Past Health Statistics

Central Statistical Office Ministry of Planning 1979

  • Total population: 15.5 Million
  • Sedentary population – 13 Million
  • Nomadic population – 2.5 Million
  • Rural – 11.3 million
  • Urban – 1.7 million
  • Birth Rate – 45.2 / 100 population
  • Death Rate – 21.07 / 100 population

Health Statistics of Afghanistan 1979

  1. Hospitals – 66
  2. Basic Health Care Centers – 151 (Approx.. 1/7500 people)
  3. Total # of beds – 3666 (1/4000 people)
  4. Doctors – 886 ( 1/1700 people)
  5. Nurses – 997 ( 1/1500 people)
  6. 1980 M.D. – 77 K.U.
  7. M.D. – 89 Nan. U.
  8. 1980 Nurses – 42 Male / 22 Female } Nursing Schools
  9. Dental Clinics – 52

Ministry of Public Health: Other Medical Personnel 1979

  1. Dentists – 95
  2. Midwifes – 376
  3. Pharmacists – 128
  4. Lab Technician – 171
  5. Compounder – 115
  6. Physical Therapist – 16

Ministry of Public Health

  1. Malaria Institute:
  2. Malaria C & T – 43,800+ / Tr
  3. Control of TB – 22,548+ / Tr
  4. Family Guidance – 80,396 families enrolled

Ministry of Public Health 1979

  1. Cholera – 9527 cc
  2. Small Pox – N.R.
  3. Typhoid – 401,280 cc
  4. Rabies
  5. Human – 58,080 cc
  6. Animal – 7,775 cc

Ministry of Public Health: Mass Immunization Program 1979

  1. B.C.G. 923,103
  2. Small Pox 643,323
  3. D.P.T. 985,913

Total 2,552,339

Medical Education in Afghanistan

Khushal A. Stanisai MD FACG  August 4, 2002

Past Background:

  • There were 2 WHO recognized medical schools in the early 70’s. One in Kabul and one in Nangarhar.
  • Both schools were part of the universities and the Ministry of Education.
  • The student enrollment was limited to < 150 /class.
  • The faculty, teaching facilities and teaching hospitals were proportionally adequate to the student ratio.

Medical Schools:

  • The war and government changes brought profound change to medical education in last 25 years.
  • The Kabul Medical School became Kabul Medical Institute (KMI) with three schools of Curative Medicine, Pediatrics and Stomatology.
  • In Peshawar one female and 3 male medical schools were opened by different Mujahedin factions during the soviet occupation
  • The warlords inside Afghanistan opened Medical Schools in Kandahar, Herat, Mazar and later on in Bamyan, Faiz Abad and Parwan provinces.
  • The Schools were opened on the basis of ethnic or religious rivalry rather then for the needs of Afghanistan.
  • No consideration was given to the availability of teaching staff or facilities.

Teaching Staff:

  • Most of the teaching staff retired, were deceased or took refuge elsewhere.
  • The remaining teachers were frozen in time with regard to medical knowledge.
  • Some of the medical staff were not paid for months. They worked as venders in the streets to feed their families in addition to teaching.
  • In most schools, the number of teachers was inadequate or non existent.

Students:

  • The number of students increased from less then 1000 to more then 10,000.
  • Many of the students were veterans who spent years in school without graduating.
  • > 2800 student were studying in KMI .
  • Some students had not even graduated from high school. They were enrolled by those in power.

Facilities & Hospital:

  • Inspection by the AMAA delegate in Peshawar, Nangarhar and Kabul found a lack or absence of teaching material, destroyed buildings and non functioning teaching hospitals specifically the famous Ali Abad teaching hospital.
  • Only non teaching surgery departments for trauma and orthopedics were functioning better with the help of NGO’s.
  • There were no teaching hospitals close to the schools.

Aid For Medical Education

  • With the exception of limited aid by NGO’s to female medical schools in Peshawar and later to the Afghan university in Peshawar, no significant medical education aid had been provided except by the AMAA and LLU.
  • LLU built living quarters for visiting teaching staff, a library center, a pathology lab & teachers.
  • The AMAA donated materials & books & provided funds for basic science teachers & students.

AMAA Past Resolutions

  • The AMAA was concerned with the number of schools & students & the lack of teaching staff & teaching facilities inside Afghanistan.
  • The AMAA resolutions annually forwarded to the authority in Kabul has asked for a drastic reduction in the number of medical schools & students, participation of females & improvement in the education environment.

 Present:

  • There are still more than 10 schools in existence. Some in name only.
  • The warlords are trying to keep their own schools with the help of agents in the west.
  • There are at least 10,000 students currently enrolled in Afghanistan.
  • About 900 more student has been added by the new administration to KMI this year. Total = 3700
  1. Only the schools in Peshawar have ceased.
  2. Reconstruction of teaching amphitheater and delivery of electricity to KMI is in progress.
  3. More books have been donated.
  4. The AMAA survey of student has been completed.
  5. Shortage of funds & lack of adequate payment to teachers still exist.
  6. Recent AMAA survey showed only a small number of female students and employees at KMI campus.
  7. Unfortunately the ethnicity and religion polarization is dividing the staff and students.
  8. The Band-Aid approach to maintaining status quo is in progress with no consideration for a solid foundation or possibility for change.
  9. The political forces are not in favor of drastic action to change.
  10. The ongoing aid and planning is not focused on higher education.

 Future proposal:

The Ministry of Higher Education needs to convene a grand council (similar to Loya Jirga) to decide the future of medical education with staff from medical schools, student representatives, foreign medical education consultants, officials from the Ministries of Public Health, Education, AMAA leadership, LLU, representatives of local government and WHO in Kabul to discuss and decide the future of medical education in Afghanistan.

The AMAA could play a leadership role to coordinate such meeting and to try for a national consensus on medical education with the following proposals in mind.

  • Drastic reduction in number of medical schools.
  • Drastic reduction in the number of medical students.
  • Accept English as standard for teaching Medicine.
  • Availability of computers and use of Internet in medical schools.
  • Availability of scholarships for training of graduates for leadership roles in medical schools (LLU).
  • Sponsorship of medical staff in Kabul by counterparts in the US (AMAA).
  • Mechanism to assure no gender discrimination for medical education.
  • Licensure examination by Ministry of Public Health.
  • Creation of Medical Quality Assurance Board by Ministry of Public Health.
  • CME course requirements to maintain licensure.

Past History of Healthcare in Afghanistan

Ibrahim Seraj, M.D.
August 4, 2002

History:

  1. In 1932 during the reign of King Nader Shah, the first and only Medical College was founded for Afghanistan, in Kabul.
  2. In 1931 a physician assistant program had already begun in Kabul, which lasted for three terms.
  3. The first students of the college were 10 high school graduates.
  4. Entrance exam was not required.
  5. Turkish Professors had the honor to train the first group of Afghan physicians.
  1. During this time the students attended for six years.
  2. All students were male, since no female attended school at that time.
  3. Following year an additional 8 students were admitted to this college.
  1. Basic sciences were included in the first year of curriculum.
  2. Students were sent to India (Bombay) to learn anatomical dissection during their second year.
  3. The clinical training started in third year during morning at the state hospital in Jade Maiwand.
  4. Didactic lessons continued in the afternoons.
  5. The sixth year was a clinical rotation in the above hospital.
  6. For many years this was the only college in Afghanistan, at the Kabul University.
  7. First group of students graduated in 1938.
  8. In 1938 “Ali Abad University Hospital” was built and inaugurated.
  9. Years later colleges of Science, Law, and others were added to Kabul University.
  10. Upon termination of the contract with Turkey a relationship with French health authorities were established.
  11. An affiliation between Kabul Medical School and Paris Medical School started.
  12. At this point 12 French professors arrived to teach basic as well as clinical sciences.
  13. At this point the school duration extended to seven years of study.

Curriculum of Medical School:

  1. First year basic sciences: PCB ( Physics, chemistry, and biology) which was common classes for colleges of Medicine and Science. In 1961 PCB was changed to MPCB. Mathematics was added.
  2. First and second year Medical School: Anatomy, physiology, biochemistry, microbiology, biophysics, and histology. Anatomical dissection was performed in Kabul, therefore there was no need to send students to India.
  3. Third year: Internal medicine, surgery, general pathology.
  4. Fourth year: General medicine, surgery, preventive medicine, infectious diseases, pharmacology, obstetrics, and organ pathology.
  5. Fifth year: Pediatrics, gynecology, dermatology, neuropsychiatry, ENT, and ophthalmology.
  6. Starting with the third year students received clinical training at the “Ali Abad and women’s University Hospitals”.
  7. This included four and half months in Internal Medicine and four and a half months in Surgery.
  8. During this time, and during their fourth and fifth years the students worked in the hospitals in the morning and in the afternoon they followed lectures at the medical school.
  9. In their sixth year students had only clinical rotations in hospitals through out Kabul, in different disciplines and no theoretical lectures.
  10. Upon completion of their rotation they had to take a clinical test in each field.
  11. Upon successful completion of the tests M.D degree was awarded to each graduate.

Jalalabad Medical School

  1. In 1963 in Afghanistan the second medical school in Jalal Abad was founded.
  2. The efforts of Dr. Gordon Hadley resulted in establishing affiliation between LLU and Jalal Abad Medical School.
  3. Curriculum of this university followed the same as that of Kabul Medical School.

General Information:

  1. In mid 1950s when the number of students increased, concours (entrance exam) was introduced.
  2. Number of graduates from Kabul and Jalal Abad medical schools increased from ten to 120 per year.
  3. From each graduating school year 10 percent remained as staff with the universities.
  4. The remaining graduated physicians became employees of the MPH, and other government institutions.
  5. Medical Schools were part of the universities.
  6. The Chancellors of these universities were directly responsible to the Minister of Education.

During and after the communist regime:

Kabul Medical School is divided into three branches (sections):

  1. Medicine
  2. Pediatrics, and
  3. Stomatology
  1. Number of students in each class increased from low one hundred to hundreds.
  2. Total number of students reached in thousands.
  3. School of medicine was named Kabul Medical Institute (KMI).
  4. KMI was transferred to MPH.
  5. In the last few years five additional medical schools were opened in the provinces
  6. Balkh (Mazar-I-Sharif) 1986
  7. Herat 19..
  8. Kandahar 1992
  9. Gulbahar (Albiruni Univ.) was brought from Faiz Abad
  10. Afghan University (Peshawar) 1999
  11. Total number of students exceeding ten thousand.
  12. Kabul Medical School in recent years again detached from the MPH and became attached by by-passing the University directly to the Minister of Higher Education.

Conclusion:

  1. The Kabul Medical School evolved to several colleges.
  2. Number of graduates exceeded the needs.
  3. Quality of education deteriorated.
  4. The curriculum suffered a major setback.
  5. No one is sure of the present curriculum.
  6. A complete re-haul is needed.
  7. LLU and the Afghan Medical Association in America is in the process of re-establishing relations with KMI and the MPH – a welcomed opportunity.