WASHINGTON, March 24, 2009 The World Bank today approved a US$30 million grant to Afghanistan, designed to improve the health and nutritional status of Afghans, focusing especially on women and children and under-served areas of the country.
The Strengthening Health Activities for Rural Poor (SHARP) project supports Afghanistan's Health and Nutrition Sector Strategy (HNSS), which is the blueprint for the government's health sector program for the period 2008-2013. Under the HNSS, the government aims to expand coverage of the Basic Package of Health Services (BPHS) to at least 90 percent of the population by 2010.
Afghanistan has made significant progress in the health sector over the last six years. A nation-wide survey conducted in late 2006 found that infant and under 5 mortality had declined by 22 percent and 26 percent, respectively, since 2001. In addition, the number of functioning primary health care facilities increased from 498 in 2002 to 1443 in 2008 and health facilities with skilled female health workers increased from 25 percent to 82 percent in the same period. Yet, Afghanistan's health indicators remain among the worst in the world. For example, the under 5 mortality rate is still 67 percent higher than the average for low income countries.
"Afghanistan has come a long way in improving the health status of its people," said Emanuele Capobianco, World Bank Health Specialist and Project Team Leader. "However, provision of basic health services remains a challenge, especially in rural areas, as more than 30 percent of the Afghan population lives over two hours away from a health facility. Expansion of health centers, greater efficiency in service delivery and continuous coordination among different players in the health sector are all key factors to bring more and better health services to a larger portion of the Afghan population."
The project will help deliver the Basic Package of Health Services (BPHS) through performance-based contracts with local and international NGOs and through direct service delivery by the Ministry of Public Health. This package focuses on primary health care interventions such as child immunization, nutrition, tuberculosis and malaria control, prenatal, obstetrical and post-partum care, family planning, and basic curative services. Currently 85 percent of the Afghan population lives in districts which have been covered by the BPHS. The approximate cost of delivering these basic services is US$4.50 per capita per year.
Each NGO is competitively contracted for the delivery of basic services in a specific geographic area. The Ministry of Public Health also invokes sanctions in case an NGO does not perform well. Performance is being reviewed by an independent third party which carries out assessments each year in more than 600 facilities nationwide.
The project will be implemented by the Ministry of Public Health over a period of 45 months, and will finance part of the HNSS. The total cost for the implementation of the NHSS is estimated at US$550 million. In addition to World Bank's support, the European Commission (EC), United States Agency for International Development (USAID), Japanese Government, Norway and several other bilateral donors through the Afghanistan Reconstruction Trust Fund (ARTF) are expected to finance the implementation of HNSS.