Akmal Dawi
VOA News
March 7, 2022

Afghanistan faces a serious risk of backtracking to its notoriously high maternal mortality rates because of sudden drops in foreign funding, a shortage of health care workers, mobility restrictions and worsening poverty, health professionals have told VOA.

More than 1,600 Afghan mothers were dying for every 100,000 live births in 2001. With strong technical and financial support from donors, the country reduced the rate to about 640 deaths by 2018.

Donors were spending about $1 billion annually on Afghanistan’s health sector, but all development funding ceased immediately when the Taliban returned to power in August.

The abrupt funding shortage crippled the country’s donor-dependent public health system amid a global pandemic and a nearly universal poverty rate in the country.

By September 2021, more than 80% of the country’s health care facilities were reported as dysfunctional because of a lack of funding and medical supplies and a shortage of personnel.

“After the change of the government in August, there was a significant drop [cumulative around 25%] in the availability and utilization of maternal health services,” Joy Rivaca Caminade, a communication specialist with the World Health Organization in Afghanistan, told VOA.

The United Nations’ children’s agency, UNICEF, gave a similar bleak assessment.

“Following the events of mid-August 2021, Afghanistan’s health sector was close to collapse, with coverage of many lifesaving interventions for women and children falling between 20 and 30% within days,” said Joe English, a UNICEF spokesperson.

Such setbacks have given rise to one of Afghanistan’s long-standing health crises — high maternal mortality.

Mortality rates during childbirth might even have gone back to what they were in 2001, said Nadia Akseer, a scientist at the Bloomberg School of Public Health at Johns Hopkins University.

While there is no data showing how much infant and maternal mortality rates have worsened over the past six months, public health experts say the situation has deteriorated and the future remains uncertain.

Too little aid

After aid organizations warned that Afghanistan was facing widespread starvation and famine during the cold season, Western donors agreed to provide only lifesaving humanitarian assistance, to be delivered through U.N. agencies and nongovernmental organizations.

In December, the World Bank announced it was transferring $100 million from the Afghanistan Reconstruction Trust Fund — a multidonor fund set up to coordinate international aid — to UNICEF and WHO to fund emergency health activities in the country until June 2022.

U.N. agencies have welcomed the funding resumption and say the aid flow must continue or there will be serious public health consequences.

There are also concerns about the insufficiency of the funding as well as the mechanisms established for disbursement.

In addition to the nearly $1 billion in foreign assistance, the former Afghan government used to allocate about $200 million for the health sector from domestic resources annually.

The current humanitarian funding is only a fraction of what the country used to spend on health programs. And while the aid is insufficient, some are criticizing the U.N.-led aid disbursement regime.

“We know that U.N. agencies have high overhead costs, and they have their own fees,” Akseer told VOA, adding that donors must find a more cost-effective aid delivery system and consider removing economic sanctions on Afghanistan.

The World Bank and other Western donors have said no funding should be given to or disbursed through the Afghan Health Ministry, which manages public health facilities and personnel all over the country.

The United States, the largest humanitarian donor to Afghanistan, has imposed strong economic and political sanctions on the Taliban government, blocking access to about $9 billion in foreign assets, held mostly by the U.S. To help mitigate the growing humanitarian crisis in Afghanistan, the U.S. Treasury has issued special licenses for the delivery of essential aid to needy Afghans on the condition that the aid will not directly benefit the Taliban.

U.N. and partner health care NGOs use foreign funds to ensure health facilities remain operational and to tackle a host of public health crises facing Afghanistan, including the pandemic, a recent increase in measles cases, growing malnutrition among children, and infectious diseases — not just infant and maternal health.

Brain drain

According to a Doctors Without Borders statement on February 23, “The Afghan heath system has been under-funded, under-staffed and dysfunctional for years. Most health facilities in Afghanistan remain under great pressure due to shortages of staff and equipment—some are barely functioning or are closed altogether.”

Even in 2016, Afghanistan had the lowest number of doctors per every 1,000 people (0.3) in Asia, according to the World Bank.

Tens of thousands of educated Afghans, among them health care professionals affiliated with international organizations, have been evacuated out of Afghanistan over the past six months.

This has created a “brain drain of health professionals,” Akseer said.

“Let’s say a midwife who worked in a typical village in Afghanistan and who was trained by an international organization, that affiliation is her ticket out of the country.”

WHO confirmed the shortage of health professionals but added there was no data to measure how this was impacting the delivery of essential health services across the country.

Afghanistan’s health problems have been compounded by economic and institutional crises.

“The increase in poverty to over 97%, the large-scale loss of livelihoods, and widespread displacement do not bode well for maternal and child health,” said English, the UNICEF spokesperson.

The Taliban’s restrictions on women’s mobility has also limited Afghan mothers’ access to health care services, aid agencies say.

“It’s very possible that just in the past six months we’ve seen higher rates of maternal mortality and maternal illness than maybe the country has seen in the past 15 years,” Akseer said.

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