U.S. studies Afghan health successes

USA TODAY
WASHINGTON — Seeking to overhaul the failure-plagued Afghanistan reconstruction program, U.S. development officials are taking lessons from one of the few bright spots: the health sector, where more than $1 billion in international aid since 2002 has produced measurable results.
Though Afghanistan's health statistics remain some of the worst in the world, they have improved markedly over the past seven years, according to annual assessments by the Bloomberg School of Public Health at Johns Hopkins University. Infant mortality has dropped 21%, while tuberculosis treatment has expanded from 15% to 97% of cases, according to the Johns Hopkins surveys and World Health Organization data.

"Here's a place where it works," said James Bever, who directs the Afghanistan-Pakistan task force at the U.S. Agency for International Development, which has spent $535 million on Afghan health programs since 2002. It works, Bever said, because the Afghan Health Ministry worked with big donors to create a list of basic services, determined a common way to build clinics and then divided the country among them. "We're trying to learn some lessons from that," he said.

In 2002, 9% of Afghans had access to basic health services, and now 85% do, Afghan Health Minister Sayed Fatimie said in an interview. "It is a tremendous achievement," he said, "because the national health system of Afghanistan had collapsed."

Since Afghan government ministries are weak and corruption-plagued, most international aid to the country has been sent through private contractors and relief groups that operate on their own. That has led to poor coordination, high overhead and spotty performance, say critics, including the relief group Oxfam.

In February, USA TODAY reported that of six audits of Afghan aid programs conducted in the last year by USAID's inspector general, only one found a program working largely as it was supposed to.

Most health care aid goes through the Afghan Health Ministry, where the main donors — USAID, the World Bank and the European Union— have not encountered the problems seen elsewhere in the government, said Julie McLaughlin, the World Bank's South Asia health manager. The ministry operates health clinics through non-governmental organizations, but most of the contractors are non-profits — often small Afghan groups, she said.

USAID has built more than 700 health clinics. Although there were initial glitches, a 2006 inspector general's audit found the program had eventually delivered most of what it promised.

"The idea that we're pouring resources down a rodent hole — at least in the health sector, that is definitely not true," said Gilbert Burnham, a physician who co-directs the Center for Refugee and Disaster Response at Johns Hopkins and has supervised reviews of the Afghan system.

There are limits. The aid has yet to change Afghanistan's status as one of the world's most dangerous places for women to have babies. The maternal death rate is among the world's highest. About 26,000 Afghan women died in childbirth in 2005, according to WHO.