By the time of the fall of the Taliban regime, Afghanistan had some of the worst health indicators in the world. The under-five mortality rate was estimated to be 256 per 1,000 births, compared to 92 for the South Asia region overall. The challenge was therefore to improve primary health care in order to decrease child and maternal mortality rates, in particular in rural areas.

Almost 6 million people in rural areas of Afghanistan now have access to primary health care, many for the first time.

Highlights:
- The number of people visiting a health center in rural areas has increased four-fold since 2004. In most low income countries the average is 0.3 visits per person per year, whereas in Afghanistan it is approaching 1.0 in areas covered by the project.
- The Ministry of Public Health has contracted with NGO service providers in districts where 80% of the population are living - boosting access to health care in rural areas.
-  An independent assessment shows a 40 percent increase in patient satisfaction.
- 60 percent increase in the number of functional health centers in the 11 provinces financed by the project during Phase I. Third party evaluations show that the centers are fully supplied, equipped, and staffed. There is almost no absenteeism, which compares well with up to 40 percent absenteeism among public sector doctors elsewhere in South Asia.
- The number of pregnant women receiving prenatal care per year has increased from 8,500 in 2003 (5 percent of pregnant women, based on the baseline household survey) to 123,000 in 2006 (63 percent, based on health management information system data). An ongoing household survey should confirm these numbers soon.
- NGOs maintained and even expanded services in unstable areas. In Helmand, one of the more insecure provinces, the number of patients seen more than doubled, from 157,000 in 2004 to 338,000 in 2006, despite the assassination of four health workers and the destruction of 15 percent of health centers.
- The number of patients diagnosed as a proportion of the expected number of TB cases has increased from less than 10 percent to almost 50 percent in less than 2 years (still short of the international standard of 70 percent).
- 8,000 patients have been diagnosed and are receiving effective TB treatment.
- More than 10,000 community health workers–half of them women–have been trained and deployed. They have helped increase family planning and childhood vaccination.
- The number of facilities with trained female health workers has increased from 25 percent before the project to 85 percent today.
- By providing virtually free health services, the project has helped increase access to preventive and curative care. It has, thereby, reduced the health-induced financial shocks that frequently push poor families deeper into poverty.

Physical access to services needs to be further improved and it will also take bold approaches to get communities to fully use the services. For example, despite a huge increase in obstetrical services, increasing the proportion of deliveries that are attended by skilled health workers will have to overcome serious social obstacles. The approaches that have been successful in Afghanistan are now being applied in other post-conflict settings such as South Sudan and Liberia.