Afghanistan health sector: Back to 2002  

Taliban’s resurgence to power in August 2021, and the subsequent withdrawal of funding for major health programmes in Afghanistan have posed serious healthcare challenges in the country.

By Naseer Ahmad

“In Afghanistan, 25 million people have among the world’s worst health and greatest needs…particularly hard hit by Afghanistan’s 23 years of war, civil strife and Taliban misrule, are Afghan women, who are experiencing – what health officials call – ”catastrophic” death rates associated with pregnancy and childbirth — the world’s worst,” reads the NYT report of October 2002.

Now the September 2021 report of The New York Times is mirroring the situation of 2002 October. It says, “The health care system in Afghanistan is teetering on the edge of collapse, endangering the lives of millions and compounding a deepening humanitarian crisis.”

“Assuming that health care coverage is cut by half because of the funding loss, deaths among women and children will increase by at least 33 percent over the next year — nearly 2,000 women and more than 26,000 children per year — according to one analysis,” the report reads.

With the World Health Organization presenting a grim situation of Afghanistan’s health sector, the government in Kabul has a tough task to rescue the health sector from a disaster. And all eyes are on the Sehatmandi programme of Afghanistan. The System Enhancement for Health Action in Transition (SEHAT) is a service delivery and health systems strengthening project implemented in 2015. SEHAT was managed by the Afghan Ministry of Public Health and financed by the World Bank-administered Afghanistan Reconstruction Trust Fund, with the World Bank, European Union, USA and Canada as major donors. The SEHAT had a strong focus on maternal and child health and included maternal mortality. The project was based on a pay-for-performance approach that directly links the payment of service providers to their performance on the delivery of 11 key health-related services such as immunization, skilled birth attendance, family planning visits, and growth monitoring of infants and children. The performance is verified by an independent third-party monitor before payment is made.

In spite of raging insurgency and large scale counter-insurgency operations across the war-torn country in the past twenty years, Afghanistan’s health sector grew during the two decades of the war. In 2003, two years after the end of the first Taliban rule, Afghanistan had only 11 physicians, 18 nurses per 100,000 people. According to the Health Financing Progress Assessment Report 2020 the Islamic Republic of Afghanistan, Afghanistan’s health system has been steadily progressing since 2002 with increasing coverage of health services throughout the country. In 2018, a total of 3,135 health facilities were functional, which ensured access to almost 87% of the population within a two-hour distance (WHO).

In 2020, 50,364 pregnant women and 79,362 children who live more than two hours away from a health facility received essential health care through mobile health teams.

The result was visible to all. There was a rise in life expectancy. The maternal, newborn and child deaths have dramatically decreased. Even though Afghanistan was facing daunting economic and development challenges in the past 20 years, the United States’ development assistance helped the governments to maintain and improve the health sector.

Over the year the program made notable achievements as the number of people who received essential health, nutrition, and population services increased 28% between 2017-19. Also, health facility visits per capita per year in 2019 reached 2.1, which translates into the provision of health, nutrition and population services to more than 60 million individual visits.

More than 4,073,000 children have been immunized from 2018 to 2020. The volume of services delivered under the Sehatmandi project has increased for 10 out of 11 payment indicators. For example, the number of couple-years of contraceptive protection provided by Sehatmandi facilities increased by 49% between 2018 and 2019, and the number of women giving birth at a health facility increased by 21% over the same period.

In the past decade, Sehatmandi has remained as the backbone of Afghanistan’s health system, providing care for millions of people through 2 331 health facilities.

Since the Taliban gained power in August 2021, major funding for the Sehatmandi programme has been withdrawn. In absence of funding, there are now serious challenges in continuing the programme. Many countries including the US, EU, Germany, UK, France, and Sweden that previously contributed huge sums to Afghanistan’s health programme have stopped donating.

The Sehatmandi programme staff have not received their salaries for months.

Dr Paul Spiegel, director of the Center for Humanitarian health at Johns Hopkins University, who visited Afghanistan in November-December last year said he had seen public hospitals lacking fuel, drugs, hygiene products and even basic items such as colostomy bags. Spiegel told Democracy Now, one of the leading U.S.-based independent daily news broadcasts in the world, on January 14, 2021, that U.S. sanctions triggered by the Taliban takeover have had devastating implications on Afghans, leaving over half of the country hungry and throwing hospitals and schools into freefall. “Everything is falling down,” he says.

The WHO’s latest report says, “the clinics are faced with shortages of medicine and supplies, and patients are not able to access the essential health services they need. If this facility closes down, increasing ill-health and mortality is inevitable. The facility’s struggles are not unique.”

The funding pause by key donors to the country’s Sehatmandi programme will cause the majority of the public health facilities to close.

In September last year, the WHO issued a statement that the health care system in Afghanistan was on the verge of collapse. “Only 17% of all Sehatmandi health facilities are now fully functional. This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts.”

There is a glimmer of hope in the UN conference that will take place in March 2022. The UK will co-host the high-level summit with the UN in March to address the issue of growing humanitarian crisis in Afghanistan. Donor countries, UN agencies and Afghan civil society are expected to take part in the virtual event.

As half of the country’s population are facing acute hunger, the UN is seeking to raise $4.4 billion to help over 24.4 million Afghans needing urgent humanitarian help to survive.

“Afghanistan is in free fall. We cannot, sadly, avoid the tragedy that is already occurring – we have to minimize it now. That means immediately allowing money (liquidity is key) to get into Afg, and pay civil servants and government hospitals and schools,” Paul Spiegel tweets.

Afghanistan’s healthcare is facing a crisis. But at the same time, the world is not watching as a spectator. On January 11, 2022, the UN launched a $5 billion funding appeal for its 2022 Afghanistan Humanitarian Response Plan, the largest single-country aid appeal in UN history. If the UN appeal is heard, there is hope that Afghanistan’s health sector will not suffer a disastrous situation as is predicted.

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