Effective implementation of National Health Strategy 2016-20

1. Effective implementation of national
health strategy 2016-2020 for achieving
Universal Health Coverage
Najibullah Safi, MD, MSc. HPM

2. Introduction
 The presentation focuses on broader environment and
action for the implementation of the national health strategy
(NHS 2016-2020)
 Specific issues and required actions related to each strategic
area and its sub-components are beyond the scope of this
presentation
 The strategy thematic* area are:
 Governance, institutional development, public health, health
services, human resource, and information management
*The Ministry of Public Health, National Health Strategy 2016-2020, September 2016
04-Jun-17 2

3. Implementation context
 Government health
expenditure (HE) as % of total
government expenditure
4.3%* - relatively constant
over the years
 Per capita HE 70.9USD* -
increased
 THE as % of GDP 9.5%* -
increased
 Reduction in resource**
 GDP per capita remains almost
constant
 Per capita foreign aid declined
over the years
 Security situation
 Number of security incidents
increased over the last 13
years***
142.4 130.6
70.7
755
688 696
0
100
200
300
400
500
600
700
800
2014 2015 2016
Per capita aid $ Per capita GDP $
0
5000
10000
15000
20000
25000
SECURITY INCIDENTS
*NHA 2014, MoPH
**Afghanistan at glance 2016-17, CSO
***Improving access to and quality of health services: the
Afghanistan Health Services Study, World Bank, May 2017
3

4. Universal Health Coverage (UHC)
 UHC means all people have access
to health services they need
without the risk of financial
hardship while paying for them
 In order to achieve UHC, we need:
 Strong, efficient, resilient, well run
health system that meets priority
health needs through people centered
integrated care
 Affordability – a system for financing
health services
 Availability of essential medicines and
technology
 Well trained motivated health workers
 Integrated programs and interventions
to address social determinates of
health
http://www.who.int/contracting/documents/QandAUHC.pdf?ua=1
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5. Identified main challenges for implementation
 The national health strategy
identified the following as major
challenges*:
 Growing insecurity
 Slow economic growth and
diminishing aid follow
 Widespread corruption
 High total fertility rate
 Difficult terrain
 Poor human resource management
 Poor referral system
 Under utilization of health facilities
 Under funded programs e.g. NCDs
 High out of pocket expenditure
 Gender inequalities
*The Ministry of Public Health, National Health Strategy 2016-2020, September 2016
** The Ministry of Public Health, draft Afghanistan health sector development framework 2017-2022
• Draft Afghanistan health sector
development framework 2017-
2022**
• Reaching underserved areas
• Addressing the growing burden
of non communicable diseases
(NCDs)
• Further improving hospital
services
• Poor feeding practices
• Low use of family planning
services
• Low level of literacy
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6. Key actions for effective implementation of
the NHS (KA for EI)
Expand the package of health services
 Review and revision of BPHS* and EPHS** in light of the
national health strategy for addressing emerging problems
(e.g. NCDs)
 Prioritization and selection of cost effective high impact
interventions
*Basic Package of Health Services
** Essential Package of Hospital Services
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7. KA for EI: Expand the coverage
 To reach the unreached and cover the so called white areas:
 Establishment of new health facilities
 Redistribution/rationalization of existing health facilities
 Partnership with private sector for the provision of tertiary care in
urban areas and for PHC in remote, underserved and insecure areas
 Enhancing the health of the poor *
 Better access through establishment of new health centers and
reducing the cost of seeking care (e.g. transportation in rural and
under served areas)
 Addressing insecurity
 Meaningful and active engagement with communities
 Negotiating with different political parties and fractions, local
influencers
 Engaging ICRC and UN agencies
* The Ministry of Public Health, Afghanistan health sector development framework 2017-202204-Jun-17 7

8. KA for EI: Enhance financial protection
 Reduce out of pocket expenditure *
 Initiate a prepayment financing mechanism
 Explore options for health insurance
 Enhance efficiency in service delivery
 Develop resource mobilization strategy
 Increased financing and increasing the proportion of resources under
MoPH stewardship *
 Investing more public resources in health sector *
 Invest at least 10% of public resources in health
 Earmark taxation for health services on tobacco and other goods having
negative impact on health
 Mobilize additional resources from traditional and non traditional
donors including private sector
* The Ministry of Public Health, Afghanistan health sector development framework 2017-202204-Jun-17 8

9. KA for EI: Improved coordination
 Improve regional cooperation
 Its crucial for Polio eradication and control of other communicable,
emerging and reemerging diseases
 Implementation of International Health Regulation (IHR)
 Reinforce intersectoral collaboration
 Strengthen coordination among different
departments/program of MoPH
 Strengthened communication and coordination with all key
stakeholders including communities
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10. KA for EI: Strengthen accountability
 Robust monitoring and evaluation of health services at all
levels
 Greater accountability for result *
 Enhance monitoring by MoPH and communities
 Effective use of sanctions including termination of contract in case of
poor performance
 Annual review of performance by senior government officials and
stakeholders
 Publication of data on performance of NGOs by province
 Strengthen community participation through effective
implementation of Citizen's Charter *
 Community monitoring of health services
 Getting more info from patients through surveys and complaint line
 MoPH officials to regularly meet communities and seek their opinion
about health services
* Ministry of Public Health, Afghanistan health sector development framework 2017-202204-Jun-17 10

11. KA for EI: Enhance efficiency
 Avoid duplication, better alignment of the off-budget
projects
 Bring off-budget to on-budget and make sure they are in line
with MoPH priorities
 Effective purchasing of health services – focus on outputs**
 Enhance opportunities for innovation and learning *
 Low cost, easily implementable, focus on priority challenges, pro
poor, rigorously evaluated
 Effective implementation of anti corruption strategy
 Reduce beaurucratic procedures particularly in procurement
and fund disbursement
 Strengthen supply management system
 Effective use of collected data and evidence based decision
making
* Ministry of Public Health, Afghanistan health sector development framework 2017-2022
** Policy brief, improving access to and quality of health services: the Afghanistan health services study, World
Bank, May 2017
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12. KA for EI: Cross cutting issues
 Formulation of annual plan with specific and measurable
targets for each strategic area
 Considering the past experience, growing insecurity, and
existing limited capacity in public sector, contracting out of
health services to NGOs may continue as*:
 Contracting-out has performed well in high conflict setting
 Service delivery has been resilient to conflict under existing model of
implementation
 Providing more flexibility and autonomy to service providers
 Increasing the focus on behavioral change
 Active engagement with community and religious leaders for
promoting desired behaviors
 Promote the use of family planning
 Promote exclusive breast feeding and improve infant and young
child feeding behaviors
*Ministry of Public Health, Afghanistan health sector development framework 2017-202204-Jun-17 12

13. KA for EI: Cross cutting issues
 Functional establishment of Medical Council
 Effective regulation of private sector
 Standardization of medical education
 Strengthen the functions of National Medicines and Health
Product Regulatory Authority
 Ensure the quality of medicines and effective use of technology
 Take appropriate measures for improving quality of care
 Based on capacity gap analysis provide capacity building
opportunities for private sector in key areas
 Training of qualified staff particularly female (e.g.
community midwives and community nurses)
 Annual review of the implementation of health strategy
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