28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Mohammad Dauod Khuram MD, MPH National Manager, Health Program Aga Khan Foundation, Afghanistan

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Afghanistan Health Status: Live expectancy at birth: Male: 44 years Female: 43 years Maternal Mortality Ratio: One of the highest in the world (1600 per 100,000 live births) Infant Mortality Rate: 129 per 1000 live births Under-five Mortality Rate: 191 per 1000 live births One of the high prevalent country for communicable and vaccine preventable diseases.

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Hospital-based Services: There are 112 public hospitals in Afghanistan: National Hospitals: 17 Regional Hospitals: 7 Provincial Hospitals: 34 District Hospital: 52 Total number of available hospital beds: 9133 Approximately 50% of the available hospital beds are at Kabul The rest of the country has 0.35 beds per 1000 population Badakhshan has 0.28 beds per 1000 population

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. National Policies for Health Care services: In 2003 Afghanistan has adopted a standard package to deliver Primary Health Care and Hospital services The Essential Package of Hospital Services was introduced by the Ministry of Public Health to: Standardize hospital structure and service delivery Improve quality of services and hospital management Promote equitable distribution of hospitals The implementation of this standard package was contracted out to Non-Governmental Organization under a partnership-based contract

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Badakhshan: Population: 574,800 Health Set up: Provincial Hospital: 1 District Hospitals : 3 Other health facilities: 58 Faizabad Hospital: No of beds: 100 Type of hospital: Provincial

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Performance-based Partnership between the Ministry of Public Health Afghanistan and the Aga Khan Development Network for delivering Essential Package of Hospital Services at Faizabad Provincial Hospital, Badakhshan Partnership contract with Roshan mobile company for operating the telemedicine at Faizabad Provincial Hospital Contract of cooperation with KfW for upgrading the hospital setup at Faizabad Provincial Hospital Service contract with Norwegian Ministry of Foreign Affairs for construction of MNCH ward at Faizabad Provincial Hospital

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. USAID: Funds the service delivery Ministry of Public Health: Principle Recipient (Client) KfW: Rehab/Constraction, equipment and e-health Aga Khan Development Network: Implementing partner as well as funding partly Roshan Mobile Company: Supporting telemedicine Swedish Committee for Afghanistan: Supporting physiotherapy services Norwegian Ministry of Foreign Affairs: construction & equipment of maternity ward CHEF: for specialized eye services

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. To deliver a standard package of services To improve the quality of patient care To promote a comprehensive referral system with other hospitals To increase efficiency of hospital operation

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Hospital Board Hospital Director Administrator AKHS(Afg) Country Program Director Nursing Departments Central Sterilization Unit Kitchen Finance & Accounting Laundry Finance Manager Nursing Manager Medical Directors Cost Sharing Human Resource Procurement/ Medical Stores Facility Management Operating Theatre Clinical Services Medical records/HMIS Diagnostic Services Pharmacy

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. The performance of this partnership contract is evaluation based on the following milestones: Bed Occupancy Rate Average Legnth of Stay at Hospital Average Number of Birth Deliveries per Month Number of Out Patients received Services Number of In-Patients received Services

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. ChallengesMitigation Recruiting and retaining qualified health workers Various motivating for attracting and retaining qualified staffs are introduced such as capacity building opportunities, baby care taking facilities, annual bonuses and other Balancing the local needs and available scope of services The hospital has been connected with FMIC at Kabul and Karachi. New center for excellence will be established that can handle some of the critical cases Hard geography and difficult communication Post operative patients from the areas with difficult access (through donkey or hours) are kept for a longer period at the hospital Ensuring optimal coordination among the actors in the partnership Regular coordination meetings are organized, joint supervision and monitoring is conducted with the provincial MoPH officials and progress updates are shared timely

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Increased the number of hospital beds from 85 to 100 Improved utilization Increased the bed occupancy rate to 95% Increased the number of child birth from the average of 183 to 222 per month Linked through telemedicine with Kabul, Bamyan and Karachi for: Staff capacity building through teleconferences Consultation on complicated cases Sharing complicated images for result Build new Maternal, Neonatal and Child ward Clinical training site for CMEP and CHNP

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Community perception regarding the quality of services is key for optimal utilization of services Maintaining proper coordination is critical for having good partnership Staff motivation and acknowledgement of best practices is critical for staff retention and efficient output

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Health Management Information Systems (HMIS)

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India.

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India.

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Thanks