Afghanistan National Hospital Survey - Management Sciences for ...

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Acknowledgements The Afghanistan National Hospital Assessment (NHA) is an initiative of the Ministry of Health (MoH) implemented by Management Sciences for Health Europe (MSH Europe). It is a collaborative effort, implemented in partnership with The Ministry of Health, the European Commission and the French Ministry of Foreign Affairs, as a follow-up to the 2002 National Health Resource Assessment (NHRA). The NHA team would like to thank all who were involved in the project, and in particular: − Health facility staff in each of the hospitals visited by the survey team − MoH staff and representatives of collaborating agencies who participated in the refinement of survey tools and facilitated their implementation − Surveyors and field supervisors who succeeded in collecting information in all scheduled hospitals in a timely and comprehensive manner − The data management staff who completed the entry of data promptly and accurately − The translators who worked on the questionnaire Special recognition goes to: − Her Excellency Dr. Sohailah Sidiq, Minister of Health − Dr. Ferozuddin Feroz, Deputy Minister, MoH − Dr. Basir Mansoor, GCMU, MoH − Dr Stanekzai, Director of Planning, MoH − Antony Savelly and the REACH project team − Dr Christian Collard, European Union − Jean-François Cauttin, European Union − Frédéric Tissot, French Ambassy This report was preapred by: − Dr. Denis Broun − Emeric Debionne − Shariar Ghane − Dr. Paul Ickx − Dr. Laurence Ickx-Laumonnier − Philippe Lanlo − Bram Piot NHA 2003 iii
FOREWORD A survey of 117 hospitals was undertaken at the request of the Ministry of Health in October and November 2003 to provide a detailed description of the public sector of hospital care and provide elements of information for the ongoing process of hospital reform. Originally, the survey was to concentrate on provincial hospitals alone, but government experts in charge of planning and hospital management indicated they wished the survey to be extended to all public sector civilian hospitals, and the list of 117 facilities was supplied by the Ministry of Health A survey tool was created during summer 2003, and tested in September 2003. Surveyors and supervisors, all government employees, were trained and sent to survey the facilities by teams of three. Each team included one doctor, one nurse and one civil works experts (architect, engineer), so that information could be gathered in the most comprehensive and reliable way. Information was obtained through interviews and direct observation. Data entry took place early in 2004 and analysis was conducted in the following months. The main lessons learnt from the survey are developed in detail in the document. They can be summed up as follows: Afghanistan has a relatively low number of hospitals and hospital beds compared with other countries with a comparable level of income. The ratio of 1 bed for 1,000 people, recommended by WHO, is not reached in any province The distribution of hospital facilities and services is uneven with large parts of the population unable to access referral facilities The physical condition of facilities is acceptable, but they often lack adequate supply of water and electricity. Hospitals are under-equipped and their equipment is not adequately maintained. Access to technical units (medical imaging, laboratory, surgery) is limited to few facilities. Facilities are under-used, with average occupancy rates below 50%. Emergencies and outpatient units are more used by the population than inpatient units. Hospitals are generally over-staffed, particularly in the large urban areas, but too few facilities have an adequate number of female staff to provide acceptable services to the whole population they are supposed to serve. Among services proposed to patients, delivery care and emergency obstetric care are particularly poor. Very few facilities can supply C-sections in safe conditions. Some provinces have little or no access to a hospital in good condition. In spite of the heavy investment efforts supported by the international community, discrepancies between provinces tend to grow. 1) Facilities surveyed 117 government facilities were visited by groups of government surveyors. Not all of them could be described as “hospitals”. NHA 2003 1 / 150 1
Page 1 and 2: Transitional Islamic State of Afgha
Page 3: Contents 1 Background and methodolo
Page 7 and 8: 3) Physical condition and staffing
Page 9 and 10: 1.2 Assessment Tools Location of th
Page 11 and 12: 1.4 Data collection and processing
Page 13 and 14: - Communication - Transportation Th
Page 15 and 16: 2.2 Overview of Provinces 2.2.1 Pro
Page 17 and 18: 2.2.3 Province of Baghlan District
Page 19 and 20: 2.2.4 Province of Balkh District Ho
Page 21 and 22: of population per hospital bed amou
Page 23 and 24: 2.2.7 Faryab Province District Hosp
Page 25 and 26: 2.2.9 Ghor province District Hospit
Page 27 and 28: 2.2.11 Hirat Province District Hosp
Page 29 and 30: 2.2.13 Kabul Province District Hosp
Page 31 and 32: 2.2.14 Kandahar Province District H
Page 33 and 34: 2.2.15 Kapisa Province District Hos
Page 35 and 36: 2.2.17 Kunar Province District Hosp
Page 37 and 38: 2.2.19 Laghman Province District Ho
Page 39 and 40: 2.2.21 Nangarhar Province District
Page 41 and 42: 2.2.22 Nimroz Province District Hos
Page 43 and 44: 2.2.24 Paktika Province District Ho
Page 45 and 46: 2.2.26 Parwan province District Hos
Page 47 and 48: 2.2.28 Sari Pul province District H
Page 49 and 50: 2.2.30 Uruzgan province District Ho
Page 51 and 52: 2.2.32 Zabul province District Hosp
Page 53 and 54: In 48 of 117 hospitals (41%), there
Page 55 and 56:
The survey was an opportunity to tr
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This combination of “quantitative
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A synthetic view of access to elect
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50 45 40 35 30 25 20 15 10 5 0 6 Ne
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24 hospitals declared the waste man
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Hospital name Province General Hosp
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4 Administration, budget and manage
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100% 90% 80% 70% 60% 50% 40% 30% 20
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• Agha Khan Organization, AMI, Ca
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Services subject to some cost recov
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- the salary progression throughout
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Payroll and finance records are ava
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Hospital with a low proportion of s
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5.2.2 Ratio between males and femal
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5.3.1 Medical staff - About 2,420 d
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6 Functional analysis of support se
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5 laundries had no access to electr
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Province Hospital name Number of te
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eceive emergencies without calling
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Province Hospital name Province Hos
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oth. These were Kapisa Provincial h
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7.2 Blood Banks The Afghan transfus
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- Kunduz Regional hospital (Kunduz
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BLOOD BANKS Active BB Potentially F
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7.2.4 Blood transfusion safety The
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Province Name The table here below
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A set of blood banks, both in facil
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Province Hospital Name Grouping and
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7.3 Maternity and emergency obstetr
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Hospitals receiving less than 30 ou
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LOGAR 28 KUNDUZ 5 PARWAN 28 BADGHIS
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7.3.4 Staff of maternities The surv
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59 hospitals declared having perfor
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- in terms of equipment, the facili
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- Mazar-i-Sharif General Civil Hosp
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7.5 Operating theaters and surgery
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KUNAR 4 76.500 WARDAK 40 10.400 NIM
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HILMAND Lashkar Gah General Hospita
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7.5.8 Operating activity Surveyed h
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These are four types of visits: - c
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major discrepancies between facilit
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Province Hospital BAMYAN Yakawlang
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province) declared that their X-Ray
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GHAZNI Ghazni Civil Provincial Hosp
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products, and although they have th
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Hospitals delivering TB drugs ( ) I
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half of the surveyed facilities did
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NANGARHAR General Hospital of Publi
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7.9.5 Cost recovery KABUL IbnSina E
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