key: cord-0068243-xrh78imt
authors: Hemat, Shafiqullah; Halimzai, Iftikhar; Noormal, Bashir; Rafiqi, Ghulam Haider
title: Call to the international community for emergency support for the Afghanistan health system
date: 2021-10-08
journal: EClinicalMedicine
DOI: 10.1016/j.eclinm.2021.101156
sha: fb988220e1237ceab83104d5ef75de8a0c52b7f6
doc_id: 68243
cord_uid: xrh78imt

nan

The Afghanistan health sector with the humanitarian support of the international community, has reached tremendous goals towards improving the health status of the Afghan population in terms of access, coverage, and quality of the health services during past two decades. By 2018, access to health services increased to 90% from just 9% in 2002; almost half of the population could reach the health facility within 30 minutes and over 90% could reach a health facility within 2 hours [1] . During the last two decades, the decrease in infant, children younger than 5 years, and maternal mortalities have shown significant improvement in health status [2] . The infant mortality rate dropped from 165 to 45 per 1000 live births, and the mortality rate in children younger than 5 years dropped from 257 to 55 per 1000 and maternal mortality ratio dropped from 1600 to 670 per 100 000 in 2015 [3] . During this period, the deteriorating security situation was a main challenge in accessing the healthcare services. This situation was further worsened by the health and socioeconomic shocks of the COVID-19 pandemic [4] .

After the Aug 15, 2021, takeover of the government by the Islamic Emirate of Afghanistan, the international community and major donors, such as the World Bank, announced a sudden suspension of their financial support to the Afghanistan health sector, which is largely foreign aid-driven [5] . The primary health-care services are provided through the Basic Package of Health Services (BPHS) that was developed by the Ministry of Public Health of Afghanistan with the support of the international community in 2003. The overall objectives of the package are to deliver effective, targeted, equitable, and sustainable preventive and curative health services to the Afghan population within seven components-mental health, maternal and newborn health, nutrition, control of communicable and non-communicable diseases and injuries, child health and immunisation, disability and provision of essential drugs [6] . The basic package of health services are provided through standardized uniform structure of health facilities at several levels across the country.

If donors' support continues to be suspended, a humanitarian crisis will follow and the ability of the Afghan health system to respond to the needs of its people will further decline rapidly. Although, WHO and UNICEF declared that they will continue their support, their supplies are rapidly dwindling and will not last more than 25 weeks [7] . Therefore, millions of children and women will be deprived of their basic right of having access to health care. Consequently, this community will remain far from reaching equitable and adequate health and social care outcomes that are required to achieve the Sustainable Development Goal 3 of good health and wellbeing for all [8] .

We would like the international community to recognise this humanitarian emergency and to continue their generous support to sustain the currently functional health care system in Afghanistan, and to ensure that no one, dies due to lack of access to aid. This continuation will enable Ministry of Public Health to take over the health facilities without loss of staff and equipment and to gradually find resources to support the current health care system. This will allow donors to have a proper and more gradual withdrawal from the Afghan health system allowing a more stable future.

Ministry of Public Health and KIT Royal Tropical Institute. Afghanistan Health Survey (AHS)

Central Statistics Organization, Ministry of Public Health, and ICF

Relief web, executive summary: the continued struggle to access medical care in Afghanistan

World Bank halts aid after Taliban takeover

Afghanistan's basic package of health services: its development and effects on rebuilding the

Amidst Kabul airport blockage, WHO and UNICEF call for assistance to deliver critical health supplies to Afghanistan

The sustainable development goals and the global compact on refugees working together to ensure that refugees and host communities are not left behind

The authors declare no conflict of interest.