An alternative model for health service delivery in Afghanistan

Abstract

Since 2001, Afghanistan has invested two decades and billions of US dollars into reconstructing its health system and bringing the coverage of health service from a meagre 12% to 90% of the population.1KIT Royal Tropical InstituteAfghanistan health survey 2018. July 16, 2019.https://www.kit.nl/wp-content/uploads/2019/07/AHS-2018-report-FINAL-15-4-2019.pdfDate accessed: September 8, 2021Google Scholar The scope of health services has been defined by the Basic Package of Health Services2Islamic Republic of Afghanistan Ministry of Public HealthA Basic Package of Health Services for Afghanistan—2010/1389. July 15, 2010.https://www.ahds.org/documents/BPHS_2010_Final_Master%20signed.pdfDate accessed: September 6, 2021Google Scholar and the Essential Package of Hospital Services,3Islamic Republic of Afghanistan Ministry of Public HealthThe Essential Package of Hospital Services for Afghanistan. Oct 20, 2005.https://www.who.int/selection_medicines/country_lists/afg_2005.pdfDate accessed: September 6, 2021Google Scholar the provision of which is highly dependent on donors. By the beginning of 2021, Afghanistan was on its way to expand the content and integrate these two packages in the form of the Integrated Package of Essential Health Services. However, the country context has completely changed after the collapse of government on Aug 15, 2021, and sustaining the health system has become a major challenge. The World Bank's decision to pause its funding will result in the closure of 2331 health facilities and unemployment of 25 000 health professionals, including 7500 women.4BBCAfghanistan: World Bank halts aid after Taliban takeover. Aug 25, 2021.https://www.bbc.com/news/business-58325545Date accessed: September 8, 2021Google Scholar With the sudden halt of health services, one of the basic human rights, one of the poorest nations on the planet has been exposed to extreme vulnerability. It is crucial to support the continuation of health services; leaving these services neglected will lead to unforeseen consequences, not only for Afghanistan but also for the world. It is of the utmost importance that an alternative financing mechanism be proposed to ensure continuity of health service delivery. Here we propose one such model. During the past two decades, the UN has had an important role in the provision of basic humanitarian services, such as water, sanitation, food, and health care, mainly in remote and underserved areas of Afghanistan and other parts of the world.5Tanin Z Ten years of the United Nations in Afghanistan: a closer look at recent history, and a glimpse into what lies ahead. Feb 2, 2012.https://afghanistan-un.org/2012/02/ten-years-of-the-united-nations-in-afghanistan-a-closer-look-at-recent-history-and-a-glimpse-into-what-lies-aheadDate accessed: September 8, 2021Google Scholar Considering their experience, the UN agencies should have a crucial role in filling the existing gap in financing the provision of health services and providing much needed leadership. WHO should also use its leadership role and, together with UNICEF and other partners, establish a project management unit and take over the provision of the Basic Package of Health Services and the Essential Package of Hospital Services with funding from the existing and new donors. Provision of health services should continue to be contracted out to non-governmental organisations. To effectively manage health services delivery, the national health management information systems (eg, responsible for collecting routine health data) and the independent third-party monitor (eg, responsible for verification of the health data, preparing balanced scorecards, and undertaking health surveys to measure performance of contracted non-governmental organisations and progress in the health sector) should continue their functions and report to the newly established project management unit. The UN principles of justice, impartiality, transparency, and integrity will be the hallmarks of the project management unit. We propose that this project management unit is purely ad hoc and will be in place during the governmental transition phase until an alternative effective and acceptable arrangement is introduced to manage the provision of the Basic Package of Health Services and the Essential Package of Hospital Services. The sole purpose of this arrangement is to ensure continuity of the highly needed health services to the most vulnerable populations and prevent excessive morbidity and mortality due to preventable causes in the country. We declare no competing interests. This Correspondence reflects the personal opinions of the authors.