WASHINGTON, March 6, 2018 — A new World Bank report finds that Afghanistan has shown improved health outcomes since 2003, with health services that have remained resilient even in highly insecure provinces. The report entitled Progress in the Face of Insecurity: Improving Health Outcomes in Afghanistan, finds however that the uptick in insecurity since 2010 has slowed some gains.
The number of children dying before their 5th birthday dropped by 34 percent from 2003 to 2015, from 137 to 91 deaths per 1,000 live births, according to UN estimates. Rates of childhood stunting-- where children who have had insufficient nutrition from birth to age 3 are too short for their age--have declined at the rate of 2 percent per year, faster than a global median of comparable countries which saw an average decline of 1.3 percent per year.
The report finds that such health gains have been made possible by expanded frontline health services and a stronger health system. For example, until 2010 in highly insecure provinces, the number of pregnant women who were seen by a health professional increased by almost 3.5 percent every year and the use of contraceptives and the number of births assisted by skilled professionals each increased by 2 percent per year. The report also analyzes the overall health system, measuring progress in six areas, including the knowledge of health professionals, the quality of medical infrastructure and equipment and availability of drugs and vaccines. All have shown sustained, though uneven, improvement since 2003.
“Afghanistan’s health gains despite continuing insecurity is a story from which the world has much to learn,” said Tim Evans, Senior Director of Health, Nutrition and Population, World Bank Group. “Rather than retreating and unravelling in adverse conditions, the health system is driving forward to secure the health of all citizens – especially mothers and children – drawing on deep reservoirs of local ingenuity.”
A key reason for Afghanistan’s success has been its innovative model of health care delivery. Local non-governmental organizations (NGOs) are on the frontlines of health-service delivery – 72 percent of the NGOs providing health services in the country today are Afghan. The government has provided financing, coordination and oversight in key areas, including regulation, accountability and monitoring, and effective national health campaigns. An additional benefit has been a growing female health workforce in many rural areas, creating quality jobs for women while also strengthening the health system.
“Long-term focus and investment by the Government of Afghanistan and many partners has moved the country forward on health, despite many challenges,” said Shubham Chaudhuri, World Bank Country Director for Afghanistan. “Afghanistan still has a long way to go to ensure quality health services for all, and we look forward to be a being a partner in that effort.”
The report points out many challenges. Since 2010, progress on maternal health has slowed. Data collection is difficult, especially in the most insecure areas, and Afghanistan’s health outcomes are still far from global averages. Its recommendations include strengthening autonomy of local health service delivery, investing in better data and monitoring and more effective purchasing of health services.