Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

better systems, better health

Comprehensive Approach to Building Afghanistan Health Economics & Finance Directorate

Better Health Systems: Strategies that WorkPresentation Series at the Global Health Council

Ibrahim ShehataFebruary 7, 2012

Summary

Challenges Planning comprehensive approach Transitioning to self-sustaining health systems

Challenges

Dependence on donor funding (85%) and no tax base for revenue generation

High level of OOP (75%) Limited capacity in budget execution (60%) Low public per capita expenditure (4%) Low capacity in applied health economics and

resource management

Planning for Comprehensive Approach

Develop a comprehensive health financing strategy that emphasizes: Mobilizing Afghan human resources Gradual decrease on donor dependency Aid coordination Sustainability

Mobilize Local Resources

Build and institutionalize the technical capacity of HEFD staff: Enrolled 7 HEFD staff in

master’s degree program in health economics

On-the-job training programs provided to HEFD staff

HEFD organizational and operational improvements

Gradual Decrease on Donor Dependency

Develop revenue generation policy that introduces “sin taxes” on interventions having negative externalities on health

Support MOPH advocacy efforts Evaluate user fees Improve budget execution to 100%

Improve Aid Coordination

Coordinate technical support with WB, EC, and other USAID projects Expenditure management information system Health financing policy Costing BPHS, EPHS, and vertical programs

Ensure Sustainability

Implement the most comprehensive public program to transition donor funded civil servant employees into the Afghan “tashkeel” (civil service system) Cost tashkeel positions Identifying staffing capacity needs currently missing in the tashkeel Both take stock of and cost the training, which will enable “topped up”

staffing positions to effectively and efficiently perform their functions Increasing competitiveness of tashkeel salaries Develop an action plan and timeline for the MoPH to implement

changes Design a five-year performance-assessment-monitoring and

evaluation process and reporting framework

Reflection

In some ways, it is easier to impact health systems in post-conflict countries because often you are designing the system from scratch without having to navigate the existing system and its bureaucracy

Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

better systems, better health

Thank you

www.HealthSystems2020.org