, comprehensive emergency obstetric care
(including C-sections), family planning, blood transfusions w/o blood banking, bladder
stones, physiotherapy, dental, nutrition, and physical therapy
Usually staffed by junior GMO, "mainly an emergency hospital where pt are assessed,
dx, stabilized & either Tx or referred up/down the HC system, 24-hour Comprehensive
Emergency Obstetric Care is a crucial aspect. Two entrances 1) ER, 2) OPD."
AFB for Tb, Blood type, Bleed Time, Hct, Widel's, Brucellosis, Glu, BUN/Creat, Pro, LFT,
X-ray, US, O2 concentrator, proctoscope
Roles include: Collecting information, community outreach, education and as an entry
point for care (in absence of BHC or CHC) and so has admin/finance/HRO, kitchen,
laundry, sterile supply, waste mgmt, med records & stats, transportation for
emergencies and transfers
44. The Provincial Hospital
100-300 Beds
More sophisticated Dx & Tx, support some specialists. Referral center for access
to Regional Hospitals and specialty care.
"Because it is primarily an emergency hospital, it does not perform complicated
elective surgery"
Has ENT, Mental health, blood banking, possibly mortuary, PT & rehabilitation,
Infectious DS plus District Hospital complement of services.
Can Tx electrolyte and fluid imbalances, alveolitis, diabetes mellitis, uterine
fibroids, pelvic mass, PID, osteomyelitis, RA, pre-term delivery, respiratory
distress, infants of DM mothers or other complicated births, open Fx, urologic
conditions
46. Population:
28,513,677 (July 2004 est.)
Age structure:
0-14 years: 44.7% (male 6,525,929; female 6,222,497)
15-64 years: 52.9% (male 7,733,707; female 7,346,226)
65 years and over: 2.4% (male 334,427; female 350,891) (2004 est.)
Median age:
total: 17.5 years (2004 est.)
Birth rate:
47.27 births/1,000 population (2004 est.)
Death rate:
21.12 deaths/1,000 population (2004 est.)
Infant mortality rate:
total: 165.96 deaths/1,000 live births
male: 170.85 deaths/1,000 live births
female: 160.82 deaths/1,000 live births (2004 est.)
Life expectancy at birth:
total population: 42.46 years
male: 42.27 years
female: 42.66 years (2004 est.)
Total fertility rate:
6.78 children born/woman (2004 est.)
The People
Dangerous stat because this group is easily
influenced by the rhetoric of radicals
Nutrition Problem
Lack of health knowledge
Lack of education in avoidance of diseases and landmines
Post-war society
47. Barriers to Care
Invisibility of women
Shortage of female
physicians
The Charikar PH
Community Midwife
program is a model
48. MDG Millennium Development Goals
In 2004 Afghanistan’s transitional government declared its intention
to achieve the Millennium Development Goals (MDGs) established
at the 2000 UN Millennium Summit. MDGs are intended to act as a
framework to guide the development of national policies and
reconstruction priorities around the world, with benchmarks set for
2015 and 2020. The government has incorporated the MDGs into
the Interim Afghanistan National Development Strategy (I-ANDS).
The eight MDGs are:
• Eradicate extreme poverty and hunger;
• Achieve universal primary education;
• Promote gender equality and empower women;
• Reduce child mortality;
• Improve maternal health;
• Combat HIV/AIDS, malaria and other diseases;
• Ensure environmental sustainability; and
• Develop a global partnership for development.
49. “By end 2010, in line with Afghanistan’s
MDGs, the Basic Package of Health
Services will be extended to cover at least
90% of the population; maternal mortality
will be reduced by 15%; and full
immunization coverage for infants under 5
for vaccine preventable diseases will be
achieved and their mortality rates reduced
by 20%”
Dr. Wali, Office of MoPH - 12 Sep 07
ANDS Benchmark
50. Aims of all Afghan Health Care Centers
& Hospitals
MMR
(Maternal Mort Rate) 1.9 / K
1 every
30
Min
IMR (Infant Mort Rate) 160.2 / K births 1 : 5
U5M
(Under 5 Mort)
239.9 / K
51. Challenges
Even with these impressive gains, it is only a start—
much remains to be done:
Infant, child and maternal mortality remain high
Health is an essential element for improving the
country’s security
Many communities continue to have inadequate
access to health services
Quality of health services must be improved
Further health gains require sustained support
from our partners for the long-term
52. Effect of Distance from Health Facility on
Prenatal Care Coverage (%)PercentageofPrenatalCareCoverage
Distances in Kilometers
53. Financing Afghan Medical Coverage
Experience thus far shows that delivering the
BPHS costs $5-$6 per person per year
Just for BPHS delivery, Afghanistan needs
$125 to $150 million per year.
This does not include improving hospital
services or further expanding primary care
Until government revenues increase, MoPH
will be dependent on external financing
Editor's Notes
Tagab- Tamir DH is MoH Kaapisa Project (07-08) list for $300K
Khangah is via NGO (USAID, WB or EC) 15 Apr 07 List
Budrab SubBHC per MoPH plan for Kuchi care on MoH Kapisa Project (07-08) list $90K
Shenkey os on MoH Kapisa Project (07-08) list $90K
AlisaySkain and Koti BHC upgrades are per MoH Kapisa Project list (07-08)
Markaz CHC is via NGO (USAID, WB or EC) 15 Apr 07 List
NijrabShaherwani DH opened 2007. NGO funded
Dara Pachagan is PRT project
Zabakhil-Pashai & Dara Farouksha sub-BHC’s are per MoH Kapisa plan for Kuchi care on MoH Kapisa Project (07-08) list $90K
Dara Kalan given purpose built building per MoH Kapisa Project List (07-08) - $90K
Giaweh BHC is on MoH Kapisa Project (07-08) list $90K
KohbandMalikar Sub-BHC built from funds designated for Sphi (Ashei) BHC for Alasay. Village did not want. Will provide Kuchi care - $90K
M. RaqiSayiad & Shoki BHC per MoH Kapisa Project List (07-08) - $90K
EPI / QA/QC lab / PH offices per MoH Kapisa Project List (07-08) - $500K
Kohistan IOnly wall for CHC
Kohistan IIDH at Kulala Kanda per MoH Kapisa Project List (07-08) - $300K
Staff existing centers – Sia Gerd staffing and supplies inadequate (only CHC in area)
Often the numbers are counted. Number of schools built, the amount of money spent, polce trained.
The ANDP was funded by CFC-A and carried out by Altai Consulting, a local research organization. This is a nation-wide survey that included 3600 respondents in all 34 provinces. The study has been carried out in four separate surveys through 2005 -2006. The goal was to get a sense of Afghan perceptions of the reconstruction efforts, the new government and the international community.
There are a number of other polls out there, this in my view is the most comprehensive and with fairly reliable methods.
A standard questionnaire, was designed and Afghans were trained, select people at random and ask each of the them the pre designed close-ended questions. It has yielded a number of useful findings, but it is also a process in which the person being surveyed, in this case the Afghans, have very little options but to give a standard yes/no or pick from a list designed by someone else.
To get a more holistic view, therefore useful to couple this kind of survey with qualitative interviews, where the respondent has the freedom to ask questions, elaborate on their answers and focus on the issues that are most critical to them
I have been working on a study at CSIS that gathered qualitative interviews with 1000 Afghans in various provinces across the country in 2005 and in 2006. Men, women, different ethnic groups, and a variety of ages and occupations, such as farmers, construction workers, teachers, police, government workers, and housewives, were included.
We trained Afghans to undertake the open ended interviews. They were able to elicit response often not shared with internationals and go to places that have become too insecure for internationals. These conversations produced 700 pages of text which have been analyzed for trends and common themes
Provincial Reconstruction Teams (PRT) are small bases with both military and civilian staff that provide security and facilitate reconstruction at the provincial level. The concept was first proposed by the Coalition Forces (CF) and the US embassy in mid-2002 during discussions about shifting from Operation Enduring Freedom’s Phase III (combat phase) to Phase IV (reconstruction phase). The establishment of PRTs was officially announced and endorsed by President Karzai in November 2002. Many NGOs are concerned that PRT involvement in humanitarian assistance blurs the distinction between the military and aid sectors. The first PRTs, established in early 2003, were led by Coalition Forces. The International Security Assistance Force (ISAF) began taking over and establishing new PRTs in the north and west in 2004, after an October 2003 UN Security Council resolution adjusted its mandate to allow for expansion beyond Kabul. Command of PRTs in the south and east was transferred from Coalition to ISAF in 2006. As of late October 2006, there are 25 PRTs operating under ISAF’s five regional commands (North, South, East, West and Central).
The PRTs comprise an average of 100–200 staff depending on location. The military personnel provide protection for the civilian component, which includes foreign affairs representatives, development officers and donors. Some PRTs also have agricultural and veterinary advisers as well as civilian police trainers. The coordination of reconstruction and development activities is the responsibility of civilian staff, as civil-military cooperation (CIMIC) officers are primarily concerned with force protection.
PRT activities are monitored and guided by a PRT Executive Steering Committee chaired by the Minister of Interior and the Commander of ISAF. The Committee includes representatives from the Ministry of Finance, Ministry of Rural Rehabilitation and Development, Coalition Forces, ISAF, UNAMA and troop contributing nations (TCNs). A PRT working group meets fortnightly to support the work of the Steering Committee.
The mission of PRTs, as endorsed by the PRT Executive Steering Committee, is to:
“assist the Islamic Republic of Afghanistan to extend its authority, in order to facilitate the development of a stable and secure environment in the identified areas of operations, and enable SSR and reconstruction efforts.”
This broadly stated mission statement is not backed by a detailed mandate, and there is no single PRT model. Instead, the structure and operation of PRTs are influenced by the situation in particular provinces as well as by TCN-specific caveats and instructions.
Provincial Reconstruction Teams (PRT) are small bases with both military and civilian staff that provide security and facilitate reconstruction at the provincial level. The concept was first proposed by the Coalition Forces (CF) and the US embassy in mid-2002 during discussions about shifting from Operation Enduring Freedom’s Phase III (combat phase) to Phase IV (reconstruction phase). The establishment of PRTs was officially announced and endorsed by President Karzai in November 2002. Many NGOs are concerned that PRT involvement in humanitarian assistance blurs the distinction between the military and aid sectors. The first PRTs, established in early 2003, were led by Coalition Forces. The International Security Assistance Force (ISAF) began taking over and establishing new PRTs in the north and west in 2004, after an October 2003 UN Security Council resolution adjusted its mandate to allow for expansion beyond Kabul. Command of PRTs in the south and east was transferred from Coalition to ISAF in 2006. As of late October 2006, there are 25 PRTs operating under ISAF’s five regional commands (North, South, East, West and Central).
The PRTs comprise an average of 100–200 staff depending on location. The military personnel provide protection for the civilian component, which includes foreign affairs representatives, development officers and donors. Some PRTs also have agricultural and veterinary advisers as well as civilian police trainers. The coordination of reconstruction and development activities is the responsibility of civilian staff, as civil-military cooperation (CIMIC) officers are primarily concerned with force protection.
PRT activities are monitored and guided by a PRT Executive Steering Committee chaired by the Minister of Interior and the Commander of ISAF. The Committee includes representatives from the Ministry of Finance, Ministry of Rural Rehabilitation and Development, Coalition Forces, ISAF, UNAMA and troop contributing nations (TCNs). A PRT working group meets fortnightly to support the work of the Steering Committee.
The mission of PRTs, as endorsed by the PRT Executive Steering Committee, is to:
“assist the Islamic Republic of Afghanistan to extend its authority, in order to facilitate the development of a stable and secure environment in the identified areas of operations, and enable SSR and reconstruction efforts.”
This broadly stated mission statement is not backed by a detailed mandate, and there is no single PRT model. Instead, the structure and operation of PRTs are influenced by the situation in particular provinces as well as by TCN-specific caveats and instructions.
The tough geography of Afghanistan is a challenge. The population is spread out over mountainous and difficult terrain and providing services to such a dispersed population is a hard. Preliminary data suggests that distance from a health center is one of the most important predictors of whether a woman receives antenatal care or not.
In response to this challenge, the Ministry is trying to secure the resources to expand coverage of the basic package of health services (BPHS) from 82% of the population to 100%. We are also financing the establishment of many health sub-centers, health facilities with just two health workers. This will reduce the distance people have to travel to reach health facilities in rural areas. We are also deploying mobile teams to conduct clinics in hard to reach areas.