International Medical Health Cooperation and Human Resource

International Medical & Health Cooperation and Human Resource Development - Report from Afghanistan Hidechika Akashi, MD, Ph. D, MPH, DTMH Graduate School of Medicine, Nagoya University Department of International Health

Health indicators of Afghanistan Indicator Afghanistan Japan U 5 MR 257 4 IMR 165 4 Life expectancy at birth 46 80 % of under 5 suffering from moderate & severe underweight 48 - Crude death rate 21 8 Crude birth rate 52 10 1, 700 8 8 x 99 MMR % of birth attended by trained health personnel (UNICEF, 2000)

Health Personnel in Afghanistan （Total: 11, 749 staff） Male Female Total Doctor 2, 155 695 2, 850 24% Nurse 2, 034 566 2, 605 22% 22 467 489 4% 2, 992 803 478 205 3, 471 1, 008 30% 9% 859 8, 865 467 2, 878 Midwife Labo, Pharmacist, Dentist, etc. Vaccinator Community health worker Total 1, 326 11% 11, 749 100% National Health Resource Assessment

Referral System in Afghanistan • National hospitals in Kabul: WAH, Karte-se 500, Malalai Maternal hospital, Rabia-Balkhi Women’s 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)

Conceptual Scheme of Health Sector Program Afghanistan Millennium Development Goals Increase coverage of health services WB, EC, USAID Afghan sector programs BPHS/EPHS/Int. Dev. /Dz Cooperation plan indiv. experts Repro. H. project Kandahar IHS MW proj. MCH UNICEF/JAPAN Child survival proj. UNFPA, WHO, UNICEF, USAID EOJ, JICA Office -3 rd country training -Long-term training WHO, UNICEF Planning JICA health sector program (Human resource development) Comm. dis. control TB Proj. GF Program coordination WHO Medical education proj.

JICA Projects in Afghanistan Projects Tuberculosis project Duration Sep. 2004~Sep. 2009 Reproductive health project Sep. 2004~Sep. 2009 Kandahar IHS Midwife training project April 2005~July 2007 Medical education project July 2005~June 2008

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

Structure of the Project Capacity development for strengthening RH program ＜Capacity Development＞ National level Cap. Develop. of RHO at central & provincial level ＜System Development＞ System development of central RH administration National RH service provider training system development ＜Management Implementation＞ National RH policy develop, implement, review, solve problems RHO training Provincial level Mainly in Urban Kabul Cap. Develop of trainers on RH service providers Training centers System development of provincial RH related administration Cap. Develop of provincial RH related persons Provincial RH related admini. plan, implement, review, & solve problems System development of RH service provider training at hospitals Training of RH service providers Co. C training On site（ DH, HC, Community） System develop for community use of DHs/HCs Enough resources at site People use of RH services Provision of proper RH services

Hidechika Akashi Management Cycle (Kaizen Cycle) Action Check “Plan-Do-See” もこのたぐい Plan Do “Kaizen：改善”

What’s happen in COC Training? Needs assessment in 1 ry/2 dary facilities Do Ordinary works Check Recognition of problems Establish SRS Action Revision of Training contents Check Action Solve through Internal discuss Check. Internal discuss Go to Supervision Check Solve problems Plan revised Activities Implement Training Do Solve problems at site Action Eval. ? Plan Check Feedback from Supervision Plan revised Activities Check Action Planning of Training Plan Feedback from Participants Plan Do Ordinary works Bring back to PHD Plan revised activities Plan Do Ordinary works Community Check Discuss in PHD Action Solve problems

What’s happen in RHO Training? Survey of background Information on RHO Check Action Revision of Training contents Plan RHO Training Plan Action Implement RHO Training Feedback from Participants Check Feedback to Training contents Plan Do Check Info sharing among RHO Do Do Ｆｅｅｄｂａｃｋ　ｔｏ MOPH RHD/ PH/Curative Supervision by MOPH staff Check Community Check Action Check Plan Check Discuss problems internally Check Implement Do ordinary works Action Find out problems through supervision Plan revised activities Plan Do Do Solve their problems at province Plan

Aid Coordination Mechanism in Afghanistan Donor support Central level Donor support Provincial level PCC PCC Donor Support + Contract -out

Contracting to NGOs (Outsourcing of Tasks) Central Government Province A PH management to NGO X Province B Province C PH management to NGO Y PH management to NGO Z IHS build/manage to Donor/NGO S to Donor/NGO T U IHS build/manage to Donor/NGO

Implementation: Which way? Public administrative management system on health was destroyed in the early stage of post-conflict. Now Contracting to International NGO or Continue the form of Future Contracting to NGOs, but to Local NGOs Need different skills : Need different human resources Public “health system” should provide health services.

Hidechika Akashi What is cooperation for development by JAPAN? Establish mutual good relationship Make structure Individual Capacity Building （How to catch fish） Make system Run the system Promote awareness change Sustainability Institutional Capacity Development