Aid Effectiveness in Rebuilding the Afghan Health System: A Reflection

This article from Global Public Health examines whether aid has been effectively used in Afghanistan in the years since 2002, a period in which the government received a high level of donor aid for health and the country experienced significant improvement across health indicators. The authors analyze the success of the Afghanistan Ministry of Public Health (MOPH)-donor partnership through the lens of five components identified in the 2005 Paris Declaration on Aid Effectiveness.

The factors discussed: 

• Ownership: a realistic role for the MOPH as the steward of the health sector that was clearly articulated to all stakeholders;
• Donor alignment: donor coordination and collaboration initiated by the MOPH;
• Joint decisions: participatory decision-making by the MOPH and donors, such as the major decision to use contracts with nongovernmental organisations for health service delivery;
• Managing for results: basing programmes on available evidence, supplementing that evidence where possible and performance monitoring of health-sector activities using multiple data sources;
• Reliable aid flows: the availability of sufficient donor funding for more than 10 years for MOPH priorities, such as the Basic Package of Health Services, and other programmes that boosted system development and capacity building;
• Human factors: these include a critical mass of individuals with the right experience and expertise being deployed at the right time and able to look beyond agency mandates and priorities to support sector reform and results.

Looking forward, the authors express concern about the consequences of external aid leaving Afghanistan, particularly the impact on health service delivery and health sector innovation in the country. Future areas of focus for the MOPH might include focusing on quality of care, capacity development, and continued inter-ministerial coordination.