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An OPD receives medicine after being examined in a clinic in Ghazni Province.

The Health Sector Emergency Reconstruction and Development Project (US$94.8 million Grant) is helping to expand delivery of highimpact basic health services and ensure equitable access, particularly for women and children in underserved rural areas. It has contributed to ensuring that 82 percent of the population has access to primary health care. Independent evaluation indicates that the quality of care had improved significantly and the number of patients served has more than tripled. The project has also helped ensure the Ministry of Public Health’s stewardship over the sector through a greater role in healthcare financing, the coordination of partners, and oversight of nongovernmental organizations (NGOs). In February 2006, a supplemental grant of US$30 million was approved to increase the project budget to expand provision of basic health services in eight new areas across the country where no clinics have been established and where health services have rarely been provided. The supplemental grant also supports the provision of vaccines for immunization campaigns (polio, measles, and neonatal tetanus). Activities include:

Seven Afghan and five international NGOs are providing services in eight provinces (Helmand, Farah, Badghis, Sari-Pul, Balkh, Samangan, Wardak, and Nimroze) as well as six clusters of districts in other underserved provinces (Badakhshan, Baghlan, Ghazni, Khost, Paktia, and Pakitka). More than 200 new health facilities have been established, and 85 percent of them now have female staff.

Thousands of community health workers have been trained and deployed to promote healthy behaviors and provide first aid. With support from the project hundreds of community midwives have been trained as a means of reducing Afghanistan’s very high maternal mortality.

Since September 2004, the Ministry of Public Health has been responsible for delivering services in the three additional provinces of Parwan, Kapisa, and Panjshir. In the meantime, since June 2006, the Ministry is also responsible for delivering Basic Package of Health services in three districts of Kabul province. The project is also financing two research projects on a Safe Water System and Health Care Financing.

The Safe Water System is being carried out in Wardak province and is testing a variety of approaches for decreasing diarrhea and other water-borne illnesses by by early 2007. The user charge and control arms of the Health Care Financing project are examining a few approaches to community health financing and will be completed by May 2007. Findings from these two pilots will guide policy formulation on safe water systems and revenue generation for the health sector in the future.