Afghanistan National Hospital Survey - Management Sciences for ...

1 Background and methodology
1.1 Scope
The hospital assessment was conducted as a follow up to the National Health Resources
Assessment (NHRA) conducted at the end of 2002. It was important for the Ministry of
Health to have a picture of the functional abilities of Afghan hospitals, and not only their
location and major services, as listed in the NHRA. One important aspect of the national
hospital assessment (NHA) was to provide a detailed analysis of some functions of major
concern for the Ministry of Health: emergencies, maternities and emergency obstetric care,
blood banks, etc.
The study provides the Ministry of Health with an assessment tool on the condition of
hospitals in the country, and gives indications regarding investment priorities using standard
indicators. The indicators and graphic tools designed by MSH Europe have been prepared to
help determine rehabilitation needs.
One of the important aspects was to determine if hospitals were able to perform their referral
obligations, as defined in the Basic Package of Health Services, and to assess their current
strengths and weaknesses for the preparation of a hospital reform.
At first, it was proposed that only provincial hospitals be taken in consideration, but the
Ministry of Health considered that the survey, to be comprehensive, had to cover all public
sector hospitals, and a list of 117 facilities was finalized by the Ministry during the
preparation of the survey instruments. This list was based on the NHRA, and the two surveys,
conducted back to back, proved highly complementary of one another.
Analyzing hospital performance required the definition of the functions of a hospital, and
surveyed Afghan facilities ranged from health centers without beds to specialized facilities
with several hundred beds. Several facilities were called “hospitals” but had no beds. Several
others were called “district hospitals” but could not provide the elements of the basic package
of hospital services, as defined by the Ministry of Health in 2003. A district hospital is
supposed to supply medicine, surgery, paediatrics and maternity services, and be supported by
technical services for laboratory and medical imaging. This was often not the case, and the
data analysis had to be conducted with functional standards in mind.
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