Need for Sustain Funding to Health System to Prevent Excessive Morbidity and Mortality in Afghanistan

Abstract

Introduction: Over the two decades, the Afghanistan health service delivery has been supported by the Afghanistan Reconstruction Trust Fund (ARTF), managed by World Bank (WB) under the contracted-out mechanism project called “Sehatmandi”. With this support the health system achieved substantial results in infant, child, and maternal health. The pausing of the WB funding to health sector after the collapse of the Afghanistan government on August 15, 2021, exposed the health system to a massive risk of losing the gains made over the last two decades. The study objective is to assess of the recent changes on the utilization of basic health services, infant, child, and maternal mortality post regime change.Method: It is a compression period cross-sectional study compares the utilization of health services over the four months period (June –September) for three consecutive years 2019 – 2021. In 2018, performance-based contracting was introduced, and a portion of the payment was linked to 11 key output indicators. For our analysis and comparison, we used 11 indicators linked with payment to NGOs, and reported by the Health Management and Information System (HMIS). For estimating the impact of recent changes on maternal, neonatal and child mortality, the LiST tool from https://list.spectrumweb.org/ was used to calculate the additional maternal, neonatal and child mortality baseline and 25, 50, 75 and 95 per cent reductions in RMNCAH intervention coverages.Results: Our data indicate that disruption of health services in 2020 due to COVID-19 and further aggravated in 2021 owing to increased insecurity and suspension of funding by the WB has resulted in significant decline in the utilization of health services. During August and September with the announced ban on financing health system. health service delivery utilization dopped to a range of 19 - 65 per cent points. Penta-3, CYP, cesarean section and antenatal care show more decrease. Utilization of child immunization was one of the initiators that with an imposed ban in certain areas, was already showed a negative trend. As Sehatmandi provides around 75% of health services, pausing fund to this program will result in 2,862 maternal deaths, 15,741 neonatal deaths, 30,519 child deaths and 4,057 still births.Conclusion: Sustaining the current level of health services delivery is crucial for avoiding excessive morbidity and mortality, particularly in vulnerable groups of the population, including women and children.Funding Information: None to declare. Declaration of Interests: None to declare. Ethics Approval Statement: We used secondary data and did not obtained ethical approval