July 20, 2008 -- When the Taliban fell in 2001, Afghanistan had some of the worst health indicators in the world. Today, despite continuing instability, health outcomes are vastly improved with household surveys indicating a 26% decline in under-five mortality. This translates into more than 80,000 lives being saved every year.
These results have been achieved through a rapid expansion of primary health care services which are delivered primarily by NGOs contracted by the Afghan Government. The Government rewards NGOs based on job performance.
This approach, funded by the World Bank, allows the government to deliver aid in a 'difficult' environment. In the health services sector, the new approach to service delivery through partnerships with NGOs has been demonstrated to be a creative and flexible response to an environment characterized by increasing insecurity, difficult logistics, and a shortage of health workers. The Ministry of Public Health concentrates on managing and directing the health sector while contracting with local and international NGOs to deliver a basic package of health services. Other international aid agencies also provide grants to NGOs to deliver basic health services.
The contracts focus on service delivery and offer performance bonuses to the NGOs if they achieve specified improvements in the quality of care and the coverage of services.
Third party health facility assessments are carried out each year in more than 600 facilities nationwide. In recent assessments, health facilities that were contracted showed improvements in quality of care (nearly a 32 percentage point improvement from 2004 to 2007). While there is still much to do, the progress made in the last few years in Afghanistan indicates that achieving major improvements in health are possible even in a difficult environment.
- Performance-Based Contracting for Health Services in Developing Countries: A Toolkit
Building an Effective State
- Building an effective state that can provide security and services to the people is at the heart of the reconstruction effort in Afghanistan. This report looks at the implications for public administration reform over the next 5-10 years, and proposes a priority agenda for action by the Government of Afghanistan and the donor community. (Access the Report)
Public Financial Management (PFM): Fiscal policy and the budget comprise a central tool for achieving Afghanistan's development objectives. The quality of the PFM systems and procedures has procedures has an important impact on development performance.
Out of total of 28 performance indicators, 18 indicators improved and two indicators deteriorated, while 8 indicators remained unchanged. Some of the indicators include Transparency, External Audit, Donor Practices, and International Comparison.
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National Solidarity Program (NSP): Despite a challenging environment the NSP is making significant progress in building community institutions in rural Afghanistan. 18,303 communities have successfully elected
Community Development Councils (CDCs). Over 31,396 community projects had been partially or fully financed, of which more than 15,111 projects had been completed. It’s the only government program to have reached all the
country’s 34 provinces, touching the lives of 18 million villagers.
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Since April 2002, the World Bank has committed over US$1.69 billion for 41 reconstruction projects. Status of Projects
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