Improving access to basic health needs, ensuring timely access to services for time-dependent or urgent conditions — such as complications during childbirth — is particularly important in a conflict-affected country.
A brief history of the Afghan health system
After the Taliban was removed from power following the 2001 United States invasion, the World Bank invested in setting up health governance in the country. According to Bourdeaux, it was different to what normally happens in conflict-affected states, where the bank tends to only support short term projects.
Together with the bank, the Ministry of Public Health decided to focus on policy priority setting and regulation. They didn’t try to “take on so much that they would inevitably fail,” she said.
Minister of Public Health, Dr. Ferozuddin Feroz outlines the remaining challenges Afghanistan needs to tackle in order to achieve universal health coverage.
With no history of a functioning health care system, the creation of the Basic Package of Health Services in 2003 was a response to Afghanistan’s urgent health needs. It aimed to provide a bare minimum of essential health services such as maternal health and public nutrition that could be scaled up rapidly through a contracting-out model, whereby local and international NGOs bid for contracts lasting between 12 and 36 months.
An outside organization would then evaluate how the contracts are being fulfilled, ensuring NGOs are honoring the contract and providing quality services, allowing the ministry to decide whether to renew the contracts or not, Bourdeaux explained.
According to Dr. Teri Reynolds, who leads the emergency and trauma care programs at WHO, having a timely, effective emergency care system amplifies the effectiveness of many other parts of the health system.
As part of the expert committee convened between 2017 and 2018 by the Afghan health minister, Reynolds helped identify the introduction of emergency trauma care services as a priority.
The new package has done “an extraordinary job of identifying what are the key interventions for integrated emergency care delivery at each level of the health system that are context relevant for Afghanistan,” she said.