The South Asia Channel

On the road to recovery

Ten years ago, Afghanistan had one of the world's worsthealth care systems. Most trained health professionals had left the country,and there were few functioning medical facilities. The Taliban had effectivelybanned women from receiving health care. As a result, an estimated one in fourchildren died under the age of five, and maternal mortality was estimated to bethe highest in the world - data collected at that time suggests one in tenwomen died of pregnancy-related complications. Life expectancy was a meager 45 years,according to the United Nations. Afghans were dying from simple, preventableillnesses -- such as diarrhea and bronchitis -- that literally cost pennies to treat.

In 2002, the newly formed Afghan government began workingwith the U.S. Agency for International Development (USAID) and otherinternational donors to restart a viable health care system. The effort wasbased on a few simple premises. First, focus on getting low-cost, low-tech,high-impact treatments to the largest number of Afghans possible, particularlyin rural areas. Second, bring together as many partners as possible -- governmentofficials, international donors, and non-governmental organizations -- tosupport a common ‘blueprint' for primary care delivery and guaranteed access tocare in all parts of the country. Third and most important, ensure Afghanscould develop their own health institutions, so that access to basic health carewould continue in the long term.

With this approach in mind, the Afghan government, withstrong support from the U.S. government and other donors, began to roll out abasic package of health services to millions of Afghans.  As a result, access to basic health serviceshas risen from 9 percent in 2001 to more than 60 percent today.

The results are of this effort are documented in the newlyreleased AfghanistanMortality Survey 2010 the first comprehensive, national survey of keyhealth and quality of life indicators. The findings released last week in Kabul paint a clear picture ofremarkable progress. 

Whereas maternal health care was effectively unavailableunder the Taliban, today six in ten women see a trained care provider duringpregnancy, family sizes are down from more than six children per mother toapproximately five, and skilled assistance during childbirth has more thandoubled.  As a result, significantly fewerwomen are dying from pregnancy-related causes than they did just a decade ago,and life expectancy has risen to about 62 years, up some 15-20 years fromprevious estimates.  

While donor contributions will remain critical to thesector's viability for years to come, Afghans themselves are increasinglyshouldering the financial costs of improving and expanding the healthsystem.  Government contributions to thehealth sector are growing and the Ministry of Public Health continues to seekways to increase revenues and reduce cost. This spirit of self-reliance is animportant reminder of the sustainable results that development partnerships candeliver, even in places haunted by conflict: longer lives, healthier familiesand the chance for children to live past their fifth birthdays.  It also develops faith in government, which iscritical for Afghanistan to overcome its struggle with violent extremism.

Both the Afghan government and the international communitymust build on these remarkable achievements and learn from this successfulpartnership.  During a time of continuedviolence and pessimism about Afghanistan's future in some quarters, tens ofthousands of men, women and children who would not have survived continued Talibanrule are alive today because of the partnership between the Afghan people,health care providers and the international community. 

Despite these gains, Afghans continue toface serious challenges and a long-term partnership between Afghanistan and theinternational community remains critical.  One in 13 children dies before their first birthday, one in 10 childrenin Afghanistan dies before age five, and one Afghan woman dies from pregnancy-relatedcauses every two hours.  As Afghansincreasingly assume responsibility for their own welfare, they build on theresults of generous investments from the American people and other allies,coupled with capable, dedicated Afghan leadership in the health sector.  The extraordinary gains in Afghanistan'shealth sector over the past decade show us what is possible.

Dr. Suraya Dalil isAfghanistan’s Acting Minister of Public Health. 



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