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Afghanistan’s health situation has undergone extraordinary improvements in recent years. However, much of the health sector is funded by international donors and run by NGOs. As the international society pulls out Afghanistan, the outlook is worrying. Will the Afghan state be able to uphold the same level of health services when the international society diverts its focus away from the country?

At a community clinic. Photo by DFID under CC license on Flickr.

Significant improvements since 2001

International aid has brought substantial improvements in Afghanistan’s health situation. There has been a positive development in most fields in the past years. Since 1990, the life expectancy at birth has risen from 42 to 49 years, maternal mortality has been reduced to a third of what it was and the number of children dying before they reach 5 years has been halved. Although some of these statistical analyses have been criticised for exaggerating the results, there is no doubt that there have been significant improvements in the past ten years.

Is the progress sustainable?

A doctor prepares to administer a vaccination. Photo by EU Humanitarian Aid and Civil Protection under CC license on FlickrThe main reason for the upward trend is the increased access to professional health services. According to World Bank statistics (2013), the number of health facilities in Afghanistan has quadrupled since 2004, from 496 to 2,047. Three quarters of these have at least one female staff member. This is crucial because in Afghan culture it is considered unacceptable for women to be seen by male health professionals. The number of community health workers, nurses and midwives, is close to 20,000, more than 50% of which are female.

But how long will it last? Is the progress so inseparably linked with the heavy footprint of the international society that the situation risks to be reversed when aid money dwindles again in the coming years?

The Afghan health system lacks infrastructure, qualified human resources and money. The World Health Organisation also identifies the lack of domestic ownership and the large degree of donor funding and control as some of the major challenges in its country cooperation strategy (2011). In other words, the health system is extremely dependent on international money, employees and expertise.

Poverty, undernourishment and a lack of clean water

Furthermore, good health care services are only a part of the solution. The lamentable health situation of Afghans is also caused by structural factors, such as extreme poverty, food shortage and a lack of clean water supplies and sanitary facilities. The U.N. proudly announces that the millennium development goal on access to clean water and sanitation has been reached ahead of 2015. But in Afghanistan, only half of the population has access to a safe water source, and in the countryside a toilet is still a luxury. In addition, insecurity and transport challenges make it difficult for rural Afghans to reach health-care services from the most remote districts. 


“Afghanistan: Better Health Outcomes for Women, Children, and the Poor”, by the World Bank, Afghanistan,

Afghanistan Multiple Indicator Cluster Survey 2010-2011: Final Report, by the Central Statistics Organisation (CSO) [Afghanistan] and UNICEF,

Country cooperation strategy for WHO and Afghanistan 2009-2013, by the World Health Organisation, and the updated strategy (2011) 

Norwegian Afghanistan Committee
Addresse:  Nawai Watt, Street # 03 •  Postal addresse:
work # 148 Shahr-i-Naw, KabulAfghanistan

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