NATIONAL HOSPITALS ASSESSMENT PRELIMINARY RESULTS

1
NATIONAL HOSPITALS ASSESSMENT PRELIMINARY
RESULTS
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Dr. Denis Broun April 4, 2004 Kabul
2
Organization of the Assessment
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• A survey of 117 hospitals was conducted in
  October November 2003
• The survey was undertaken by surveyors and
  supervisers of the Ministry of Health
• The surveyed hospitals were identified from the
  national facilities database
• Excellent cooperation was received from hospital
  managers and staff.

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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Acknowledgement
• This assessment has been made possible thanks to
  the financial support of
• The European Commission
• The French Government
• and
• USAID
• UNFPA
• JICA

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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
GENERAL FINDINGS
5
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Location of Hospitals Clinics included in
survey (with main roads)
6
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Some facilities are called hospitals but have
  no beds
• Khan Abad Hospital (Kunduz Province)
• Imam Sahib Hospital (Kunduz Province)
• Shahjoi Hospital (Zabul Province)
• Others have less than 10 beds and can hardly
  operate as hospitals
• Said Karam Hospita (Paktya Province) 1 bed
• Tamir Hospital (Paktya Province) 2 beds
• Tafahosat Hospital (Balkh Province) - 3 beds
• Hairatan Hospital (Balkh Province) 4 beds
• Qaisar Hospital (Faryab Province) 6 beds
• Bilchiragh Hospital (Faryab Province) - 6 beds
• Panjwayi District Hospital (Kandahar Province)
  6 beds
• Arghistan District Hospital (Kandahar Province) _
  8 beds
• Rustaq Hospital (Takhar Province) 9 beds
• Dehrawood Hospital (Uruzgan Province) 9 beds
• 3 health clinics without beds were also surveyed

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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Type of facilities covered by the
survey Facilities without beds, health centers
and clinics with beds 10 (8.5) Specialized
hospitals 10 (85) 7 in Kabul District
hospitals 76 (65) Provincial hospitals (or
equivalent) 21 (18)
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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Number of beds per hospital Less than 10 beds
17 14.5 10 to 20 beds 17 14.5 29 to 30
beds 17 14.5 30 to 40 beds 11 9.4 40 to 50
beds 6 5.1 Total hospitals of less than 50
beds 68 (58) 50 to 100 beds 28 23.9 100 to
200 beds 8 6.8 200 to 300 beds 7 6.0 More
than 300 beds 6 5.1
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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Number of beds by hospital
10
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Distribution of hospital beds per province
• Hospitals are unevenly distributed among the
  various parts of the country. The figures of
  population per hospital bed show these
  discrepancies rather well, although they to not
  give a full picture of the situation.
• Kabul province has the largest concentration of
  hospital beds (although they are unevenly
  distributed among districts within the province).
• The provinces of Utuzgan, Nuristan, Ghor and Sari
  Pul have the lowest quantity of hospital beds per
  population in the country.

11
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Bed ratio per province population per hospital
bed
12
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Variations in the number of beds Some facilities
have an important discrepancy between the
official and the actual number of beds.
Discrepancies have been found in both
directions Hospital with less beds than
anticipated Qal-i-Naw hospital (Badghis) 60 beds
instead of 96 expected Karte 3 Surgical hospital
(Kabul) 416 beds instead of 454 expected Qalat
hospital (Zabul) 82 beds instead of 102
expected Hospital with more beds than
anticipated Faryab Central hospital (Faryab) 100
beds instead of 43 expected Emergency Surgical
Centre for War Victims (Kabul) 102 beds instead
of 81 expected Panjshir Emergency Surgical
hospital (Parwan) 85 beds instead of 49 expected.
13
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Types of hospital beds available According to
the Basic Package, district hospitals (and
provincial hospitals) should be able to provide
at least medicine, surgery and maternity
services. However, the assessment showed that
this was seldom the case, and many districts do
not have access to a facility able to provide
such services. Thre provinces do not have a
single such facility in any district (Uruzgan,
Zabul, Nuristan).
14
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Presence of medicine, surgery and maternity
together in an least one hospital
Provinces without one facility with the 3 basic
hospital services
Hospitals with functional  maternity, surgery
and medicine  departments. In yellow, provinces
without such hospitals
15
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
BED OCCUPANCY RATES
16
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Questionnaires included questions about average
  length of stay and bed occupancy rate.
• Most hospitals did not have this information
  available. Only 19 of the 117 facilities
  surveyed (16) had both indicators available.
• The average length of stay varied between 4 and
  10 days, with a median at 7 days.
• The bed occupancy rate varied between 10 and 85
  with a median at 50
• The bed occupancy rates declared by the hospital
  directors corresponded to the observations made
  by the surveyors.

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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• On the day of the survey
• Of the 8,237 beds in the surveyed facilities,
  3,843 were occupied. The corresponding bed
  occupancy rate amounts to 46.4
• 46.7 of the beds were occupied by female
  patients
• 21 of the hospitals with beds (19) did not have
  a single in-patient hospitalized. These empty
  hospitals wards were seen in facilities with 10
  to 30 beds

18
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Only 7 hospitals had an occupancy rate above 80
  on the day of the survey
• Bamyan Central Hospital (Bamyan province)
• Hirat Regional Hospital (Hirat province)
• Ali Abad Hospital (Kabul province)
• IbnSina Emergency Hospital (Kabul province)
• Indira Gandhi Child Health Hospital (Kabul
  province)
• Mirwais Hospital (Kandahar province)
• Parwan Provincial Hospital (Parwan province)

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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
STAFFING OF HOSPITALS
20
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Levels of staffing in the surveyed hospitals The
117 surveyed facilities declared that they had a
total of 13,247 employees, of which 7,635 support
staff (57.6). Th number of staff per facility
varied from 5 in Panjwayi District hospital
(Kandahar) to 584 in Indira Gandhi Child Health
hospital (Kabul). Hospitals in Kabul district
employed a total of 5,441 staff, representing 41
of the total hospital staff of the country.
21
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Proportion of Staff categories by province
(sizetotal nb staff in province)
22
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Staff ratio per bed By all standards, Afghan
hospitals have too much staff compared to the
required level, especially in the light of the
needs of primary care facilities. The average
number of staff per bed for the country is 1.57,
which corresponds to a level of specialization
that Afghan hospitals do not have on the whole.
This figure takes in consideration the actual
number of beds. Another ratio to consider is that
of the total number of personnel present at the
time of the survey over the number of occupied
beds. This ration is as high as 2.7. There are
important variations in the ratio from one
province to another.
23
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Total staff per bed, by province (all categories)
24
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
 Medical  staff per bed, by province (doctors,
nurses/midwives, other health workers)
25
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Staff density Some facilities operate well with a
reasonable number of staff Medical Hospital of
Nangarhar (Nangarhar), General Hospital of Public
Health (Nangarhar), Nasgee hospital (Baghlan),
Ata Turk hospital (Kabul), Hirat Regional
hospital (Hirat) operate with a density of 1
staff per bed or less. Others have a much larger
staff density, still with a low bed occupancy
rate Kabul Mental hospital (Kabul), Police
Hospital (Kabul), Indira Gandhi Child Health
hospital (Kabul), Kunduz Regional hospital
(Kunduz) have more than 2.5 staff per bed. In
spite of high densities of staff, 25 of
facilities declared that they had to cancel
vacations in 2002 because of staff shortages.
26
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Payment of staff In more than 64 of surveyed
cases, full salaries had not been received in 4
months or more. Only 7 of facilities had
received full civil servant salaries in the last
3 months.
27
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Female staff Female staff represented 24.5 of
the total staff of the surveyed hospitals
28
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Male/female ratio among hospital staff
29
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Percentage of female staff (all categories) by
province
30
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Preliminary conclusions on the first part of the
  survey analysis
• Afghanistan has a relatively low number of
  hospitals and hospital beds compared with other
  developing countries. The ratio of 1 bed for
  1,000 people 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
• Hospitals are generally over-staffed,
  particularly in the large urban areas.
• Too few facilities have an adequate number of
  female staff to provide accesptable services to
  the whole population they are supposed to serve.

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TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
PHYSICAL CONDITION OF HOSPITALS
32
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Age and Rehabilitation Afghan hospitals are not
very old. Dates of construction stated by
interviewees during the survey ranged between
1312 (Maiwand Hospital) and 1382 (Sharan district
hospital in Paktika). The physical condition of
buildings is often acceptable. It was assessed
in detail service by service. 43 hospitals (37)
are currently undergoing a rehabilitation
project. This imposes heavy management and
coordination constraints. 53 hospitals (45.3)
are currently undergoing an expansion project
(which may be part of the rehabilitation project).
33
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Damages 47 of the 117 surveyed hospitals (40)
suffered some degree of damage because of actions
of war. War damages to hospitals started as early
as 1358, and the most recent war damaged dated
back to 1380. The peak of destructions happened
in 1371. In addition, two hospitals of Wardak
province were damaged by an earthquake in 1379.
34
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Access to power
• 19 hospitals had no access to power at all
  (16).
• 34 hospitals had a haphazard supply of
  electricity with power available less than 12
  hours per day.
• 85 hospitals (73) had a functional generator to
  supply electricity
• 4 hospitals used solar energy as a complement
  Rukha hospital (Parwan), Mehtar Laam Baba
  Regional hospital (Laghman), Noor hospital
  (Kabul) and Dasht-i-Qala hospital (Takhar) and
  one used wind energy Mehtar Laam Baba Regional
  hospital (Laghman)

35
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Access to electrical power in surveyed hospitals
36
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Access to water 20 hospitals had no access to
water at all (18) 12 additional facilities had
access less than 12 hours per day. 14 of
hospitals connected to a water distribution
network also have a water tower in case of failure
Number of hospitals with access to water.
37
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Access to drinking water in surveyed hospitals
38
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Water Power Supply Water Power gt 12h
(53) Water Power lt 12h (22)
In green good access to water and power In red
access to water and power less than 12 hours/day.
39
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Sanitation 96 out of 117 hospitals indicated the
sanitation system in use. Waste water was
generally managed by a combination 2 or more
systems 7 of the 10 hospitals connected to a
city sewage system had a septic tank or a pit
before spreading 67 of the 69 hospitals with a
septic tank but no connection to a city sewage
system used in addition a pit before spreading
and or had pits below latrines. 17 hospitals have
neither a connection to a city sewage system nor
a septic tank but have pits before spreading and
or below latrines. On the whole, appropriate
attention was paid to sanitation in surveyed
hospitals
40
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Solid waste management 47 hospitals, accounting
for 35 of the beds in the country, had no
functional waste management system 74 hospitals
had an incinerator, of which 53 in perfect
condition 24 hospitals have an additional system
for medical waste or other solid waste to
compensate for the relatively poor condition of
their incinerators. Specific management of
medical waste remained exceptional and deserves
more attention.
41
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Access to communication
Nb of facilities with No radio, no telephone Radio or telephone
151 beds 3 11
51-150 beds 13 18
11-50 beds 31 16
10 beds 21 4
Total 68 49
16 facilities ( 13.5) had no communication
capability whatsoever, but more reported that
their communication was not permanently
functional.
42
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Surveyed hospitals with access to communication
(functional phone or radio)
43
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Transportation A lot of cars and ambulances have
been supplied to Afghan hospitals over the past 2
years. There are major discrepancies between
regions and facilities regarding the availability
of transportation. It is often facilities located
in difficult to access areas which are less well
equiped.
44
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Surveyed hospital with vehicle (ambulance, car or
van)
45
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Diagrams to determe investment priorities
46
Hirat Regional Hospital (Hirat) has a better than
average infrastructure, but still access the
power network irregularly.
In Garziwal hospital (Faryab), the good
infrastructure is not supported by any other
element that would make the hospital functional
47
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Preliminary conclusions on the second part of the
  survey analysis
• Afghan hospitals are in a relatively good
  condition in spite of the 20 years of armed
  conflict. Strong international cooperation is
  rehabilitating and expanding facilities, but
  actual needs seem not to have always been
  thoroughly analyzed.
• In spite of recent investment, access to power
  and water remains a problem for many hospitals,
  and could be addressed relatively easily.
• Waste management, especially for medical waste,
  requires additional efforts.
• The building cluster indicators approach may
  help target investment priorities.

48
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Analysis of specific hospital functions
• The survey gathered elements of a complete
  functional analysis of facilities. However,
  particular functions were analyzed in priority
• Emergencies
• Blood banks
• Maternities and emergency obstetric care
• Operating theaters and sterilization

49
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
EMERGENCIES
Emergencies are the main point of entry of
patients with the hospital system. The emergency
department (ER) is often used for primary care
consultations Many district hospitals that did
not have in-patients received patients in the ER.
50
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• Performance of emergency rooms
• 30 of all surveyed facilities had no emergency
  room at all.
• Some entire provinces have access to only one
  single ER.
• Most ER were poorly equipped and not able to
  handle some of their basic functions
• only 10 hospitals could perform an
  electrocardiogram in the ER.
• only 26 hospitals had oxygen available in the
  ER.
• Over 40,000 patients/month are seen in ER of 82
  hospitals
• Actual total is probably much larger, as several
  hospitals do not keep a registry of emergency
  cases.
• 252 hospital beds are labeled emergency room
  beds.

51
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Staffing of emergency rooms Only 14 hospitals
(17 of facilities with an ER) did not have a
doctor present 24h/24h Of these 9 had a doctor
available on call at all time Only 5 ER were
without medical staff at night (6). 59 of the 82
hospitals with an emergency room accepted
patients for emergency obstetric care during
daytime (72) and 57 during night time (69.5).
52
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Equipment of ER Based on their level of
equipment and access to emergency drugs, surveyed
Ers were broken down into functional Ers (19
hospitals 23.1) and potentially functional
Ers (63 hospitals). Only Qalat hospital (Zabul)
was found to have a fully equiped ER. Two
functional operating rooms (Nimroz hospital and
Kapisa Provincial hospital) operated in buildings
in serous need of repair. Three functional Ers
operated without adequate access to electricity
and water Lashkar Gah General hospital
(Hilmand), Qalat hospital (Zabul), Kapisa
Provincial hospital (Kapisa)
53
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Intensive care units 37 hospitals (31.6) have
an intensive care unit (ICU). Among these, only
20 have oxygen available, 18 have at least one
ventilator in operating condition, 26 have
succion equipment, 9 had intubation sets at the
time of the survey. ICUs are not fully
operational The busiest ICU in the country is in
Ahmed Shah Baba Minah hospital (Kabul), but other
large hospitals have more than 200 patients
treated per month in intensive careCentral
Hospital of Public Health (Nangarhar), Hirat
Regional hospital (Hirat), Indira Gandhi Child
Health hospital (Kabul), Medical Hospital of
Nangarhar (Nangarhar) and Ghazni Civil Provincial
hospital (Ghazni).
54
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Blood banks 25 of the surveyed facilities (21)
declared that they had some transfusion
activities. 7 additional facilities had some or
all of the equipment needed to perform
transfusions. Transfusion happens in the larger
than average facilities (average 158 beds) An
average 2,000 transfusions were performed per
month in the hospitals of the country. This
corresponds to a yearly transfusion incidence
rate less than 0.11. The transfusion incidence
rate in developed countries is usually situated
between 3 and 5.
55
(No Transcript)
56
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Blood donations 82.5 of all transfusions were
made with blood donated by a family member of the
patient, 9.1 with blood from a paid donor 8.4
with blood from a volunteer donor. The average
in countries with a low human development index
is 31 of donations from voluntary
non-remunerated donors and 61 from family and
relatives. Only 14 hospitals had a registry of
donors and 12 had a plan to contact donors in
case of need.
57
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
Quality of blood for transfusion
Grouping and cross-matching Test for syphilis Test for HIV Test for Hep. B Test for Hep. C
100 76 72 72 60
Only 10 operational transfusion services had the
capacity to pack cells and thus separate and keep
plasma or administer red cells or platelets to
patients.
58
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• MATERNITIES
• 24 of the 117 surveyed hospitals (20.5)
  declared not to provide maternity services.
• 59 facilities declared receiving out-patients
  for maternity related services.
• Some inconsistencies were noticed Qaisar
  hospital (Faryab) declared receiving over 250
  patients per month on average, but had no
  gynecologist or midwife on the staff.
• Conversely, Khair Khana hospital in Kabul
  declared receiving less than 60 out-patients per
  month on average in spite of a staff of 18
  gynecologists and 14 midwives.

59
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• MATERNITIES / Out-patients
• The average number of out-patients per month
  varied from
• From 2 in Baglan district hospital (Baghlan)
• to 4,792 in the Medical Hospital of Nangarhar
  (Nangarhar).

Province Hospital name Out-patients/r month

NANGARHAR Medical Hospital of Nangarhar 4,792
HIRAT Hirat Regional Hospital 3,929
KABUL Rabia-i-Balkhi Hospital 2,100
NANGARHAR Sultan Pur Clinic 2,008
GHAZNI Ghazni Civil Provincial Hospital 1,439
KANDAHAR Abdul Hakim Hospital 1,287
JAWZJAN Provincial Hospital Jawzjan 1,042
HIRAT Guzara District Hospital 750
BADAKHSHAN Faizabad Hospital 621
PARWAN Rukha Hospital 596
60
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
MATERNITIES / In-patients 69 hospitals declared
they had at least one maternity bed. 38 (55)
have small maternities of 5 beds or less. Of
these 5 declared not having performed a single
delivery in the 6 months before the survey. 19
(14.5) have 20 beds or more. .At the time of the
survey, there were four provinces without a
single maternity bed
61
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
KABUL 391 FARYAB 8
NANGARHAR 88 HILMAND 8
HIRAT 50 BAMYAN 7
BALKH 42 KUNAR 6
BADAKHSHAN 28 KAPISA 5
LOGAR 28 KUNDUZ 5
PARWAN 28 BADGHIS 4
BAGHLAN 22 GHOR 4
WARDAK 22 JAWZJAN 4
PAKTYA 21 NIMROZ 4
GHAZNI 16 PAKTIKA 3
LAGHMAN 15 SAMANGAN 2
KHOST 14 NURISTAN 0
FARAH 13 SARI PUL 0
KANDAHAR 10 URUZGAN 0
TAKHAR 10 ZABUL 0
Maternity beds / 100,000 population
62
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
MATERNITIES / Deliveries 6 hospitals performed
more than 200 normal deliveries per month on
average. 32 hospitals performed less than 20
normal deliveries per month.
Province Hospital name Maternity beds Normal deliveries
KABUL Malalay Maternity Hospital 217 1,333
KABUL Rabia-i-Balkhi Hospital 113 1,305
NANGARHAR Medical Hospital of Nangarhar 55 805
HIRAT Hirat Regional Hospital 40 488
KHOST Khost Hospital 14 319
GHAZNI Ghazni Civil Provincial Hospital 10 244
KANDAHAR Abdul Hakim Hospital 10 208
KABUL Karte 3 Surgical Hospital 20 200
63
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH
MATERNITIES / Cost recovery 21 of the 69 (30.5)
hospitals practicing deliveries declared to
charge for that service. The amount charged
varied between 10 and 1,000 Afs. The median
amount of the charge was 58 Afs. Hospitals
declaring to charge for deliveries were all
locate in the Eastern half of the country,
although hospitals in the other half would
eventually charge for other services..
64
Hospital charging for deliveries
65
TRANSITIONAL ISLAMIC STATE OF AFGHANISTAN
MINISTRY OF HEALTH

• MATERNITIES / Staff
• The survey identified 373 obstetricians/gynecolog
  ists and 341 midwives.
• Staff is poorly distributed among facilities.
  Most hospitals performing deliveries had a small
  amount of staff not enough to cover night shifts
  (only 58 of the 69 hospitals had staff in the
  maternity at night).
• Other hospitals have a large number of
  specialists Malalay Maternity hospital has 21
  of all specialists working in the countrys
  hospitals.
• Kabul province, with about 16 of the total
  population of Afghanistan, concentrated 46 of
  obstetricians/gynecologists and 45 of midwives.
• Four district hospitals perform deliveries
  without one single obstetrician or midwife.