Government of Afghanistan signs new agreement with the World Bank Aimed at Improving Health and Nutrition Status of Afghans

KABUL, April 09, 2009 ─ Ministry of Finance, Islamic Republic of Afghanistan, today, signed a US$30 million grant assistance with the World Bank. The Bank’s new assistance will support the Strengthening Health Activities for Rural Poor (SHARP) project in Afghanistan. SHARP aims to improve the health and nutritional status of Afghans, focusing especially on women and children and under-served areas of the country.

Afghanistan has made significant progress in the health sector over the last six years. A nation-wide survey conducted in late 2006 found that infant and under 5 mortality had declined by 22 percent and 26 percent, respectively, since 2001. In addition, the number of functioning primary health care facilities increased from 498 in 2002 to 1443 in 2008 and health facilities with skilled female health workers increased from 25 percent to 82 percent in the same period. Yet, Afghanistan’s health indicators remain among the worst in the world. For example, the under 5 mortality rate is still 67 percent higher than the average for low income countries.

"Considerable achievements have been made in improving the health of many Afghans despite the substantial challenges," said HE Dr. Omar Zakhailwal, Minister of Finance (MoF), Islamic Republic of Afghanistan. "Scaling up successes and improving services further will require a long term commitment by the Government of Afghanistan and the international community. To this end, the Ministry of Finance will support efforts to improve the health status of Afghans throughout the country."

The SHARP project supports Afghanistan’s Health and Nutrition Sector Strategy (HNSS), which is the blueprint for the government’s health sector program for the period 2008-2013. Under the HNSS, the government aims to expand coverage of the Basic Package of Health Services (BPHS) to at least 90 percent of the population by 2010.

"Our experience since 2003 indicates that contracting has worked very well both for health services delivered by the ministry as for services delivered by the nongovernmental organizations (NGOs)," said HE Dr. Mohammad Amin Fatimie, Minister of Public Health (MoPH), Islamic Republic of Afghanistan. "The results in improving the coverage of basic health services for mothers and children are very satisfactory and we are encouraged by them to continue working along the same mechanisms. If the implementers of the service contracts do not perform well and continue to do so their contract will be terminated. "

The project will help deliver the Basic Package of Health Services (BPHS) through performance-based contracts with local and international NGOs and through direct service delivery by the Ministry of Public Health. This package focuses on primary health care interventions such as child immunization, nutrition, tuberculosis and malaria control, prenatal, obstetrical and post-partum care, family planning, and basic curative services. Currently 85 percent of the Afghan population lives in districts which have been covered by the BPHS. The approximate cost of delivering these basic services is US$4.50 per capita per year.

Each NGO is competitively contracted for the delivery of basic services in a specific geographic area. The Ministry of Public Health also invokes sanctions in case an NGO does not perform well. Performance is being reviewed by an independent third party which carries out assessments each year in more than 600 facilities nationwide.

"The World Bank has supported the reconstruction of the health sector since 2003 and has witnessed the important role played by MOPH in building a vision for the sector and in leading implementers." said Nick Krafft, World Bank Country Director for Afghanistan. "MoPH has progressively strengthened its stewardship role and through the HNSS has clearly articulated its priorities for the next four years. The HNSS has become a platform for leveraging and harmonizing donor financing as well as coordinating different players. The World Bank remains committed to support the HNSS and further build ministry’s stewardship capacity with the final objective of delivering higher quality health services to a larger number of Afghans."

The project will be implemented by the Ministry of Public Health over a period of 45 months, and will finance part of the HNSS. The total cost for the implementation of the NHSS is estimated at US$550 million. In addition to World Bank’s support, the European Commission (EC), United States Agency for International Development (USAID), Japanese Government, Norway and several other bilateral donors through the Afghanistan Reconstruction Trust Fund (ARTF) are expected to finance the implementation of HNSS.

About the World Bank assistance:

Since the resumption of operations in Afghanistan in April 2002, the World Bank Group has financed 41 projects, committing around US$1.72 billion of which US$1.28 billion is grant and US$436.4 credit (interest-free loan).  The World Bank funded projects mostly support rural livelihoods, rebuilding infrastructure, education and basic health services. The World Bank also manages the US$3 billion Afghanistan Reconstruction Trust Fund (ARTF). Since 2002, the IFC, the World Bank Group’s private sector arm, has provided US$62.6 million of equity financing while its Multilateral Investment Guarantee Agency has guaranteed US$77.9 million of investment.