Hakeema, 35, who works as a midwife, raises the sleeve of her patient and wraps her sphygmomanometer around the arm of 25-year-old Jameela, who has come to Yakawlang District Hospital for a check-up. Jameela is five months pregnant. She walked for almost half an hour from her nearby village to reach the hospital. The room where the check-up takes place is filled with pregnant women who have come to the hospital to be seen by Hakeema and other medical professionals. Noises of the patients and medical staff fill the poorly lit halls of the hospital.
“Before this hospital was rebuilt 10 years ago, we had to drive for hours to get to Bamyan city center for medical purposes,” Jameela says. “Now most of our health problems are solved in this hospital. This has brought about significant ease to life of the residents of this district.”
In 2001, Afghanistan faced a dismal public health landscape. Decades of war had led to the destruction and impeded building of health infrastructure, leaving less than 10 percent of the population within an hour’s travel to even the most basic healthcare services. Maternal mortality was 1,600 per 100,000 and child mortality was 257 per 1,000 were among the highest in the world.
However, Afghanistan has made tremendous achievements in the realm of health care in the past 15 years. The number of healthcare facilities has increased by 400 percent , with 50 new healthcare centers constructed in 2015 alone, bringing the total number of medical facilities nationally to 2,200. Today, 67 percent of Afghans have access to at least basic healthcare facilities within one hour of travel from their homes.
Healthcare access in Afghanistan now reaches the remotest villages, in parts of the country cutting a days-long journey to a healthcare center to minutes. “We have made revolutionary progress with regards to expansion of health services in Afghanistan. However, we don’t want to remain complacent. We want to take health facilities to the doorsteps of the people,” says Dr. Ferozedin Feroz, Minister of Public Health.
The numbers speak to the widespread effect of this increased access to healthcare. Maternal mortality has fallen by more than three quarters, from 1,600 per 100,000 in 2002 to 327 deaths per 100,000 in 2013. Child mortality has plummeted from 257 per 1,000 births in 2002 to 97 per 1,000 births in 2013.
In 2002, only a quarter of health facilities had a female health worker; by 2015 this number had increased to 85 percent and growing, according to USAID. Women now comprise 20 percent of Afghanistan’s 41,500 health workers . A huge factor in the dramatic decrease in infant and maternal mortality rates is the increase of midwives across the country, facilitated by an intensive midwife training program. In 2002, Afghanistan had only 500 midwives nationwide . Today, this number has increased tenfold to more than 5,000, Dr. Feroz says. The Afghan Midwives Association, established in 2005, provides training and support to midwives in every single province.
“Because of the reluctance of the midwives to work in the countryside, we started a training program where we recruit women from communities, train them in the provincial center and send them back to their communities to work as midwives,” said Dr. Feroz. “Today Afghanistan has a midwife training center and a nursing training center in all 34 provinces. This has been crucial to expanding the presence of midwives and nurses across communities.”
In large part due to a lack of health services, Afghanistan has been plagued by preventable diseases, including tuberculosis (TB), malaria and polio. The Ministry of Public Health tracks TB cases, and improved TB services across five provinces and trainings across 15 provinces have helped the country treat an estimated 56,000 new TB cases annually. Immunization rates have steadily increased from less than 30 percent in 2000 to more than 75 percent in 2014 for DPT and 66 percent in 2014 for measles.
As drug addiction has been becoming a growing concern, The National Unity Government has put special focus on the rehabilitation of addicts, building 120 addiction prevention and treatment centers since 2014. The National Unity Government has also made addressing mental health a priority. To this end, the government has trained and dispatched more than 300 mental health counselors to comprehensive health centers across the country.
The Ministry of Public Health also developed the National Medicine and Health Products Regulatory Authority , which has created an effective framework for controlling drugs and medical products to ensure they meet the necessary quality and standards. The National Unity Government has also formed Afghanistan’s first medical staff licensing body, the National Medical Council.
The remarkable achievements of the healthcare sector in Afghanistan over the past 15 years have largely been accomplished with international support. While the country has made huge gains in health, Afghanistan’s health care access and quality still pales in comparison with its regional neighbors. Even with huge gains in access to healthcare, the Ministry of Public Health still estimates that each healthcare center serves between 15,000-30,000 people, on average. Healthcare in Afghanistan remains fragile, and while access has dramatically improved, nearly a third of the country’s population remain without access to even the most basic healthcare services.
“The future is bright if we manage to build on the achievements we have had in the past 15 years, says Wahidullah Majroh, Spokesperson of the Ministry of Public Health. I am optimistic that we can further expand health services to our population. It is our achievements, commitment and support from our international partners that gives me hope and confidence.”