What's Next for Health in Afghanistan?
October 6, 2010
Julia Nagel
Web and Social Media Assistant, Global Health Policy Center
When Dr. Suraya Dalil, Afghanistan’s Minister of Health, spoke to a small audience at CSIS on September 17th, she presented a complex picture of health in Afghanistan.
She began with the successes. Dr. Dalil shared her view that advances are being made in both the health and education sectors. Since 2002, for example, the number of trained midwives has increased – from 400 to over 2,500 – resulting in a much greater number of healthy births. The polio immunization effort also has borne fruit: 90% of children under the age of five have been vaccinated against polio. In addition to these figures, seven million children are currently attending school in Afghanistan, with the number expected to rise to ten million by 2015.
After enumerating these more optimistic statistics, Dr. Dalil then looked up from her sheet of paper and asked, “What’s next?” Although a simple question, in the context of Afghanistan, I found her choice of words compelling. Rather than spend time talking about the magnitude of the challenges in front of her, Dr. Dalil made it clear that she wants to continue moving forward and concentrate on achievable successes. She thus laid out what is needed.
First, Dr. Dalil emphasized the need to recruit female staff in health facilities and the importance of retaining that staff. While she noted earlier in her address that women have made progress in Afghanistan – both in government and in health – she also commented that their achievements are fragile. For example, Afghanistan has one of the highest maternal mortality rates in the world. Training female health workers is crucial in curbing these figures.
Next she stated that above all, when women are asked what they want, they overwhelmingly answer: education for their children and access to healthcare. In a country mired by violence and war, I found it incredible that security is not the number one concern. However the answer these women gave is telling. As one person in the room noted, when education and health facilities are available, security improves; as a result, so does the legitimacy of the government. When real achievements are made in these two spheres, people feel the difference. Dr. Dalil thus stressed that even more funding is needed to strengthen these areas, particularly healthcare.
Right now, she said, Afghan citizens are traveling to India and Pakistan – paying considerable sums of money – because there aren’t enough health facilities in Afghanistan for secondary and tertiary care. Severe burn victims are evacuated to hospitals as far away as Europe and the United States, because none of the hospitals in Kabul have a specialized burn unit.
To put the shortage of health care facilities in perspective – for the 4 million people who live in Kabul, there are only 17 hospitals. That’s approximately 240,000 people per hospital. The city of Boston, by comparison, also has 17 hospitals. However Boston’s population is just over 600,000 people, one sixth of Kabul’s. This comparison is startling. While aid is crucial to the continued strengthening of Afghanistan’s health sector, Dr. Dalil reminded the audience that targeted aid – directed towards hospitals, medicine, and salaries for health care workers – is particularly important. 
In 2003, for example, the Afghan Ministry of Health made a conscious decision to outsource most healthcare delivery functions to non-government organizations (NGOs). This decision, whereby both money and operational responsibility were allocated judiciously, led to the measurable improvements in public health that Dr. Dalil described earlier. This decision also allowed funds to be put towards community health workers (CHWs). On average, CHWs provide basic health services to 100 to 150 households – approximately 1,000 to 1,500 individuals – creating a lasting impact in the country.
One particular initiative that received praise from the audience was the incorporation of the community health curriculum into the primary education system. Teaching children, from an early age, the importance of health and basic hygiene positively affects the country for years to come. Many people remarked that this was a commendable idea that should be funded in more countries.
In her closing remarks, Dr. Dalil spoke briefly about the polio eradication effort and the need for this and other health initiatives to be community-driven. She also stated that her other immediate priorities included: improving quality control of pharmaceutical products imported into Afghanistan and increasing women’s access to services.
While the health challenges in a country like Afghanistan’s may appear insurmountable, listening to Dr. Dalil articulate them – with commitment and foresight – gave me confidence that progress can be achieved. Now I ask, what’s next?
