International Medical

1
International Medical Health Cooperation and
Human Resource Development- Report from
Afghanistan -

• Hidechika Akashi, MD, PhD, MPH, DTMH
• Graduate School of Medicine, Nagoya University
• Department of International Health

2
Health indicators of Afghanistan
(UNICEF, 2000)
3
Health Personnel in Afghanistan(Total 11,749
staff)
National Health Resource Assessment
4
Referral System in Afghanistan

• National hospitals in Kabul WAH,
• Karte-se 500, Malalai Maternal hospital,
• Rabia-Balkhi Womens hospital,
• Provincial hospitals
• District hospitals
• (Polyclinic)
• CHC (Comprehensive Health Center)
• BHC (Basic Health Center)

Covered by EPHS (Essential Package of Hospital
Services)
Covered by BPHS (Basic Package of Health
Services)
5
Conceptual Scheme of Health Sector Program
Afghanistan Millennium Development Goals
Increase coverage of health services

• EOJ, JICA Office
• 3rd country training
• Long-term training

WB, EC, USAID
Afghan sector programs BPHS/EPHS/Int.Dev./Dz
WHO, UNICEF
Planning
Cooperation plan indiv.experts
JICA health sector program (Human resource
development)
Repro.H. project
TB Proj.
MCH
Comm.dis.control
Kandahar IHS MW proj.
GF
Program coordination
UNICEF/JAPAN Child survival proj.
WHO
ltJICA Afghanistan Health Sector Program
Evaluation Report, 2007gt
UNFPA, WHO, UNICEF,USAID
Medical education proj.
6
JICA Projects in Afghanistan
7
3 components of RH Project

• Human resource development of RHOs (Reproductive
  Health Officers)
• Human resource development of service providers
  on RH (clinical practitioners)
• Development of district health system on RH in
  Urban Kabul

8
Structure of the Project
ltCapacity Developmentgt ltSystem Developmentgt
ltManagement Implementationgt National level
RHO training
Provincial level Training centers On
site(DH, HC, Community)
CoC training
9
Management Cycle(Kaizen Cycle)
Hidechika Akashi
Kaizen??
Plan-Do-See ??????
10
Whats happen in COC Training?
Needs assessment in 1ry/2dary facilities
Recognition of problems
ltSRS Training Implementation bodygt
ltKabul PHDgt
ltHealth Facilitiesgt
Community
11
Whats happen in RHO Training?
Survey of background Information on RHO
ltRHO Training body RHOgt
ltMoPHgt
Plan
Action
Do
Check
Feedback to MOPH RHD/ PH/Curative
Community
ltHealth Facilitiesgt
ltProvincesgt
12
Aid Coordination Mechanismin Afghanistan
Donor support
Donor support
Central level
Donor support
Donor Support Contract -out
Provincial level
13
Contracting to NGOs (Outsourcing of Tasks)

• Central Government
• Province A Province B Province C
• PH management PH management PH management
• to NGO X to NGO Y to NGO Z
• IHS build/manage IHS build/manage IHS
  build/manage
• to Donor/NGO S to Donor/NGO T to
  Donor/NGO U

14
Implementation Which way?
Public administrative management system on
health was destroyed in the early stage of
post-conflict.
Now
Contracting to International NGO
Need different skills Need different human
resources
or
Continue the form of Contracting to NGOs, but
to Local NGOs
Public health system should provide health
services.
Future
15
What is cooperation for developmentby JAPAN?
Hidechika Akashi

• Establish mutual good relationship
• Make structure
• Individual Institutional
• Capacity Building Make system Capacity
• (How to catch fish) Development
• Run the system
• Promote awareness change
• Sustainability