Afghanistan National Health Resources Assessment (ANHRA) - Afghanistan

Afghan nationals were trained in data collection, which included information on how to adequately fill out the questionnaires and how to introduce the assessment to facility staff and health workers working in the communities. They were also trained in the use of global positioning satellite (GPS) technology in order to accurately pinpoint existing facilities. Training included a step-by-step walk-through of each questionnaire, role plays, and trial data collection sessions.

In the field, surveyors contacted local health authorities and local NGO offices to check the security situation and to request information on facilities that were not listed on the national database. Except for two districts, all districts in the country were covered in a two-month period, including many in areas where the central government had little or no authority.

The database is maintained and updated at the Health and Management Information Department in the Ministry of Health (MoH) in Kabul; information is provided upon request. The database is meant to be a reference for the MOH and the donors in the health sector for planning and implementation of health services. A CD containing the report has been sent to MoH departments, provincial health departments, all other ministries, donors, and NGOs and UN agencies active in health. National and provincial maps showing health facility to population ratios are available for download on the Afghanistan Information Management Service (AIMS) website (click here to access provincial health maps in Dari or English).

To support these on-the-ground efforts, the MoH provided a signed letter asking health and other authorities, including NGO staff, to cooperate actively. The letter was countersigned and stamped by the directors of most of the major health NGOs. The closing ceremony of the training, including a speech of the deputy minister, was televised. National radio announced the start of the survey with an appeal for all partners involved in health to cooperate.

The central government traveled to provincial- and district-level health authorities to share the preliminary results of the survey (rather than asking a few people to come to Kabul). Central ministry staff were also thus enabled to see local problems with their own eyes. These results were presented by the survey team to staff of the MoH, then by MoH staff to donors and NGOs in Kabul. In addition, a packet of key findings and issues was developed based on the input of the provincial staff and translated into Dari and Pashtu. Provincial health directors were invited to help lead a national workshop in Kabul to examine the results, to plan a future course of action, and to train the attendees (most of whom were provincial ministry staff) to run a participatory workshop. Starting in December 2002, 5-day decentralised planning workshops have been organised in all 32 provinces. Participants include NGOs working in the health sector; representatives of the governor; public sector health representatives from each district; representatives of the Ministry for Rural Development, Ministry of Education, and Ministry of Women's Affairs; and regional and provincial staff of WHO, UNICEF, and The United Nations Population Fund (UNFPA). During the workshops, results of the assessment are reviewed, discussed and updated. Then priority interventions are defined. Specifically, the appropriate location to establish new clinics was determined in this forum.

In December 2002, Afghanistan's Deputy Minister of Public Health discussed the results of the survey with more than 80 Congressional staff, government officials, and the public at a briefing on Capitol Hill in Washington, DC, United States. He urged these government officials to support reconstruction of the health system in Afghanistan by providing the necessary funding for effective and affordable health programmes.

Population, Health, Women, Children.

In December 2002, a 212-page ANHRA final assessment report was published; click here to access it in PDF format. Among the survey's findings were:

• 70% of existing primary care clinics are unable to provide even basic mother and child services
• 90% of hospitals do not have the complete equipment to perform C-sections
• 40% of all basic health facilities do not have female staff
• more than 25% of children die before their fifth birthday
• 40% of child deaths are due to the preventable causes of diarrhea and acute respiratory infections.

These results cohere with a study conducted by the US Centers for Disease Control and UNICEF, which found that Afghanistan has one of the highest maternal mortality rates in the world at 1,600 per 100,000 live births. (In the United States, the maternal mortality rate is 12 per 100,000).

Afghanistan has experienced more than a quarter century of conflict, exacerbated by disease, drought, and poverty. Rebuilding Afghanistan will cost roughly $15 billion over the next ten years, according to a joint preliminary assessment conducted by the World Bank, the Asian Development Bank, and the United Nations Development Program. The questions that remain are whether the government will make the money available and whether health will be a priority.

Recently, USAID awarded MSH the Rapid and Effective Action Combating HIV/AIDS (REACH) project, which is a 3 year follow-up of the AHSEP programme.