Afghanistan Policy Page

A one-page brief on a major issue concerning U.S. policy and engagement in Afghanistan.

Health in Afghanistan

4 February 2010

Take Aways

• Population health is important in Afghanistan because of the instability caused by social disruptions and high economic costs of illnesses.

• Afghanistan’s fragile healthcare infrastructure is targeted by Taliban militants.

• Afghanistan has seen some improvements in the health sector since the fall of the Taliban, but many major healthcare challenges remain.

• The Ministry of Public Health has become quite capable, but international assistance is still required to address Afghanistan’s dire humanitarian needs, to foster a healthier and more stable society.

Key Issues

Afghanistan’s Major Health Concerns

• Family Health – 13% infants die before age one, and 20% die before age five. Only one third of married Afghan women are knowledgeable of modern contraception, and the average woman will have over six children.

• Tuberculosis – Afghanistan has approximately 46,000 new tuberculosis cases per year, killing 8,200 in 2007.

• Nutrition – Malnutrition prevalence remains high due to Afghanistan’s rampant poverty; 39% of children under five are under weight for their age.

Challenges for Healthcare

• Security Environment – Health access in the countryside is increasingly difficult, and internationally supported health facilities are often targeted by the Taliban.

• Inadequate Health Facilities – Only 65% of Afghans are within two hours walking distance of a primary care facility. Medical performance at clinics and hospitals suffer from disruptions to electricity and clean water availability.

• Insufficient Medical Personnel – Afghanistan has very few doctors, and more female health personnel are needed, which is necessary for female health access in Afghanistan’s socially conservative society.

• Refugees – Over 3 million Afghan refugees in Pakistan and Iran, and 400,000 internally displaced persons have urgent health needs.

Improvement since the fall of the Taliban – Largely through the efforts of USAID, Afghanistan’s health sector has improved since 2002.

• At the fall of the Taliban, only 9% of Afghans had access to basic health services, which has increased to 85% in 2009.

• Between 2002 and 2008, Afghanistan saw a 38% reduction in child mortality and a 40% reduction in maternal mortality

Afghan Capacity – The Ministry of Public Health is one of the few ministries that achieved a 4 out of 5 rating for self sufficiency by USAID, and many believe it is sufficiently transparent to handle donor funds. Employees are competitively recruited, promoted by merit, and monitored by independent third parties for effectiveness.

Polio Eradication Efforts – Afghanistan is one of only four countries where polio remains endemic, but over 90 percent of children under age five have been vaccinated against the disease since 2002. Over 7.5 million children were immunized in 2009, including 800,000 in high risk districts due to successful negotiations of “Days of Tranquility” cease-fires with local parties opposed to the national government.

Top Key Facts

• Life expectancy is 46 years, this compares to 65 in Pakistan and 78 in the United States.

• Total Afghan government expenditure on health: ten dollars per capita (5.5% of national budget)

• Afghanistan only has 2 doctors per 10,000.

• In rural areas there are fewer than six doctors, seven nurses, and four midwives for every 100,000 women.

• One out of eight Afghan women die from causes related to pregnancy and childbirth each year. Afghanistan’s maternal mortality rate is only exceeded by Sierra Leone.

• Afghanistan now has 84% immunization coverage for diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza, and 75% coverage for measles – UNICEF’s estimate for pre-2001 is as low as 20%.

• Tuberculosis treatment has increased from 15% to 97% of cases since 2002.

Possible Questions

• What best practices that have been learned by USAID from assisting the Ministry of Public Health achieve its near self-sufficiency, and can they be applied elsewhere?

• What is being done to increase the number of Afghan medical professionals and female healthcare workers?

• How are the high infant, child, and maternal mortality rates being addressed?

• What is being done to secure medical facilities from Taliban attacks?

In the News

“There will only be lasting peace in Afghanistan when there are real improvements to the lives of the Afghan people… They urgently need more doctors, midwives and teachers.” Patrick Watt, Save the Children’s Director of Development Policy. 28 January, 2010.