Achieving maternal and child health gains in Afghanistan: a Countdown case study in resilience

Session: Countdown to 2015: Conclusions and New Beginnings—Findings and Lessons Learned from Global and Country-level Analyses

Presenter: Nadia Akseer, Centre for Global Child Health, Hospital for Sick Children, Toronto
Download presentation slides

Background: Following the 2001 US invasion, Afghanistan has experienced a tumultuous period of democracy overshadowed by festering conflict, widespread insurgency, and vast inflows of development assistance. However, little systematic evidence has been available on health gains for the most vulnerable populations (women and children) over that time.

Methods: In a comprehensive, systematic assessment of RMNCH over the last decade, data from 11 nationally representative surveys on population health, nutrition, immunization, and household assets, as well as information on health system performance and human resources, were used to estimate national and subnational time trends for key health indicators. Linear regression methods were used to determine predictors of change in health care service utilization.

Results: In just over a decade from 2003 to 2013, under-5 mortality in Afghanistan decreased by almost 30% and stunting decreased by 29%. Coverage rates for essential maternal health interventions (antenatal care, SBA, facility births) all tripled, and key immunization rates more than doubled. Between 2005 and 2013, the number of deployed nurses, midwives, and physicians multiplied by 8 to 15 times. Key contributors to increases in SBA and facility births were improvements in deployment of community midwives, reduced time to reach a health facility, increased proximity from residence to a paved road, and improved maternal literacy.

Conclusions: Despite conflict and grinding poverty, Afghanistan has made remarkable progress, built on strong donor support and stewardship together with effective policy frameworks, improved access to care, and more skilled health workers. However, indicators disaggregated by province and income gradient reveal huge subnational disparities. To maintain and further accelerate health and development gains, Afghanistan must increase investments in addressing social determinants of health, promoting evidence-based interventions to address newborn survival, and implementing effective programs targeted at reducing health inequities.