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    Afghanistan: A health system is on the brink of collapse

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    Afghanistan: A health system is on the brink of collapse

    Over two decades, Afghanistan witnessed an increase in life expectancy. Maternal, new-born and child deaths, too, reduced dramatically. All that seems to have been turned on its head today, as the withdrawn funding for health and care has seriously jeopardised the gains of previous decades.

    Ayesha, 29, is a midwife in a rural health facility in Afghanistan. She graduated from the provincial midwifery school supported by the government’s Sehatmandi programme, which provides essential primary care services including for maternal, new-born and child health.

    “I was born in a very remote district where health facilities were not available. I witnessed many pregnant mothers dying because there was no health care facility at my village or on the way to hospitals, located more than 50 km away” Ayesha said. “I decided to become a midwife and serve the women and children in the villages. I love my job and attend numerous institutional deliveries, and have contributed to the reduction of maternal mortality.”

    However, life-saving health services have come under severe threat in recent months. The Sehatmandi programme, for instance, has been the backbone of Afghanistan’s health system, providing care for millions of people through 2,331 health facilities. But major funding for the programme has been withdrawn since the Taliban gained power in August 2021. The country has received only minimal funding to help cover immediate needs for the early part of the year. Gaps remain in the country’s health system’s ability to sustain the delivery of essential services.

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    The primary care facility in the village is vital, serving 58,000 people including 13,340 women of childbearing age and 11,600 children under-five. Importantly, it provides emergency obstetric care, including caesarean section services. Without this, women would have to travel far, and put themselves and their babies at risk.

    Primary health care under threat

    The lack of funds has crippled the health facilities that the community desperately needs – staff have not received their salaries for months and the clinic short of medicines and supplies. There is fear of the inevitable – more illness and people dying. The facility’s struggles are not unique.

    The situation is replicated across the country because the Sehatmandi programme is no longer able to receive appropriate financial support due to the change in Afghanistan’s government. Donors find it impossible to provide financing through the new regime and major funding has been withdrawn. Previously funded by the World Bank, the European Commission and USAID, there are now serious challenges to continuing these vital primary health care services.

    The population is also suffering due to a recent drought that has affected crops and livestock. This, combined with rising food prices and the collapse of public services, has led to an acute shortage of food.

    Urgent call for international support

    Over two decades, Afghanistan witnessed an increase in life expectancy. Maternal, new-born and child deaths, too, reduced dramatically. All that has been turned on its head today, as the withdrawn funding has seriously jeopardised the gains of previous decades.

    “The recent funding pause by key donors to the country’s biggest health programme will cause the majority of the public health facilities to close,” says Dr Luo Dapeng, WHO Representative in Afghanistan. “As a result, more mothers, infants and children will die of reduced access to essential health care.”

    While it may be challenging to find alternative and innovative ways to support the Sehatmandi programme, it is essential for the health and lives of the population of one of the poorest countries in the world and for health security globally.

     

    Image: WHO/Obiadullah Sidiqi

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