Rebuilding the Afghan health system: the role of aid effectiveness
In a recent article, the Minister of Public Health (MOPH) of Afghanistan, together with some of the development partners, discusses how each of the five principles of aid effectiveness – ownership, alignment, harmonization, managing for results, and mutual accountability – were put in practice in Afghanistan.
During the last decade, aid for health in Afghanistan grew substantially, from US$1.8 million in 2003 to US$148.7 million in 2009 and US$187.0 million in 2014. This aid has been largely aligned to country priorities as it supported the development of the Basic Package of Health Service (BPHS), as a clear statement of priorities that stakeholders could rally around. Early on the Government, with support from partners, established a Grants and Contracts Management Unit (GCMU) within the MOPH. This unit was in charge of coordinating all development partners’ support for the sector, and contracting out the service delivery to a large network of health NGOs. Part of the aid was used to build capacity of the Ministry of Public Health, for the GCMU, but also for the health information systems, and various departments in the MOPH.
Harmonization was facilitated through a geographical approach, by which the three main donors – US Agency for International Development, the European Commission, and the World Bank, were assigned to specific provinces where each was the single responsible agency for supporting the BPHS. In addition, regular meetings and ‘retreats’ between MOPH and partners ensured timely updates and exchanges on strategic issues. This was considered to be a key element in fostering a high degree of mutual accountability. Lastly, while managing for results was a key priority for the Government, it was also an area that needed more focus and attention. The MOPH together with partners carried out regular household surveys to track outcomes and coverage of key services, even as security deteriorated. However, these surveys were financed by different sources, and used different methodologies, which made comparisons difficult.
According to the authors of the article, the key factors in aid effectiveness in Afghanistan included:
- strong leadership of the MOPH in promoting and aligning donor support to the country priorities, mainly BPHS
- a focus on data-driven decision on real health needs
- commitment of partners to support country priorities and align their support in accordance with the approaches proposed by MOHP
- a long-term approach for technical assistance and capacity building, in the form of external partners technical staff on the ground since 2002
- participatory decision-making at all levels
- a focus on management for results, through performance monitoring of health sector activities.
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