This presentation was given at the Global Symposium on Health Systems Research.

1. The Parliamentarians’ Perception of
the Public Health Sector in
Afghanistan
First Global Symposium on Health System Research
November 18, 2010

2. Overview
• Background
• Methodology
• Findings
• Recommendations

3. Background
• Who should set health sector priorities?
• Politicians views not systematically taken into
account
• Objectives:
– To assess the parliamentarians’ perception
regarding the public health sector
– To measure and document political support

4. Methodology
• Questions
– to what extent the parliamentarians agree with
the selected priorities in the public health sector
– how the activities of the Ministry are perceived by
parliamentarians
– how important the health sector is compared to
other sectors
– what problems parliamentarians think people face
in accessing health services
• Random sampling

5. Data collection
• Public health department of Kabul Medical
University
• Data collected by medical students
• Almost one third of the parliamentarians took
part in the survey
• Funding from DelPHI

6. Findings

7. Quality of health services improved
1.5
72.1
1.5
20.6
4.4 Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

8. Amount of health services increased
4.4
63.2
5.9
22.1
4.4 Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

9. Access to health services increased
1.5
63.61.5
28.8
4.6 Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

10. People happy with public health services
1.5
23.5
8.8
58.8
7.4 Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

11. Provincial officials are competent
1.5
41.8
11.9
34.3
10.5 Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

12. People know what the MOPH is doing
1.5
21.5
16.9
53.9
6.2 Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

13. MOPH provides enough information to
parliament
1.5
16.4
10.5
58.2
13.4 Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

14. MOPH successful in regulating private
pharmacies
1.5
10.5
10.5
47.8
29.9
Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

15. MOPH successful in regulating private
clinics
1.5
13.4
14.9
46.3
23.9
Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

16. MOPH successful in regulating private
hospitals
1.5
16.9
13.9
36.9
30.8
Strongly Agree
Agree
DKN
Disagree
Strongly Disagree

17. Top health problems
Child health problems 1
Maternal health problems 2
Mental health problems 3
Drugs 4
Tuberculosis 5
Malaria 6
Diabetes 7
War related injuries 8
Cardiac disorders 9
Road accidents 10
Cancer 11
Disability 12
Eye problems 13
HIV/AIDS 14

18. 29.4
25
19.1
26.5
Establish one of the Following
1 Hospital
3 Large Clinics
6 Medium Clinics
20 Small Clinics
What to do with limited fixed resources

19. MOPH focus
7.4
69.1
17.7
5.9
Rural Areas
Urban Areas
Both
DKN
36.8
1.5
60.3
1.5
Where it isWhere it should be

20. User fees
23.5
76.5
ClinicsYes
No
19
69.1
2.9
HospitalsYes
No
DKN

21. Continue working with NGOs
56.7
38.8
4.5
Yes
No
DKN

22. Reasons for low utilization
Reasons Ranking
Facilities too far 1
Low quality of services 2
Lack of female staff 3
Poor roads 4
Security problems 5
Lack of transport 6
Poor behavior of health workers 7
Cost of services 8
Cost of transport 9
Lack of knowledge 10
Family objection 11

23. Ranking of sectors
Sectors Ranking
Security 1
Health 2
Education 3
Agriculture and irrigation 4
Transport including roads 5
Administration reforms 6
Electricity/energy 7
Labor and public affairs 8
Housing 9
Industry 10

24. Proportion of budget spent on health
Actually Spent Should be Spent
Median of responses 10% 19%

25. Recommendations
• Structured approach to incorporating
parliamentarians and communities
perspectives in policies, strategies and
activities
• Scope for building new alliances
• Regular provision of information
• Follow up surveys