How Better Leadership, Management and Governance Has Improved Health Programs in Afghanistan

At the fall of the Taliban regime in 2001, the health situation in the Afghanistan was dire. Access to primary care was below 10%, and immunization rates were below 20%, and nine out of 10 women were on their own for labor and delivery. Not surprisingly, maternal, child, and infant mortality were among the highest in the world.

The leadership at the top level of the Ministry of Public Health had disappeared. Under the new Islamic Republic of Afghanistan established in early 2002, the Afghan public health officers who remained in the country during the years of conflict and those who returned all worked closely together, and with the representatives and experts from the international community to address the numerous challenges.

Shina Aghazarat Basic Health Center in Panjab district Bamyan Province funded by USAID.

Shina Aghazarat Basic Health Center in Panjab district Bamyan Province funded by USAID.

In the chaotic situation prevailing at the beginning, MoPH leaders who did not have much public health management knowledge and experience, but they were cooperative and remained open to good ideas and exchange of views. Representatives and experts from the international agencies helped us with the process of defining the strategic and operational options and opportunities. The international community in general and donors such as USAID, the World Bank, and the European Commission in particular demonstrated all along a high degree of focus, patience, and stability in particular during the sensitive initial phase when the Afghan governance mechanisms were not quite fully back in place yet. One cannot overstate how exceptional this joint effort and cooperation has been.

Critical policy decisions such as defining of the basic package of health services (BPHS), contracting out of health services to NGOs, and the MoPH focusing on a stewardship role have proven to be the right ones, and have allowed for a smoother, more systematic and better organized way of addressing the six building blocks of health system strengthening in Afghanistan. These wise policy decisions and their effective implementation could not have been possible without the good governance and leadership manifested by all the Afghan and international partners and decision-makers.

Overall, the health situation in Afghanistan has seen much improvement; health indicators from the 2010 Afghan National Mortality Survey show that maternal mortality has fallen by two-thirds, from an estimated 1,600 per 100,000 live births in 2002 to less than 400 in most parts of the country.

We can see today that health programs have better success where and when leadership, management, and governance are better. Some regions which have benefited from such capable leaders and managers for many years (such as Herat) are shining better. But other regions are improving as well. Even Khost province which was quite unstable for a long time is now in a better situation when it comes to its governance and management, and health indicators there show good progress at last.

The MoPH in Afghanistan is capable of managing resources in very professional and transparent ways, which has encouraged donors to channel more resources through the government for BPHS implementation and health system strengthening. The MoPH has also put into place best practice mechanisms such as specialized technical working groups, a consultative committee, and an executive decision-making mechanism in which stakeholders inputs and participation play a critical role. Continuing to strengthen Afghan capacity in inspired leadership, sound management, and transparent governance must be a top priority in order to consolidate the gains achieved, and move us toward a truly sustainable health system.

Rural health worker and community leader disccuss health issues during a training.

Rural health worker and community leader disccuss health issues during a training.

One of the goals of the health sector in Afghanistan is to see the capacity of the MoPH continue to grow in playing its stewardship role so that the decentralization of the health system is effective and continues to improve its efficiency in offering better health services to the population. Intensifying our efforts and focusing on cultivating accountability across the sector is also an important challenge, and a goal for Afghans as we strive to strengthen our country and increase its stability.

Dr. Mubarakshah Mubarak is the Project Director for the USAID-funded LMG project in Afghanistan.