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Islamic Republic of Afghanistan - Enhanced Integrated Framework ...

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high baseline level <strong>of</strong> 165 infant deaths per1000 live births, a 20 percent reduction ininfant mortality was targeted by 2010. Withthe infant mortality rate estimated by the2006 <strong>Afghanistan</strong> Health Survey to be 129per 1000 live births, a 22 percent reductionfrom the baseline level has already beenachieved.• The Afghan Compact High Level Benchmarkfor reduction <strong>of</strong> under-five mortalityhas been reached ahead <strong>of</strong> the schedule.From a high baseline level <strong>of</strong> 257 underfivedeaths per 1000 live births, a 20 percentreduction in under-five mortality was targetedby 2010. With the under-five mortalityrate estimated by the 2006 <strong>Afghanistan</strong>Health Survey to be 191 per 1000 livebirths, a 26 percent reduction from thebaseline level has already been achieved.There are a number <strong>of</strong> challenges and constraintsthat must be addressed if continuedprogress is to be made, including:• Inadequate financing for many <strong>of</strong> thekey programs;• Reliance on external sources <strong>of</strong> funding;• Inadequately trained health workers;• Lack <strong>of</strong> qualified female health workers inrural areas;• Dispersed population, geographical barriersand a lack <strong>of</strong> transportation infrastructure• Low levels <strong>of</strong> utilization for certain healthservices, especially preventive services;• Variable levels <strong>of</strong> service quality;• Insecurity which makes program implementationdifficult, recruitment and retention<strong>of</strong> staff, expansion <strong>of</strong> service coverageand monitoring by the provincial and centrallevels;• Lack <strong>of</strong> effective financial protectionmechanisms for poor households to receivethe care they need without experiencing financialdistress;• Lack <strong>of</strong> mechanisms for effective regulation<strong>of</strong> for-pr<strong>of</strong>it private sector clinics andpharmacies.Policy framework: sector strategyThe strategy is for the MoPH to maintain andstrengthen its stewardship role for the Healthand Nutrition Sector. For that purpose, a neworganizational chart and programmatic structurehave been defined, enabling a comprehensiveapproach to health service delivery, withprimary health care services, hospital services,disease control, nutrition and reproductive andchild health integrated under the same HealthCare Services Provision General Directorate.The overarching priority policy <strong>of</strong> the MoPHhas been to obtain nearly universal coverage <strong>of</strong>a standard Basic Package <strong>of</strong> Health Services(BPHS) through a ‘contracting out’ initiative, tocreate strong linkages with the hospital sectorthrough an effective referral mechanism.However, the MoPH will also be responsiblefor creating an enabling environment for expansion<strong>of</strong> the Health Care System beyond theprovision <strong>of</strong> the BPHS.The MoPH will focus on the following policyareas:• Leadership at all levels in policy formulationand translating policies into concreteactions to ensure that actions are gearedtoward attaining the specified goals;• Conducting monitoring and evaluation <strong>of</strong>the implementation <strong>of</strong> health care servicesin order to ensure quality, equity and efficiency<strong>of</strong> the health system;• Coordinating the contributions <strong>of</strong> all nationaland international agencies involvedin the Health and Nutrition Sector, upholdingstandards and mapping services toavoid duplication and gaps;• Decentralization <strong>of</strong> appropriate responsibilityand managerial autonomy to theprovincial level;• Increase the active participation <strong>of</strong> communitiesin the management <strong>of</strong> their localhealth care services through developingstrong, active participatory links withshura (community committees) and trainingand supporting community healthworkers;• Developing legislation and regulations t<strong>of</strong>acilitate growth and assure quality in theprivate sector provision or civil serviceprovision <strong>of</strong> health care services. For moreinformation refer to the Volume II.Economical and Social Development 109

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