Afghanistan Mortality Survey 2010 - Measure DHS

workload of the BHC, up to two additional health care workers (HCWs) may need to be added to performwell-defined tasks (e.g., supervision of community health workers and outreach activities).Comprehensive Health Center (CHC): The CHC covers a larger catchment area of 30,000-100,000 people, offering a wider range of services than the BHC. In addition to assisting normaldeliveries, the CHC can handle certain complications, grave cases of childhood illness, treatment ofcomplicated cases of malaria, and outpatient care for mental health patients. The facility has limited spacefor inpatient care but does have a laboratory. Staff of a CHC outnumber staff of a BHC and include bothmale and female doctors, male and female nurses, midwives, and laboratory and pharmacy technicians.Additionally, the CHC aims to provide maternal health care services, particularly comprehensiveemergency obstetric care services.District Hospital (DH): The DH handles all services in the BPHS, including the mostcomplicated cases. The hospital is staffed with female obstetricians/gynecologists, a surgeon, ananesthetist, a pediatrician, midwives, laboratory and X-ray technicians, a pharmacist, a dentist, and adental technician. Each DH covers an approximate population of 100,000 to 300,000 people dispersed inone to four districts.Provincial Hospital (PH): The PH is the referral hospital for the Provincial Public Health (PPH)Care System. In essence, the PH differs little from a DH: it offers the same clinical services and possiblya few additional specialty services. In most cases, the PH is the final referral point for patients referredfrom the districts. In some instances, the PH can refer patients to higher levels of care in the regionalhospital or to a specialty hospital (SH) in Kabul.Regional Hospital (RgH): The RgH is primarily a referral hospital with a number of specialtiesfor assessing, diagnosing, stabilizing and treating, or referring back to a lower-level hospital. The RgHprovides professional inpatient and emergency services at a higher level than is available at DHs and PHs,yet the overall objective remains reduction of maternal mortality, infant mortality, and under-5 mortalityas well as reduction in other diseases and conditions responsible for high mortality and morbidity.National Hospitals (NH): NHs or SHs are referral centers for tertiary medical care and arelocated primarily in Kabul. They provide education and training for HCWs and act as referral hospitalsfor the PHs and RgHs.As of 2011, there are 10,277 health posts, 468 health sub-centers, 807 basic health centers, 388comprehensive health centers, 67 district hospitals, 29 provincial hospitals, 5 regional hospitals and 24national hospitals throughout the country (MoPH, 2011).Afghanistan’s health sector has made a remarkable recovery after years of war and neglect, andthe impressive reduction in infant mortality rates counts among the country’s success stories since 2001(UNDP/GIRoA, 2008). Output level indicators, such as the proportion of children immunized againstmeasles, have seen impressive improvements in recent years. By the time of the last survey on childmortality, Afghanistan was four years ahead of the schedule set for the Millennium Development Goals(MDG) and on target to reduce under-5 mortality and three years ahead of the schedule set for the MDGon infant mortality reduction. Similarly, the rate of progress in measles vaccination has been faster thanwhat had been projected when the Afghan MDG targets were set. If Afghanistan maintains the currentrate of progress on measles vaccination, it is estimated that it could achieve full immunization status fornewborn children as early as 2012 (UNDP/GIRoA, 2008).Progress on maternal health is more difficult to assess because of the lack of up-to-date outcomeleveldata. Available figures show a mixed picture for the indicators listed in the revised Afghan MDGtargets. On the one hand, it is noted that output level indicators, and the proportion of women receivingIntroduction | 7