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Afghanistan Mortality Survey

2010 Health Study Shows Significant Gains in Afghan Maternal and Child Health

The Afghanistan Mortality Survey is a landmark study that shows impressive gains in key health, education, and quality of life indicators. A decade ago, Afghanistans health system was shattered leading to widespread prevalence of malnutrition, infectious disease, and high infant and maternal mortality rates. Since the departure of the Taliban, the Ministry of Public Health (MoPH) with support of USAID, World Bank, and the European Commission, has been successful in rebuilding the healthcare system with low cost high impact interventions, to improve the health of Afghans, primarily women and children. This survey is the first comprehensive study ever conducted in Afghanistan and provides crucial data that reaffirms the investment in health and the importance to protect these gains while continuing to foster improvement.

Access the full report (pdf, 3mb) and summary (pdf, 9mb)
Read the Associated Press coverage and the op-ed by Afghan Minister of Public Health Dr. Suraya Dalil

Key Findings

• Fewer Women die during Pregnancy and Childbirth.
• More Children survive to their Fifth Birthday.
• Women are having fewer children.
• More Women Use Life Saving Care.

Factors Influencing Maternal & Child Health Improvements

• Deployment of community midwives and community health workers, community outreach, and first referral hospital (now available to 77 percent of the population) have contributed to improvements in maternal and child health. USAID, the World Bank, and the European Commission have invested more than $820 million to match the magnitude of the public health challenges in Afghanistan and have closely coordinated their efforts with the MoPH to reshape and rebuild the Afghan health sector.
• The Basic Package of Health Services (BPHS)¹ and the Essential Package of Health Services (EPHS)²provides the health sector with uniform standards in preventive and curative health services and equips the MoPH to effectively monitor and implement health care activities.
• The MoPH and donors are committed to primary health care, reaching underserved populations, and improving the central and provincial capacity to govern and provide oversight of the health system.

Lessons Learned

• Even in the midst of a humanitarian crisis, use of a development approach, including development of human resource and pharmaceutical policies, to build capacity from the outset proved to be both critical and a sound investment.
• Sufficient time is necessary to examine and consider options before making key decisions on the deployment of human and capital resources. Determination that the MoPH would take on a stewardship role instead of direct provision of health services was crucial.
• Donor coordination is essential and it has worked well in Afghanistan including coordinated financial and technical support provided by USAID, World Bank, and the EU.
• Dramatic mortality reduction builds on contributions from many sectors, such as education, womens empowerment, and infrastructure.

Way Forward for USAID

• Safeguard the Fragile Gains and Investments: Despite the improvements, one in 10 children dies before age five and one Afghan women dies about every 2 hours from pregnancy related causes. Afghanistan has higher fertility and lower contraceptive use than neighboring Bangladesh, India, and Pakistan. Substantial investments must be maintained to safeguard these hard-won gains in maternal and child health, while continuing to address challenges.
• Strengthened Healthcare System: USAID will support the MOPH in strengthening the overall health systems aimed at improving the health status of the general population. Specifically, USAID will continue to work on strengthening the stewardship capacity of the central MoPH to deliver quality health services including improving the quality of the BPHS and EPHS and strengthening the service delivery capacity of the hospital and private sectors.
• Sustainable Health Financing Options: USAID is supporting the MoPH in exploring innovative and sustainable health financing options such as hospital autonomy, social and community health insurance, excise taxes, public-private partnerships in the hospital sector, and progressive user fee schemes in the public sector that will contribute to the MoPHs ability to become financially sustainable in the long-term.
• Sustainable Human Resource Development: USAID will continue to support the MoPH in developing their human resource development capacity, including recruitment, pre-service training, in-service training, deployment, and opportunities for professional growth.

1. Service elements of BPHS include: Maternal newborn care, child health immunization, public nutrition, communicable disease treatment and control, mental health, disability and physical rehabilitation services, regular supply of essential drugs.

2. The EPHS has three purposes: (1) to identify a standardized package of hospital services at each level of hospital, (2) to provide a guide for the MOPH, private sector, nongovernmental organizations (NGOs), and donors on how the hospital sector should be staffed, equipped, and provided materials and drugs, and (3) to promote a health referral system that integrates the BPHS with hospitals.

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