HMIS First Publication to give detail on HMS system and Perfromance indicator comparative review .

1. HIS PUBLICATION No. 1
Month-06
Ministry of Public Health
GD of Policy and Planning
Introduction
This newsletter is designed to provide a basic synopsis of routine HMIS and is structured by first discussing
briefly HMIS performance indicators, some health status indicators by MoPH priority health areas and then
by discussing some service performance indicators. The primary data source is that of the HMIS, however
some indicators are triangulated with those of the household survey and the Afghan Mortality Survey.
There are over 120 MoPH-HMIS indicators which can be used by health professionals to monitor program
progress. This newsletter selects some of those indicators by MoPH priority areas including indicators for
Maternal and Child Health, Tuberculosis, Malaria, Mental Health and the Hospital Sector.
Some of the proxy MoPH indicators contained within this report include:
 % 1 yr olds immunized with DPT3
 % 1-yr olds w/ measles vaccine
 % institutional deliveries
 % of pregnant women received
 1 ANC visit
 Couple Month Protection
 # delivered women receiving 1 PNC/total # delivered women
 # of new TB SP+ cases found/est. prev TB
 # TB cases cured (SP-)/ total # TB cases under Rx 8 months
 # reported mental health cases
 % HF with stock-out of 1 essential drug
 % of HF with at least one FHW
 # of acute malnutrition cases
 % of acute malnutrition cases
 Trend of Acute W. diarrhea in U5
page 1

2.  Trend of Pneumonia in U5
This newsletter is designed to stimulate discussion amongst health professionals with regard to the direction
of the health sector. It aims to build the capacity and confidence of people to begin to analyze information so
that they may ask questions, check their program data internal consistency checks and begin to monitor their
own program progress.
Monitoring is the responsibility of everyone. Data Quality is the responsibility of everyone. Data Use is the
responsibility of everyone. The availability of timely and accurate information ensures that decision-makers
have no excuse for not taking information into consideration while making decisions. Accountability within
governance structure starts with examining vertical and horizontal program information. The information
within this newsletter could be used at central level by program or department managers during their regular
discussions with stakeholders, at provincial level during the PHCC meetings and also shared with health
facility staff.
Description of the HMIS system
Health system strengthening is related to the production and use of quality health information at all levels of
the health system. Routine Health Information Systems (RHIS) are receiving increasing attention as a
sustainable strategy towards integrated, country-owned national systems.
The HMIS is a system based on qualitative and quantitative indicators on which data is routinely collected,
processed, analyzed, interpreted, disseminated, and used to improve the provision of health services
according to the MOPH‟s priorities and ultimately to improve the health of the population. The following
data is captured using the HMIS.
BPHS
FSR (Facility Status Report)
 General Facility Status
 Human Resource Status
 Equipment Status
 Status of Services provided
MIAR (Monthly Integrated Activity Report)
 OPD Services
 Nutrition Services
 Maternal and Neonatal Care
 Stock Status
 Immunization Services
 Laboratory Services
 TB Services
 Community Supervision
MAAR (Monthly Aggregated Activity Report)/ Health Post Services
 Family Planning
 Obstetric Referral
 Nutrition Screen
page 2

3.  Under Five Morbidity
 Stock Information
 Community Health Meeting
 Immunization Referrals
CAAC (Catchments Area Annual Census) with key target groups
 Family Planning Coverage
 Pregnancies
 Immunization Coverage
 Maternal and Neonatal death
EPHS
HSR (Hospital Status Report)
 General Status of the Hospital
 Human Resources Status
 Equipment Status
 Status of Services Provided
 Supervision
HMIR (Hospital Monthly Inpatient Report)
 Inpatient Services
 Nutrition Services for under fives
 Imaging services Status
 Stock Status
 Cases and deaths Status
What HMIS can and cannot do
I. The HMIS is limited to the collection of routine management information and as such is not able to
capture all the information needs for all program areas. It provides trends to examine health sector
performance. The HMIS is limited to priority indicators selected for monitoring progress in the
implementation of the BPHS/EPHS. The HMIS does not capture information on notifiable diseases.
II. There are limitations to the use of HMIS data. The population denominator is reduced by 25%
because it was assumed that 75% of the population only has access to health services. This means
that the HMIS does not capture information on 25% of the population, which may or may not have
a higher morbidity and mortality thus could lead to over or under reporting of the services statistics
or morbidity and mortality.
III. The HMIS data quality, completeness, timeliness and accuracy, is validated by a third party which
demonstrates accuracy of over 90% , which is almost double that found in Pakistan and Uganda, and
similar to China and Mexico. National mortality survey (APHI et al 2010) data validated the trends
in service coverage, infant and maternal mortality in HMIS data after accounting for underreporting.
page 3

4. Information flow
Below is a diagram demonstrating the flow of HMIS information across the health sector. The diagram
identifies what forms are to be completed and the feedback and results which should be discussed within
each tier of the health sector. At the last health retreat in 2012 it was identified that there needed to be
strengthening of information sharing for planning and monitoring at Provincial Level. It will be the role of
the HMIS Officers to ensure the appropriate dissemination of health information to both the community and
at the Quarterly Provincial Health Coordination Committee meetings. The HMIS Officers will also need to
coach and mentor health facility staff to use information to improve the health outcomes of the population.
National Indicator Analysis
Annual Progress Reports
Semi-Annual HMIS Report and
Conference
MoPH
Executive
Directorates MoPH 1. Facility Codes and Database
Departments HMIS 2. Staff Codes and Database
Maintains 3. Service Statistics Database
UNIT
4. Grants Management Database
5. Training Database
1. Monthly reports by Facility
2. Quarterly reports by Facility 1. Feedback reports (Quarterly)
3. Staff changes in province 2. Reports/information on request
4. Training in province 3. Meetings (Semi-Annual)
5. Grants management reports 4. Supervision visits
6. Ad-hoc reports
Analysis for
1. Facility Database Action/ provincial planning
2. Staff Database Maintains PHO
3. Service Statistics Database NGO
4. Grants Mgt. Database Hospitals
5. Training Database
1. Feedback reports (Quarterly)
1. Monthly reports 2. Reports/information on request
2. Quarterly Facility reports 3. Meetings (PHCC Quarterly)
3. Reports from Health Posts 4. Supervision visits
4. Community Survey reports
SC/BHC/
CHC/DH Analysis for
Health Post Action
activity reports
Annual Census
Health Post
Community
page 4

5. Number and type of health facilities
Health Facilities by projects:
Program BHC CHC DH PH RH SH SHC mobile Other TOT
PGC (EC) 178 83 13 5 1 82 13 6 381
HSS/GAVI 76 15 2 93
MoPH 60 24 3 11 3 13 11 3 33 161
Other 111 19 7 2 2 10 63 46 65 325
PCH(USAID) 267 169 27 5 1 70 11 550
SHARP(WB) 196 84 19 5 0 0 170 5 1 480
BHC: Basic Health Centre, CHC: Comperhensive Health Centre, DH : District Hosptial, SHC: Sub Health
Centre, PH: Provincial Hospital, RH: Regional Hospital, SH: Special Hospital
page 5

6. Number of health facilities by Province-1390:
Province BHC CHC DH MC PH RH SH SHC Other Total
Badakhshan 33 13 2 21 1 35 5 110
Badghis 24 3 1 1 1 14 44
Baghlan 26 15 2 1 1 17 3 65
Balkh 44 14 5 1 1 1 1 33 6 106
Bamyan 23 10 3 3 1 29 6 75
Dykundi 14 8 2 4 1 13 1 43
Farah 5 11 1 1 17 2 37
Faryab 21 16 2 3 1 14 3 60
Ghazni 37 26 3 1 8 5 80
Ghor 21 8 2 1 1 20 2 55
Helmand 30 14 4 1 11 3 63
Hirat 38 25 4 4 1 25 3 100
Jawzjan 16 7 2 1 1 1 7 2 37
Kabul 74 38 8 10 22 3 26 181
Kandahar 19 20 1 3 1 2 6 52
Kapisa 15 8 1 1 1 15 1 42
Khost 10 12 1 9 5 37
Kunar 21 10 1 1 10 2 45
Kunduz 32 12 1 3 1 17 9 75
Laghman 17 8 2 1 13 1 42
Logar 20 7 2 7 1 6 4 47
Nangarhar 73 19 3 3 1 2 19 6 126
Nimroz 5 2 1 1 7 2 18
Nooristan 11 1 2 10 24
Paktika 18 4 2 1 7 1 33
Paktya 17 8 2 1 11 2 41
Panjsher 9 2 2 1 7 6 27
Parwan 32 10 1 2 1 22 1 69
Samangan 13 5 2 1 1 11 33
Sar-e-Pul 16 8 2 1 1 21 49
Takhar 37 13 3 3 1 15 4 76
Urozgan 7 6 2 1 1 17
Wardak 26 9 3 1 1 18 1 59
Zabul 8 7 1 1 5 22
Grand Total 812 379 69 82 28 6 24 472 118 1990
BHC: Basic Health Centre, CHC: Comperhensive Health Centre, DH : District Hosptial, SHC: Sub Health
Centre, PH: Provincial Hospital, RH: Regional Hospital, SH: Special Hospital
page 6

7. Number of health facilities by service implementers-1390:
Implementer BHC CHC mobile SHC DH PH RH SH Other TOL
SCA 66 30 5 58 6 2 2 169
MoPH 61 24 3 11 3 11 3 13 33 161
SM (MoPH) 53 20 3 44 3 2 1 126
HN-TPO 69 37 1 34 5 2 1 2 151
CHA 39 25 4 60 6 1 2 137
BDN 42 31 3 24 5 1 2 108
AADA 37 24 4 21 3 2 91
CAF 53 20 1 9 4 1 88
BRAC 42 19 2 15 5 1 0 84
ACTD 33 14 1 25 3 1 77
SAF 34 23 1 12 4 3 77
AMI 29 17 3 21 2 2 1 75
Other 28 5 4 5 2 1 2 7 14 68
Merlin 27 11 12 11 1 2 64
AHDS 22 27 4 4 1 1 0 59
Kinder Berg 3 1 17 29 4 54
AKDN 18 8 1 23 1 1 1 53
ARCS 43 8 1 1 53
IMC 35 5 5 4 1 1 1 52
MRCA 18 7 2 5 2 1 1 36
Move 21 2 8 1 0 32
Ibn Sina 6 8 1 11 1 3 30
SDO 12 11 3 2 1 29
Emergency 2 1 20 23
DAC 8 2 8 1 1 20
CWS 7 2 7 0 16
STEP 1 1 7 0 9
MSI 3 6 9
HADAAF 7 0 7
Wadan 1 6 7
SHUHADA 1 4 1 0 6
LEPCO 5 5
AKHS 3 1 1 0 5
IAM 2 2 4
AIL 3 1 0 4
ToT 812 379 82 472 69 28 6 24 118 1990
page 7

8. HMIS Report submission:
 94% of health facilities in Afghanistan submit their MIAR.
 12447 health posts submitted their HMIS reports
HMIS
Submission 1390 Submission
MIAR 94%
FSR 89%
HMIR 81%
HSR 81%
Number of health facilities submitting MAAR 1049
Number of health posts submitted MAR 12447
Submission rate for Monthly Integrated Activity Report (MIAR):
 The BPHS including SHC, BHC, CHC, DH had the highest MIAR submission in 1390. The lowest
rate belonged to special hospitals (SH).
 Among HMIS forms MIAR had the highest submission rate.
 Mobile health facilities had the lowest FSR submission.
 District hospitals had the highest rate of HSR submission in 1390.
HMIS Report Submission By Type of Health Facility
98%
100% 94% 93%
91% 89% 90%
90%
81%
80%
70%
60% MIAR
50% FSR
40% HMIR
31%
30% HSR
20%
10%
0%
BHC CHC DH SHC mobile PH RH SH
BHC: Basic Health Centre, CHC: Comperhensive Health Centre, DH : District Hosptial, SHC: Sub Health
Centre, PH: Provincial Hospital, RH: Regional Hospital, SH: Special Hospital
page 8

9. HMIS Reports Submission by Province in 1390:
Noorstan , Dykundi, Logar, Samangon, Paktya and Kunar had the highest HMIS reports submission.
Provinces %MIAR % FSR % HSR %HMIR % MAAR # MAR
Badakhshan 100% 87% 100% 100% 100% 417
Badghis 84% 81% 100% 100% 78% 310
Baghlan 94% 92% 100% 100% 92% 607
Balkh 93% 89% 63% 100% 84% 799
Bamyan 100% 83% 75% 98% 100% 406
Dykundi 94% 97% 100% 100% 100% 321
Farah 87% 100% 100% 100% 94% 369
Faryab 100% 89% 100% 100% 93% 513
Ghazni 92% 89% 75% 100% 88% 750
Ghor 98% 98% 100% 100% 77% 409
Helmand 93% 95% 60% 57% 77% 429
Hirat 98% 85% 100% 100% 78% 1010
Jawzjan 99% 97% 75% 100% 92% 333
Kabul 72% 43% 33% 44% 30% 420
Kandahar 100% 89% 100% 100% 74% 476
Kapisa 97% 92% 100% 100% 60% 169
Khost 99% 97% 100% 75% 97% 304
Kunar 97% 90% 100% 100% 100% 251
Kunduz 95% 92% 100% 100% 93% 318
Laghman 100% 98% 100% 75% 99% 277
Logar 94% 98% 100% 100% 100% 153
Nangarhar 88% 84% 83% 99% 84% 839
Nimroz 100% 100% 100% 100% 86% 105
Nooristan 92% 100% 100% 100% 100% 140
Paktika 95% 79% 100% 100% 83% 188
Paktya 97% 94% 100% 100% 96% 305
Panjsher 100% 89% 50% 67% 85% 115
Parwan 100% 100% 100% 100% 70% 336
Samangan 96% 93% 100% 100% 100% 140
Sar-e-Pul 98% 96% 100% 100% 93% 264
Takhar 99% 94% 100% 100% 94% 480
Urozgan 94% 100% 100% 100% 77% 185
Wardak 93% 94% 75% 94% 83% 156
Zabul 91% 90% 50% 100% 89% 154
Monthly Aggregated Activity Report (MAAR) Submission Rate:
Excluding Kabul province, Kapisa health facilities have the lowest health post and MAAR submission.
% of Health Facilities Submit MAAR _ 1390
100%
80%
60%
40%
20%
0%
Ghazni
Kabul
Hirat
Baghlan
Bamyan
Helmand
Kunar
Kunduz
Urozgan
Zabul
Balkh
Kapisa
Laghman
Paktika
Paktya
Samangan
Takhar
Badghis
Sar-e-Pul
Kandahar
Badakhshan
Ghor
Jawzjan
Nimroz
Panjsher
Wardak
Dykundi
Khost
Logar
Nooristan
Parwan
Farah
Faryab
Nangarhar
page 9

10. Linkages with other systems
Currently the MoPH HIS databases are at the level that allows departments to easily search and extract data
from their own databases or to do other queries using a common link.
The MoPH HMIS database is the “common” database through which other departmental databases interact
with the core system. The MoPH HMIS Department is to take the technical lead in facilitating database
development. The diagram below briefly demonstrates the link between a number of the databases and the
HMIS common database.
Some of the databases being used in the MoPH include the M&E database, HMIS, DEWS, EPI database, HR
database, Procurement database, Expenditure Management Information System and Payroll system. These
need to be integrated, wherever feasible technically and required operationally, and brought under one data
centre control via a database warehouse. Improving connectivity to the database at provincial level will also
be a priority of the MoPH.
page 10

11. MoPH Priority Health Problems and Indicators:
Health service policy for the national level is set at the central level by a mandatory minimum package of
health services, the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services
(EPHS). In 2010, the MoPH identified key health indicators which could be used to measure progress against
the key priority areas. This section reviews progress against some of those indicators.
Below are the results of the most recent LQAS Household Survey conducted in USAID and EC provinces.
Figure 2: Summary of PGC Household Survey 2011
page 11

12. 1. Reproductive Health
This section covers important indicators for reproductive health include the provision and use of
contraceptives, the provision of TT2, institutional deliveries and caesarian section rates.
Percentage of service delivery points providing FP counseling and/or FP products:
Less than 80% of health facilities in the following provinces are providing FP services: Farah,
Helmand , Kabul, Kapisa , Panjsher and Zabul.
Availability of Modern Contraceptive at Health Facilities
(1390)
120%
100%
80%
60%
40%
20%
0%
Zabul
Nimroz
Kapisa
Laghman
Panjsher
Bamyan
Kabul
Khost
Sar-e-Pul
Urozgan
Helmand
Samangan
Ghazni
Kunar
Parwan
Badghis
Hirat
Paktika
Farah
Logar
Wardak
Balkh
Dykundi
Faryab
Ghor
Jawzjan
Kandahar
Takhar
Badakhshan
Paktya
Baghlan
Kunduz
Nangarhar
Nooristan
Women Receiving TT2
A woman receiving two or more injection of tetanus toxoid (TT2 or more) during pregnancy is an important
indicator of ANC service and preventing neonatal tetanus. Percentage of pregnant women receiving two or
more TT injections under HMIS data was close to that of the AMS findings as evidenced in the table below.
In addition, the regional distributions of TT2 or more were also similar in HMIS and AMS, indicating that
AMS findings validate HMIS data.
Percentage distribution of TT2 or more coverage, contraceptive use by regions in AMS 2010, HMIS
2010 and NRVA 2007-08
Domains TT2 or more coverage % Contraceptive use CYP 2010 is comparable
to following % of
% women using
contraceptive for a year
AMS HMIS NRVA AMS NRVA HMIS- CYP
North 60 74 13 255948 19
Central 44 42 31 420282 22
page 12

13. South 47 53 15 338386 23
Total 50 55 33 20 15 1014617 22
Number of Functional Emergency Obstetric Care (EmOC) Units:
Emergency obstetric signal functions are defined as:
 Administration of parenteral antibiotics;
 Administration of parenteral oxytocic drugs;
 Administration of parenteral anticonvulsants for pregnancy-induced hypertension;
 Performance of manual removal of placenta;
 Performance of removal of retained products (e.g. vacuum aspiration);
 Performance of assisted vaginal delivery (e.g. ventouse, forceps);
 Performance of surgery (e.g. Cesarean section); and
 Performance of blood transfusion.
Facilities are divided into those that provide „basic‟ emergency obstetric care (EmOC) and „comprehensive‟
EmOC. If a facility has performed each of the first 6 functions, it qualifies as providing basic EmOC. If it has
provided all 8 of the functions, it qualifies as a „comprehensive‟ EmOC facility.
Comp. Basic Comp. Basic
Provinces EmOC EmOC Provinces EmOC EmOC
Badakhshan 2 56 Kunar 1 23
Badghis 2 19 Kunduz 1 53
Baghlan 3 50 Laghman 1 15
Balkh 5 74 Logar 3 20
Bamyan 3 34 Nangarhar 4 62
Dykundi 1 23 Nimroz 1 6
Farah 3 22 Nooristan 1 9
Faryab 6 33 Paktika 4 9
Ghazni 3 45 Paktya 3 21
Ghor 3 14 Panjsher 1 12
Helmand 3 24 Parwan 1 40
Hirat 6 37 Samangan 3 20
Jawzjan 2 27 Sar-e-Pul 3 33
Kabul 6 38 Takhar 4 54
Kandahar 2 28 Urozgan 1 9
Kapisa 1 8 Wardak 2 27
Khost 1 16 Zabul 1 9
page 13

14. Proportion of Institutional Deliveries
The proportion of births delivered in facilities with basic or comprehensive EmOC.
Caesarian Section Rate:
The Caesarian section rate is the proportion of pregnant women who have a cesarean section in a specific
geographical area and time period. This indicator demonstrates the extent to which a particular life-saving
obstetric service is being performed in EmOC facilities. It reflects the availability, accessibility and utilization
of services as well as the functioning of the health service system. The appropriate use of a cesarean section
leads to a decrease in maternal mortality and morbidity, as well as decreasing perinatal morbidity and
mortality. While cesarean sections may be performed solely for the health of the fetus or newborn,
UNICEF/WHO/UNFPA recommend a C-section rate between 5 and 15 per cent of all births, based on
estimates from a variety of sources. Rates less than 5 per cent may indicate inadequate availability and/or
access to EmOC.
Helmand, Kapisa, Faryab, Badghis, and Laghman had the lowest caesarian section rate in 1390. Kabul , Hirat,
and Balkh had the highest caesarian section rate.
page 14

15. Caesarian Section Rate
(1390/2011)
6.0%
4.9%
5.0% 4.4%
3.7%
4.0%
3.0% 2.3% 2.2% 2.2% 2.0%
2.0% 1.4% 1.5%
1.2% 0.9% 1.1% 1.0% 0.9% 1.2%
0.8% 0.6% 0.8% 0.7% 0.7% 0.5%
1.0% 0.1% 0.4%
0.1%
0.0%
Khost
Hirat
Kunduz
Kabul
Dykundi
Kapisa
Wardak
Paktika
Faryab
Kunar
Sar-e-Pul
Farah
Logar
Nimroz
Ghazni
Parwan
Helmand
Zabul
Urozgan
Laghman
Takhar
Baghlan
Paktya
Bamyan
Panjsher
Badghis
Ghor
Balkh
Jawzjan
Badakhshan
Nangarhar
Samangan
Kandahar
Postnatal Care (PNC):
The first hours, days and weeks after childbirth are a dangerous time for both mother and newborn infant.
Among women who die each year due to complications of pregnancy and childbirth, most deaths occur
during or immediately after childbirth. Care in the period following birth is critical not only for survival but
also to the future of mothers and newborn babies. Major changes occur during this period that determine
their well-being and potential for a healthy future. Postpartum care for the mother has focused on routine
observation and examination of vaginal blood loss, uterine involution, blood pressure and body temperature.
Similarly, postnatal care for the baby has focussed on cord care, hygiene and weight monitoring and feeding
and/or immunizations.
Over-reporting is seen in Logar, Nangarhar, Khost and Kapisa provinces.
% PNC_1390
160%
140%
120%
100%
80%
60%
40%
20%
0%
Khost
Kunduz
Hirat
Kabul
Dykundi
Kapisa
Wardak
Kunar
Logar
Nimroz
Sar-e-Pul
Farah
Ghazni
Paktika
Parwan
Faryab
Helmand
Laghman
Urozgan
Baghlan
Paktya
Zabul
Nooristan
Ghor
Takhar
Balkh
Bamyan
Jawzjan
Panjsher
Badghis
Badakhshan
Nangarhar
Samangan
Kandahar
page 15

16. 2. Child Health
This section covers important indicators for child health including diarrhea and pneumonia cases, trends
immunization and malnutrition.
Diarrhea and Pneumonia Cases
Acute respiratory infections, diarrheal diseases, malnutrition, neonatal tetanus and measles are the main
causes of death among children aged 0-59 months in Afghanistan. A review of data reveals diarrhea is
widespread throughout the year with an increase in the number of cases started from May, reaching the
highest levels in the months of June, July and August and gradually decreasing again from the month of
September onwards
 Kunar, Laghman, Nangarhar, and Nimroz had the highest rate of diarrhea and pneumonia cases per
under 5 population in 1390.
# of Diarrhea and Pneumonia Cases in Children Less than 5 Y per 1000
population (U 5Y)
1500
1000
500
0
Samang…
Noorist…
Nangar…
Badakh…
Badghis
Hirat
Laghman
Ghor
Ghazni
Logar
Faryab
Baghlan
Kapisa
Nimroz
Paktya
Helmand
Urozgan
Sar-e-Pul
Paktika
Farah
Dykundi
Takhar
Kabul
Kunar
Jawzjan
Wardak
Zabul
Khost
Bamyan
Kandahar
Balkh
Parwan
Panjsher
Kunduz
Diarrhea Pneumonia
 Nangarhar, Kabul, Badakhshan and Kandahar had highest numbers of pneumonia and diarrhea cases
in 1390.
 More than 240000 cases and 160000 cases are seen in Nangarhar and Kabul health facilities.
# of Pneumonia and Diarrhea Cases (1390/2011)
260000
240000
220000
200000
180000
160000
140000
120000
100000
80000
60000
40000
20000
0
Takhar
Logar
Sar-e-Pul
Nimroz
Zabul
Panjsher
Kabul
Khost
Urozgan
Samangan
Parwan
Kapisa
Ghor
Faryab
Ghazni
Kunar
Wardak
Badghis
Paktika
Hirat
Helmand
Farah
Dykundi
Jawzjan
Badakhshan
Nangarhar
Balkh
Baghlan
Kunduz
Kandahar
Bamyan
Laghman
Nooristan
Paktya
Diarrhea cases Pneumonia cases
page 16

17.  Acute Respiratory Infection (ARI) and Diarrhoea Disease (DD) contribute to 40% of all OPD
consultation.
 29 % of consultations are due to ARI and 11% due to diarrhoea diseases
Proportion of All DD and ARI among all OPD cases in 1390
Diarrhea
Diseases
11%
ARI
29%
Other Cases
60%
Immunization Coverage:
The following graphs indicate that trends in immunization have not substantially increased despite increases
in deliveries at health facilities. This could represent a missed opportunity to encourage vaccination amongst
mothers of newborns.
HMIS Department, MoPH 06/24/2012 10
page 17

18. Measles:
Nangarhar, Kabul, Khost, Kandahar, Ganzni, Kunar , Helmand and Paktya had the highest cases of measles
in 1390.
# of measles cases-1390 (2011)
2000
1500
1000
500
0
Hirat
Nooristan
Laghman
Logar
Faryab
Ghor
Ghazni
Urozgan
Baghlan
Paktya
Helmand
Samangan
Paktika
Nimroz
Dykundi
Kapisa
Farah
Takhar
Kabul
Nangarhar
Zabul
Khost
Sar-e-Pul
Wardak
Parwan
Bamyan
Jawzjan
Kunar
Balkh
Panjsher
Badghis
Kandahar
Badakhshan
Kunduz
Low Birth Weight:
Malnutrition:
In Afghan preschool children 6-59 months, 54% (39.9-60%) are suffering from stunting and 7 % from
wasting (Acute Malnutrition). This level of stunting or chronic malnutrition is the highest level in the world .
The WHO classifies Afghanistan as country with “very high” prevalence of chronic malnutrition.
page 18

19.  In terms of percentage, Panjsher, Sar e Pul, Kunar , Zabul, Bamyan and Paktya provinces show a
high % of acute malnutrition.
% of Acute Malnutrition (# of Cases/U 5Y population) 1390
30%
25%
20%
15%
10%
5%
0%
Panjsher
Helmand
Nimroz
Kabul
Khost
Sar-e-Pul
Zabul
Faryab
Kapisa
Ghazni
Parwan
Urozgan
Samangan
Badghis
Hirat
Farah
Kunar
Paktika
Logar
Wardak
Dykundi
Ghor
Jawzjan
Takhar
Badakhshan
Nooristan
Baghlan
Balkh
Kandahar
Paktya
Kunduz
Bamyan
Laghman
Nangarhar
 In terms of absolute numbers Badakhshan, Baghlan, Faryab, Hirat, Kabul, Kunar, Kundoz,
Nangarhar , Paktya and Sur e pul have the highest acute malnutrition cases in 1390.
# of Acute Malnutrition by Province1390
25000
20000
15000
10000
5000
0
Panjsher
Helmand
Nimroz
Kabul
Khost
Sar-e-Pul
Zabul
Kapisa
Badghis
Parwan
Urozgan
Farah
Ghazni
Hirat
Kunar
Paktika
Samangan
Logar
Wardak
Dykundi
Faryab
Ghor
Jawzjan
Takhar
Badakhshan
Paktya
Baghlan
Balkh
Kandahar
Kunduz
Bamyan
Laghman
Nangarhar
Nooristan
3. Tuberculosis
TB is a major public health and development challenge in Afghanistan. The country is one of 22 TB high-
burden countries in the world. The World Health Organization estimates that every year in Afghanistan, more
than 53 000 new cases of TB occur and more than 10,500 people die because of this curable disease. Women,
already a vulnerable group in Afghanistan, account for 66% of cases.
page 19

20. TB detection rate (from HMIS):
TB Detection 1390
1
0.8
0.6
0.4
0.2
0
Sar-e-Pul
Jawzjan
Kandahar
Wardak
Nimroz
Zabul
Kapisa
Panjsher
Kabul
Khost
Helmand
Paktika
Samangan
Urozgan
Faryab
Ghazni
Kunar
Parwan
Badghis
Hirat
Logar
Dykundi
Farah
Balkh
Ghor
Takhar
Badakhshan
Baghlan
Bamyan
Laghman
Paktya
Kunduz
Nangarhar
Nooristan
4. Service Workload
Average New Out Patient Department per Month by Type of Health Facility
Among BPHS health facilities district hospitals (DH) had the highest average OPD per month in 1390.
New OPD Per Month by Type of HF 1390
6000
5276
5000
4000
3000
2341
2000
1369 1291
814
1000
0
Mobile Sub Center BCH CHC DH
OPD per Capita by province:
Consultation rates varied markedly by province, ranging from 2.6 in Logar to 0.8 in Kandahar.
page 20

21. Trend of Patients/Clients per Month per Health Facility in last 8 Years:
There has been a 95% increase in average number of Patients/Clients per month per health facility:
Average Number of Patients/Clients per month per Health Facility
2000
1800 1878
1735 1779 1773
Number of visited cases
1600
1400 1404
1200 1275
1138
1000 960
800
600
400
200
0
Y 83 Y 84 Y 85 Y 86 Y 87 Y 88 Y 89 Y 90
Last 8 past years
Number of admissions by type of hospital
 Provincial hospital had the highest admission in 1390 but bed turn over shows Regional Hospital and
after District Hospital had higher bed turn over.
 Overall 1378388 patients were admitted in Afghanistan hospitals during 1390.
page 21

22. # Of Admissions by Type of Hospital
(1390/2011)
SH, 246358,
18%
DH, 331089,
24%
RH, 392424,
28% PH, 408517,
30%
Bed Turnover Rate:
Bed turnover rate is a measure of the extent of hospital utilization. It is the number of times there is a change
of occupant for a bed during a given time period. It is given by the formula:
 Hospital bed turnover rate = Number of discharges (including deaths) in a given time period /
Number of beds in the hospital during that time period
Bed Turnover Per Month
12.0
9.8
10.0
8.0 7.5
6.9
6.0
4.0
2.0
0.0
DH PH RH
page 22

23. Bed occupancy rate in hospitals:
The occupancy rate is a calculation used to show the actual utilization of an inpatient health facility for a
given time period. Bed occupancy rates have been proposed to reflect the ability of a hospital to provide safe
efficient patient care. A good hospital works well when bed occupancy rates are between 60 and 80%. This
creates the flexibility that is good for patients.
By type of hospital: Regional hospitals are over-occupied.
Bed Occupancy Rate by Type of Hospital 1390
120%
102%
100%
79%
80%
60% 62%
60%
40%
20%
0%
DH PH RH all Tyep
By province: Badakhshan, Baghlan, Jawzjan, Kandahar and Kunar hospitals are over-occupied
Bed Occupancy Rate 1390
180%
160%
140%
120%
100%
80%
60%
40%
20%
0%
Logar
Takhar
Nimroz
Sar-e-Pul
Zabul
Kabul
Khost
Kapisa
Panjsher
Badghis
Ghor
Ghazni
Parwan
Urozgan
Helmand
Paktika
Samangan
Hirat
Farah
Faryab
Kunar
Wardak
Dykundi
Jawzjan
Badakhshan
Baghlan
Balkh
Kandahar
Kunduz
Nooristan
Bamyan
Laghman
Nangarhar
Paktya
page 23

24. Consultation per Health Post per Month
Zabul, Laghman , Nooristan and Kunar had the lowest figure for this indicator in 1390. Badghis, Faryab,
Jawzjan and Farah had the highest figure for this indicator in 1390.
Average Patient seen by HP Per Month -1390
140 121 122
111 117
120
95 100
100 91 90 92 86 87 92
74 77 75
80 67 70 68
59 60
60 53
41 43 46 45
37 31
40 30 33 26
18 13 14
20 11
0
Nimroz
Kapisa
Panjsher
Sar-e-Pul
Zabul
Bamyan
Kabul
Khost
Samangan
Ghazni
Helmand
Kunar
Urozgan
Badghis
Paktika
Parwan
Hirat
Logar
Wardak
Farah
Faryab
Ghor
Jawzjan
Badakhshan
Balkh
Dykundi
Kandahar
Nangarhar
Takhar
Baghlan
Paktya
Kunduz
Nooristan
Laghman
5. Mental Health Services
The following map shows utilization of mental health services by province. Mental health services are less
utilized in north, northeast and central region.
page 24

25. 6. Staffing (by facility type)
Proportion of health facilities with at least one female health worker:
Proportion of HF with At Lest One Female
Health Worker_1390
100%
80%
60%
40%
20%
0%
Province population per clinical health worker:
Province BPHS facility per Province BPHS facility per
Name 10000population Name 10000population
Badakhshan 1,18 Kunar 0,95
Badghis 0,93 Kunduz 0,66
Baghlan 0,70 Laghman 0,98
Balkh 0,81 Logar 1,12
Bamyan 1,67 Nangarhar 0,82
Daykuni 0,95 Nimroz 1,08
Farah 0,62 Nuristan 1,88
Faryab 0,72 Paktika 0,79
Ghazni 0,69 Paktya 0,76
Ghor 0,85 Panjshir 1,60
Hilmand 0,67 Parwan 1,16
Hirat 0,55 Samangan 0,94
Jawzjan 0,66 Sar-i- Pul 0,94
Kabul 0,32 Takhar 0,77
Kandahar 0,44 Urozgan 0,40
Kapisa 0,99 Wardak 1,02
Khost 0,58 Zabul 0,77
page 25

26. Registered health workers (from HR database):
Physicians per 10,000 population
Midwives per 10,000 population
page 26

27. Availability of recommended staffing according to BPHS and EPHS:
Although there were almost 2, 000 graduated community midwives from various training programs (CMEs
and IHSs) there remain concerns with the employment and retention of those newly graduated within the
health sector. Trainees are selected by provincial teams. There may need to be a stronger selection process of
candidates.
Human Resource in Health Sector (1390/2011)
Dentist
Anesthesia Nurse
Radiography Technician
Dental Technician
Pharmacist
Pharmacy Technician
Other
Male
Lab Technician
Female
Vaccinator
Midwife
Administration
Nurse
Doctor
Suppor Staff
0 2000 4000 6000 8000
7. Infrastructure, Utilities and Transport
 27% of BHC, 14% of CHC and 8% of DH are in temporary buildings.
 24% of BHC , 5% of CHC and 2% of DH didn‟t have electricity at all in 1390
 50% of BHC, 57% CHC and 72% of DH had appropriate waste disposal system.
 13% of DH had no ambulance transportation in 1390.
page 27

28. Infrastructure, Utilities and Transport-1390 for BPHS Facillities (BHC, CHC,
DH)
100% 87%
90% 76%
80% 71% 72%
73% 64%
70% 54% 57% 58%
60% 50%
50%
40% 27% 28%
30% 14%
20%
20% 8% 14% 4%
BHC
10%
0% CHC
DH
% BPHS Facilities (BHC, CHC , DH) with Temporary Building -
1390
70% 62%
60% 55%
45% 47%
50% 42% 38%
40% 31% 27% 29% 26% 31% 32%
30%
22% 23% 27%
30% 18% 17%
20% 11% 13% 13% 14% 18% 10% 10%
11% 14%
9%8% 8%
10% 4% 0%0% 0%
0%
Sar-e-Pul
Badakhshan
Dykundi
Ghor
Faryab
Balkh
Khost
Baghlan
Ghazni
Helmand
Laghman
Logar
Nooristan
Hirat
Nimroz
Paktya
Urozgan
Paktika
Samangan
Kabul
Kapisa
Farah
Kunar
Nangarhar
Wardak
Bamyan
Kandahar
Takhar
Badghis
Jawzjan
Panjsher
Parwan
Zabul
Kunduz
Functioning laboratory:
Blood transfusion capacity existed only in a minimum number of health facilities in Parwan , Bamyan, Zabul,
Wardak and Panjsher provinces.
% of HF with % of HF with
% with Blood % with Blood
functional Transfusion functional Transfusion
Province Lab capacity Province Lab capacity
Badakhshan 44% 28% Kunar 50% 42%
Badghis 44% 7% Kunduz 49% 20%
Baghlan 46% 19% Laghman 48% 22%
page 28

29. % of HF with % of HF with
% with Blood % with Blood
functional Transfusion functional Transfusion
Province Lab capacity Province Lab capacity
Balkh 21% 7% Logar 33% 33%
Bamyan 39% 4% Nangarhar 67% 18%
Dykundi 22% 12% Nimroz 31% 6%
Farah 33% 20% Nooristan 63% 42%
Faryab 41% 14% Paktika 48% 16%
Ghazni 39% 33% Paktya 43% 13%
Ghor 19% 8% Panjsher 28% 5%
Helmand 35% 15% Parwan 25% 1%
Hirat 38% 16% Samangan 26% 21%
Jawzjan 48% 17% Sar-e-Pul 28% 10%
Kabul 65% 10% Takhar 32% 25%
Kandahar 62% 7% Urozgan 65% 41%
Kapisa 35% 10% Wardak 31% 5%
Khost 42% 25% Zabul 32% 5%
Availability of Functional Lab and Transfusion Capacity in Health Facility-
1390
80%
60%
40%
20%
0%
Kapisa
Kunar
Nimroz
Panjsher
Kabul
Khost
Sar-e-Pul
Zabul
Ghazni
Helmand
Parwan
Urozgan
Badghis
Hirat
Paktika
Samangan
Farah
Logar
Wardak
Dykundi
Faryab
Ghor
Jawzjan
Takhar
Badakhshan
Paktya
Baghlan
Balkh
Bamyan
Kandahar
Kunduz
Laghman
Nooristan
Nangarhar
% with functional Lab % of HF with Blood Transfusion capacity
page 29

30. Blood Transfusion Reaction Rate:
Samangan , Wardak , Paktika and Jawzjan experience a high rate of transfusion reaction.
Blood Transfusion Reaction Rate
(average per month in 1390)
4.00%
3.50%
3.00%
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
Stock Out of Essential Drugs:
Based on HMIS data essential drug stock out had a steady decrease from 1383 to 1390.
% of BPHS HFs with at least One Essential Drug Stock Out
80
76
73
62 63
59 60
55
Y 1383 Y 1384 Y 1385 Y 1386 Y 1387 Y 1388 Y 1389 Y 1390
page 30

31. 8. Conclussion:
Information to be of use needs to be discussed and shared. Some recommendations could be to review
referral practices between primary and tertiary care settings, to review in more detail the shifts in the burden
of disease within and between communicable and non communicable diseases, determine how better to
strengthen pharmaceutical supply and examine why new female graduates are not being retained or employed
n the health sector.
page 31