1. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health better systems, better health Comprehensive Approach to Building Afghanistan Health Economics & Finance Directorate Better Health Systems: Strategies that Work Presentation Series at the Global Health Council Ibrahim Shehata February 7, 2012

2. Summary Challenges Planning comprehensive approach Transitioning to self-sustaining health systems

3. Challenges Dependence on donor funding (85%) and no tax base for revenue generation High level of OOP (75%) Limited capacity in budget execution (60%) Low public per capita expenditure (4%) Low capacity in applied health economics and resource management

4. Planning for Comprehensive Approach Develop a comprehensive health financing strategy that emphasizes: Mobilizing Afghan human resources Gradual decrease on donor dependency Aid coordination Sustainability

5. Mobilize Local Resources Build and institutionalize the technical capacity of HEFD staff: Enrolled 7 HEFD staff in master’s degree program in health economics On-the-job training programs provided to HEFD staff HEFD organizational and operational improvements

6. Gradual Decrease on Donor Dependency Develop revenue generation policy that introduces “sin taxes” on interventions having negative externalities on health Support MOPH advocacy efforts Evaluate user fees Improve budget execution to 100%

7. Improve Aid Coordination Coordinate technical support with WB, EC, and other USAID projects Expenditure management information system Health financing policy Costing BPHS, EPHS, and vertical programs

8. Ensure Sustainability Implement the most comprehensive public program to transition donor funded civil servant employees into the Afghan “tashkeel” (civil service system) Cost tashkeel positions Identifying staffing capacity needs currently missing in the tashkeel Both take stock of and cost the training, which will enable “topped up” staffing positions to effectively and efficiently perform their functions Increasing competitiveness of tashkeel salaries Develop an action plan and timeline for the MoPH to implement changes Design a five-year performance-assessment-monitoring and evaluation process and reporting framework

9. Reflection In some ways, it is easier to impact health systems in post-conflict countries because often you are designing the system from scratch without having to navigate the existing system and its bureaucracy

10. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health better systems, better health Thank you www.HealthSystems2020.org