Role of Multilateral Development Banks in Afghanistan's Health Care Sector

Role of MDBs in incentivizing
Private Sector to Participate in
Health Care Sector of Afghanistan
WBGx: F4D01X Financing for Development

Afghanistan Country Profile
WBGx: F4D01X Financing for Development | 2017 All Rights Reserved | Tushar Kothavale 2

Source: http://www.maphill.com/afghanistan/location-maps/savanna-style-map/
“Landlocked and
Mountainous
Afghanistan has
suffered from such
chronic instability
and conflict during
its modern history
that its economy
and infrastructure
are in ruins, and
many of its people
are refugees.”

Country Fact Sheet
• Country: Islamic Republic of Afghanistan
• Capital: Kabul
• Population: 33.37 Million (2016 projected by UN)
• Area: 652,864 Square Kilometers (251,827 Square miles)
• Major Languages: Dari, Pashto
• Life Expectancy: 59 years (men), 62 years (women)
• Currency: Afghani
• Gross Domestic Product: 21122 Million USD (2014, UN Data)
• GDP Per Capita: 667.8 USD (2014, UN Data)
Image Credits: http://baltic-review.com/severe-food-insecurity-on-the-rise-in-
afghanistan/

Afghanistan is a conflict state
• The Taliban, who imposed strict Islamic rule following a
devastating civil war, were ousted by a US-led invasion in
2001 but have recently been making a comeback.
• The internationally-recognized government set up following
the adoption of a new constitution in 2004 has struggled to
extend its authority beyond the capital and to forge national
unity.
• Nato-led foreign combat troops had the main responsibility
for maintaining security after 2001, and the formal end of
Nato's combat mission in December 2014 was followed by an
upsurge in Taliban activity.
Image Credits: http://edition.cnn.com/2016/02/25/asia/afghanistan-war-
analysis/

Afghanistan’s Health Care
Infrastructure is in Shambles

Afghanistan's health status is one of the worst
in the world
• Maternal mortality, is at 1,600/100,000 live births per year
(UNICEF 2002), which is among the highest and infant and
under-five mortality rates are estimated at 165 and 257 per
1,000 live births per year respectively (WHO 2002).
• The epidemiological profile is dominated by communicable
diseases—TB and malaria being the main ones—that can be
prevented and/or treated using low-cost and simple strategies.
• In spite of lack of reliable data, there is a consensus that
HIV/AIDS is emerging as a serious health concern, given the
increasing number of drug users.
• Epidemics are frequent, including cholera, Congo-Crimea
haemorrhagic fever, measles, meningitis, pertussis and malaria
(population at risk is estimated at 12 million (MoH/NMP
2004)). Outbreaks of scurvy have also been reported.
• The anthropometric data point to high levels of both acute and
chronic malnutrition.
Image Credits: http://proof.nationalgeographic.com/2016/04/11/these-
haunting-photos-reveal-todays-afghanistan/

Health Sector Issues
• The sector needs to recover from decades of neglect,
under-funding, institutional vacuum and fragmentation.
• At the end of the conflict, what was left of the health
system was characterized by: inadequate infrastructures
with dilapidated facilities unevenly distributed across
the country; impaired access to health services due to
difficult communications and poor security; chronic
shortage of skilled health providers (especially female);
poor information system; and weak implementation of
the newly approved national health policy.
• Health expenditure is 0.5% of the GDP and represents
6.1% of the current expenditure, for a public health
expenditure of $1 per capita (CSO 2003). There are
one doctor and one nurse per 6,000 and 2,500 people
respectively (CSO 2003), and the population per
hospital bed ranges between 1,100 and 16,000 (CSO
2002).

Health Sector Issues
• Inequality in access to healthcare is a significant
issue.
• DPT3 (Diphtheria Pertussis, Tetanus) routine
immunization has an estimated coverage of only
30%.
• Coverage of Primary Health Care is still low, but
increasing; around 50% of the population (and 70%
of districts) are covered by the Basic Package of
Health Care Services (BPHS) and reinforced by
vertical programmes.
• The system is under-funded: the average cost of
subcontracting the BPHS is around $4 per capita per
year, and expansion of coverage is hampered by a
shortage of funds. Further, an insufficient budget is
allocated to secondary and tertiary hospitals that are
run by the Ministry of Health (MoH).

Why is Private Sector shy in investing in
Afghanistan’s Health Care Sector?

Main Priorities in Afghanistan’s health sector
• Restored and upgraded health care facilities, including expanded provision of services to rural areas
still unreachable;
• Ensured availability of essential drugs;
• Funding for services expansion, addressing inefficiencies in out-sourcing;
• Strengthened Ministry of Health capacity managing and monitoring contracts;
• Strengthened health information system (including surveillance);
• Trained health workers for sectors where shortage is acute (e.g. midwives, female nurses);
• Strengthened capacity of national authorities in emergency preparedness and response, mainly for the
recurrent natural disasters.
However the Government can not achieve all these main priorities without the help of Private
Sector which will aid in scaling the Health Care Infrastructure in Afghanistan.

Obstacles in unlocking Private Sector
Participation
• Security is a major issue in conflict state.
• For private sector the risks far outweigh the
returns from any venture.
• There is no accurate information available
regarding the opportunities – risks –returns.
• There is no one to handhold in a conflict state.
(perception that the government is too weak for
handholding)
Image Credits: http://www.aljazeera.com/indepth/inpictures/2016/07/frontline-hospital-afghanistan-
160719103717841.html

The Potential Solutions

How can MDGs unlock financial opportunities
in Afghanistan’s Health Care Sector?
• Financial Additionality: Using
a wide range of direct financing
and mobilization instruments
such as Infrastructure
Development Assistance (IDA),
the official sector can contribute
funding and help build the
confidence necessary to attract
commercial funding.
160719103717841.html

• Design Additionality: The MDGs
can contribute technical to improve
their “bankability” or attractiveness
to private-sector investors. This can
occur through ensuring efficiency,
transparency, and adherence to
accepted standards in project
design, including environmental
standards.
160719103717841.html

• Policy Additionality: MDBs
and similar entities can provide
support to Afghanistan
Government/ Ministry of
Health to improve the policy
and regulatory environment for
investment and mitigate the
risk of significant policy
reversals.
160719103717841.html

• Demonstration Additionality:
The MDGs can support first few
projects in Afghanistan’s Health
Care Sector (such as through
funding from IDA) to illustrate the
possibilities of success by
improving private-sector
perceptions of the risk/return
trade-off for investments
undertaken in the Health Care
Sector.Image Credits: https://www.nytimes.com/2015/10/04/world/asia/afghanistan-bombing-hospital-doctors-without-
borders-kunduz.html?_r=0

• Specific Targets in SDGs which will be achievable through the intervention:
 Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable
essential medicines and vaccines for all.
 Strengthen the capacity of all countries, in particular developing countries, for early
warning, risk reduction and management of national and global health risks.

References/ Credits
• http://www.un.org/sustainabledevelopment/sustainable-development-goals/
• http://www.bbc.com/news/world-south-asia-12011352
• http://www.who.int/hac/donorinfo/afg/en/index1.html
• https://www.usaid.gov/afghanistan/health
• http://data.un.org/CountryProfile.aspx
• http://www.aljazeera.com/news/2016/08/afghanistan-health-care-system-
struggles-rebound-160810104017464.html

Thank You
Author:
Tushar Kothavale
http://in.linkedin.com/pub/tushar-
kothavale/15/379/a19
Image Credits: http://www.bbc.com/news/world-asia-37560704

Role of Multilateral Development Banks in Afghanistan's Health Care Sector

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