Countdown to 2015: a future of hope for Afghanistan

Kabul, Afghanistan: Despite conflict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health over the last decade, says the first systematic analysis and case study of the country.

Afghanistan, with over four decades of conflict and political instability, has some of the worst health and mortality indicators seen globally. Although progress has been made, there has been limited analysis of the status and trends of maternal and child health indicators in the country – until now.

The first comprehensive, systematic assessment of reproductive, maternal, newborn, and child health (RMNCH) and survival in Afghanistan over the last decade was published today in the Lancet Global Health. The study is part of the Countdown to 2015 initiative and represents a collaborative effort of several institutions. The Centre for Global Child Health at the Hospital for Sick Children (SickKids) and the Aga Khan University led the initiative, with additional support from in-country experts and UNICEF in Afghanistan.

The study reviews trends in maternal and child survival, contextual factors and coverage of key life-saving interventions.

Key findings from the report and the gains:

• Although the rate of reduction was insufficient to achieve the Millennium Development Goals, Afghanistan managed to reduce maternal mortality (estimated 64% reduction) and achieve gains in child survival (29% reduction since 2003).
• There have been major gains in social determinants of health such as female education, reduction in food insecurity, and some evidence of reduction in childhood stunting (short stature) by 30%, however malnutrition remains rampant and disparities are widespread.
• With concerted efforts in outreach and service delivery, there have been major gains in scaling up essential interventions across the continuum of care for women, newborns, and children in Afghanistan. For example, the rates of delivering in a health facility, of women seeking antenatal care services, and of having a skilled attendant at birth, have more than tripled from baseline 2003 levels. Key contributors of gains were improvements in maternal literacy, increased training and deployment of community midwives, and the shortening of distance/time to reach health facilities.
• Childhood immunization rates have shown much improvement; however pneumonia and diarrhea remain major killers after the newborn period, from which 28% and 20%, respectively, of Afghan children die.

The downside:

• Despite these gains, inequities across subnational populations – differences in access to care between the richest and poorest and for those living in isolated and inaccessible areas – remain pervasive in Afghanistan, and must be tackled to further accelerate progress.
• Although Afghanistan experienced increases in support during the past decade as part of reconstruction efforts, the country’s dependency on donors raises questions about the sustainability of Afghanistan’s remarkable health gains.

“It is critical that fragile democracies and transitional societies like Afghanistan are fully supported in their ambitions to improve the lives of women and children, and to move from a survival agenda to one that encompasses health and human development,” says lead author of the report Nadia Akseer, PhD Candidate focused on child health in Afghanistan and biostatistician at the SickKids Centre for Global Child Health in Toronto. “Results from our analysis underscore the importance of investments in education for boys and girls and in the empowerment of adolescent girls and women, to prevent a vicious cycle of poverty and ill health among families in Afghanistan.”

Afghanistan’s Ambassador to Switzerland and Permanent Representative to the UN and international organizations based in Geneva, Dr. Suraya Dalil, stated, “The independent scientific analysis and findings presented in the report underscores the importance of evidence-based programs and implementation of innovative strategies targeting women and children in Afghanistan – a core commitment of the Afghan government. Afghanistan needs support to sustain those gains and pursue its journey on health and development”.

Dr. Mickey Chopra, the outgoing co-chair of the Countdown to 2015 consortium comments: “These results are a testimony to the bravery of health workers, resilience of communities and the innovations within the health system. But too many women and children are still being missed and this study is an important contribution to working towards this end.”

Since its first report launched in 2008, Countdown to 2015 has worked to track interventions coverage, equity gaps, health systems, policies, and financials in 75 of the most high-burden countries globally in an effort to reduce preventable maternal, newborn and child mortality. Annual reports and in-depth country profiles have been used to call on governments to be accountable, to identify knowledge gaps and propose actions to reach Millennium Development Goals 4 and 5, and moving forward, the new Sustainable Development Goals.

“It is evaluations such as these that provide evidence that despite barriers, even the poorest and most fragile countries of the world such as Afghanistan, can show resilience” said Professor Zulfiqar A. Bhutta, senior author of the report and leader at both the SickKids Centre for Global Child Health and Aga Khan University. “Investments in addressing major bottlenecks, improving health governance and current packages of care will go a long way in reducing the burden of maternal, newborn and child ill health and help Afghanistan achieve the sustainable development goals.”

AKU also manages a tertiary medical centre for children in Kabul the French Medical Institute for Children, a public-private partnership between the French and Afghan Governments, La Chaine de l’Espoir and AKU.

“The Aga Khan Development Network, and AKU, has played an important role over the last 15 years in working with the Ministry of Public Health in improving the care for mothers and children at all the levels of care – primary, secondary and tertiary, and in training and educating the health workers – and we are confident that the results will continue to improve in the future,” said Nadeem Mustafa Khan, a member of FMIC Provisional Operating Committee.

The full study can be viewed Monday May 16^th, 2016 at 23:30 BST/6:30PM EST at:

Lancet Global Health 2016; 4: e395–413: http://www.thelancet.com/journals/langlo/onlinefirst

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