The document discusses guidelines for developing a national hospitals policy in Afghanistan. It outlines the objectives of establishing a policy and minimum requirements for national hospitals. Key points discussed include defining the role of national hospitals, recommending specific hospitals for national status, developing licensing standards, and establishing guidelines for governance, management, financing, and quality of care. The workshop aims to finalize recommendations for a national hospitals policy, strategic plan, and minimum standards.

1. Policy and Guidelines for
National Hospitals
– 1st
Discussion Document
Consensus Building Workshop
19th - 20th October 2009
- Dr. Michael Niechzial and Dr. Amol Deshmukh
Support to Institutional Development Project
Islamic Republic of Afghanistan, MOPH / EU

2. 19th Oct 20092 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Workshop Objective
Discuss, debate and
recommend content
Resulting in
‘Policy on National Hospitals’
‘Strategic and Operational
Plan for National Hospitals’
‘Minimum Requirements for
National Hospitals’

3. 19th Oct 20093 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Workshop Outcome
 Definition and Role
 Policy
 Guidelines for Strategic and Operational plans
 Guidelines for Minimum Requirements
 Recommend Hospitals - prioritisation and phasing if required
 Establishing ‘National Hospitals Responsibility Team’and their
ToR / Work Plan

4. 19th Oct 20094 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Challenges of Hospital Sector in Afghanistan
 General Hospital Sector
 Resource variation, utilisation, dependence and role of donors
 Medical Supplies
 Management – General, Financial and HR
 Nursing
 Potential National Hospitals / Tertiary Care Sector
 Unorganised sector and unequal access for patients
 Trained Human Resources
 Quality of Care
 Others
 Categorisation of Kabul Hospitals
 Bed requirement in Kabul

5. 19th Oct 20095 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Need for Tertiary Care and National Hospitals
 Balance between primary, secondary and tertiary
 Requirement as per HNSS: Strategy 2.1
 Emergency Medical Services
 Resource optimisation
 Training healthcare professionals

6. 19th Oct 20096 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Definition and Role
I. Be Centres of Excellence in the respective
speciality/specialities
II. Provide Evidence Based Medicine and guide other
hospitals
III. Capacity building of healthcare professionals
IV. Support MOPH in National Health Programs
V. Establish International linkages for academic and
clinical excellence

7. 19th Oct 20097 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Autonomy
 Legal framework to establish independent hospital entity e.g.
trust
 Establishment of Hospital Boards
 Memorandum of Understandings with reputed international
hospitals or hospital groups for supporting the National
Hospitals
 Establishing organisation for centrally directing and monitoring
the professional training courses
 Study the process of transfer of human resources from the
Government rolls to the autonomous bodies.
 Study and recommend accounting and finance systems to be
adopted and implemented by autonomus bodies/hospitals
 Option of MOPH establishing a autonomy unit and task force to
mange the whole process.

8. 19th Oct 20098 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Recommending Guidelines for developing Min. Standards
 To be developed speciality wise
 To include essential requirements for each speciality
 In line with the guidelines which are of high priority
 Proposed general structure:
 Emergency Medical Services and Ambulance
 Staffing and Staff Performance
 Financial Performance Requirements
 Audits - Internal and External Financial
 Infrastructure Requirements
• PG Training centre
• Bed Strength
 Equipment Requirements (Speciality wise)
 Drugs and consumables
 Quality of care
 Professional Education and Training requirements

9. 19th Oct 20099 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Guidelines and Minimum Requirement (Standards)
No. Guidelines Prioritisation
Component I: Licensing, Registration and Accreditation
1. Licensing, Registration and Accreditation of National Hospitals High
Component II: Governance and Hospital Management
2 Governance and Autonomy to National Hospitals High
3 Annual Hospital Plans and conformity to the plan Low
4
Effective and efficient utilisation of resources like staff, budgets, beds and
equipments
5 Cross utilisation of services between hospitals Medium
6 Donors supporting National Hospitals High
7 Involvement of communities Low
8 Availability of essential supplies and medicines High
9 Essential committees to be functional in Hospitals High
10 Selection of Medical Director, Nursing Director & Director admin High
11
Qualifications required and selection of Medical, Nursing and Administration
Directors
High

10. 19th Oct 200910 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Guidelines and Minimum Requirement (Standards)
No. Guidelines Prioritisation
Component III: Professional Training and Education
12
Professional Training & Education for Medical, Nursing, Technicians &
Management Staff
High
Component IV: HR Management
13 Minimum Requirements for Hospital Management Staff Medium
14 Minimum staffing requirements Medium
15 Planning annual hospital HR plan and conformity to the plan Medium
Component V: Financial Management
16 Financial management of National Hospitals High
17 Regulatory framework for financing, revenue generation and expenditure High
18 Cash management, accounting standards, & financial audits Medium
19 Developing budgets & conformity to planned budgets Medium

11. 19th Oct 200911 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Guidelines and Minimum Requirement (Standards)
No. Guidelines Prioritisation
Component VI: Quality of Clinical and Support Services
20 Essential patient safety norms High
21 Infection Control & environmental hygiene High
22 Clinical guidelines & protocols Medium
23 Diagnostic Services High
24
Nursing Administration & Management; provision of uniform Nursing care;
and Nursing care SOPs’
High
25 Medical Record & HMIS Medium
26 Essential Equipments, Supplies, and Drugs & Consumables High
Component VII: Integration into referral system
27 Integration of National Hospitals into a national / regional referral system Medium

12. 19th Oct 200912 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
ToR for National Hospitals Responsibility Team
 Study recommended National Hospitals
 Study on Autonomy
 Develop drafts for submission
 ‘Policy for National Hospitals’
 ‘Strategic and Operational Plan for National Hospitals’
 ‘Minimum Requirements for National Hospitals’
 Other work as required

13. 19th Oct 200913 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Recommended Hospitals
 General National Hospitals
Eastern Region / Kabul: Jumhoriat Hospital
Western Region / Herat:
Northern Region / Mazar-e-Sharif:
Southern Region / Kandahar: Mirwais Hospital
Central Region / Chagcharan: ?(Provincial Hospital)
 Specialised National Hospitals
For Emergency Health Services: Ibn Sina Emergency Hospital
For Trauma & Orthopaedics: Wazir Akbar Khan Hospital
For Paediatrics: Indira Gandhi Institute of Child Health
For Obstetrics & Gynaecology: Malalai Hospital
For Ophthalmology: NOOR Eye Hospital
For Pulmonology and Cardiac Sciences: Ibn-Sina Chest Hospital
For Psychiatry: Mental Hospital
For Dentistry and Maxillofacial Surgery: Stomatology Hospital
For Burns and Plastic Surgery: Esteqlal Hospital
For Infectious Diseases: Antoni Hospital

14. 19th Oct 200914 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Recommended Hospitals
 Hospitals suggested for status of secondary level care
(EPHS):
Ataturk Hospital
Ehayi Mo Jadad Hospital
Kair Khana Hospital
Rabia Balkhi Hospital
The above shortlisted hospitals should further undergo
prioritisation and phasing in view of sound allocation of
resources in phased manner to develop the National
Hospitals.

15. 19th Oct 200915 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Guidelines for the Establishment and Operation of National Hospitals
 The National Hospitals of Afghanistan will provide tertiary care services as part
of the comprehensive referral network of the health system.
 The role of National Hospitals, as part of a unified national health system, will
be:
 To develop as Centres of Excellence in the respective specialities
 To provide Evidence Based Medicine and guide other hospitals
 To provide professional training for healthcare professionals
 To support MOPH in National Health Programs
 To establish international linkages for academic and clinical excellence
 The National Hospitals must be rationally distributed so their services are
accessible on an equitable basis for the entire population. The National
Hospitals should collectively provide services in all specialities as per the
disease prevalence and load.
 The MOPH will carry out a detailed analysis and recommend Hospitals in
Kabul, Regional Hospitals, and others for conferring status of National
Hospital. The recommendation should include the resource planning for the
hospitals including its recommendation on granting autonomy.
The Draft Policy Statement

16. 19th Oct 200916 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Guidelines for the Establishment and Operation of National Hospitals
 Emergency medical services for life threatening diseases should be provided as per need.
The MOPH will recommend services which will be subsidised (completely or partially) by
the government and those which will be paid for by the patients.
 The MOPH will develop licensing and registration requirements for National Hospitals which
will include minimum requirements (standards). Private hospitals and hospitals not under
the MOPH can also be conferred the National Hospital status provided they satisfy the
licensing and registration requirements.
 The National Hospitals must undergo national accreditation within one year and
international hospital within three years of acquiring National Hospital status. The
accreditation standards should ensure financial, administrative and clinical efficiency and
effectiveness so as to provide quality care to all patients.
 The MOPH will develop and implement strategies, strategic plans and operational plans to
achieve the desired outputs of the above mentioned policies. These should include the
following areas:
 Licensing, Registration and Accreditation
 Governance and Hospital Management
 Professional Training and Education
 HR Management
 Financial Management
 Quality of Clinical and Support Services
 Integration into the national referral system

17. Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
THANK YOU!

18. 19th Oct 200918 Dr Michael Niechzial & Dr Amol R Deshmukh Afghanistan National Hospitals Policy
Progress Milestones
 June 2008 - Theme for Policy Presented
 August 2008 - Guidelines for Policy Presented
 3rd
August 2009 - First draft of document Presented
 Now Oct 2009 - Finalise Recommendations
 End Oct 2009 - Submit second / final draft