Results

Government Reforms in Health Care Show Results

Government Reforms in Health Care Show Results

Overview

Despite increasing insecurity compounded by economic challenges, Afghanistan has made notable progress in improving key indicators in the areas of maternal and child health, nutrition, and health service delivery. The Demographic and Health Survey (DHS) shows a sharp reduction in the under-five mortality rate from 97 per 1,000 live births in 2010 to 55 in 2015. This decline can be explained in part by significant increases in the coverage of critical health services. The key enablers for the improvements seen in the health sector are strong local stewardship, development of sound and stable policy frameworks, prioritization of investments in primary care and the introduction of a basic package of health services (BPHS) and essential package of hospital services (EPHS) delivered by nongovernmental organizations (NGOs) as contracted service providers, and a reasonably large influx of financial assistance.

Challenge

Despite significant progress in the coverage and quality of health services, as well as a drop in maternal, infant, and under-five mortality, Afghanistan health indicators are still worse than the average for low-income countries, indicating a need to further decrease barriers for women in accessing services.

Afghanistan also has one of the highest levels of child malnutrition in the world. About 36.6 percent of children under five suffer from chronic malnutrition, and both women and children suffer from high levels of vitamin and mineral deficiencies. 

Approach

Given the political, security and financial uncertainties, it was deemed necessary to have one source of financing for the health sector, and all development partners to move toward a programmatic or sectoral approach. Such a sectoral approach would make Sehatmandi more responsive to the medium/longer-term needs of the sector and enable financing for sectoral priorities to be better planned through a well-coordinated effort by the government and development partners. The joint support to the health sector also will help harmonize donor support and align it with key priorities of the country.

The Sehatmandi (Health) Project implemented by the Ministry of Public Health (MoPH) aims to increase the utilization and quality of health, nutrition, and family planning services across Afghanistan. It seeks to improve delivery of basic health services and essential hospital services; strengthen the health system and its performance; and boost demand and community accountability for key health services.

Results

  • Child mortality rate: Under-five mortality rate dropped from 191 to 50 per 1,000 live births from 2006 to 2018, and newborn mortality rate fell from 53 to 23 per 1,000 live births from 2003 to 2018.
  • Health facilities: The number of functioning health facilities increased from 496 in 2002 to over 2,800 in 2018, while the proportion of facilities with female staff increased in the same period.
  • Attended births: Births attended by skilled health personnel among the lowest income quintile increased to 58.8 percent from 14.9 percent.
  • Immunization: PENTA 3 immunization coverage (a combination of five vaccines in one covering polio, diphtheria, Pertussis, tetanus, haemophilus influenzae type b, and hepatitis B) doubled, from 29 percent to 61 percent among children age 12 to 23 months in the lowest income quintile.
  • Contraception: Contraceptive prevalence rate (using any modern method) increased from 5.3 percent to 17.4 percent between 2000 and 2018.

ARTF Contribution

Sehatmandi is supported by an ARTF grant of $425 million. It has approved funding from March 18, 2018, to June 30, 2021. 

Partners

Sehatmandi is co-financed by the World Bank's International Development Association grant of $140 million, and Global Financing Facility grant of $35 million. 

Moving Forward

Sehatmandi project will be nationwide, covering all 34 provinces of the country. The project beneficiaries will include the entire population  who are expected to benefit from the better access to quality primary and secondary health and nutrition services. Poor people will disproportionately benefit from the project as it (a) focuses on the primary health centers (PHCs) where services are more likely to be utilized by the poor; (b) focuses on rural areas where the poor are concentrated; (c) expands the number of PHCs in lagging provinces that tend to be poorer; and (d) supports completely free care through the BPHS facilities, which reduces financial barriers to access, particularly by the poor.