Dr. Abdul Tawab Kawa Saljuqi presented at the Global Health Alliance Meeting in Tucson, Arizona on March 29th 2010. He discussed Afghanistan's demographic situation, public health system, and current health indicators. Afghanistan has a population of 24 million with a literacy rate of 35-40% and GDP per capita of $426. Key health challenges include low life expectancy, limited access to water/sanitation, and high rates of child and infant mortality, though some indicators like prenatal care and immunizations are improving.

1. Dr. Abdul Tawab Kawa Saljuqi (MD)
MPH Student
Health Promotion and Health Behavior Section
Mel and Enid Zuckerman College of Public Health
University of Arizona
Global Health Alliance Meeting
March 29th 2010
Tucson, Arizona, USA
Photo by Luke Powell

2. • A musical Slide Show
• Afghanistan’’s Demographic
Situation
• Briefing on Public Health
System and Current situation
• Question and Answer
Photo by Luke Powell

3. Photo by Luke Powell

4. Afghanistan Map Located in South Central Asia

5. • The heart of Asia Between
• Pakistan ( south and East)
• Iran ( west)
)
• Tajikistan (North)
• Uzbekistan ( North)
Turkmenistan ( North))
China ( North East)
Photo by Luke Powell

6. Afghanistan
(647500 km2)
2.2 times
Larger than
Arizona
(295,254 km2) Photo by Hussain Hassrat

7. • Population: 24 million CSO , 2007
– Female / Male Ratio : 49/51
• Literacy Rate : 35 40 %
(Ministry of Education 2007)
• GDP : 426 USD ( WB) 2008
Photo by Luke Powell

8. • Life expectancy is 43
years, compared to 59
years for low income
countries worldwide.
Photo from Google Image
Source : WHO

9. • Moreover only
Moreover,
13 percent of
Afghans have
access to safe
drinking water
and 12 percent to
adequate
sanitation Photo from UNICEF website
UNICEF best estimates 2008

10. • Access to electricity :
among the lowest in
the world.
world
• The situation has
however improved in
Kabul, Mazar and
Hirat

11. • More than 7 million children
to h l 2.5 illi
t school 2 5 million girls
il
• More than 4500 schools all
over the country
• More than 170000 teachers
• Implementation of Healthy
School Initiative since 2006
with MoPH and UNICEF
Photo from UNICEF website
Source: Afghan Ministry of Education website

12. Agricultural Production:
A i lt l P d ti
wheat, fruit, nuts, wool,
mutton, sheepskins,
lambskins
Major Agricultural
Exports:
Nuts, fruit, spices
Agriculture: 31% of GDP
GDP,
80% of employment
US Department of Agriculture/Afghanistan Photo from Afghanistan Land of Beauty and Culture

13. Photo from Afghanistan Land of Beauty and Culture
•83000 US forces
•45000 ISAF and NATO
•More th 80 % of i t
M than f international
ti l
assistance spent on security
•70 000 Afghan
g
National Army
•NATO website/Afghanistan
•United States Accountability
Office report on Security in
Afghanistan

14. Islam (99%)
Others (1%) ( Hinduism and
Christianity)
Photo from Afghanistan Land of Beauty and Culture
Source : Wikipedia / Religion in Afghanistan

15. Surprise Visit of
Obama to Afghanistan
to eat some h l h
healthy
Food!
March 28 2010
Photo from White House photo gallery

16. • Afghanistan National
Development Strategy
and Health and
Nutrition Sector Strategy
2008 2013
• Two main strategies for
health
h lth care provision :
ii
Basic Package of Health
Services and Essential
Package of Hospital
Services , contracted out

17. • Two main strategies for
health care provision :
Basic Package of H lth
B i P k f Health
Services and Essential
Package of Hospital
Services , contracted out

18. Present Health Situation
A five year communication
strategy for Afghanistan
Based on 8 Gaps
Proposes 8 Strategies
Supported by a Policy
And five year Action Plan
After 2 years of struggle

19. Governmental
Ministry of Public
Organizations
Health
Donors
Legislation
NGOs
UN
Private Sector
Community

20. • % of GDP spend on
Health
• USAID
• EU
• WB
• Other : JICA, CIDA, DFID,
, , ,
AFD, ADB
• A very small amount
from national revenue Photo from Afghanistan Land of Beauty and Culture

21. Health Facilities and Referral System in BPHS
Health HP
Post HP Comprehensive
HP
Health Center
HP HP
HP
HP
Basic Health
Center HP Referrals
HP
30,000 people
HP
HP
HP
HP
District or Provincial
HP HP Hospital
Health Post Supervision & supplies from BHC, CHC & DH

22. Facility Level Key Staff Population
Coverage
Health Post 2 CHW (male/female)
( ) 1,000 1,500
1,000-1,500
Basic Health 1 Nurse (male), 1 15,000-30,000
Midwife/Community Midwife, 2
Center
Vaccinator, 1 Community Health
Supervisor (5 2)
S i (5+2)
Comprehensive 2 Doctors (m/f); 2 Community 30,000-60,000
Midwives;
Health Center 2 nurses (m/f); 1 Lab Tech
1 Pharmacy tech., 2 Vaccinator, 1
Administrator, 1 Community Health
Supervisor
(12+4)
First Referral 4 Doctors (m/f), 1 surgeon, 1 anesthetist, 1
Pediatrician, 4 Midwife, 10 nurse, 1 X-ray tech, 2
100,000-300,000
Hospital Lab Tech, 1 Pharmacist, 2 Vaccinator, 1 Dentist,
1 Dental Tech, 1 Administrator, 1 Community
Health Supervisor
(31+7)
Source : Basic Package of Health Services 2005

23. • Maternal and newborn health
• Child health and immunization
• Public nutrition
bli ii
• Communicable diseases control
• Mental Health
• Disability
• Supply of Essential Drugs
Source : BPHS of health services 2005

24. Progress of Health Indicators
Photo by Hadi Zaher

25. Ahmad Jan Naeem’s presentation in International Conference on Primary Health Care, Doha 2008

26. Ahmad Jan Naeem’s presentation in International Conference on Primary Health Care, Doha 2008

27. Ahmad Jan Naeem’s presentation in International Conference on Primary Health Care, Doha 2008

28. Ahmad Jan Naeem’s presentation in International Conference on Primary Health Care, Doha 2008

29. Key Development
y p
Indicators
• Infant mortality rate,
per 1,000 live births:
Down from 129 in 2006
to about 111 in 2008.
• Under 5 mortality rate,
per 1,000 live births:
Down from 191 in 2006
D f i
to about 161 in 2008.
Photo from H
Ph t f Hussain H
i Hassrat
t
World Bank Report on Afghanistan 2009

30. • Prenatal care to
pregnant women: Up
from 11% in 2004 to
49% in 2008.
• Child immunization
rates: Up from 12% in
2005 to 33% in 2008
2008.
Photo from Afghanistan Land of Beauty and Culture
World Bank Report on Afghanistan 2009

31. • Health service utilization increased among project
area populations from a rate of 0.3 consultations
p p
per capita annually at the outset to 1.64 per capita
by the mid 2009.
Photo from Afghanistan Land of Beauty and Culture

32. Childern Mortality Rates
2002-2006
300
257
Deaths per 100 live births
250
191
200
165
00
150 129
100
50
0
2002 2006
Years
Infant Mortality Rate Under 5 Mortality Rate
Health Information Management System (HMIS), Ministry of Public Health

33. Increased in Investment 2002 to 2006
c eased es e 00 o 006
Intestment in Health Sector (Million USD)
1400
1200
1000
illion USD
800
Mi
600
400
200
0
2001 2002 2003 2004 2005 2006 Total
Years
Deputy Minister of Public Health’s Presentation for International Health Literacy Conference 2009

34. Progress in Percentage of Health
Facilities with at least one female health
worker, Afghanistan 2003, 2008
Health Information Management System (HMIS), Afghan Ministry of Public Health

35. • Presence of more than
20000 Community
Health Workers
H lth W k
• Communication and
vaccination Campaigns
Photo by CBHC Department, Ministry of Public Health

36. • Community
interaction by
Partnership
Development Quality
( PDQ ) and
Participatory
Learning Approach (
PLA) strategies
Photo from BRAC website

37. 1400000
mber of dileveri per year
1200000
1000000
Delivery
ies
800000
Ante Natal Care
600000 Family Planning
400000
200000
Num
0
1383 1384 1385 1386 1387
2004 2005 2006 2007 2008
Years
Health Information Management System (HMIS), Ministry of Public Health

38. Polio vaccine Coverage
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Y2003 Y2005 Y2006 Y2008
Health Information Management System (HMIS), Ministry of Public Health

39. BCG coverage
80%
75%
70%
65%
60%
55%
50%
Y2003 Y2005 Y2006 Y2008
Health Information Management System (HMIS), Ministry of Public Health

40. Full Immunization in Afghanistan
40%
35%
30%
25%
20%
15%
10%
5%
0%
Y2003 Y2005 Y2006 Y2008
Health Information Management System (HMIS), Ministry of Public Health

41. DPT Coverage in Afghanistan
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Y2003 Y2005 Y2006 Y2008
Health Information Management System (HMIS), Ministry of Public Health

43. Photo from Afghanistan Land of Beauty and Culture

44. Thank Tashakor
you
Mannana
Photo from Afghanistan Land of Beauty and Culture